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Blomström-Lundqvist, CarinaORCID iD iconorcid.org/0000-0003-2806-3903
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Publications (10 of 197) Show all publications
Regitz-Zagrosek, V., Roos-Hesselink, J. W., Bauersachs, J., Blomström-Lundqvist, C., Cifkova, R., De Bonis, M., . . . Warnes, C. A. (2019). 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy.. Kardiologia polska, 77(3), 245-326
Open this publication in new window or tab >>2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy.
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2019 (English)In: Kardiologia polska, ISSN 0022-9032, E-ISSN 1897-4279, Vol. 77, no 3, p. 245-326Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-381134 (URN)10.5603/KP.2019.0049 (DOI)30912108 (PubMedID)
Available from: 2019-04-04 Created: 2019-04-04 Last updated: 2019-04-04
Lip, G. Y. .., Collet, J.-P., Haude, M., Byrne, R., Chung, E. H., Fauchier, L., . . . Huber, K. (2019). 2018 Joint European consensus document on the management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous cardiovascular interventions: a joint consensus document of the European Heart Rhythm Association (EHRA), European Society of Cardiology Working Group on Thrombosis, European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), Latin America Heart Rhythm Society (LAHRS), and Cardiac Arrhythmia Society of Southern Africa (CASSA). Europace, 21(2), 192-+
Open this publication in new window or tab >>2018 Joint European consensus document on the management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous cardiovascular interventions: a joint consensus document of the European Heart Rhythm Association (EHRA), European Society of Cardiology Working Group on Thrombosis, European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), Latin America Heart Rhythm Society (LAHRS), and Cardiac Arrhythmia Society of Southern Africa (CASSA)
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2019 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 21, no 2, p. 192-+Article in journal (Refereed) Published
Abstract [en]

In 2014, a joint consensus document dealing with the management of antithrombotic therapy in atrial fibrillation (AF) patients presenting with acute coronary syndrome (ACS) and/or undergoing percutaneous coronary or valve interventions was published, which represented an effort of the European Society of Cardiology Working Group on Thrombosis, European Heart Rhythm Association (EHRA), European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS) and Asia-Pacific Heart Rhythm Society (APHRS). Since publication of this document, additional data from observational cohorts, randomized controlled trials, and percutaneous interventions as well as new guidelines have been published. Moreover, new drugs and devices/interventions are also available, with an increasing evidence base. The approach to managing AF has also evolved towards a more integrated or holistic approach. In recognizing these advances since the last consensus document, EHRA, WG Thrombosis, EAPCI, and ACCA, with additional contributions from HRS, APHRS, Latin America Heart Rhythm Society (LAHRS), and Cardiac Arrhythmia Society of Southern Africa (CASSA), proposed a focused update, to include the new data, with the remit of comprehensively reviewing the available evidence and publishing a focused update consensus document on the management of antithrombotic therapy in AF patients presenting with ACS and/or undergoing percutaneous coronary or valve interventions, and providing up-to-date consensus recommendations for use in clinical practice.

Keywords
European Heart Rhythm Association, Consensus document, Position paper, Atrial fibrillation, Acute coronary syndrome, Coronary artery disease, Myocardial infarction, Percutaneous coronary intervention, Stent, Antithrombotic therapy, Antiplatelet agents, Anticoagulation, Vitamin K antagonists, Non-vitamin K antagonist oral anticoagulants, Low molecular weight heparin, Parenteral anticoagulants, Left atrial appendage occlusion, Stroke, Thromboembolism, Thrombosis, Bleeding
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-365929 (URN)10.1093/europace/euy174 (DOI)000462550800006 ()30052888 (PubMedID)
Note

Blomström-Lundqvist, Carina & Stefan, James is part of: ESC Scientific Document Group.

For complete list of authors see http://dx.doi.org/10.1093/europace/euy174

Available from: 2018-11-15 Created: 2018-11-15 Last updated: 2019-04-29Bibliographically approved
Holmqvist, F., Kesek, M., Englund, A., Blomström-Lundqvist, C., Karlsson, L. O., Kennebäck, G., . . . Insulander, P. (2019). A decade of catheter ablation of cardiac arrhythmias in Sweden: ablation practices and outcomes. European Heart Journal, 40(10), 820-830
Open this publication in new window or tab >>A decade of catheter ablation of cardiac arrhythmias in Sweden: ablation practices and outcomes
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2019 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 40, no 10, p. 820-830Article in journal (Refereed) Published
Abstract [en]

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.

Keywords
Catheter ablation, Adverse events, Outcome
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-367225 (URN)10.1093/eurheartj/ehy709 (DOI)000461141900010 ()30452631 (PubMedID)
Funder
Swedish Association of Local Authorities and RegionsThe Crafoord FoundationSwedish Heart Lung Foundation
Available from: 2018-11-29 Created: 2018-11-29 Last updated: 2019-04-12Bibliographically approved
Stabile, G., Trines, S. A., Arbelo, E., Dagres, N., Brugada, J., Kautzner, J., . . . Blomström-Lundqvist, C. (2019). Atrial fibrillation history impact on catheter ablation outcome: Findings from the ESC-EHRA atrial fibrillation ablation long-term registry. Pacing and Clinical Electrophysiology, 42(3), 313-320
Open this publication in new window or tab >>Atrial fibrillation history impact on catheter ablation outcome: Findings from the ESC-EHRA atrial fibrillation ablation long-term registry
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2019 (English)In: Pacing and Clinical Electrophysiology, ISSN 0147-8389, E-ISSN 1540-8159, Vol. 42, no 3, p. 313-320Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Atrial fibrillation (AF) promotes atrial remodeling that in turn promote AF perpetuation. The aim of our study was to investigate the impact of AF history length on one-year outcome of AF catheter ablation in a cohort of patients enrolled in the Atrial Fibrillation Ablation Registry.

METHODS: We described the real-life clinical epidemiology, therapeutic strategies and the short- and mid-term outcomes of 1948 patients (71.9% with paroxysmal AF) undergoing AF ablation procedures, stratified according to AF history duration (< 2 years or ≥ 2 years).

RESULTS: The mean AF history duration was 46,2±57,4 months, 592 patients had an AF history duration < 2 years (mean 10,2±5,9 months), and 1356 patients ≥ 2 years (mean 75,5±63,5 months) (P < 0.001). Patients with AF history duration < 2 years were younger, had a lower incidence of hypertension, coronary artery disease, hypertrophic cardiomyopathy and had a lower CHA2 DS2 -VaSc Score. At one year, the logrank test showed a lower incidence of AF recurrence in patients with AF history duration < 2 years (28.9%) than in patients with AF history duration ≥ 2 years (34.0%) (P = 0.037). AF history duration ≥ 2 years, overall ablation procedure duration, hypertension and chronic kidney disease were all predictors of recurrences after the blanking period.

CONCLUSIONS: In this multicenter registry, performing catheter ablation in patients with an AF history ≥ 2 years was associated with higher rates of AF recurrences at one year. Since cumulative time in AF in not necessarily equivalent to AF history, its role remains to be clarified.

Keywords
Atrial fibrillation, Atrial fibrillation duration, Catheter ablation, Mid-term outcome, recurrence predictors
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-373390 (URN)10.1111/pace.13600 (DOI)000460951100005 ()30632196 (PubMedID)
Funder
AstraZeneca
Available from: 2019-01-14 Created: 2019-01-14 Last updated: 2019-04-11Bibliographically approved
Normand, C., Linde, C., Bogale, N., Blomström-Lundqvist, C., Auricchio, A., Stellbrink, C., . . . Dickstein, K. (2019). Cardiac resynchronization therapy pacemaker or cardiac resynchronization therapy defibrillator: what determines the choice?-findings from the ESC CRT Survey II. Europace, 21(6), 918-927
Open this publication in new window or tab >>Cardiac resynchronization therapy pacemaker or cardiac resynchronization therapy defibrillator: what determines the choice?-findings from the ESC CRT Survey II
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2019 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 21, no 6, p. 918-927Article in journal (Refereed) Published
Abstract [en]

AIMS: The decision to implant a cardiac resynchronization therapy pacemaker (CRT-P) or a cardiac resynchronization therapy defibrillator (CRT-D) may be challenging. There are no clear guideline recommendations as no randomized study of cardiac resynchronization therapy (CRT) has been designed to compare the effects of CRT-P with those of CRT-D on patients' outcomes. In the CRT Survey II, we studied patient and implantation centre characteristics associated with the choice of CRT-P vs. CRT-D.

METHODS AND RESULTS: Clinical practice data from 10 692 patients undergoing CRT implantation of whom 7467 (70%) patients received a CRT-D and 3225 (30%) received a CRT-P across 42 ESC countries were collected and analysed between October 2015 and January 2017. Factors favouring the selection of CRT-P implantation included age >75 years, female gender, non-ischaemic heart failure (HF) aetiology, New York Heart Association functional Class III/IV symptoms, left ventricular ejection fraction >25%, atrial fibrillation, atrioventricular (AV) block II/III, and implantation in a university hospital.

CONCLUSION: In a large cohort from the CRT Survey II, we found that patients allocated to receive CRT-P exhibited particular phenotypes with more symptomatic HF, more frequent comorbidities, advanced age, female gender, non-ischaemic HF aetiology, atrial fibrillation, and evidence of AV block. There were substantial differences in the proportion of patients allocated to receive CRT-P vs. CRT-D between countries.

Keywords
Cardiac resynchronization therapy, Cardiac resynchronization therapy defibrillator, Cardiac resynchronization therapy pacemaker, Heart failure, Implantable cardioverter-defibrillator
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-385414 (URN)10.1093/europace/euz002 (DOI)000471244000019 ()31157387 (PubMedID)
Available from: 2019-06-13 Created: 2019-06-13 Last updated: 2019-07-05Bibliographically approved
Temporelli, P. L., Tilz, R. R., Arbelo, E., Dagres, N., Laroche, C., Crijns, H. J., . . . Tavazzi, L. (2019). Clinical characteristics of heart failure patients undergoing atrial fibrillation ablation today in Europe. Data from the atrial fibrillation registries of the European Society of Cardiology and the European Heart Rhythm Association. [Letter to the editor]. European Journal of Heart Failure, 21(5), 690-693
Open this publication in new window or tab >>Clinical characteristics of heart failure patients undergoing atrial fibrillation ablation today in Europe. Data from the atrial fibrillation registries of the European Society of Cardiology and the European Heart Rhythm Association.
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2019 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 21, no 5, p. 690-693Article in journal, Letter (Other academic) Published
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-380256 (URN)10.1002/ejhf.1458 (DOI)000471307000023 ()30896056 (PubMedID)
Available from: 2019-03-25 Created: 2019-03-25 Last updated: 2019-07-02Bibliographically approved
Mörtsell, D., Jansson, V., Malmborg, H., Lönnerholm, S. & Blomström-Lundqvist, C. (2019). Clinical outcome of the 2nd generation cryoballoon for pulmonary vein isolation in patients with persistent atrial fibrillation — A sub-study of the randomized trial evaluating single versus dual cryoballoon applications. International Journal of Cardiology, 278, 120-125, Article ID S0167-5273(18)35500-1.
Open this publication in new window or tab >>Clinical outcome of the 2nd generation cryoballoon for pulmonary vein isolation in patients with persistent atrial fibrillation — A sub-study of the randomized trial evaluating single versus dual cryoballoon applications
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2019 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 278, p. 120-125, article id S0167-5273(18)35500-1Article in journal (Refereed) Published
Abstract [en]

Aims: To assess the efficacy of the 2nd generation Cryoballoon for pulmonary vein isolation (PVI) in patients with persistent atrial fibrillation (PersAF), and to compare it to patients with paroxysmal atrial fibrillation (PAF).

Methods: The outcome (arrhythmia recurrence at 12 months) was prospectively assessed in patients with PersAF(n = 77) and compared to that in patients with PAF(n = 62), who underwent PVI within a randomized trial evaluating single versus dual applications with the 2nd generation cryoballoon. Other endpoints included symptoms of AF, quality of life, procedure related characteristics, redo ablation rates and adverse events. Variables predicting recurrences were studied including all patients.

Results: Freedom from arrhythmia recurrence was 64.9% after a single ablation and 68.8% after one or more procedures, which was significantly lower compared to PAF patients; 82.2% (p = 0.029) and 83.9% (p = 0.048) respectively, at 12 months. The improvements in EHRA score (−1.3 ± 0.8, p < 0.0001), symptom severity score (SSQ) (−5.0 ± 4.2, p < 0.0001) and EQ5D-5 L global score (+10.4 ± 20.3, p = 0.0002) after ablation was significant compared to baseline. The re-ablation rate was 7/77 (9.1%) which did not differ from that in PAF patients, 9/62 (14.5%), p = 0.42. Procedure duration, 104.8 ± 37.4 versus 113 ± 31.2 min (p = 0.129), application time, 1605 ± 659 versus 1521 ± 557 s (p = 0.103) and total adverse events after 12 months, 8/77 (10.4%) versus 5/62 (8.1%) (p = 0.77) did not differ in PersAF versus PAF patients.

Conclusion: Both symptoms and QoL improved significantly in patients with PersAF after ablation. Freedom from AF was clinically significant but lower than in PAF patients. The cryoballoon seems an effective technique also in patients with persistent AF.

Keywords
Ablation, Atrial fibrillation, Cryoballoon, Persistent
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-365913 (URN)10.1016/j.ijcard.2018.10.097 (DOI)000456396200029 ()30409738 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20150751Swedish Research Council, 2014-36708-117759-70
Available from: 2018-11-15 Created: 2018-11-15 Last updated: 2019-02-12Bibliographically approved
Traykov, V., Bongiorni, M. G., Boriani, G., Burri, H., Costa, R., Dagres, N., . . . Blomström-Lundqvist, C. (2019). Clinical practice and implementation of guidelines for the prevention, diagnosis and management of cardiac implantable electronic device infections: results of a worldwide survey under the auspices of the European Heart Rhythm Association.. Europace, Article ID euz137.
Open this publication in new window or tab >>Clinical practice and implementation of guidelines for the prevention, diagnosis and management of cardiac implantable electronic device infections: results of a worldwide survey under the auspices of the European Heart Rhythm Association.
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2019 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, article id euz137Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIMS: Cardiac implantable electronic device (CIED) infection rates are increasing. Worldwide compliance and disparities to published guidelines for the prevention, diagnosis and management of these conditions are not well elucidated. The purpose of this survey, therefore, was to clarify these issues through an inquiry to arrhythmia-related associations and societies worldwide.

METHODS AND RESULTS: A questionnaire comprising 15 questions related to CIED infections was distributed among members of seven arrhythmia societies worldwide. A total of 234 centres in 62 countries reported implantation rates of which 159 (68.0%) performed more than 200 device implantations per year and 14 (6.0%) performed fewer than 50 implantations per year. The reported rates of CIED infections for 2017 were ≤2% in 78.7% of the centres, while the infection rates exceeded 5% in 7.8% of the centres. Preventive measures for CIED infection differed from published recommendations and varied among different regions mainly in terms of pocket irrigation and administering post-operative antimicrobial therapy the use of which was reported by 39.9% and 44% of the respondents, respectively. Antibacterial envelopes were used by 37.7% of the respondents in selected circumstances. In terms of pocket infection management, 62% of the respondents applied complete system removal as an initial step. Diagnostic pocket needle aspiration and pocket surgical debridement were reported by 15.8% and 11.8% of centres, respectively.

CONCLUSION: Clinical practices for prevention and management of CIED do not fully comply with current recommendations and demonstrate considerable regional disparities. Further education and programmes for improved implementation of guidelines are mandatory.

Keywords
Cardiac implantable electronic device infection, Cardiac resynchronization therapy, EHRA survey, Guidelines, Implantable cardioverter-defibrillator, Prevention
National Category
Medical and Health Sciences
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-388097 (URN)10.1093/europace/euz137 (DOI)31209483 (PubMedID)
Available from: 2019-06-27 Created: 2019-06-27 Last updated: 2019-06-27
Mörtsell, D., Arbelo, E., Dagres, N., Brugada, J., Laroche, C., Trines, S. A., . . . Blomström-Lundqvist, C. (2019). Cryoballoon vs. radiofrequency ablation for atrial fibrillation: a study of outcome and safety based on the ESC-EHRA atrial fibrillation ablation long-term registry and the Swedish catheter ablation registry.. Europace, 21(4), 581-589
Open this publication in new window or tab >>Cryoballoon vs. radiofrequency ablation for atrial fibrillation: a study of outcome and safety based on the ESC-EHRA atrial fibrillation ablation long-term registry and the Swedish catheter ablation registry.
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2019 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 21, no 4, p. 581-589Article in journal (Refereed) Published
Abstract [en]

Aims: Pulmonary vein isolation (PVI), the standard for atrial fibrillation (AF) ablation, is most commonly applied with radiofrequency (RF) energy, although cryoballoon technology (CRYO) has gained widespread use. The aim was to compare the second-generation cryoballoon and the irrigated RF energy regarding outcomes and safety.

Methods and results: Of 4657 patients undergoing their first AF ablation, 982 with CRYO and 3675 with RF energy were included from the Swedish catheter ablation registry and the Atrial Fibrillation Ablation Long-Term registry of the European Heart Rhythm Association of the European Society of Cardiology. The primary endpoint was repeat AF ablation. The major secondary endpoints included procedural duration, tachyarrhythmia recurrence, and complication rate. The re-ablation rate after 12 months was significantly lower in the CRYO vs. the RF group, 7.8% vs. 11%, P = 0.005, while freedom from arrhythmia recurrence (30 s duration) did not differ between the groups, 70.2 % vs. 68.2%, P = 0.44. The result was not influenced by AF type and lesion sets applied. In the Cox regression analysis, paroxysmal AF had significantly lower risk for re-ablation with CRYO, hazard ratio 0.56 (P = 0.041). Procedural duration was significantly shorter with CRYO than RF, (mean ± SD) 133.6 ± 45.2 min vs. 174.6 ± 58.2 min, P < 0.001. Complication rates were similar; 53/982 (5.4%) vs. 191/3675 (5.2%), CRYO vs. RF, P = 0.806.

Conclusion: The lower re-ablation rates and shorter procedure times observed with the cryoballoon as compared to RF ablation may have important clinical implications when choosing AF ablation technique despite recognized limitations with registries.

National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-365915 (URN)10.1093/europace/euy239 (DOI)000466852900013 ()30376055 (PubMedID)
Funder
AstraZenecaSwedish Heart Lung Foundation, 20150751Swedish Research Council, 2014-36708-117759-70
Available from: 2018-11-15 Created: 2018-11-15 Last updated: 2019-05-29Bibliographically approved
Blomström-Lundqvist, C., Gizurarson, S., Schwieler, J., Jensen, S. M., Bergfeldt, L., Kennebäck, G., . . . Mörtsell, D. (2019). Effect of Catheter Ablation vs Antiarrhythmic Medication on Quality of Life in Patients With Atrial Fibrillation: The CAPTAF Randomized Clinical Trial. JAMIA Journal of the American Medical Informatics Association, 321(11), 1059-1068
Open this publication in new window or tab >>Effect of Catheter Ablation vs Antiarrhythmic Medication on Quality of Life in Patients With Atrial Fibrillation: The CAPTAF Randomized Clinical Trial
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2019 (English)In: JAMIA Journal of the American Medical Informatics Association, ISSN 1067-5027, E-ISSN 1527-974X, Vol. 321, no 11, p. 1059-1068Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE Quality of life is not a standard primary outcome in ablation trials, even though symptoms drive the indication. OBJECTIVE To assess quality of life with catheter ablation vs antiarrhythmic medication at 12 months in patients with atrial fibrillation. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial at 4 university hospitals in Sweden and 1 in Finland of 155 patients aged 30-70 years with more than 6 months of atrial fibrillation and treatment failure with 1 antiarrhythmic drug or beta-blocker, with 4-year follow-up. Study dateswere July 2008-September 2017. Major exclusionswere ejection fraction <35%, left atrial diameter > 60 mm, ventricular pacing dependency, and previous ablation. INTERVENTIONS Pulmonary vein isolation ablation (n= 79) or previously untested antiarrhythmic drugs (n= 76). MAIN OUTCOMES AND MEASURES Primary outcomewas the General Health subscale score (Medical Outcomes Study 36-Item Short-Form Health Survey) at baseline and 12 months, assessed unblinded (range, 0 [worst] to 100 [best]). There were 26 secondary outcomes, including atrial fibrillation burden (% of time) from baseline to 12 months, measured by implantable cardiac monitors. The first 3 months were excluded from rhythm analysis. RESULTS Among 155 randomized patients (mean age, 56.1 years; 22.6% women), 97% completed the trial. Of 79 patients randomized to receive ablation, 75 underwent ablation, including 2 who crossed over to medication and 14 who underwent repeated ablation procedures. Of 76 patients randomized to receive antiarrhythmic medication, 74 received it, including 8 who crossed over to ablation and 43 for whom the first drug used failed. General Health score increased from 61.8 to 73.9 points in the ablation group vs 62.7 to 65.4 points in the medication group (between-group difference, 8.9 points; 95% CI, 3.1-14.7; P=.003). Of 26 secondary end points, 5 were analyzed; 2 were null and 2 were statistically significant, including decrease in atrial fibrillation burden (from 24.9% to 5.5% in the ablation group vs 23.3% to 11.5% in the medication group; difference -6.8%[95% CI, -12.9% to -0.7%]; P=.03). Of the Health Survey subscales, 5 of 7 improved significantly. Most common adverse events were urosepsis (5.1%) in the ablation group and atrial tachycardia (3.9%) in the medication group. CONCLUSIONS AND RELEVANCE Among patients with symptomatic atrial fibrillation despite use of antiarrhythmic medication, the improvement in quality of life at 12 months was greater for those treated with catheter ablation compared with antiarrhythmic medication. Although the study was limited by absence of blinding, catheter ablation may offer an advantage for quality of life.

Keywords
atrial fibrillation, catheter ablation, antiarrhythmic drug, quality of life
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-362212 (URN)10.1001/jama.2019.0335 (DOI)000461683500014 ()30874754 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20150751Swedish Research Council, 2014-36708-117759-70Medtronic, Sweden
Available from: 2018-10-02 Created: 2018-10-02 Last updated: 2019-05-06Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-2806-3903

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