| 1. |
- Andersson, Tommy, 1970-, et al.
(författare)
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All-cause mortality in 272 186 patients hospitalized with incident atrial fibrillation 1995-2008 : a Swedish nationwide long-term case-control study
- 2013
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 34:14, s. 1061-1067
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Tidskriftsartikel (refereegranskat)abstract
- Aims To evaluate long-term all-cause risk of mortality in women and men hospitalized for the first time with atrial fibrillation (AF) compared with matched controls. Methods and results A total of 272 186 patients (44% women) <= 85 years at the time of hospitalization with incidental AF 1995-2008 and 544 344 matched controls free of in-hospital diagnosis of AF were identified. Patients were followed via record linkage of the Swedish National Patient Registry and the Cause of Death Registry. Using Cox regression models, the long-term relative all-cause mortality risk, adjusted for concomitant diseases, in women vs. controls was 2.15, 1.72, and 1.44 (P < 0.001) in the age categories <= 65, 65-74, and 75-85 years, respectively. The corresponding figures for men were 1.76, 1.36, and 1.24 (P < 0.001). Among concomitant diseases, neoplasm, chronic renal failure, and chronic obstructive pulmonary disease contributed most to the increased all-cause mortality vs. controls. In patients with AF as the primary diagnosis, the relative risk of mortality was 1.63, 1.46, and 1.28 (P < 0.001) in women and 1.45, 1.17, and 1.10 (P < 0.001) in men. Conclusion Atrial fibrillation was an independent risk factor of all-cause mortality in patients with incident AF. The concomitant diseases that contributed most were found outside the thromboembolic risk scores. The highest relative risk of mortality was seen in women and in the youngest patients compared with controls, and the differences between genders in each age category were statistically significant.
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| 2. |
- Andersson, Tommy, 1970-
(författare)
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Atrial fibrillation and cause of death, sex differences in mortality, and anticoagulation treatment in low-risk patients
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Atrial fibrillation (AF) is the most common arrhythmia but information on cause of death in patients with AF is sparse, and whether individuals at low risk of cerebral infarction (CVL) should receive antico-agulant medication is controversial. Studies of sex differences with respect to mortality risk have shown conflicting results.Methods: Data were obtained from Swedish National Registers. In Study I, there were 272 186 AF patients and matched controls and in Studies II and III, 9519 AF patients and no other diagnosis and matched controls. Study IV compared treatment with warfarin to no treatment in 48 433 patients with AF. Hazard ratio (HR) was calculated with 95% confidence intervals and outcome rates as number per 1000 person-years.Results: Ischemic heart disease (IHD) was the most common underlying cause of death and was present in 40.2% of AF patients at a HR of 1.7 (1.4-2.1). CVL/stroke was a cause of death in 13.1%, HR 2.7 (1.8-4.0). Among underlying and contributing causes of death, the most common diagnoses were IHD in 43.5%, HR 1.7 (1.4-2.0) and heart failure in 33.1%, HR 2.9 (2.2-3.7). The HRs for mortality in females with AF in age categories ≤65, 65-74, and 75-85 were 2.15, 1.72, and 1.44, and for males 1.76, 1.36, and 1.24. The rates of mortality in females with AF in age categories 55-64, 65-74, and 75-85 were 6.2, 20.7, and 57.3, and for males 8.5, 27.3, and 64.5. In patients 65-74 years, females with a CHA2DS2-VASc score of 2, and males with a score of 1 receiving warfarin treatment showed a significantly reduced risk of cerebral infarc-tion/stroke, HR 0.46 (0.25-0.83) for females and for males, HR 0.39 (0.21-0.73).Conclusions: Most common causes of death in AF patients were CVL/stroke, heart failure, and IHD. HR of mortality in patients with AF was higher in females than in males but absolute risk was higher in males with AF compared to females with AF. Anticoagulant therapy was benefi-cial in patients ≥65 years, regardless of the CHA2DS2-VASc score.
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| 3. |
- Andersson, Tommy, 1970-, et al.
(författare)
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Gender-related differences in risk of cardiovascular morbidity and all-cause mortality in patients hospitalized with incident atrial fibrillation without concomitant diseases: A nationwide cohort study of 9519 patients
- 2014
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 177:1, s. 91-99
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Tidskriftsartikel (refereegranskat)abstract
- Background: Previous studies of patients with "lone" and "idiopathic" atrial fibrillation (AF) have provided conflicting evidence concerning the development, management and prognosis of this condition. Methods: In this nation-wide, retrospective, cohort study, we studied patients diagnosed with incidental AF recorded in national Swedish registries between 1995 and 2008. Controls were matched for age, sex and calendar year of the diagnosis of AF in patients. All subjects were free of any in-hospital diagnosis from 1987 and until patients were diagnosed with AF and also free of any diagnosis within one year from the time of inclusion. Follow-up continued until 2009. We identified 9519 patients (31% women) and 12,468 matched controls. Results: Relative risks (RR) versus controls for stroke or transient ischemic attack (TIA) in women were 19.6, 4.4, 3.4 and 2.5 in the age categories <55, 55-64, 65-74 and 75-85, years respectively. Corresponding figures for men were 3.4, 2.5, 1.7 and 1.9. RR for heart failure were 6.6, 6.6, 6.3 and 3.8 in women and 7.8, 4.6, 4.9 and 2.9 in men. All RR were statistically significant with p < 0.01. RR for myocardial infarction and all-cause mortality were statistically significantly increased only in the two oldest age categories in women and 65-74 years in men. Conclusions: Patients with AF and no co-morbidities at inclusion had at least a doubled risk of stroke or TIA and a tripled risk of heart failure, through all age categories, as compared to controls. Women were at higher RR of stroke or TIA than men. (C) 2014 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/licenses/by-nc-sa/3.0/).
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| 4. |
- Andersson, Tommy, 1970-, et al.
(författare)
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Patients with atrial fibrillation and outcomes of cerebral infarction in those with treatment of warfarin versus no warfarin with references to CHA(2)DS(2)-VASc score, age and sex - A Swedish nationwide observational study with 48 433 patients
- 2017
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:5
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Tidskriftsartikel (refereegranskat)abstract
- Aims There is controversy in the guidelines as to whether patients with atrial fibrillation and a low risk of stroke should be treated with anticoagulation, especially those with a CHA(2)DS(2)-VASc score of 1 point. In a retrospective, nationwide cohort study, we used the Swedish National Patient Registry, the National Prescribed Drugs Registry, the Swedish Registry of Education and the Population and Housing Census Registry. 48 433 patients were identified between 1 January 2006 and 31 December 2008 with incident atrial fibrillation who were divided in age categories, sex and a CHA(2)DS(2)-VASc score of 0, 1, 2 and >= 3 and they were included in a time-varying analysis of warfarin treatment versus no treatment. The primary end-point was cerebral infarction and stroke, and patients were followed until 31 December 2009. Patients with 1 point from the CHA(2)DS(2)-VASc score showed the following adjusted hazard ratios (HR) with a 95% confidence interval: men 65-74 years 0.46 (0.25-0.83), men < 65 years 1.11 (0.56-2.23) and women < 65 years 2.13 (0.94-4.82), where HR < 1 indicates protection with warfarin. In patients < 65 years and 2 points, HR in men was 0.35 (0.18-0.69) and in women 1.84 (0.86-3.94) while, in women with at least 3 points, HR was 0.31 (0.16-0.59). In patients 65-74 years and 2 points, HR in men was 0.37 (0.23-0.59) and in women 0.39 ( 0.21-0.73). Categories including age >= 65 years or >= 3 points showed a statistically significant protection from warfarin. Our results support that treatment with anticoagulation may be considered in all patients with an incident atrial fibrillation diagnosis and an age of 65 years and older, i.e. also when the CHA(2)DS(2)-VASc score is 1.
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| 5. |
- Andersson, Tommy, 1970-, et al.
(författare)
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Patients without comorbidities at the time of diagnosis of atrial fibrillation : causes of death during long-term follow-up compared to matched controls
- 2017
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Ingår i: Clinical Cardiology. - : John Wiley & Sons. - 0160-9289 .- 1932-8737. ; 40:11, s. 1076-1082
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Little is known about the long-term, cause-specific mortality risk in patients without comorbidities at the time of diagnosis of atrial fibrillation (AF).METHODS: From a nation-wide registry of patients hospitalized with incident AF between 1995 and 2008 we identified 9 519 patients with a first diagnosed AF and no comorbidities at the time of AF diagnosis. They were matched with 12 468 controls. The follow-up continued until December 2008. Causes of death were classified according to the ICD-10 codes.RESULTS: During follow-up, 11.1% of patients with AF and 8.3% of controls died. Cardiovascular diseases were the most common causes of death and the only diagnoses which showed significantly higher relative risk in patients with AF than controls (HR 2.0, 95% CI 1.8-2.3), and the relative risk was significantly higher in women than in men. Stroke was a more common cause among patients with AF, 13.1% versus 9.7% (HR 2.7, 95% CI 1.8-4.0), while cerebral hemorrhage was more common among controls, 4.7% versus 10.2% (HR 0.9, 95% CI 0.6-1.5). The time from AF diagnosis to death was 6.0 ± 3.1 years.CONCLUSIONS: In patients with incident AF and no known comorbidities at the time of AF diagnosis, only cardiovascular diseases were more often causes of death as compared to controls. Women carried a significantly higher relative risk than men.
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| 6. |
- Andersson, T., et al.
(författare)
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What do patients with incident atrial fibrillation and no comorbidities at the time of diagnosis die of?
- 2017
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Konferensbidrag (refereegranskat)abstract
- Introduction: Little is known about the long-term mortality risk and the causes of death in patients without comorbidities at the time of diagnosis of atrial fibrillation (AF).Purposes: To identify the causes of death in patients with AF and without comorbidities at the time of AF diagnosis.Methods: We identified 9 519 patients with first diagnosed AF and no co-morbidities at the time of AF diagnosis in a nation-wide registry of patients hospitalized between 1995 and 2008. They represented 3.5% of the original cohort of 271186 patients hospitalized with incident AF. Patients with any diagnosis from ICD9 and ICD10 at the time of AF diagnosis wereexcluded. They were matched for age, sex and calendar year of AF diagnosis with 12 468 controls. The follow-up continued until December 2008. Causes of death were classified according to the ICD-10 codes.Results: During follow-up, 11.1% and 8.3% of patients with AF and controls died, HR 1.3, 95% CI 1.2–1.4. Most of the difference was explained by deaths of cardiovascular causes, 8.3% versus 3.9%, (HR 2.0, 95% CI 1.8–2.3). The cause of death pattern was the same in controls although at much lower rates. The age adjusted relative risk was higher in women than in men, HR 2.3, 95% CI 1.9–2.8 versus HR 1.7, 95% CI 1.4–2.0. Myocardial infarction was the most common cardiovascular cause of death but was less common among patients with AF than in controls, 20.5% versus 32.0%. Stroke was a more common cause among patients with AF, 13.1% versus 9.7% (HR 2.7, 95% CI 1.8–4.0), while cerebral hemorrhage was more common among controls, 4.7% versus 10.2% (HR 0.9, 95% CI 0.6–1.5). The time from AF diagnosis to death was 6.0±3.1 years, as compared to the time from inclusion to death, 5.8±3.1 years, in controls.Conclusions: Only cardiovascular diseases were more often causes of death than in controls. Women carried a significantly higher relative risk than men. The duration between AF diagnosis and death suggests that there is often time enough for early intervention with antithrombotic therapy, rhythm and/or rate control and treatment of risk factors as they appear. Interestingly, controls had the same cause of death pattern although at much lower rates.
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| 7. |
- Björkenheim, Anna, 1980-, et al.
(författare)
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Assessment of Atrial Fibrillation–Specific Symptoms Before and 2 Years After Atrial Fibrillation Ablation : Do Patients and Physicians Differ in Their Perception of Symptom Relief?
- 2017
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Ingår i: JACC. - : Elsevier. - 2405-500X .- 2405-5018. ; 3:10, s. 1168-1176
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of this study was to evaluate patient-reported and physician-assessed atrial fibrillation (AF)–related symptoms after AF ablation.Background: Success of AF ablation is usually defined as freedom from AF, although symptom relief is often patients’ desire.Methods: Symptom relief was assessed as perceived by patients using the short, validated, AF-specific symptom questionnaire AF6 and as classified by physicians using the European Heart Rhythm Association (EHRA) classification at baseline and 6, 12, and 24 months after AF ablation. Recurrence of arrhythmia was documented by continuous electrocardiographic monitoring.Results: In total, 54 patients completed the 24-month follow-up. All 6 items on the AF6, AF6 sum score, and EHRA class improved significantly over time. The greatest improvement was seen during the first 6 months after ablation, but AF6 scores showed continued improvement up to 12 months, in contrast to EHRA class. There was a low correlation between AF6 score and EHRA class, but the predictive ability was low. Both AF6 scores and EHRA class were significantly correlated with AF burden at all times after ablation. A change of >9 points in AF6 sum score corresponded to a meaningful reduction in symptom severity.Conclusion: Patient-reported and physician-assessed outcomes were both useful in assessing symptom relief after AF ablation, although patient-reported outcomes were more sensitive tools. There was also a discrepancy between patient-reported and physician-assessed outcomes after ablation. Freedom from AF and a low AF burden most often resulted in a reduction of symptoms, but symptom relief also occurred despite little effect on the arrhythmia.
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| 8. |
- Björkenheim, Anna, 1980-
(författare)
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Catheter ablation for atrial fibrillation : effects on rhythm, symptoms and health-related quality of life
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: AF ablation is an increasingly used treatment in patients with AF to improve patient-reported outcomes (PROs). Atrioventricular junction ablation (AVJA) is a palliative treatment option in therapy refractory AF that improves PROs but renders the patient pacemaker dependent.Aims: To evaluate rhythm control and PROs before and up to two years after AF ablation. To analyze the long-term incidence of and predictors of hospitalization for HF and all-cause mortality in patients who underwent AVJA and right ventricular pacing.Methods and Results: Fifty-four patients underwent AF ablation and both continuous rhythm monitoring via an implantable loop recorder (ILR) and intermittent rhythm monitoring three, six, 12 and 24 months after ablation. 76 % of patients had at least one AF recurrence, of whom 24 % were only detected by ILR. One third of symptom recordings did not show AF. The AF-specific AF6 scores, physician-assessed EHRA symptom class and both SF-36 summary scores all improved significantly from before to two years after ablation. There was a weak correlation between the change in AF6 scores and EHRA class from before to six and 12 months but not to 24 months after ablation. Responders to ablation (AF burden < 0.5 %), reached age- and sex-matched norms in all SF-36 domains, but non-responders only in social functioning and MCS. All AF6 scores showed at least moderate improvement in both responders and non-responders. Higher AF burden was independently associated with poorer PCS and AF6 scores. In 162 patients who underwent AVJA, hospitalization for HF occurred in 20 % of patients (two-year cumula-tive incidence 9.1 %) and 22 % died (two-year cumulative incidence 5.2 %) during a median follow-up of five years. QRS ≥ 120 ms and left atrial diame-ter were independent predictors of hospitalization for HF, and hypertension and previous HF of death.Conclusions: Continuous rhythm monitoring was superior to intermittent monitoring. The AF-specific AF6 was more sensitive to changes related to AF burden after AF ablation than both EHRA class and the SF-36. The long-term hospitalization rate for HF and all-cause mortality was low after AVJA.
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| 9. |
- Björkenheim, Anna, 1980-, et al.
(författare)
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Does zero atrial fibrillation burden after atrial fibrillation ablation mean that patients are free of symptoms?
- 2017
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Ingår i: Europace, Supplements. - : Oxford University Press. - 1099-6044 .- 1749-365X. ; 19:Duppl. 3, s. iii264-iii264
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Success of atrial fibrillation (AF) ablation is usually defined as freedom of AF, although symptomatic relief often is what the patient’s desire. After ablation the proportion of ‘silent’ AF increases and success based on symptomatic AF recurrence may be overestimated.Purpose: To investigate the symptomatology of patients who are truly free of AF after ablation.Methods: In 57 patients the symptomatology after AF ablation was assessed as perceived by the patient using a validated AF-specific symptom questionnaire (AF6) and the overall treatment effect (OTE), and as classified by the physician using the EHRA score, at baseline, 6, 12 and 24 months. The cardiac rhythm was continuously monitored by an implantable loop recorder throughout the 2-year follow-up.Results: At 6, 12 and 24 months 14 (26%), 23 (43%) and 23 (43%) patients had an AF burden 0% during the past 6 months, and 13 of them had an AF burden 0% during the entire 2 year follow-up. All patients reported ‘OTE better’ at all time-points. All patients were also classified into EHRA I at 6 months. Being completely free of AF for six months periods did not mean complete freedom of symptoms, but the median AF6 sum score was consistently low with a narrowing IQR over time, 0 (IQR 0-27), 0.5 (IQR 0-7) and 0 (IQR 0-11) at 6, 12 and 24 months. At 6 months 8/14 patients (57%) scored AF6=0, the others 6, 11, 26, 28, 30 and 46 points. At 12 months 13/23 patients (56%) scored AF6=0, the others 1,1,3,3,5,7,7,7,14 and 22 points. At 24 months 12/23 (52%) patients scored AF6=0, the others 1, 1, 2, 4, 9, 11, 17, 20, 24, 32 and 42 points. Among the AF6 items, ‘worry/anxiety due to AF’ was the most common, while ‘tiredness due to AF’ was the highest scoring item. In the patients with AF burden 0% during the entire 2-year follow-up all patients were improved in OTE and all patients were classified into EHRA class I at all times after ablation and the median AF6 sum score was 4 (IQR0-28), 0.5 (IQR 0-8) and 1 (0-5) at 6, 12 and 24 months after ablation.Conclusions: Sudden elimination of AF by ablation does not automatically eliminate all symptoms that the patients associated with AF, but all patients felt better and were classified in EHRA class I at all time-points. Less than a half of the patients at any time-point scored some symptoms, but the symptoms gradually decreased over time, especially between 6 and 12 months.
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| 10. |
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| 11. |
- Björkenheim, Anna, 1980-, et al.
(författare)
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Patient-reported outcomes in relation to continuously monitored rhythm before and during 2 years after atrial fibrillation ablation using a disease-specific and a generic instrument
- 2018
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Ingår i: Journal of the American Heart Association. - : Wiley-Blackwell Publishing Inc.. - 2047-9980. ; 7:5
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Tidskriftsartikel (refereegranskat)abstract
- Background--Atrial fibrillation (AF) ablation improves patient-reported outcomes, irrespective of mode of intermittent rhythm monitoring. We evaluated the use of an AF-specific and a generic patient-reported outcomes instrument during continuous rhythm monitoring 2 years after AF ablation. Methods and Results--Fifty-four patients completed the generic 36-Item Short-Form Health Survey and the AF-specific AF6 questionnaires before and 6, 12, and 24 months after AF ablation. All patients underwent continuous ECG monitoring via an implantable loop recorder. The generic patient-reported outcomes scores were compared with those of a Swedish age- and sexmatched population. After ablation, both summary scores reached normative levels at 24 months, while role-physical and vitality remained lower than norms. Responders to ablation (AF burden < 0.5%) reached the norms in all individual 36-Item Short-Form Health Survey domains, while nonresponders (AF burden > 0.5%) reached norms only in social functioning and mental component summary. All AF6 items and the sum score showed moderate to large improvement in both responders and nonresponders, although responders showed significantly greater improvement in all items except item 1 from before to 24 months after ablation. Higher AF burden was independently associated with poorer physical component summary and AF6 sum score. Conclusions--The AF-specific AF6 questionnaire was more sensitive to changes related to AF burden than the generic 36-Item Short-Form Health Survey. Patients improved as documented by both instruments, but a higher AF burden after ablation was associated with poorer AF-specific patient-reported outcomes and poorer generic physical but not mental health. Our results support the use of an AF-specific instrument, alone or in combination with a generic instrument, to assess the effect of ablation. © 2018 The Authors.
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| 12. |
- Björkenheim, Anna, 1980-, et al.
(författare)
-
Patient-reported outcomes in relation to continuously monitored rhythm before and during two years after atrial fibrillation ablation using a disease-specific and a generic instrument
- 2018
-
Konferensbidrag (refereegranskat)abstract
- Background: Atrial fibrillation (AF) ablation improves patient-reported outcomes (PROs), irrespective of mode of intermittent rhythm monitoring.Purpose: To evaluate the use of an AF-specific and a generic PRO instrument during continuous rhythm monitoring two years after AF ablation.Methods: Fifty-four patients completed the generic SF-36 and the AF-specific AF6 questionnaires before and six, 12 and 24 months after AF ablation. All patients underwent continuous ECG monitoring via an implantable loop recorder. The generic PRO scores were compared to those of a Swedish age- and sex-matched population.Results: After ablation both summary scores reached normative levels at 24 months, while physical functioning, role-physical and vitality remained lower than norms. Responders to ablation (AF burden <0.5%) reached the norms in all individual SF-36 domains, while non-responders (AF burden >0.5%) reached norms only in social functioning. All AF6 items and the sum score showed moderate to large improvement in both responders and non-responders, although responders had significantly lower scores 24 months after ablation. Higher AF burden was independently associated with poorer PCS and AF6 sum score.Conclusions: The AF-specific AF6 questionnaire was more sensitive to changes related to AF burden than the generic SF-36. Patients improved as documented by both instruments, but a higher AF burden after ablation was associated with poorer AF-specific PROs and poorer generic physical but not mental health. Our results support the use of an AF-specific instrument, alone or in combination with a generic instrument, to assess the effect of ablation.
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| 13. |
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| 14. |
- Björkenheim, Anna, 1980-, et al.
(författare)
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Predictors of hospitalization for heart failure and of all-cause mortality after atrioventricular nodal ablation and right ventricular pacing for atrial fibrillation
- 2014
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Ingår i: Europace. - : Oxford University Press. - 1099-5129 .- 1532-2092. ; 16:12, s. 1772-1778
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Atrioventricular junction ablation (AVJA) is a highly effective treatment in patients with therapy refractory atrial fibrillation (AF) but renders the patient pacemaker dependent. We aimed to analyse the long-term incidence of hospitalization for heart failure (HF) and all-cause mortality in patients who underwent AVJA because of AF and to determine predictors for HF and mortality.Methods and results: We retrospectively enrolled 162 consecutive patients, mean age 67 +/- 9 years, 48% women, who underwent AVJA because of symptomatic AF refractory to pharmacological treatment (n = 117) or unsuccessful repeated pulmonary vein isolation (n = 45). Hospitalization for HF occurred in 32 (20%) patients and 35 (22%) patients died, representing a cumulative incidence for hospitalization for HF and mortality over the first 2 years after AVJA of 9.1 and 5.2%, respectively. Hospitalization for HF occurred to the same extent in patients who failed pharmacological treatment as in patients with repeated pulmonary vein isolation (PVI), although the mortality was slightly higher in the former group. QRS prolongation >= 120 ms and left atrial diameter were independent predictors of hospitalization for HF, while hypertension and previous HF were independent predictors of death.Conclusion: The long-term hospitalization rate for HF and all-cause mortality was low, which implies that long-term ventricular pacing was not harmful in this patient population, including patients with unsuccessful repeated PVI.
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| 15. |
- Björkenheim, Anna, 1980-, et al.
(författare)
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Rhythm Control and its Relation to Symptoms During the First Two Years After Radiofrequency Ablation for Atrial Fibrillation
- 2016
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Ingår i: Pacing and Clinical Electrophysiology. - Hoboken, USA : Wiley-Blackwell Publishing Inc.. - 0147-8389 .- 1540-8159. ; 39:9, s. 914-925
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate rhythm control up to two years after AF ablation and its relation to reported symptoms.Background: The implantable loop recorder (ILR) continuously records the ECG, has an automatic AF detection algorithm and a possibility for patients to activate an ECG recording during symptoms.Methods: Fifty-seven patients (mean age 57±9 years, 60% male, 88% paroxysmal AF) underwent AF ablation following ILR implantation. Device data were downloaded at the ablation and three, six, 12, 18 and 24 months after ablation.Results: Fifty-four patients completed the two-year follow-up. Thirteen (24%) patients had no AF episodes detected by ILR during follow-up. Ten of 41 patients (24%) with AF recurrence were only detected by ILR and AF recurrences were detected earlier by ILR (P<0.001). The median AF burden in patients with AF recurrence was 5.7% (IQR 0.4-14.4) and was even lower in patients with AF only detected by ILR (P = 0.001). Forty-eight % of the patients indicated symptoms via the patient activator but 33% of those recordings were not due to AF. Early AF recurrence (within 3 months) was highly associated with later AF recurrence (P<0.001). AF burden >0.5% and longest >6h before the ablation were independent predictors of AF recurrence during intermittent but not continuous monitoring.Conclusions: After AF ablation, the AF burden was low throughout the 24 months follow-up. Nevertheless, symptoms were commonly indicated but one third of patient activated recordings did not show AF. Continuous monitoring was superior to intermittent follow-up in detecting AF episodes and assessing the AF burden.Clinical trial registration: URL: http://clinicaltrials.gov. Unique Identifier: NCT00697359.
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| 16. |
- Boriani, Giuseppe, et al.
(författare)
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Plateau waveform shape allows a much higher patient shock energy tolerance in AF patients.
- 2007
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Ingår i: Journal of cardiovascular electrophysiology. - : Wiley. - 1540-8167 .- 1045-3873. ; 18:7, s. 728-34
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- OBJECTIVES: To evaluate the possible pain reduction of the plateau waveform in atrial fibrillation (AF) patients. BACKGROUND: Previous studies have indicated that reduced amplitude waveforms would be less painful than a conventional (65/65% tilt) biphasic waveform. Computer modeling suggested that a moderately long (10-12 msec) plateau (flat topped) shock waveform would deliver equivalent effectiveness with the lowest possible peak amplitude. METHODS: We enrolled 27 patients at two sites with persistent AF with a total of 220 shocks delivered during internal atrial cardioversion using an interleaved crossover design. Patient response was scored in three ways: (1) a verbally reported discomfort score, (2) visual analog scale (VAS), and (3) a blinded observer reporting a contraction score. RESULTS: All scores were significantly reduced (P < 0.0001) by the plateau waveform with impressive statistics: Verbal discomfort (3.51 +/- 0.13 to 2.89 +/- 0.12), VAS (7.00 +/- 0.56 to 5.91 +/- 0.36), and contraction scores (1.94 +/- 0.12 to 1.62 +/- 0.12). The average pain threshold shift (TS) for the Verbal score was 2.34, while that for the VAS score was 2.30. (This means that the patient typically could tolerate 2.34 times as much energy with the plateau waveform for the same level of verbally reported discomfort.) The contraction TS was less at 1.57. Response scores were also corrected for the shock sequence number to control for the sensitization effect from multiple shocks. This increased the TS for the Verbal score to 3.58, but the shock number was not significant for the VAS. A pulmonary artery electrode return was associated with lower pain compared with a coronary sinus position. CONCLUSION: A plateau shaped biphasic waveform resulted in significantly increased shock energy pain tolerances. Controlling for session sensitization, patients tolerated over three times as much energy for the same verbally reported discomfort score.
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| 17. |
- 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. ; 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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| 18. |
- 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. - : Ovid Technologies (Wolters Kluwer Health). - 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/m(2) to 3.72 (95% CI, 2.44-5.66) among men with BMI of 40.0 to 50.0 kg/m(2), compared with those with BMI of 18.5 to <20.0 kg/m(2). During a median follow-up of approximate to 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/m(2) compared with those with BMI <20 kg/m(2) 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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| 19. |
- 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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| 20. |
- 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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| 21. |
- Johansson, Benny, et al.
(författare)
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The a' velocity by tissue-Doppler echocardiography correlates to invasive mean left atrial pressure in patients with normal ejection fraction
- 2022
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Ingår i: Scandinavian Cardiovascular Journal. - : Taylor & Francis. - 1401-7431 .- 1651-2006. ; 56:1, s. 6-12
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To evaluate the correlation of a' velocity by tissue-Doppler measurements with invasively measured mean left atrial pressure in patients with normal ejection fraction.Design: In this retrospective study, we evaluated the septal a', lateral a' and average a' velocity by tissue-Doppler echocardiography, in 125 in-hospital patients, 1-12 h before an elective pulmonary vein isolation due to intermittent atrial fibrillation, and compared to invasively measured mean left atrial pressure (LAP) during the invasive procedure. The patients, aged 35-81 years, had to be in sinus rhythm at both examinations, no atrial fibrillation during two procedures, no or mild valve disease and normal ejection fraction (>50%).Results: Invasively measured mean LAP correlated well to septal a' (r = -0.435), lateral a' (r = -0.473) and average a' velocity (r = -0.491). Normal mean LAP (<= 12 mmHg) was found in 95 patients and elevated mean LAP (>12 mmHg) in 30 patients. The patients with elevated mean LAP had a lower septal a' velocity (6.5 +/- 2.7 vs 8.6 +/- 2.3 cm/s; p < .01), lateral a' velocity (5.9 +/- 2.3 vs 8.6 +/- 2.1 cm/s; p < .01) and average a' velocity (6.2 +/- 2.4 vs 8.8 +/- 2.1 cm/s; p < .01) compared to patients with normal mean LAP. Septal a', lateral a' and average a' velocity were good predictors of elevated mean LAP with AUC of 0.78, 0.83 and 0.82. Average a' velocity with cut-off < 7.25 cm/s had a sensitivity of 83% and a specificity of 77% to predict elevated mean LAP.Conclusion: The a' velocity is a good indicator of mean LAP and might be considered in the evaluation of left ventricle filling pressure in patients with normal ejection fraction.
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| 22. |
- Poci, Dritan, 1969
(författare)
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Atrial fibrillation – on its trigger mechanisms, risks and consequences
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Atrial fibrillation (AF) frequently impairs quality of life, but in long-term it is associated with an increased morbidity and mortality. Persistent AF may cause changes in the sinus node function, and if converted to sinus rhythm (SR), there is a substantial risk of recurrence of AF. Atrioventricular junctional ablation (AVJA) is a therapeutic option for patients with drug refractory persistent/permanent AF, but permanent right ventricular pacing after ablation, according to some reports, has been associated with the development of heart failure (HF). Methods: 172 patients with persistent AF underwent elective DC cardioversion and analysis of 5 minutes ECG recordings was made in those converted to sinus rhythm (SR). Another 213 patients were followed for 6±3 years after AVJA. Forty-nine of the patients (23%) were known to have HF before AVJA, and aggravated or new HF was in long-term followed. Of 2335 consecutive patients admitted with acute coronary syndromes (ACS), 442 had known AF (n=204), new AF at admission (n=54) or developed new AF during hospitalization (n=184). The short- and long-term mortality and morbidity were followed in patients with and without AF, and were related to their CHADS2 scores at admission. Results: After successful cardioversion of persistent AF, 30% of the patients had a recurrence of AF within 1 week. Premature atrial contractions (PAC) were equally frequent in patients with and without AF recurrence. A low sinus rate and/or sinus pauses >2 s were observed in 31 patients in the first few minutes but did not predict recurrence of AF. One quarter of the patients with known HF before AVJA showed an aggravation of HF, while 13% developed new symptoms of HF during long-term right ventricular pacing after AVJA. High age and low EF were independent predictors of new HF, while high age and coronary artery disease were independent predictors of all-cause mortality. In patients with ACS and AF, short-term mortality (<30 days) was 13.8%, and differed significantly between the AF subgroups. All-cause 10-year mortality did not differ between subgroups, as opposed to the rate of hospitalization for stroke. The all-cause mortality at 10-years showed a strong association with the CHADS2 scores both in patients with and without AF, although strongest in patients without AF (hazard ratio [HR] and 95% confidence interval per unit increase in the six-graded CHADS2 score 1.53 [1.42-1.64], p<0.0001 vs 1.28 [1.16-1.43], p<0.0001 after adjustment for potential confounders). Conclusions: PACs and transient sinus bradycardia were the most common potential trigger mechanisms after cardioversion of persistent AF, but they did not predict recurrences of AF. AVJA followed by right ventricular pacing was associated with aggravated HF in a quarter of patients with previously known HF, while development of new symptoms of HF occurred much less often. In patients with ACS the type of AF influenced the 30-day mortality and the long-term risk of hospitalization for stroke. The CHADS2 score helped to identify patients with a higher risk for subsequent stroke and death, both in patients with and without AF.
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| 23. |
- Poci, Dritan, 1969-, et al.
(författare)
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Do Some Patients Younger Than 65 Years Old And With Incident Atrial Fibrillation Need Anticoagulation Treatment? : Conclusions From A Swedish Nationwide Registry Study
- 2018
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Konferensbidrag (refereegranskat)abstract
- Background: It is still under debate whether patients with atrial fibrillation (AF) and a low risk of cerebral infarction would benefit from anticoagulation.Objective: We aimed to assess whether younger patients with AF and lower CHA2DS2-VASc score would benefit from anticoagulation treatment.Methods: In a retrospective, nationwide cohort study, using the Swedish national registries, 59981 hospitalized patients were identified with incident AF. After exclusion of 11548 patients because of warfarin use before the AF diagnosis, or death, emigration or stroke within 30 days of AF diagnosis, the remaining 48 433 patients, among whom 27166 patients had no warfarin treatment, were, after adjustment for age, sex and year of AF diagnosis, divided according to age, sex and CHA2DS2-VASc score 0, 1, 2 and ≥3 and included in a time-varying analysis of warfarin treatment versus no treatment. Patients were followed up to 48 months after the inclusion.Results: In men <65 years and with a CHA2DS2-VASc score 2 or ≥3, the relative risk of having a stroke or cerebral infarction was lower when they received warfarin treatment, HR 0.35 (95% CI 0.18-0.69) and HR 0.37 (95% CI 0.23-0.59) respectively, as compared to HR 1.11 (95% CI 0.56-2.23) when the score was 1. Women younger than 65 years had a low relative risk when CHA2DS2-VASc score was ≥3 points, HR 0.31 (95% CI 0.16-0.59), as compared to HR 1.84 (95% CI 0.86-3.94) and HR 2.13 (95% CI 0.94-4.84) when the score was 2 and 1 respectively. The risk of intracranial bleeding was low and similar in all subgroups on anticoagulation except in the youngest men without risk factors.Conclusion: Women and men <65 years had a beneficial effect of warfarin if they had two risk factors other than age and sex, without an increased risk of bleeding. Our results support prophylactic anticoagulation treatment in patients under 65 years and a CHA2DS2-VASc score ≥2, other than age and sex.
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| 24. |
- Poci, Dritan, et al.
(författare)
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Effect of New Versus Known Versus No Atrial Fibrillation on 30-Day and 10-Year Mortality in Patients With Acute Coronary Syndrome
- 2012
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Ingår i: American Journal of Cardiology. - : Elsevier BV. - 0002-9149 .- 1879-1913. ; 110:2, s. 217-221
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Tidskriftsartikel (refereegranskat)abstract
- Coronary artery disease promotes the development of atrial fibrillation (AF). The aim of this study was to determine short- and long-term mortality in patients with acute coronary syndromes (ACS) and AF, depending on the AF presentation. A total of 2,335 consecutive patients with ACS were included. AF was classified as known persistent or permanent AF, known paroxysmal AF, new AF at admission, and new AF during hospitalization for ACS. Four hundred forty-two patients had any AF: 54 with known persistent or permanent AF, 150 with known paroxysmal AF, 54 with new AF at admission, and 184 with new AF during hospitalization. Statistically significant differences among subgroups related to previous heart failure (p <0.0001), stroke (p = 0.04), myocardial infarction (p <0.0001), angina pectoris (p <0.0001), hypercholesterolemia (p = 0.007), coronary artery bypass grafting (p <0.0001), and percutaneous coronary intervention (p = 0.03) were observed. Thirty-day mortality differed among the subgroups (p = 0.02) and was lowest in patients with known paroxysmal AF (7.3%). Ten-year mortality ranged from 53% to 78% among the subgroups. There were 5 predictors of long-term mortality across the subgroups: age (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.04 to 1.09, p <0.0001), previous myocardial infarction (HR 1.4, 95% CI 1.0 to 1.8, p = 0.04), heart failure (HR 1.8, 95% CI 1.3 to 2.4, p = 0.0002), diabetes (HR 1.7, 95% CI 1.2 to 2.2, p = 0.0005), and smoking (HR 1.7, 95% CI 1.2 to 2.3, p = 0.001). In conclusion, patient characteristics and 30-day mortality differed significantly among the subgroups, but long-term mortality did not. Any AF associated with ACS almost doubled the long-term mortality risk. AF in patients with ACS should therefore be regarded as an important risk factor irrespective of its presentation. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;110:217-221)
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| 25. |
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| 26. |
- Poci, Dritan, 1969, et al.
(författare)
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New or aggravated heart failure during long-term right ventricular pacing after AV junctional catheter ablation
- 2009
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Ingår i: Pacing Clin Electrophysiol. ; 32:2, s. 209-216
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Atrioventricular junctional ablation (AVJA) improves symptoms and quality of life in patients with pharmacologically resistant atrial fibrillation (AF). However, long-term right ventricular stimulation has also been reported to lead to deterioration of the left ventricular function. We retrospectively analyzed the incidence of new or aggravated heart failure (HF) during long-term right ventricular stimulation following AVJA. METHODS: Two hundred thirteen patients (110F:103M), 73 +/- 10 years old, were followed for a period of 6 +/- 3 years after AVJA. Forty-nine patients (23%) were known to have HF before AVJA. New HF was diagnosed if at least two of the following criteria were present: NYHA class >2, an LVEF <45%, and medication for HF. Aggravated HF was defined as an increase in the functional class and/or new prescription of medication for HF. All-cause death was a secondary endpoint. RESULTS: During follow-up, 26% of the patients with known HF showed an aggravation of HF, while 13% developed new symptoms of HF. High age and low EF were independent predictors of new or aggravated HF and of new HF, while none of the tested variables predicted aggravation of known HF. The all-cause mortality was 16%, where high age and coronary artery disease were found to be independent predictors. CONCLUSION: AVJA followed by right ventricular pacing was associated with aggravated HF in 23% of patients with known HF, while development of new symptoms of HF occurred much less often during follow-up (13%). The majority of patients who underwent AVJA continued to do well during long-term follow-up.
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| 27. |
- Poci, Dritan, 1969, et al.
(författare)
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Role of the CHADS(2) Score in Acute Coronary Syndromes Risk of Subsequent Death or Stroke in Patients With and Without Atrial Fibrillation
- 2012
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Ingår i: Chest. - : Elsevier BV. - 0012-3692 .- 1931-3543. ; 141:6, s. 1431-1440
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Tidskriftsartikel (refereegranskat)abstract
- Background: Atrial fibrillation (AF) is common in patients with acute coronary syndromes (ACS). We aimed to describe the value of the CHADS(2) (congestive heart failure, hypertension, age >= 75 years, diabetes, prior stroke or transient ischemic attack) score as a risk assessment tool for mortality and stroke in patients with ACS, irrespective of the presence or absence of AF. Methods: Consecutive patients with ACS admitted to the coronary care unit were prospectively included in a risk stratification study. We calculated the CHADS(2) scores from the data collected at admission, and all patients were followed until January 1, 2007, or death. Results: Of 2,335 patients with ACS in this study, 442 (age 71 +/- 8 years, 142 women) had AF. Their mean CHADS(2) score was 1.6 +/- 1.4 vs 1.0 +/- 1.1 in patients without AF (P < .0001). The all-cause mortality at 10 years was strongly associated with the CHADS(2) score in patients with AF (hazard ratio [HR] and 95% CI per unit increase in the six-grade CHADS(2) score, 1.21 [1.07-1.36]; P = .002), hut the same association was also present in patients without AF (HR 1.38 [1.28-1.48], P < .0001), after adjustment for potential confounders. The more complicated GRACE (Global Registry Of Acute Coronary Events) risk score provided a better prediction for short- and long-term mortality than the simpler CHADS(2) score (P < .0001). Hospitalization for stroke was significantly associated with the CHADS(2) score in patients without AF (but not in those with AF) after adjustment (HR 1.46 [1.27-1.68], P <.0001). Conclusions: In patients with ACS, AF is associated with poor prognosis. The CHADS(2) score developed for AF has even greater prognostic value in patients who do not have AF, and it may help to identify patients with high risk for subsequent stroke or death and a need for optimization of risk-reducing treatment. CHEST 2012; 141(6):1431-1440
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| 28. |
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| 29. |
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| 30. |
- Själander, Sara, et al.
(författare)
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Assessment of Use vs Discontinuation of Oral Anticoagulation After Pulmonary Vein Isolation in Patients With Atrial Fibrillation
- 2017
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Ingår i: JAMA cardiology. - : American Medical Association. - 2380-6583 .- 2380-6591. ; 2:2, s. 146-152
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE: Pulmonary vein isolation (PVI) is a recommended treatment for patients with atrial fibrillation, but it is unclear whether it results in a lower risk of stroke.OBJECTIVES: To investigate the proportion of patients discontinuing anticoagulation treatment after PVI in association with the CHA(2)DS(2)-VASc (congestive heart failure, hypertension, age >= 75 years [doubled], diabetes, stroke [doubled], vascular disease, age 65-74 years, sex category [female]) score, identify factors predicting stroke after PVI, and explore the risk of cardiovascular events after PVI in patients with and without guideline-recommended anticoagulation treatment.DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort studywas conducted using Swedish national health registries from January 1, 2006, to December 31, 2012, with a mean-follow up of 2.6 years. A total of 1585 patients with atrial fibrillation undergoing PVI from the Swedish Catheter Ablation Register were included, with information about exposure to warfarin in the national quality register Auricula. Data analysis was performed from January 1, 2015, to April 30, 2016.EXPOSURES: Warfarin treatment.MAIN OUTCOMES AND MEASURES: Ischemic stroke, intracranial hemorrhage, and death.RESULTS: In this cohort of 1585 patients, 73.0% were male, the mean (SD) age was 59.0 (9.4) years, and the mean (SD) CHA(2)DS(2)-VASc score was 1.5 (1.4). Of the 1585 patients, 1175 were followed up for more than 1 year after PVI. Of these, 360 (30.6%) discontinued warfarin treatment during the first year. In patients with a CHA(2)DS(2)-VASc score of 2 or more, patients discontinuing warfarin treatment had a higher rate of ischemic stroke (5 events in 312 years at risk [1.6% per year]) compared with those continuing warfarin treatment (4 events in 1192 years at risk [0.3% per year]) (P = .046). Patients with a CHA(2)DS(2)-VASc score of 2 or more or those who had previously experienced an ischemic stroke displayed a higher risk of stroke if warfarin treatment was discontinued (hazard ratio, 4.6; 95% CI, 1.2-17.2; P = .02 and hazard ratio, 13.7; 95% CI, 2.0-91.9; P = .007, respectively).CONCLUSIONS AND RELEVANCE: These findings indicate that discontinuation ofwarfarin treatment after PVI is not safe in high-risk patients, especially those who have previously experienced an ischemic stroke.
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| 31. |
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| 32. |
- Skröder, Sofia, 1995-, et al.
(författare)
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Validation of a handheld single-lead ECG algorithm for atrial fibrillation detection after coronary revascularization
- 2023
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Ingår i: Pace-Pacing and Clinical Electrophysiology. - : Wiley-Blackwell Publishing Inc.. - 0147-8389 .- 1540-8159. ; 46:7, s. 782-787
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAtrial fibrillation (AF) is a rapidly increasing global public health concern entailing a high risk for ischemic stroke that can largely be avoided with anticoagulation therapy. AF is often underdiagnosed and there is a need for a reliable method of detection in individuals with additional risk factors for stroke such as coronary artery disease. We aimed to validate an automatic rhythm interpretation algorithm in thumb ECG in subjects with recent coronary revascularization. MethodsThumb ECG, a patient-operated handheld single-lead ECG recording device with an automatic interpretation algorithm, was performed three times daily for a month after coronary revascularization and 2-week periods 3, 12, and 24 months post-procedure. The detection of AF by the automatic algorithm on subject and single-strip ECG level was compared to manual interpretation. Results48,308 of 30 s thumb ECG recordings from 255 subjects (mean 212 +/- 3.5 recordings per subject) were retrieved from a database (AF 47 subjects/655 recordings; non-AF 208 subjects/47,653 recordings). The algorithm sensitivity at subject level was 100%, specificity 11.2%, positive predictive value (PPV) 20.2%, and negative predictive value (NPV) 100%. At the single-strip ECG level, sensitivity was 87.6%, specificity 94.0%, PPV 16.8%, and NPV 99.8%. The most common reasons for false positive results were technical disturbance and frequent ectopic beats. ConclusionsThe automatic interpretation algorithm in a handheld thumb ECG device can rule out AF in patients recently undergoing coronary revascularization with high accuracy, but manual confirmation is needed to confirm the diagnose of AF because of high false positive rates.
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| 33. |
- Sztaniszlav, Aron, 1979-, et al.
(författare)
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All-cause mortality trends in patients hospitalized for atrial fibrillation in Sweden: Role of age, stroke risk, and education
- 2022
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Ingår i: Ijc Heart & Vasculature. - : Elsevier BV. - 2352-9067. ; 43
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Tidskriftsartikel (refereegranskat)abstract
- Background: The incidence of atrial fibrillation (AF) has long been increasing, and AF is associated with increased mortality. Over time, mortality trends may differ between subgroups depending on their underlying risk patterns and treatments. Aim: To explore all-cause-mortality trends over time in patients hospitalized for incident AF, and the effects of age, stroke risk, and education level. Methods and results: Patients hospitalized for incident AF between January 1995 and December 2003 were selected from Swedish national registries. Based on date of index admission, patients were divided into four cohorts and followed for five years. Age- and sex-matched controls were selected. Kaplan-Meier estimates and Cox regressions with trend analysis were used for statistical evaluation. There were 64,489 patients (mean age 72 +/- 10.1 years) and 116,893 controls. There was a significantly decreasing trend in the relative risk of all-cause mortality in AF patients over time, with a trend hazard ratio of 0.94 (95 % confidence interval [CI] 0.92-0.96, p < 0.001) in women and 0.91 (95 % CI 0.89-0.93, p < 0.001) in men. The mortality trends did not differ significantly between AF patients and controls. The mortality risk remained unchanged in women aged 18-64 years, in patients with low stroke risk, and in patients with post-secondary education. Conclusion: The all-cause mortality risk decreased over time in both patients and controls, but subgroup analysis revealed an unchanged mortality trend in women aged 18-64 years, in patients with low stroke risk, and in patients with post-secondary education.
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| 34. |
- Sztaniszlav, Aron, 1979-, et al.
(författare)
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Trends in all-cause mortality of atrial fibrillation in hospitalized patients in Sweden between 1995-2008
- 2021
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 42:Suppl. 1, s. 296-296
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Atrial fibrillation (AF) is the most common arrythmia. Both its incidence and prevalence increased significantly during the last decades. AF is associated with high morbidity and mortality.Purpose: The aim of this study was to describe and evaluate the trends of all-cause mortality in patients first-ever hospitalized for AF, and the effect of age, sex, stroke risk, and education level on mortality over time.Methods: In this observational retrospective cohort study, we enrolled the patients who were hospitalized primarily and for the first time because of AF between 1st January 1995 and 31st December 2004. In regard to the date of the index admission patients were divided into four cohorts and they were followed up to five years. Patients were compared with an age and sex matched control population. All data were collected from Swedish national registries. Kaplan-Meier plots and Cox regression with trend analysis were used for statistical evaluation.Results: In total 64 489 AF patients (mean age 72±10.1 year) were included in this study. The control group comprised 116 893 individuals. 81.9% of the women and 58.5% of the men were older than 65 years of age. 65.5% of women and 58.5% of the men had a stroke risk of CHADS2-VA2Sc ≥2.We found a significantly decreasing trend of the relative risk for all-cause mortality in AF patients over time: trend HR: 0.94 (95% CI: 0.92–0.96, p<0.001) in women and trend HR: 0.91 (95% CI: 0.89–0.93 p<0.001) in men. The mortality trends between AF patients and their controls did not show significant difference: trend HR: 0.99 (95% CI: 0.96–1.02, p=0.59) in women and trend HR: 1.00 (95% CI: 0.97–1.03, p=0.98) in men. The subpopulation analysis showed that the mortality risk remained unchanged over the time in women aged 18–69 years (trend HR: 0.91 – 95% CI: 0.82–1.02, p=0.099), in patients with low stroke risk (trend HR: 1.08 – 95% CI: 0.92–1.26, p=0.36 in women and trend HR: 0.95 – 95% CI: 0.87–1.05, p=0.30 in men) and in patients with post-secondary level of education (trend HR: 0.93 – 95% CI 0.83–1.04, p=0.23 in women and trend HR: 1.04 – 95% CI: 0.96–1.12, p=0.32 in men).Conclusion: The all-cause mortality risk of the AF hospitalized patients was higher compared to control population and had a decreasing tendency during the time of the study. However, this trend is not significantly different from the control population. We found unchanged mortality trend in younger patients, in those with lower stroke risk, and in patients with higher education level.
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| 35. |
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| 36. |
- Walfridsson, Ulla, et al.
(författare)
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Gender and age differences in symptoms and health-related quality of life in patients with atrial fibrillation referred for catheter ablation
- 2019
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Ingår i: Pacing and Clinical Electrophysiology. - : John Wiley & Sons. - 0147-8389 .- 1540-8159. ; 42:11, s. 1431-1439
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Tidskriftsartikel (refereegranskat)abstract
- Background: Primary indication for catheter ablation of atrial fibrillation (AF) is to reduce symptoms and improve health-related quality of life (HRQoL). There are data showing differences between the genders and between younger and older patients. To evaluate this, we studied a large Scandinavian cohort of patients referred for catheter ablation of AF.Methods: Consecutive patients filled out the ASTA questionnaire, assessing symptoms, HRQoL, and perception of arrhythmia, prior to ablation. Patients were recruited from four Swedish and one Danish tertiary center.Results: A total of 2493 patients (72% men) filled out the ASTA questionnaire. Women experienced eight of the nine ASTA scale symptoms more often than men. Patients <65 years reported four symptoms more often, only tiredness was more frequent in those >= 65 years (P = .007). Women and patients <65 years experienced more often palpitations and regarding close to fainting and this was more common among women, no age differences were seen. Women and men scored differently in 10 of the 13 HRQoL items. Only negative impact on sexual life was more common in men (P < .001). Older patients reported more negative influence in four of the HRQoL items and the younger in one; ability to concentrate.Conclusions: Women experienced a more pronounced symptom burden and were more negatively affected in all HRQoL concerns, except for the negative impact on sexual life, where men reported more influence of AF. Differences between age groups were less pronounced. Disease-specific patient-reported outcomes measures (PROMs) add important information where gender differences should be considered in the care.
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| 37. |
- Wecke, Liliane, et al.
(författare)
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Vectorcardiography shows cardiac memory and repolarization heterogeneity after ablation of accessory pathways not apparent on ECG
- 2013
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 166:1, s. 152-157
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Pacing induced cardiac memory is an established phenomenon, but following successful WPW ablation, cardiac memory was present on ECG in variable proportions of patients depending on accessory pathway (AP) location. We hypothesized that vectorcardiography (VCG), which is more sensitive than ECG, would show cardiac memory after WPW ablation independent of AP location. METHODS: Thirty-six patients were followed after successful AP ablation, 11 with overt posteroseptal (PS), 13 with overt left-sided (LS) and 12 with concealed APs (controls). VCGs were recorded the day before and after the procedure, ≥once/week for 6-8weeks and after ≥3months. T vector and T-vector loop parameters were analyzed and compared. RESULTS: After ablation of overt APs, there was a correlation between the directions of the preexcited maximum QRS-vector and the post-ablation maximum T-vector, confirming the presence of cardiac memory. Ablation of overt APs was followed by cardiac memory apparent in different directions. Thus, ablation of PS APs was followed by most pronounced changes in T-vector elevation and LS APs with significant changes only in T-vector azimuth. Cardiac memory disappeared within a month in >80% of cases. Furthermore, T-vector loop morphology changes suggested a period of repolarization heterogeneity immediately after ablation of overt APs. CONCLUSIONS: According to VCG analysis cardiac memory was present after ablation of overt APs independent of location as consistently as after ventricular pacing, and disappeared within a similar time frame during normal ventricular activation. In addition, signs of transient repolarization heterogeneity were observed after ablation of overt APs.
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