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- Johansson, Birgitta, 1960, et al.
(författare)
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Short-term sinus rhythm predicts long-term sinus rhythm and clinical improvement after intraoperative ablation of atrial fibrillation.
- 2008
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Ingår i: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - : Oxford University Press (OUP). - 1532-2092. ; 10:5, s. 610-7
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Our aim was to compare the long-term effects on rhythm and quality of life (QoL) after left atrial epicardial radiofrequency (RF) ablation vs. no ablation in patients undergoing cardiac surgery. METHODS AND RESULTS: Thirty-nine patients with ECG documented atrial fibrillation (AF) scheduled for coronary artery bypass grafting (CABG) with or without concomitant valve surgery were consecutively elected for epicardial RF ablation. Thirty-nine age- and gender-matched patients scheduled for CABG with or without concomitant valve surgery only and with documented AF served as controls. The follow-up after ablation was 32 +/- 11 months. The percentage of patients in sinus rhythm (SR) at long-term follow-up was 62 vs. 33% (P = 0.03) after ablation and no ablation, respectively. SR at 3 months was highly predictive of that at 32 months (sensitivity 95%, positive predictive value 86%). Long-term SR was associated with better QoL, fewer symptoms, higher ejection fraction, and smaller left and right atria than AF. CONCLUSION: SR at 3 months was highly predictive of long-term SR that was associated with clinical improvement when compared with patients still in AF. AF at 3 months did not preclude a later stabilization to SR.
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| 2. |
- Blomström-Lundqvist, Carina, et al.
(författare)
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A randomized double-blind study of epicardial left atrial cryoablation for permanent atrial fibrillation in patients undergoing mitral valve surgery: the SWEDish Multicentre Atrial Fibrillation study (SWEDMAF).
- 2007
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Ingår i: European heart journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 28:23, s. 2902-8
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The efficacy of epicardial left atrial (LA) cryoablation in eliminating atrial fibrillation (AF) in patients undergoing mitral valve surgery (MVS) is unknown. We hypothesized that MVS combined with LA cryoablation is superior to MVS alone. METHODS AND RESULTS: Sixty-nine patients with permanent AF, included at four centres, underwent MVS with or without epicardial LA cryoablation. The primary endpoint was regained sinus rhythm. Risk factors for failed AF cryoablation were elucidated. Sixty-five out of 69 patients reached the primary endpoint. At 6 and 12 months follow-up, 73.3% of patients who underwent cryoablation had regained sinus rhythm at both follow-ups, compared with 45.7 and 42.9% of patients, respectively, who underwent MVS alone (group differences, at 6 months P = 0.024, after 12 months P = 0.013). The in-hospital complication rate was 11.4% in the MVS group and 26.5% in the cryoablation group (P = 0.110). Risk factors for failed elimination of AF by cryoablation were duration of permanent AF (P = 0.012) and presence of coronary artery disease (P = 0.047), according to multiple logistic regression analysis. CONCLUSION: This first prospective randomized study showed that combining MVS with epicardial LA cryoablation is significantly better in eliminating pre-operative permanent AF than MVS alone.
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| 3. |
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| 4. |
- Johansson, Birgitta, 1960
(författare)
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Aspects of Intraoperative Ablation for Atrial Fibrillation
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Increasing knowledge about mechanisms that trigger and maintain atrial fibrillation (AF) has influenced the possibilities for treatment and even cure of AF. The surgical Cox Maze III procedure is still the gold standard for the curative treatment of AF. The development of new technologies has made it possible to mimic most of the Cox Maze III procedure, including isolation of the pulmonary veins, by means of intraoperative ablation using an epicardial lesion set. Aim: To assess the efficacy of intraoperative epicardial ablation in patients with a primary indication for cardiac surgery and with documented AF. To assess whether sinus rhythm (SR) after surgery is of clinical benefit to the patient. To identify preoperative factors that can help to predict SR postoperatively. Method: Intraoperative ablation was performed with radiofrequency energy (RF) in papers I and IV or with cryo energy in II, III and IV. The lesion set was identical in all studies. The study design was randomization in paper II and with age and gender matched controls in papers I and III. Assessment of quality of life (QoL) and symptoms at long-term follow-up was made in paper I and of echocardiographic effects in relation to rhythm before and after coronary artery by-pass grafting (CABG) in paper III. The effects of intraoperative ablation and mitral valve surgery (MVS) were studied in paper II. In paper IV an assessment of potential preoperative echocardiographic predictors for SR after surgery was made in patients from papers I and III. Results: In papers I, II and III concomitant intraoperative epicardial ablation with RF or cryo energy was significantly more effective in restoring SR than CABG or valve surgery alone. At 32±11 months after heart surgery and intraoperative RF ablation, patients in SR had better QoL and fewer symptoms than patients with AF. In paper III atrial and ventricular function was slightly decreased 22±6 months postoperatively, but still within or close to reference limits for patients in SR before and after surgery. There was a continued deterioration of echocardiographic variables in patients with AF pre- and postoperatively. Preoperative right atrial size and left ventricular diastolic function predicted long-term rhythm outcome (IV). SR at three months was a strong predictor of long-term SR (I and III). Independent preoperative predictors for SR at follow-up were paroxysmal/persistent AF (I), low BMI (I), short duration of AF (II), no coronary artery disease (II), SR before surgery (III) and a small left atrial area (III). Conclusions: Concomitant intraoperative ablation was significantly more effective than CABG or valve surgery alone in restoring and maintaining SR. Patients with SR at long-term follow-up had better QoL and fewer symptoms. Preoperative predictors for SR postoperatively were right atrial size and left ventricular diastolic function. SR at three months was a strong predictor of long-term SR. The findings speak in favour of offering intraoperative ablation as a concomitant procedure to patients scheduled for CABG or valve surgery and with documented AF. Key words: atrial fibrillation, radiofrequency, cryo, epicardial, intraoperative ablation, quality of life, atrial function, predictors of rhythm ISBN 978-91-628-7739-2 Gothenburg 2009
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| 5. |
- Johansson, Karl-Axel, et al.
(författare)
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The quality assurance process for the ARTSCAN head and neck study - a practical interactive approach for QA in 3DCRT and IMRT.
- 2008
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Ingår i: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. - : Elsevier BV. - 0167-8140 .- 1879-0887. ; 87:2, s. 290-9
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Tidskriftsartikel (refereegranskat)abstract
- AIM: This paper describes the quality assurance (QA) work performed in the Swedish multicenter ARTSCAN (Accelerated RadioTherapy of Squamous cell CArcinomas in the head and Neck) trial to guarantee high quality in a multicenter study which involved modern radiotherapy such as 3DCRT or IMRT. MATERIALS AND METHODS: The study was closed in June 2006 with 750 randomised patients. Radiation therapy-related data for every patient were sent by each participating centre to the QA office where all trial data were reviewed, analysed and stored. In case of any deviation from the protocol, an interactive process was started between the QA office and the local responsible clinician and/or physicist to increase the compliance to the protocol for future randomised patients. Meetings and workshops were held on a regular basis for discussions on various trial-related issues and for the QA office to report on updated results. RESULTS AND DISCUSSION: This review covers the 734 patients out of a total of 750 who had entered the study. Deviations early in the study were corrected so that the overall compliance to the protocol was very high. There were only negligible variations in doses and dose distributions to target volumes for each specific site and stage. The quality of the treatments was high. Furthermore, an extensive database of treatment parameters was accumulated for future dose-volume vs. endpoint evaluations. CONCLUSIONS: This comprehensive QA programme increased the probability to draw firm conclusions from our study and may serve as a concept for QA work in future radiotherapy trials where comparatively small effects are searched for in a heterogeneous tumour population.
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