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  • 1. Ahmed, Fozia Z.
    et al.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Bloom, Heather
    Cooper, Christopher
    Ellis, Christopher
    Goette, Andreas
    Greenspon, Arnold J.
    Love, Charles J.
    Johansen, Jens Brock
    Philippon, Francois
    Tarakji, Khaldoun G.
    Holbrook, Reece
    Sherfesee, Lou
    Xia, Ying
    Seshadri, Swathi
    Lexcen, Daniel R.
    Krahn, Andrew D.
    Use of healthcare claims to validate the Prevention of Arrhythmia Device Infection Trial cardiac implantable electronic device infection risk score2021In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 23, no 9, p. 1446-1455Article in journal (Refereed)
    Abstract [en]

    AIM: The Prevention of Arrhythmia Device Infection Trial (PADIT) infection risk score, developed based on a large prospectively collected data set, identified five independent predictors of cardiac implantable electronic device (CIED) infection. We performed an independent validation of the risk score in a data set extracted from U.S. healthcare claims.

    METHODS AND RESULTS: Retrospective identification of index CIED procedures among patients aged ≥18 years with at least one record of a CIED procedure between January 2011 and September 2014 in a U.S health claims database. PADIT risk factors and major CIED infections (with system removal, invasive procedure without system removal, or infection-attributable death) were identified through diagnosis and procedure codes. The data set was randomized by PADIT score into Data Set A (60%) and Data Set B (40%). A frailty model allowing multiple procedures per patient was fit using Data Set A, with PADIT score as the only predictor, excluding patients with prior CIED infection. A data set of 54 042 index procedures among 51 623 patients with 574 infections was extracted. Among patients with no history of prior CIED infection, a 1 unit increase in the PADIT score was associated with a relative 28% increase in infection risk. Prior CIED infection was associated with significant incremental predictive value (HR 5.66, P < 0.0001) after adjusting for PADIT score. A Harrell's C-statistic for the PADIT score and history of prior CIED infection was 0.76.

    CONCLUSION: The PADIT risk score predicts increased CIED infection risk, identifying higher risk patients that could potentially benefit from targeted interventions to reduce the risk of CIED infection. Prior CIED infection confers incremental predictive value to the PADIT score.

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  • 2. Aktaa, Suleman
    et al.
    Abdin, Amr
    Arbelo, Elena
    Burri, Haran
    Vernooy, Kevin
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Boriani, Giuseppe
    Defaye, Pascal
    Deharo, Jean-Claude
    Drossart, Inga
    Foldager, Dan
    Gold, Michael R
    Johansen, Jens Brock
    Leyva, Francisco
    Linde, Cecilia
    Michowitz, Yoav
    Kronborg, Mads Brix
    Slotwiner, David
    Steen, Torkel
    Tolosana, José Maria
    Tzeis, Stylianos
    Varma, Niraj
    Glikson, Michael
    Nielsen, Jens Cosedis
    Gale, Chris P
    European Society of Cardiology Quality Indicators for the care and outcomes of cardiac pacing: developed by the Working Group for Cardiac Pacing Quality Indicators in collaboration with the European Heart Rhythm Association of the European Society of Cardiology2022In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 24, no 1, p. 165-172Article in journal (Refereed)
    Abstract [en]

    AIMS: To develop a suite of quality indicators (QIs) for the evaluation of the care and outcomes for adults undergoing cardiac pacing.

    METHODS AND RESULTS: Under the auspice of the Clinical Practice Guideline Quality Indicator Committee of the European Society of Cardiology (ESC), the Working Group for cardiac pacing QIs was formed. The Group comprised Task Force members of the 2021 ESC Clinical Practice Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy, members of the European Heart Rhythm Association, international cardiac device experts, and patient representatives. We followed the ESC methodology for QI development, which involved (i) the identification of the key domains of care by constructing a conceptual framework of the management of patients receiving cardiac pacing, (ii) the development of candidate QIs by conducting a systematic review of the literature, (iii) the selection of the final set of QIs using a modified-Delphi method, and (iv) the evaluation of the feasibility of the developed QIs. Four domains of care were identified: (i) structural framework, (ii) patient assessment, (iii) pacing strategy, and (iv) clinical outcomes. In total, seven main and four secondary QIs were selected across these domains and were embedded within the 2021 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization therapy.

    CONCLUSION: By way of a standardized process, 11 QIs for cardiac pacing were developed. These indicators may be used to quantify adherence to guideline-recommended clinical practice and have the potential to improve the care and outcomes of patients receiving cardiac pacemakers.

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  • 3. Amara, Walid
    et al.
    Larsen, Torben B
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Hernández Madrid, Antonio
    Chen, Jian
    Estner, Heidi
    Todd, Derick
    Bongiorni, Maria G
    Potpara, Tatjana S
    Dagres, Nikolaos
    Sagnol, Pascal
    Blomstrom-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Patients' attitude and knowledge about oral anticoagulation therapy: results of a self-assessment survey in patients with atrial fibrillation conducted by the European Heart Rhythm Association.2016In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 18, no 1, p. 151-155Article in journal (Refereed)
    Abstract [en]

    The purpose of this European Heart Rhythm Association survey was to assess the attitude, level of education, and knowledge concerning oral anticoagulants (OACs) among patients with atrial fibrillation (AF) taking vitamin K antagonists (VKAs), non-VKA oral anticoagulants (NOACs) or antiplatelets. A total of 1147 patients with AF [mean age 66 ± 13 years, 529 (45%) women] from 8 selected European countries responded to this survey. The overall use of OACs and antiplatelets was 77 and 15.3%, respectively. Of the patients taking OACs, 67% were on VKAs, 33% on NOACs, and 17.9% on a combination of OACs and antiplatelets. Among patients on VKAs, 91% correctly stated the target international normalized ratio (INR) level. The proportion of patients on VKA medication who were aware that monthly INR monitoring was required for this treatment and the proportion of patients on NOAC who knew that renal function monitoring at least annually was mandatory for NOACs was 76 and 21%, respectively. An indirect estimation of compliance indicated that 14.5% of patients temporarily discontinued the treatment, and 26.5% of patients reported having missed at least one dose. The survey shows that there is room for improvement regarding education and adherence of patients taking OACs, particularly regarding monitoring requirements for NOACs.

  • 4.
    Bagge, Louise
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Surgical ablation for atrial fibrillation in mitral valve disease: impact of the maze procedure-authors' response2018In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 20, no FI_3, p. f458-f459Article in journal (Refereed)
  • 5.
    Bagge, Louise
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Probst, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Jensen, Steen M
    Faculty of Medicine, Department of Public Health and Clinical Medicine (Heart centre) Umeå University, SE-901 87 Umeå, Sweden.
    Blomström, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Thelin, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Holmgren, Anders
    Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology, Umeå University, SE-901 87 Umeå, Sweden.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Quality of life is not improved after mitral valve surgery combined with epicardial left atrial cryoablation as compared with mitral valve surgery alone: a substudy of the double blind randomized SWEDish Multicentre Atrial Fibrillation study (SWEDMAF)2018In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 20, no FI_3, p. f343-f350Article in journal (Refereed)
    Abstract [en]

    Aims

    Concomitant surgical ablation of atrial fibrillation (AF) in patients undergoing mitral valve surgery (MVS) has almost become routine despite lack of convincing information about improved quality-of-life (QOL) and clinical benefit. Quality-of-life was therefore assessed after MVS with or without epicardial left atrial cryoablation.

    Methods and results

    Sixty-five patients with permanent AF randomized to MVS with or without left atrial cryoablation, in the double-blinded multicentre SWEDMAF trial, replied to the Short Form 36 QOL survey at 6 and 12 months follow-up. The QOL scores at 12 month follow-up did not differ significantly between patients undergoing MVS combined with cryoablation vs. those undergoing MVS alone regarding Physical Component Summary mean 42.8 (95% confidence interval 38.3–47.3) vs. mean 44.0 (40.1–47.7), P = 0.700 or Mental Component Summary mean 53.1 (49.7–56.4) vs. mean 48.4 (44.6–52.2), P = 0.075. All patients, irrespective of allocated procedure, reached the same QOL after surgery as an age-matched Swedish general population. The Physical Component Summary in patients with sinus rhythm did also not differ from those in AF at 12 months; mean 45.4 (42.0–48.7) vs. mean 40.5 (35.5–45.6), P = 0.096) nor was there a difference in Mental Component Summary; mean 51.0 (48.0–54.1) vs. mean 49.6 (44.6–54.5), P = 0.581).

    Conclusion

    Left atrial cryoablation added to MVS does not improve health-related QOL in patients with permanent AF, a finding that raises concerns regarding recommendations made for this combined procedure.

  • 6. Balabanski, Tosho
    et al.
    Brugada, Josep
    Arbelo, Elena
    Laroche, Cécile
    Maggioni, Aldo
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Kautzner, Josef
    Tavazzi, Luigi
    Tritto, Massimo
    Kulakowski, Piotr
    Kalejs, Oskars
    Forster, Tamas
    Villalobos, Federico Segura
    Dagres, Nikolaos
    Impact of monitoring on detection of arrhythmia recurrences in the ESC-EHRA EORP atrial fibrillation ablation long-term registry2019In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 21, no 12, p. 1802-1808Article in journal (Refereed)
    Abstract [en]

    AIMS: Monitoring of patients after ablation had wide variations in the ESC-EHRA atrial fibrillation ablation long-term (AFA-LT) registry. We aimed to compare four different monitoring strategies after catheter AF ablation.

    METHODS AND RESULTS: The ESC-EHRA AFA-LT registry included 3593 patients who underwent ablation. Arrhythmia monitoring during follow-up was performed by 12-lead electrocardiogram (ECG), Holter ECG, trans-telephonic ECG monitoring (TTMON), or an implanted cardiac monitoring (ICM) system. Patients were selected to a given monitoring group according to the most extensive ECG tool used in each of them. Comparison of the probability of freedom from recurrences was performed by censored log-rank test and presented by Kaplan-Meier curves. The rhythm monitoring methods were used among 2658 patients: ECG (N = 578), Holter ECG (N = 1874), TTMON (N = 101), and ICM (N = 105). A total of 767 of 2658 patients (28.9%) had AF recurrences during follow-up. Censored log-rank test discovered a lower probability of freedom from relapses, which was detected with ICM compared to TTMON, ECG, and Holter ECG (P < 0.001). The rate of freedom from AF recurrences was 50.5% among patients using the ICM while it was 65.4%, 70.6%, and 72.8% using the TTMON, ECG, and Holter ECG, respectively.

    CONCLUSION: Comparing all main electrocardiographic monitoring methods in a large patient sample, our results suggest that post-ablation recurrences of AF are significantly underreported by TTMON, ECG, and Holter ECG. The ICM estimates AF ablation recurrences most reliably and should be a preferred mode of monitoring for trials evaluating novel AF ablation techniques.

  • 7.
    Benz, Alexander P.
    et al.
    McMaster Univ, Populat Hlth Res Inst, 237 Barton St E, Hamilton, ON L8L 2X2, Canada.;Johannes Gutenberg Univ Mainz, Univ Med Ctr Mainz, Dept Cardiol, Langenbeckstr 1, D-55131 Mainz, Germany..
    Hijazi, Ziad
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Lindbäck, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR).
    Connolly, Stuart J.
    McMaster Univ, Populat Hlth Res Inst, 237 Barton St E, Hamilton, ON L8L 2X2, Canada..
    Eikelboom, John W.
    McMaster Univ, Populat Hlth Res Inst, 237 Barton St E, Hamilton, ON L8L 2X2, Canada..
    Kastner, Peter
    Roche Diagnost GmbH, Penzberg, Germany..
    Ziegler, Andre
    Roche Diagnost GmbH, Penzberg, Germany..
    Alexander, John H.
    Duke Univ, Duke Clin Res Inst, Durham, NC USA..
    Granger, Christopher B.
    Duke Univ, Duke Clin Res Inst, Durham, NC USA..
    Lopes, Renato D.
    Duke Univ, Duke Clin Res Inst, Durham, NC USA..
    Oldgren, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR).
    Siegbahn, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Wallentin, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR).
    Plasma angiopoietin-2 and its association with heart failure in patients with atrial fibrillation2023In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 25, no 7, article id euad200Article in journal (Refereed)
    Abstract [en]

    Aims: Several biomarkers are associated with clinical outcomes in patients with atrial fibrillation (AF), but a causal relationship has not been established. This study aimed to evaluate angiopoietin-2, a novel candidate biomarker of endothelial inflammation and vascular remodelling, in patients with AF.

    Methods and results: Angiopoietin-2 was measured in plasma obtained from patients with AF treated with aspirin monotherapy (exploration cohort, n = 2987) or with oral anticoagulation (validation cohort, n = 13 079). Regression models were built to assess the associations between angiopoietin-2, clinical characteristics, and outcomes. In both cohorts, plasma angiopoietin-2 was independently associated with AF on the baseline electrocardiogram and persistent/permanent AF, age, history of heart failure, female sex, tobacco use/smoking, body mass index, renal dysfunction, diabetes, and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Angiopoietin-2 was independently associated with subsequent hospitalization for heart failure after adjusting for age, creatinine, and clinical characteristics in the exploration cohort [c-index 0.79, 95% confidence interval (CI) 0.75-0.82; third vs. first quartile, hazard ratio (HR) 1.74, 95% CI 1.26-2.41] and in the validation cohort (c-index 0.76, 95% CI 0.74-0.78; HR 1.58, 95% CI 1.37-1.82). In both cohorts, the association persisted when also adjusting for NT-proBNP (P & LE; 0.001). In full multivariable models also adjusted for NT-proBNP, angiopoietin-2 did not show statistically significant associations with ischaemic stroke, cardiovascular and all-cause death, or major bleeding that were consistent across the two cohorts.

    Conclusions: In patients with AF, plasma levels of angiopoietin-2 were independently associated with subsequent hospitalization for heart failure and provided incremental prognostic value to clinical risk factors and NT-proBNP.

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  • 8. Bertaglia, Emanuele
    et al.
    Blank, Benjamin
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Brandes, Axel
    Cabanelas, Nuno
    Dan, G-Andrei
    Dichtl, Wolfgang
    Goette, Andreas
    de Groot, Joris R
    Lubinski, Andrzej
    Marijon, Eloi
    Merkely, Béla
    Mont, Lluis
    Piorkowski, Christopher
    Sarkozy, Andrea
    Sulke, Neil
    Vardas, Panos
    Velchev, Vasil
    Wichterle, Dan
    Kirchhof, Paulus
    Atrial high-rate episodes: prevalence, stroke risk, implications for management, and clinical gaps in evidence2019In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 21, no 10, p. 1459-1467Article, review/survey (Refereed)
    Abstract [en]

    Self-terminating atrial arrhythmias are commonly detected on continuous rhythm monitoring, e.g. by pacemakers or defibrillators. It is unclear whether the presence of these arrhythmias has therapeutic consequences. We sought to summarize evidence on the prevalence of atrial high-rate episodes (AHREs) and their impact on risk of stroke. We performed a comprehensive, tabulated review of published literature on the prevalence of AHRE. In patients with AHRE, but without atrial fibrillation (AF), we reviewed the stroke risk and the potential risk/benefit of oral anticoagulation. Atrial high-rate episodes are found in 10-30% of AF-free patients. Presence of AHRE slightly increases stroke risk (0.8% to 1%/year) compared with patients without AHRE. Atrial high-rate episode of longer duration (e.g. those >24 h) could be associated with a higher stroke risk. Oral anticoagulation has the potential to reduce stroke risk in patients with AHRE but is associated with a rate of major bleeding of 2%/year. Oral anticoagulation is not effective in patients with heart failure or survivors of a stroke without AF. It remains unclear whether anticoagulation is effective and safe in patients with AHRE. Atrial high-rate episodes are common and confer a slight increase in stroke risk. There is true equipoise on the best way to reduce stroke risk in patients with AHRE. Two ongoing trials (NOAH-AFNET 6 and ARTESiA) will provide much-needed information on the effectiveness and safety of oral anticoagulation using non-vitamin K antagonist oral anticoagulants in patients with AHRE.

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  • 9.
    Blomström Lundqvist, Carina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Auricchio, Angelo
    Brugada, Josep
    Boriani, Giuseppe
    Bremerich, Jens
    Cabrera, Jose Angel
    Frank, Herbert
    Gutberlet, Matthias
    Heidbuchel, Hein
    Kuck, Karl-Heinz
    Lancellotti, Patrizio
    Rademakers, Frank
    Winkels, Gerard
    Wolpert, Christian
    Vardas, Panos E
    The use of imaging for electrophysiological and devices procedures: a report from the first European Heart Rhythm Association Policy Conference, jointly organized with the European Association of Cardiovascular Imaging (EACVI), the Council of Cardiovascular Imaging and the European Society of Cardiac Radiology2013In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 15, no 7, p. 927-936Article in journal (Refereed)
    Abstract [en]

    Implantations of cardiac devices therapies and ablation procedures frequently depend on accurate and reliable imaging modalities for pre-procedural assessments, intra-procedural guidance, detection of complications, and the follow-up of patients. An understanding of echocardiography, cardiovascular magnetic resonance imaging, nuclear cardiology, X-ray computed tomography, positron emission tomography, and vascular ultrasound is indispensable for cardiologists, electrophysiologists as well as radiologists, and it is currently recommended that physicians should be trained in several imaging modalities. There are, however, no current guidelines or recommendations by electrophysiologists, cardiac imaging specialists, and radiologists, on the appropriate use of cardiovascular imaging for selected patient indications, which needs to be addressed. A Policy Conference on the use of imaging in electrophysiology and device management, with representatives from different expert areas of radiology and electrophysiology and commercial developers of imaging and device technologies, was therefore jointly organized by European Heart Rhythm Association (EHRA), the Council of Cardiovascular Imaging and the European Society of Cardiac Radiology (ESCR). The objectives were to assess the state of the level of evidence and a first step towards a consensus document for currently employed imaging techniques to guide future clinical use, to elucidate the issue of reimbursement structures and health economy, and finally to define the need for appropriate educational programmes to ensure clinical competence for electrophysiologists, imaging specialists, and radiologists.

  • 10.
    Blomström-Lundqvist, Carina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia. Örebro Univ, Fac Med & Hlth, Sch Med Sci, Dept Cardiol, SE-70182 Örebro, Sweden..
    Naccarelli, Gerald, V
    Penn State Univ Coll Med, Penn State Hershey Heart & Vasc Inst, 500 Univ Dr, Hershey, PA 17033 USA..
    McKindley, David S.
    Sanofi, 55 Corp Dr, Bridgewater, NJ 08807 USA..
    Bigot, Gregory
    IVIDATA Life Sci, 79 Rue Baudin, F-92300 Paris, Levallois Perre, France..
    Wieloch, Mattias
    Sanofi, Rue Boetie 54-56, F-75008 Paris, France.;Lund Univ, Dept Coagulat Disorders, Jan Waldenstroms Gata 14, S-20502 Lund, Sweden..
    Hohnloser, Stefan H.
    Goethe Univ Frankfurt, Dept Cardiol, Div Clin Electrophysiol, Theodor Stern Kai 7, D-60590 Frankfurt, Germany..
    Effect of dronedarone vs. placebo on atrial fibrillation progression: a post hoc analysis from ATHENA trial2023In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 25, no 3, p. 845-854Article in journal (Refereed)
    Abstract [en]

    Aims: This post hoc analysis of the ATHENA trial (NCT00174785) assessed the effect of dronedarone on the estimated burden of atrial fibrillation (AF)/atrial flutter (AFL) progression to presumed permanent AF/AFL, and regression to sinus rhythm (SR), compared with placebo.

    Methods and results: The burden of AF/AFL was estimated by a modified Rosendaal method using available electrocardiograms (ECG). Cumulative incidence of permanent AF/AFL (defined as >= 6 months of AF/AFL until end of study) or permanent SR (defined as >= 6 months of SR until end of study) were calculated using Kaplan-Meier estimates. A log-rank test was used to assess statistical significance. Hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were estimated using a Cox model, adjusted for treatment group. Of the 4439 patients included in this analysis, 2208 received dronedarone, and 2231 placebo. Baseline and clinical characteristics were well balanced between groups. Overall, 304 (13.8%) dronedarone-treated patients progressed to permanent AF/AFL compared with 455 (20.4%) treated with placebo (P < 0.0001). Compared with those receiving placebo, patients receiving dronedarone had a lower cumulative incidence of permanent AF/AFL (log-rank P < 0.001; HR: 0.65; 95% CI: 0.56-0.75), a higher cumulative incidence of permanent SR (log-rank P < 0.001; HR: 1.19; 95% CI: 1.09-1.29), and a lower estimated AF/AFL burden over time (P < 0.01 from Day 14 to Month 21).

    Conclusion: These results suggest that dronedarone could be a useful antiarrhythmic drug for early rhythm control due to less AF/AFL progression and more regression to SR vs. placebo, potentially reflecting reverse remodeling.

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  • 11.
    Blomström-Lundqvist, Carina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Ostrowska, Bozena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Prevention of cardiac implantable electronic device infections: guidelines and conventional prophylaxis2021In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 23, no Supplement 4, p. iv11-iv19Article in journal (Refereed)
    Abstract [en]

    Cardiac implantable electronic devices (CIED) are potentially life-saving treatments for several cardiac conditions, but are not without risk. Despite dissemination of recommended strategies for prevention of device infections, such as administration of antibiotics before implantation, infection rates continue to rise resulting in escalating health care costs. New trials conveying important steps for better prevention of device infection and an EHRA consensus paper were recently published. This document will review the role of various preventive measures for CIED infection, emphasizing the importance of adhering to published recommendations. The document aims to provide guidance on how to prevent CIED infections in clinical practice by considering modifiable and non-modifiable risk factors that may be present pre-, peri-, and/or post-procedure.

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  • 12.
    Blomström-Lundqvist, Carina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Svedung Wettervik, Victoria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Reflections on the usefulness of today’s atrial fibrillation ablation procedure endpoints and patient-reported outcomes2022In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 24, no Supplement_2, p. ii29-ii43Article in journal (Refereed)
    Abstract [en]

    The improvement of Patient-reported outcomes, such as health-related quality of life, is the main indication for atrial fibrillation ablation. Despite this guideline derived indication for an AF ablation procedure the current standardized primary endpoint in AF ablation trials is still rhythm-related, and primarily a 30-second long AF episode. The review presents reflections on the non-rational arguments of using rhythm related endpoints rather than Patient-reported outcomes in AF ablation procedure trials despite the mismatch between many of the rhythm related variables and symptoms. Arguments for health-related quality of life as the most optimal primary endpoint in clinical trials are presented while atrial fibrillation burden is presented as the most optimal electrical complementary endpoint, apart from being the major variable in mechanistic trials.

  • 13.
    Blomström-Lundqvist, Carina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Traykov, Vassil
    Erba, Paola Anna
    Burri, Haran
    Nielsen, Jens Cosedis
    Bongiorni, Maria Grazia
    Poole, Jeanne
    Boriani, Giuseppe
    Costa, Roberto
    Deharo, Jean-Claude
    Epstein, Laurence M.
    Saghy, Laszlo
    Snygg-Martin, Ulrika
    Starck, Christoph
    Tascini, Carlo
    Strathmore, Neil
    European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)2020In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 22, no 4, p. 515-516agArticle in journal (Refereed)
    Abstract [en]

    Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially life-saving treatments for a number of cardiac conditions, but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased healthcare costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, anti-bacterial envelopes, prolonged antibiotics post-implantation, and others. Guidance on whether to use novel device alternatives expected to be less prone to infections and novel oral anticoagulants is also limited, as are definitions on minimum quality requirements for centres and operators and volumes. Moreover, an international consensus document on management of CIED infections is lacking. The recognition of these issues, the dissemination of results from important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.

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  • 14. Bongiorni, Maria G
    et al.
    Burri, Haran
    Deharo, Jean C.
    Starck, Christoph
    Kennergren, Charles
    Saghy, Laszlo
    Rao, Archana
    Tascini, Carlo
    Lever, Nigel
    Kutarski, Andrzej
    Fernandez Lozano, Ignacio
    Strathmore, Neil
    Costa, Roberto
    Epstein, Laurence
    Love, Charles
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Fauchier, Laurent
    Defaye, Pascal
    Arnar, David O.
    Klug, Didier
    Boveda, Serge
    Cosedis Nielsen, Jens
    Boriani, Giuseppe
    Zhang, Shu
    Martin, Andrew Paul
    Prutkin, Jordan M.
    de Zuloaga, Claudio
    2018 EHRA expert consensus statement on lead extraction: recommendations on definitions, endpoints, research trial design, and data collection requirements for clinical scientific studies and registries: endorsed by APHRS/HRS/LAHRS2018In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 20, no 7, article id 1217Article in journal (Refereed)
    Abstract [en]

    The number of cardiac implantable electronic device (CIED) implantations has increased over recent years as a result of population growth, increasing life expectancy, adoption of guidelines, and better access to healthcare. Transvenous lead extraction (TLE), as a part of an overall lead management strategy, has also been increasing, not only as a consequence of this growth, but also because of increasing rates of infection, lead failure, awareness of indications for lead management, and development of extraction tools. Clinical research is essential for understanding efficacy and risks of TLE, which has important implications regarding decision-making and therapeutic strategies in patients who are candidates for this procedure. Data on TLE have mainly come from retrospective series, with variable reporting of endpoints. Recently, the ELECTRa registry conducted by the European Heart Rhythm Association (EHRA), has reported the largest prospective experience on lead extraction published to date in 3555 patients recruited from 19 European countries. There remain unresolved issues, which is a strong incentive for conducting further specifically-designed clinical trials to answer important questions in this area. In addition to clinical studies, national registries are potentially useful for evaluating epidemiology of TLE as well as for quality control and understanding resource implications. Standardization of definitions and reporting of parameters are paramount in order to analyse, compare, and pool data for scientific purposes. Expert consensus statements on lead extraction have been published by the Heart Rhythm Society (HRS) in 2009 and 2017, and by EHRA in 2012. Experience from the ELECTRa registry has been valuable for identifying challenges faced with conducting scientific studies in this field, and provides a framework for future endeavours.

    This writing group has been commissioned by EHRA to provide recommendations for designing scientific studies, reports and registries relating to lead extraction.

  • 15. Bongiorni, Maria Grazia
    et al.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Kennergren, Charles
    Dagres, Nikolaos
    Pison, Laurent
    Svendsen, Jesper Hastrup
    Auricchio, Angelo
    Current practice in transvenous lead extraction: a European Heart Rhythm Association EP Network Survey2012In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 14, no 6, p. 783-786Article in journal (Refereed)
    Abstract [en]

    AIM:

    Current practice with regard to transvenous lead extraction among European implanting centres was analysed by this survey.

    METHODS AND RESULTS:

    Among all contacted centres, 164, from 30 countries, declared that they perform transvenous lead extraction and answered 58 questions with a compliance rate of 99.9%. Data from the survey show that there seems to be an overall increasing experience of managing various techniques of lead extraction and a widespread involvement of cardiac centres in this treatment. Results and complication rates seem comparable with those of main international registries.

    CONCLUSION:

    This survey gives an interesting snapshot of lead extraction in Europe today and gives some clues for future research and prospective European registries.

  • 16. Bongiorni, Maria Grazia
    et al.
    Chen, Jian
    Dagres, Nikolaos
    Estner, Heidi
    Hernandez-Madrid, Antonio
    Hocini, Meleze
    Larsen, Torben Bjerregaard
    Pison, Laurent
    Potpara, Tatjana
    Proclemer, Alessandro
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Todd, Derick
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    EHRA research network surveys: 6 years of EP wires activity2015In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 11Article in journal (Refereed)
    Abstract [en]

    Clinical practice should follow guidelines and recommendations mainly based on the results of controlled trials, which are often conducted in selected populations and special conditions, whereas clinical practice may be influenced by factors different from controlled scientific studies. Hence, the real-world setting is better assessed by the observational registries enrolling patients for longer periods of time. However, this may be difficult, expensive, and time-consuming. In 2009, the Scientific Initiatives Committee of the European Heart Rhythm Association (EHRA) has instigated a series of surveys covering the controversial issues in clinical electrophysiology (EP). With this in mind, an EHRA EP research network has been created, which included EP centres in Europe among which the surveys on 'hot topic' were circulated. This review summarizes the overall experience conducting EP wires over the past 6 years, categorizing and assessing the topics regarding clinical EP, and evaluating the acceptance and feedback from the responding centres, in order to improve participation in the surveys and better address the research needs and aspirations of the European EP community.

  • 17. Bongiorni, Maria Grazia
    et al.
    Marinskis, Germanas
    Lip, Gregory Y H
    Svendsen, Jesper Hastrup
    Dobreanu, Dan
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    How European centres diagnose, treat, and prevent CIED infections: Results of an European Heart Rhythm Association survey2012In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 14, no 11, p. 1666-1669Article in journal (Refereed)
    Abstract [en]

    The purpose of our survey is to analyse the clinical approach used to prevent and treat cardiovascular implantable electronic device (CIED) infections in Europe. The survey involves high-volume implanting centres. According to the survey the incidence of CIED infections shows a slight decrease in most centres and is substantially under 2% in the majority of centres interviewed. However, there are still differences in terms of prophylactic antibiotic therapy: 8.9% of the centres administer oxacillin as preoperative treatment, 4.4% of them do not give any antibiotic therapy, all centres use some kind of skin antisepsis, but only 42.2% use chlorhexidine. In case of local infection, 43.5% of centres perform lead extraction as first approach. In the case of systemic infection or evidence of lead or valvular endocarditis, 95% of centres treat these conditions by extracting the leads, which indicates that the adherence to the lead extraction guidelines is quite good.

  • 18. Bongiorni, Maria Grazia
    et al.
    Proclemer, Alessandro
    Dobreanu, Dan
    Marinskis, Germanas
    Pison, Laurent
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Preferred tools and techniques for implantation of cardiac electronic devices in Europe: results of the European Heart Rhythm Association survey2013In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 15, no 11, p. 1664-1668Article in journal (Refereed)
    Abstract [en]

    The aim of this European Heart Rhythm Association (EHRA) survey was to assess clinical practice in relation to the tools and techniques used for cardiac implantable electronic devices procedures in the European countries. Responses to the questionnaire were received from 62 members of the EHRA research network. The survey involved high-, medium-, and low-volume implanting centres, performing, respectively, more than 200, 100199 and under 100 implants per year. The following topics were explored: the side approach for implantation, surgical techniques for pocket incision, first venous access for lead implantation, preference of lead fixation, preferred coil number for implantable cardioverter-defibrillator (ICD) leads, right ventricular pacing site, generator placement site, subcutaneous ICD implantation, specific tools and techniques for cardiac resynchronization therapy (CRT), lead implantation sequence in CRT, coronary sinus cannulation technique, target site for left ventricular lead placement, strategy in left ventricular lead implant failure, mean CRT implantation time, optimization of the atrioventricular (AV) and ventriculo-ventricular intervals, CRT implants in patients with permanent atrial fibrillation, AV node ablation in patients with permanent AF. This panoramic view allows us to find out the operator preferences regarding the techniques and tools for device implantation in Europe. The results showed different practices in all the fields we investigated, nevertheless the survey also outlines a good adherence to the common standards and recommendations.

  • 19. Boriani, Giuseppe
    et al.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Hohnloser, Stefan H
    Bergfeldt, Lennart
    Botto, Giovanni L
    Capucci, Alessandro
    Lozano, Ignacio Fernández
    Goette, Andreas
    Israel, Carsten W
    Merino, José L
    Camm, A John
    Safety and efficacy of dronedarone from clinical trials to real-world evidence: implications for its use in atrial fibrillation2019In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 21, no 12, p. 1764-1775Article in journal (Refereed)
    Abstract [en]

    Efficacy and safety of dronedarone was shown in the ATHENA trial for paroxysmal or persistent atrial fibrillation (AF) patients. Further trials revealed safety concerns in patients with heart failure and permanent AF. This review summarizes insights from recent real-world studies and meta-analyses, including reports on efficacy, with focus on liver safety, mortality risk in patients with paroxysmal/persistent AF, and interactions of dronedarone with direct oral anticoagulants. Reports of rapidly progressing liver failure in dronedarone-prescribed patients in 2011 led to regulatory cautions about potential liver toxicity. Recent real-world evidence suggests dronedarone liver safety profile is similar to other antiarrhythmics and liver toxicity could be equally common with many Class III antiarrhythmics. Dronedarone safety concerns (increased mortality in patients with permanent AF) were raised based on randomized controlled trials (RCT) (ANDROMEDA and PALLAS), but comedication with digoxin may have increased the mortality rates in PALLAS, considering the dronedarone-digoxin pharmacokinetic (PK) interaction. Real-world data on apixaban-dronedarone interactions and edoxaban RCT observations suggest no significant safety risks for these drug combinations. Median trough plasma concentrations of dabigatran 110 mg during concomitant use with dronedarone are at acceptable levels, while PK data on the rivaroxaban-dronedarone interaction are unavailable. In RCTs and real-world studies, dronedarone significantly reduces AF burden and cardiovascular hospitalizations, and demonstrates a low risk for proarrhythmia in patients with paroxysmal or persistent AF. The concerns on liver safety must be balanced against the significant reduction in hospitalizations in patients with non-permanent AF and low risk for proarrhythmias following dronedarone treatment.

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  • 20. Boriani, Giuseppe
    et al.
    Fauchier, Laurent
    Aguinaga, Luis
    Beattie, James M
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Cohen, Ariel
    Dan, Gheorghe-Andrei
    Genovesi, Simonetta
    Israel, Carsten
    Joung, Boyoung
    Kalarus, Zbigniew
    Lampert, Rachel
    Malavasi, Vincenzo L
    Mansourati, Jacques
    Mont, Lluis
    Potpara, Tatjana
    Thornton, Andrew
    Lip, Gregory Y H
    European Heart Rhythm Association (EHRA) consensus document on management of arrhythmias and cardiac electronic devices in the critically ill and post-surgery patient, endorsed by endorsed by Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Cardiac Arrhythmia Society of Southern Africa (CASSA), and Latin American Heart Rhythm Society (LAHRS).2019In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 21, no 1, p. 7-8Article in journal (Refereed)
  • 21. Brignole, Michele
    et al.
    Auricchio, Angelo
    Baron-Esquivias, Gonzalo
    Bordachar, Pierre
    Boriani, Giuseppe
    Breithardt, Ole-A
    Cleland, John
    Deharo, Jean-Claude
    Delgado, Victoria
    Elliott, Perry M
    Gorenek, Bulent
    Israel, Carsten W
    Leclercq, Christophe
    Linde, Cecilia
    Mont, Lluís
    Padeletti, Luigi
    Sutton, Richard
    Vardas, Panos E
    2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: The Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA)2013In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 15, no 8, p. 1070-1118Article in journal (Refereed)
  • 22. Brugada, Josep
    et al.
    Blom, Nico
    Sarquella-Brugada, Georgia
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Deanfield, John
    Janousek, Jan
    Abrams, Dominic
    Bauersfeld, Urs
    Brugada, Ramon
    Drago, Fabrizio
    de Groot, Natasja
    Happonen, Juha-Matti
    Hebe, Joachim
    Yen Ho, Siew
    Marijon, Eloi
    Paul, Thomas
    Pfammatter, Jean-Pierre
    Rosenthal, Eric
    Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement2013In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 15, no 9, p. 1337-1382Article in journal (Refereed)
    Abstract [en]

    In children with structurally normal hearts, the mechanisms of arrhythmias are usually the same as in the adult patient. Some arrhythmias are particularly associated with young age and very rarely seen in adult patients. Arrhythmias in structural heart disease may be associated either with the underlying abnormality or result from surgical intervention. Chronic haemodynamic stress of congenital heart disease (CHD) might create an electrophysiological and anatomic substrate highly favourable for re-entrant arrhythmias.As a general rule, prescription of antiarrhythmic drugs requires a clear diagnosis with electrocardiographic documentation of a given arrhythmia. Risk-benefit analysis of drug therapy should be considered when facing an arrhythmia in a child. Prophylactic antiarrhythmic drug therapy is given only to protect the child from recurrent supraventricular tachycardia during this time span until the disease will eventually cease spontaneously. In the last decades, radiofrequency catheter ablation is progressively used as curative therapy for tachyarrhythmias in children and patients with or without CHD. Even in young children, procedures can be performed with high success rates and low complication rates as shown by several retrospective and prospective paediatric multi-centre studies. Three-dimensional mapping and non-fluoroscopic navigation techniques and enhanced catheter technology have further improved safety and efficacy even in CHD patients with complex arrhythmias.During last decades, cardiac devices (pacemakers and implantable cardiac defibrillator) have developed rapidly. The pacing generator size has diminished and the pacing leads have become progressively thinner. These developments have made application of cardiac pacing in children easier although no dedicated paediatric pacing systems exist.

  • 23. Calkins, Hugh
    et al.
    Hindricks, Gerhard
    Cappato, Riccardo
    Kim, Young-Hoon
    Saad, Eduardo B
    Aguinaga, Luis
    Akar, Joseph G
    Badhwar, Vinay
    Brugada, Josep
    Camm, John
    Chen, Peng-Sheng
    Chen, Shih-Ann
    Chung, Mina K
    Cosedis Nielsen, Jens
    Curtis, Anne B
    Davies, D Wyn
    Day, John D
    d'Avila, André
    Natasja de Groot, N M S
    Di Biase, Luigi
    Duytschaever, Mattias
    Edgerton, James R
    Ellenbogen, Kenneth A
    Ellinor, Patrick T
    Ernst, Sabine
    Fenelon, Guilherme
    Gerstenfeld, Edward P
    Haines, David E
    Haissaguerre, Michel
    Helm, Robert H
    Hylek, Elaine
    Jackman, Warren M
    Jalife, Jose
    Kalman, Jonathan M
    Kautzner, Josef
    Kottkamp, Hans
    Kuck, Karl Heinz
    Kumagai, Koichiro
    Lee, Richard
    Lewalter, Thorsten
    Lindsay, Bruce D
    Macle, Laurent
    Mansour, Moussa
    Marchlinski, Francis E
    Michaud, Gregory F
    Nakagawa, Hiroshi
    Natale, Andrea
    Nattel, Stanley
    Okumura, Ken
    Packer, Douglas
    Pokushalov, Evgeny
    Reynolds, Matthew R
    Sanders, Prashanthan
    Scanavacca, Mauricio
    Schilling, Richard
    Tondo, Claudio
    Tsao, Hsuan-Ming
    Verma, Atul
    Wilber, David J
    Yamane, Teiichi
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation.2018In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 20, no 1, p. e1-e160Article in journal (Refereed)
    Download full text (pdf)
    fulltext
  • 24. Camm, A John
    et al.
    Kirchhof, Paulus
    Lip, Gregory Y H
    Schotten, Ulrich
    Savelieva, Irene
    Ernst, Sabine
    Van Gelder, Isabelle C
    Al-Attar, Nawwar
    Hindricks, Gerhard
    Prendergast, Bernard
    Heidbuchel, Hein
    Alfieri, Ottavio
    Angelini, Annalisa
    Atar, Dan
    Colonna, Paolo
    De Caterina, Raffaele
    De Sutter, Johan
    Goette, Andreas
    Gorenek, Bulent
    Heldal, Magnus
    Hohloser, Stefan H
    Kolh, Philippe
    Le Heuzey, Jean-Yves
    Ponikowski, Piotr
    Rutten, Frans H
    Vahanian, Alec
    Auricchio, Angelo
    Bax, Jeroen
    Ceconi, Claudio
    Dean, Veronica
    Filippatos, Gerasimos
    Funck-Brentano, Christian
    Hobbs, Richard
    Kearney, Peter
    McDonagh, Theresa
    Popescu, Bogdan A
    Reiner, Zeljko
    Sechtem, Udo
    Sirnes, Per Anton
    Tendera, Michal
    Vardas, Panos E
    Widimsky, Petr
    Vardas, Panos E
    Agladze, Vazha
    Aliot, Etienne
    Balabanski, Tosho
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine.
    Capucci, Alessandro
    Crijns, Harry
    Dahlöf, Björn
    Folliguet, Thierry
    Glikson, Michael
    Goethals, Marnix
    Gulba, Dietrich C
    Ho, Siew Yen
    Klautz, Robert J M
    Kose, Sedat
    McMurray, John
    Perrone Filardi, Pasquale
    Raatikainen, Pekka
    Salvador, Maria Jesus
    Schalij, Martin J
    Shpektor, Alexander
    Sousa, João
    Stepinska, Janina
    Uuetoa, Hasso
    Zamorano, Jose Luis
    Zupan, Igor
    Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC)2010In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 12, no 10, p. 1360-1420Article in journal (Refereed)
  • 25. Camm, A John
    et al.
    Lip, Gregory Y H
    De Caterina, Raffaele
    Savelieva, Irene
    Atar, Dan
    Hohnloser, Stefan H
    Hindricks, Gerhard
    Kirchhof, Paulus
    2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation: developed with the special contribution of the European Heart Rhythm Association2012In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 14, no 10, p. 1385-1413Article in journal (Refereed)
  • 26. Chen, Jian
    et al.
    Dagres, Nikolaos
    Hocini, Melece
    Fauchier, Laurent
    Bongiorni, Maria Grazia
    Defaye, Pascal
    Hernandez-Madrid, Antonio
    Estner, Heidi
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Catheter ablation for atrial fibrillation: results from the first European Snapshot Survey on Procedural Routines for Atrial Fibrillation Ablation (ESS-PRAFA) Part II2015In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 11, p. 1727-1732Article in journal (Refereed)
    Abstract [en]

    The European Snapshot Survey on Procedural Routines in Atrial Fibrillation Ablation (ESS-PRAFA) is a prospective, multicentre snapshot survey collecting patient-based data on current clinical practices during atrial fibrillation (AF) ablation. The participating centres were asked to prospectively enrol consecutive patients during a 6-week period (from September to October 2014). A web-based case report form was employed to collect information of patients and data of procedures. A total of 455 eligible consecutive patients from 13 countries were enrolled (mean age 59 ± 10.8 years, 28.8% women). Distinct strategies and endpoints were collected for AF ablation procedures. Pulmonary vein isolation (PVI) was performed in 96.7% and served as the endpoint in 91.3% of procedures. A total of 52 (11.5%) patients underwent ablation as first-line therapy. The cryoballoon technique was employed in 31.4% of procedures. Procedure, ablation, and fluoroscopy times differed among various types of AF ablation. Divergences in patient selection and complications were observed among low-, medium-, and high-volume centres. Adverse events were observed in 4.6% of AF ablation procedures. In conclusion, PVI was still the main strategy for AF ablation. Procedure-related complications seemed not to have declined. The centre volume played an important role in patient selection, strategy choice, and had impact on the rate of periprocedural complication.

  • 27. Chen, Jian
    et al.
    Hocini, Mélèze
    Larsen, Torben Bjerregaard
    Proclemer, Alessandro
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Clinical management of arrhythmias in elderly patients: results of the European Heart Rhythm Association survey2015In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 2, p. 314-317Article in journal (Refereed)
    Abstract [en]

    The purpose of this survey was to assess clinical practice in management of cardiac arrhythmias in elderly patients (age ≥75 years) in the European countries. The data are based on an electronic questionnaire sent to the European Heart Rhythm Association Research Network members. Responses were received from 50 centres in 20 countries. The results of the survey have shown that management of cardiac arrhythmias is generally in accordance with the guidelines and consensus recommendations on management of cardiac arrhythmias, although there are some areas of variation, especially on age limit and exclusion of elderly patients for anticoagulation, ablation, and device therapy.

  • 28. Chen, Jian
    et al.
    Todd, Derick M
    Hocini, Mélèze
    Larsen, Torben Bjerregaard
    Bongiorni, Maria Grazia
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Current periprocedural management of ablation for atrial fibrillation in Europe: results of the European Heart Rhythm Association survey.2014In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 16, no 3, p. 378-81Article in journal (Refereed)
    Abstract [en]

    The purpose of this EP Wire survey was to assess clinical practice in periprocedural management of atrial fibrillation ablation. This survey is based on an electronic questionnaire sent to the European Heart Rhythm Association Research Network members. Responses were received from 78 centres in 20 countries. The results of the survey have shown that periprocedural management is generally in accordance with guidelines and consensus recommendations on ablation for atrial fibrillation ablation, although there are some areas of variation. Differences between high- and low-volume centres are observed with respect to patient selection, antiarrhythmic drug management, and heparin bridging.

  • 29. Chen, Jian
    et al.
    Todd, Derick M
    Proclemer, Alessandro
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Estner, Heidi L
    Broadhurst, Paul
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Management of patients with ventricular tachycardia in Europe: results of the European Heart Rhythm Association survey2015In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 8, p. 1294-1299Article in journal (Refereed)
    Abstract [en]

    The purpose of this European Heart Rhythm Association (EHRA) survey was to assess clinical practice in the management of ventricular tachycardia (VT). The data are based on an electronic questionnaire sent to the members of the EHRA Research Network. Responses were received from 31 centres in 16 countries. The results of the survey show that the management of VT is in general in accordance with guidelines. Antiarrhythmic drugs are still frequently used for VT treatment. In patients at high risk of sudden cardiac death, an implantable cardioverter-defibrillator is routinely recommended, while the treatment options vary for patients with moderate or low risk. A discreet attitude is adopted for catheter ablation in high-risk patients as demonstrated by a relatively low rate of catheter ablation.

  • 30. Dagres, Nikolaos
    et al.
    Bongiorni, Maria Grazia
    Dobreanu, Dan
    Madrid, Antonio
    Svendsen, Jesper Hastrup
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Current investigation and management of patients with syncope: results of the European Heart Rhythm Association survey2013In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 15, no 12, p. 1812-1815Article in journal (Refereed)
    Abstract [en]

    The aim of this European Heart Rhythm Association (EHRA) survey was to provide an insight into the current practice of work-up and management of patients with syncope among members of the EHRA electrophysiology research network. Responses were received from 43 centres. The majority of respondents (74%) had no specific syncope unit and only 42% used a standardized assessment protocol or algorithm. Hospitalization rates varied from 10% to 25% (56% of the centres) to >50% (21% of the centres). The leading reasons for hospitalization were features suggesting arrhythmogenic syncope (85% of respondents), injury (80%), structural heart disease (73%), significant comorbidities (54%), and older age (41%). Most widely applied tests were electrocardiogram (ECG), echocardiography, and Holter monitoring followed by carotid sinus massage and neurological evaluation. An exercise test, tilt table test, electrophysiological study, and implantation of a loop recorder were performed only if there was a specific indication. The use of a tilt table test varied widely: 44% of respondents almost always performed it when neurally mediated syncope was suspected, whereas 37% did not perform it when there was a strong evidence for neurally mediated syncope. Physical manoeuvres were the most widely (93%) applied standard treatment for this syncope form. The results of this survey suggest that there are significant differences in the management of patients with syncope across Europe, specifically with respect to hospitalization rates and indications for tilt table testing in neurally mediated syncope. The majority of centres reported using ECG, echocardiography, and Holter monitoring as their main diagnostic tools in patients with syncope, whereas a smaller proportion of centres applied specific assessment algorithms. Physical manoeuvres were almost uniformely reported as the standard treatment for neurally mediated syncope.

  • 31. Dagres, Nikolaos
    et al.
    Bongiorni, Maria Grazia
    Larsen, Torben Bjerregaard
    Hernandez-Madrid, Antonio
    Pison, Laurent
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Current ablation techniques for persistent atrial fibrillation: results of the European Heart Rhythm Association Survey2015In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 10Article in journal (Refereed)
    Abstract [en]

    The aim of this survey was to provide insight into current practice regarding ablation of persistent atrial fibrillation (AF) among members of the European Heart Rhythm Association electrophysiology research network. Thirty centres responded to the survey. The main ablation technique for first-time ablation was stand-alone pulmonary vein isolation (PVI): in 67% of the centres for persistent but not long-standing AF and in 37% of the centres for long-standing persistent AF as well. Other applied techniques were ablation of fractionated electrograms, placement of linear lesions, stepwise approach until AF termination, and substrate mapping and isolation of low-voltage areas. However, the percentage of centres applying these techniques during first ablation did not exceed 25% for any technique. When stand-alone PVI was performed in patients with persistent but not long-standing AF, the majority (80%) of the centres used an irrigated radiofrequency ablation catheter whereas 20% of the respondents used the cryoballoon. Similar results were reported for ablation of long-standing persistent AF (radiofrequency 90%, cryoballoon 10%). Neither rotor mapping nor one-shot ablation tools were used as the main first-time ablation methods. Systematic search for non-pulmonary vein triggers was performed only in 10% of the centres. Most common 1-year success rate off antiarrhythmic drugs was 50-60%. Only 27% of the centres knew their 5-year results. In conclusion, patients with persistent AF represent a significant proportion of AF patients undergoing ablation. There is a shift towards stand-alone PVI being the primary choice in many centres for first-time ablation in these patients. The wide variation in the use of additional techniques and in the choice of endpoints reflects the uncertainties and lack of guidance regarding the most optimal approach. Procedural success rates are modest and long-term outcomes are unknown in most centres.

  • 32. Dagres, Nikolaos
    et al.
    Cantù, Francesco
    Geelen, Peter
    Lewalter, Thorsten
    Proclemer, Alessandro
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Current practice of ventricular tachycardia ablation in patients with implantable cardioverter-defibrillators2012In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 14, no 1, p. 135-137Article in journal (Refereed)
    Abstract [en]

    We performed a survey on current practice of ventricular tachycardia (VT) ablation in patients with implantable cardioverter-defibrillators among the European Heart Rhythm Association Research Network. The main indication for the procedure is the occurrence of multiple shocks or electrical storm, while prophylactic ablation is only rarely performed. The epicardial approach is seldom used and mostly only after failure of endocardial ablation. The main ablation strategy is targeting the clinical VT only by substrate mapping and ablation, and by targeting fractionated potentials with utilization of modern electroanatomical mapping systems. Still, a considerable number of centres frequently perform the procedure using conventional mapping catheters only.

  • 33. Dagres, Nikolaos
    et al.
    Lewalter, Thorsten
    Lip, Gregory Y. H.
    Pison, Laurent
    Proclemer, Alessandro
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Current practice of antiarrhythmic drug therapy for prevention of atrial fibrillation in Europe: The European Heart Rhythm Association survey2013In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 15, no 4, p. 478-481Article in journal (Refereed)
    Abstract [en]

    The aim of this survey was to provide insight into current practice regarding the use of antiarrhythmic drugs for atrial fibrillation (AF) among members of the European Heart Rhythm Association research network. Thirty-seven centres responded. Rhythm control was preferred in patients with significant AF-related symptoms by 73 of centres, in all patients after a first detected episode by 59, and in young patients even if AF was well tolerated by 49 of centres. The most common strategy after successful conversion of the first AF episode was a wait-and-see approach without initiation of antiarrhythmic drugs (49). Conventional -blockers were always or sometimes used as first-choice drugs for AF prevention by 76 of centres. Only 11 used dronedarone regularly as a first-choice drug. The diagnostic work-up for exclusion of heart disease prior to initiation of class IC antiarrhythmic drugs was limited. Markers monitored for proarrhythmia risk were QRS duration for class IC drugs (68) and the QT interval for sotalol and amiodarone (65). In conclusion, rhythm control is more widely employed than expected. Beta-blockers are widely used for AF prevention in contrast to the limited use of the new drug dronedarone.

  • 34. Daubert, Jean-Claude
    et al.
    Saxon, Leslie
    Adamson, Philip B
    Auricchio, Angelo
    Berger, Ronald D
    Beshai, John F
    Breithard, Ole
    Brignole, Michele
    Cleland, John
    Delurgio, David B
    Dickstein, Kenneth
    Exner, Derek V
    Gold, Michael
    Grimm, Richard A
    Hayes, David L
    Israel, Carsten
    Leclercq, Christophe
    Linde, Cecilia
    Lindenfeld, Joann
    Merkely, Bela
    Mont, Lluis
    Murgatroyd, Francis
    Prinzen, Frits
    Saba, Samir F
    Shinbane, Jerold S
    Singh, Jagmeet
    Tang, Anthony S
    Vardas, Panos E
    Wilkoff, Bruce L
    Zamorano, Jose Luis
    2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management2012In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 14, no 9, p. 1236-1286Article in journal (Refereed)
  • 35.
    Deharo, Jean-Claude
    et al.
    Univ Hosp La Timone, Dept Cardiol, Marseilles, France..
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Leclercq, Christophe
    Univ Hosp Pontchaillou, Dept Cardiol, CIC IT 804, INSERM 1099, Rennes, France..
    Amara, Walid
    GHI Le Raincy Montfermeil, Dept Cardiol, Montfermeil, France..
    Doering, Michael
    Univ Leipzig, Ctr Heart, Dept Electrophysiol, D-04109 Leipzig, Germany..
    Bongiorni, Maria G.
    Univ Hosp Pisa, Cardiol Dept 2, Pisa, Italy..
    Chen, Jian
    Haukeland Hosp, Dept Heart Dis, N-5021 Bergen, Norway.;Univ Bergen, Dept Clin Sci, Bergen, Norway..
    Dagres, Nicolaus
    Univ Leipzig, Ctr Heart, Dept Electrophysiol, D-04109 Leipzig, Germany..
    Estner, Heidi
    Univ Munich, Dept Cardiol, Med Klin 1, Campus Grosshadern,Marchioninistr 15, D-81377 Munich, Germany..
    Larsen, Torben B.
    Aalborg Univ Hosp, AF Study Grp, Dept Cardiol, Aalborg, Denmark..
    Johansen, Jens B.
    Odense Univ Hosp, Dept Cardiol, DK-5000 Odense, Denmark..
    Potpara, Tatjana S.
    Univ Belgrade, Sch Med, Cardiol Clin, Clin Ctr Serbia, Belgrade, Serbia..
    Proclemer, Alessandro
    IRCAB Fdn Udine, Univ Hosp S Maria della Misericordia, Dept Cardiol, Udine, Italy..
    Pison, Laurent
    Maastricht Univ, Med Ctr, Dept Cardiol, Maastricht POB 5800, NL-6200 MD Maastricht, Netherlands.;Cardiovasc Res Inst, Maastricht POB 5800, Amsterdam, Netherlands..
    Brunet, Caroline
    Univ Hosp La Timone, Dept Cardiol, Marseilles, France..
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Perioperative management of antithrombotic treatment during implantation or revision of cardiac implantable electronic devices: the European Snapshot Survey on Procedural Routines for Electronic Device Implantation (ESS-PREDI)2016In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 18, no 5, p. 778-784Article in journal (Refereed)
    Abstract [en]

    The European Snapshot Survey on Procedural Routines for Electronic Device Implantation (ESS-PREDI) was a prospective European survey of consecutive adults who had undergone implantation/surgical revision of a cardiac implantable electronic device (CIED) on chronic antithrombotic therapy (enrolment March-June 2015). The aim of the survey was to investigate perioperative treatment with oral anticoagulants and antiplatelets in CIED implantation or surgical revision and to determine the incidence of complications, including clinically significant pocket haematomas. Information on antithrombotic therapy before and after surgery and bleeding and thromboembolic complications occurring after the intervention was collected at first follow-up. The study population comprised 723 patients (66.7% men, 76.9% aged a parts per thousand yen66 years). Antithrombotic treatment was continued during surgery in 489 (67.6%) patients; 6 (0.8%) had their treatment definitively stopped; 46 (6.4%) were switched to another antithrombotic therapy. Heparin bridging was used in 55 out of 154 (35.8%) patients when interrupting vitamin K antagonist (VKA) treatment. Non-vitamin K oral anticoagulant (NOAC) treatment was interrupted in 88.7% of patients, with heparin bridging in 25.6%, but accounted for only 25.3% of the oral anticoagulants used. A total of 108 complications were observed in 98 patients. No intracranial haemorrhage or embolic events were observed. Chronic NOAC treatment before surgery was associated with lower rates of minor pocket haematoma (1.4%; P= 0.042) vs. dual antiplatelet therapy (13.0%), VKA (11.4%), VKA + antiplatelet (9.2%), or NOAC + antiplatelet (7.7%). Similar results were observed for bleeding complications (P= 0.028). Perioperative management of patients undergoing CIED implantation/surgical revision while on chronic antithrombotic therapy varies, with evidence of a disparity between guideline recommendations and practice patterns in Europe. Haemorrhagic complications were significantly less frequent in patients treated with NOACs. Despite this, the incidence of severe pocket haematomas was low.

  • 36. Di Cori, Andrea
    et al.
    Auricchio, Angelo
    Regoli, François
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Butter, Christian
    Dagres, Nikolaos
    Deharo, Jean-Claude
    Maggioni, Aldo P
    Kutarski, Andrzej
    Kennergren, Charles
    Laroche, Cécile
    Rinaldi, Christopher A
    Dovellini, Emilio Vincenzo
    Golzio, Pier Giorgio
    Thøgersen, Anna Margrethe
    Bongiorni, Maria Grazia
    Clinical impact of antithrombotic therapy in transvenous lead extraction complications: a sub-analysis from the ESC-EORP EHRA ELECTRa (European Lead Extraction ConTRolled) Registry2019In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 21, no 7, p. 1096-1105Article in journal (Refereed)
    Abstract [en]

    AIMS: A sub-analysis of the ESC-EHRA European Lead Extraction ConTRolled (ELECTRa) Registry to evaluate the clinical impact of antithrombotic (AT) on transvenous lead extraction (TLE) safety and efficacy.

    METHODS AND RESULTS: ELECTRa outcomes were compared between patients without AT therapy (No AT Group) and with different pre-operative AT regimens, including antiplatelets (AP), anticoagulants (AC), or both (AP + AC). Out of 3510 pts, 2398 (68%) were under AT pre-operatively. AT patients were older with more comorbidities (P < 0.0001). AT subgroups, defined as AP, AC, or AP + AC, were 1096 (31.2%), 985 (28%), and 317 (9%), respectively. Regarding AP patients, 1413 (40%) were under AP, 1292 (91%) with a single AP, interrupted in 26% about 3.8 ± 3.7 days before TLE. In total, 1302 (37%) patients were under AC, 881 vitamin K antagonist (68%), 221 (17%) direct oral anticoagulants, 155 (12%) low weight molecular heparin, and 45 (3.5%) unfractionated heparin. AC was 'interrupted without bridging' in 696 (54%) and 'interrupted with bridging' in 504 (39%) about 3.3 ± 2.3 days before TLE, and 'continued' in 87 (7%). TLE success rate was high in all subgroups. Only overall in-hospital death (1.4%), but not the procedure-related one, was higher in the AT subgroups (P = 0.0500). Age >65 years and New York Heart Association Class III/IV, but not AT regimens, were independent predictors of death for any cause. Haematomas were more frequent in AT subgroups, especially in AC 'continued' (P = 0.025), whereas pulmonary embolism in the No-AT (P < 0.01).

    CONCLUSIONS: AT minimization is safe in patients undergoing TLE. AT does not seem to predict death but identifies a subset of fragile patients with a worse in-hospital TLE outcome.

  • 37. Dickstein, Kenneth
    et al.
    Normand, Camilla
    Anker, Stefan D.
    Auricchio, Angelo
    Blomstrom, Carina Lundqvist
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Bogale, Nigussie
    Cleland, John
    Filippatos, Gerasimos
    Gasparini, Maurizio
    Gitt, Anselm
    Hindricks, Gerhard
    Kuck, Karl-Heinz
    Ponikowski, Piotr
    Stellbrink, Christoph
    Ruschitzka, Frank
    Linde, Cecilia
    European Cardiac Resynchronization Therapy Survey II: rationale and design2015In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 1, p. 137-141Article in journal (Refereed)
    Abstract [en]

    The Cardiac Resynchronization Therapy (CRT) Survey II is a 6 months snapshot survey initiated by two ESC Associations, the European Heart Rhythm Association and the Heart Failure Association, which is designed to describe clinical practice regarding implantation of CRT devices in a broad sample of hospitals in 47 ESC member countries. The large volume of clinical and demographic data collected should reflect current patient selection, implantation, and follow-up practice and provide information relevant for assessing healthcare resource utilization in connection with CRT. The findings of this survey should permit representative benchmarking both nationally and internationally across Europe.

  • 38.
    Ding, Wern Yew
    et al.
    Univ Liverpool, Liverpool Ctr Cardiovasc Sci, Liverpool, Merseyside, England.;Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England..
    Proietti, Marco
    Univ Liverpool, Liverpool Ctr Cardiovasc Sci, Liverpool, Merseyside, England.;Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England.;Univ Milan, Dept Clin Sci & Community Hlth, Milan, Italy.;IRCCS Ist Clin Scientif Maugeri, Geriatr Unit, Milan, Italy..
    Boriani, Giuseppe
    Univ Modena & Reggio Emilia, Dept Biomed Metab & Neural Sci, Cardiol Div, Policlin Modena, Modena, Italy..
    Fauchier, Laurent
    Ctr Hosp Univ Trousseau, Serv Cardiol, Tours, France..
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Marin, Francisco
    Univ Murcia, Hosp Univ Virgen Arrixaca, Dept Cardiol, CIBERCV, Murcia, Spain..
    Potpara, Tatjana S.
    Univ Belgrade, Sch Med, Belgrade, Serbia.;Clin Ctr Serbia, Cardiol Clin, Intens Arrhythmia Care, Belgrade, Serbia..
    Lip, Gregory Y. H.
    Univ Liverpool, Liverpool Ctr Cardiovasc Sci, Liverpool, Merseyside, England.;Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England.;Aalborg Univ, Dept Clin Med, Aalborg Thrombosis Res Unit, Aalborg, Denmark..
    Clinical utility and prognostic implications of the novel 4S-AF scheme to characterize and evaluate patients with atrial fibrillation: a report from ESC-EHRA EORP-AF Long-Term General Registry2022In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 24, no 5, p. 721-728Article in journal (Refereed)
    Abstract [en]

    Aims: The 4S-AF classification scheme comprises of four domains: stroke risk (St), symptoms (Sy), severity of atrial fibrillation (AF) burden (Sb), and substrate (Su). We sought to examine the implementation of the 4S-AF scheme in the EORP-AF General Long-Term Registry and compare outcomes in AF patients according to the 4S-AF-led decision-making process.

    Methods and results: Atrial fibrillation patients from 250 centres across 27 European countries were included. A 4S-AF score was calculated as the sum of each domain with a maximum score of 9. Of 6321 patients, 8.4% had low (St), 47.5% EHRA I (Sy), 40.5% newly diagnosed or paroxysmal AF (Sb), and 5.1% no cardiovascular risk factors or left atrial enlargement (Su). Median follow-up was 24 months. Using multivariable Cox regression analysis, independent predictors of all-cause mortality were (St) [adjusted hazard ratio (aHR) 8.21, 95% confidence interval (CI): 2.60-25.9], (Sb) (aHR 1.21, 95% CI: 1.08-1.35), and (Su) (aHR 1.27, 95% CI: 1.14-1.41). For CV mortality and any thromboembolic event, only (Su) (aHR 1.73, 95% CI: 1.45-2.06) and (Sy) (aHR 1.29, 95% CI: 1.00-1.66) were statistically significant, respectively. None of the domains were independently linked to ischaemic stroke or major bleeding. Higher 4S-AF score was related to a significant increase in all-cause mortality, CV mortality, any thromboembolic event, and ischaemic stroke but not major bleeding. Treatment of all 4S-AF domains was associated with an independent decrease in all-cause mortality (aHR 0.71, 95% CI: 0.55-0.92). For each 4S-AF domain left untreated, the risk of all-cause mortality increased substantially (aHR 1.35, 95% CI: 1.16-1.56).

    Conclusion: Implementation of the novel 4S-AF scheme is feasible, and treatment decisions based on this scheme improve mortality rates in AF.

  • 39. Dobreanu, Dan
    et al.
    Dagres, Nikolaos
    Svendsen, Jesper Hastrup
    Marinskis, Germanas
    Bongiorni, Maria Grazia
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Approach to cardiac resyncronization therapy2012In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 14, no 9, p. 1359-1362Article in journal (Refereed)
    Abstract [en]

    AIMS:

    The purpose of this EP Wire is to compare indications, techniques, implant strategy, and follow-up regarding cardiac resynchronization therapy (CRT) in several countries across Europe.

    METHODS AND RESULTS:

    Forty-one centres, members of the EHRA-EP Research Network, responded to this survey and completed the questions. Thirty-two per cent of the responding centres always use CRT in heart failure (HF) patients with New York Heart Association functional class II and QRS width >120 ms, and 55% of the responding centres demand additional criteria when indicating CRT, most often QRS width >150 ms (49%) and echocardiographic criteria of asynchrony (34%). Only 10% of centres indicate CRT in all HF patients with QRS >120 ms and right bundle branch block, and 51% demand additional criteria, most frequently echocardiographic asynchrony parameters. The vast majority of centres also indicate CRT in patients with atrial fibrillation and standard criteria for CRT. In 24% of the centres, biventricular pacemaker (CRT-P) is implanted in all situations, unless there is an indication for secondary prevention of sudden cardiac death, while 10% always choose to implant a biventricular defibrillator (CRT-D). There are no clear evidence-based recommendations concerning the implant procedure and follow-up in patients treated with CRT; therefore, the chosen strategies vary widely from one centre to another.

    CONCLUSION:

    This EP Wire survey shows a wide variation not only as far as CRT indications are concerned, but especially in techniques, implant strategy, and follow-up across the European countries.

  • 40. Dobreanu, Dan
    et al.
    Svendsen, Jesper Hastrup
    Lewalter, Thorsten
    Hernández-Madrid, Antonio
    Lip, Gregory Y H
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Current practice for diagnosis and management of silent atrial fibrillation: results of the European Heart Rhythm Association survey2013In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 15, no 8, p. 1223-1225Article in journal (Refereed)
    Abstract [en]

    Although it is well known that silent atrial fibrillation (AF) is associated with morbidity and mortality rates similar to those of symptomatic AF, no specific strategy for screening and management of this form of AF has been advocated. The purpose of this survey was to identify current practices for the diagnosis and management of silent AF. This survey is based on an electronic questionnaire sent to the European Heart Rhythm Association Research Network partners. Responses were received from 33 centres in 16 countries. The preferred screening methods for silent AF in patients with rhythm control by pharmacological therapy was 12-lead electrocardiogram (ECG) at outpatient visits (31.3%) and periodical 24 h Holter ECG recordings (34.4%), while after pulmonary vein isolation the corresponding figures were 6.3 and 65.6%, respectively. No consensus has been reached concerning the therapeutic approach for such patients. Most responders preferred rate control over rhythm control in patients with silent AF, although some favoured pulmonary vein isolation in young patients. However, oral anticoagulant therapy in patients at high thromboembolic risk was considered mandatory by most, provided that at least one episode of silent AF was documented, without recommending further investigations. The results of this survey have confirmed that there is currently no consensus regarding the screening and management of patients with silent AF and that clinical practice is not always consistent with the few existing evidence-based recommendations.

  • 41.
    Duncker, David
    et al.
    Hannover Med Sch, Hannover Heart Rhythm Ctr, Dept Cardiol & Angiol, Carl Neuberg Str 1, D-30625 Hannover, Germany..
    Svennberg, Emma
    Karolinska Inst, Dept Clin Sci, Danderyd Univ Hosp, Stockholm, Sweden..
    Deharo, Jean-Claude
    CHU Timone, Dept Cardiol, F-13385 Marseille, France.;Aix Marseille Univ, Fac Med, F-13385 Marseille, France..
    Costa, Francisco Moscoso
    Hosp Santa Cruz, Cardiol Dept, Lisbon, Portugal..
    Kommata, Varvara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    The 'afibmatters.org' educational website for patients with atrial fibrillation from the European Heart Rhythm Association2021In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 23, no 11, p. 1693-1697Article in journal (Other academic)
  • 42.
    Essebag, Vidal
    et al.
    McGill Univ, Hlth Ctr, 1650 Cedar Ave,Room E5-200, Montreal, PQ H3G 1A4, Canada.;Hop Sacre Coeur, Montreal, PQ, Canada..
    Proietti, Riccardo
    Swansea Univ, Cardiol Dept, Morriston Hosp, Swansea SA6 6NL, W Glam, Wales.;Luigi Sacco Hosp, Cardiol Dept, Milan, Italy..
    Birnie, David H.
    Univ Ottawa Heart Inst, Ottawa, ON, Canada..
    Wang, Jia
    McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada..
    Douketis, James
    McMaster Univ, Dept Med, St Josephs Healthcare, Hamilton, ON, Canada..
    Coutu, Benoit
    Ctr Hosp Univ Montre, Montreal, PQ, Canada..
    Parkash, Ratika
    Queen Elizabeth 2 Hlth Sci Ctr, Halifax, NS, Canada..
    Lip, Gregory Y. H.
    Univ Birmingham, Inst Cardiovasc Sci, City Hosp, Birmingham, W Midlands, England..
    Hohnloser, Stefan H.
    Klinikum Johann Wolfgang Goethe Univ, Frankfurt, Germany..
    Moriarty, Andrew
    Craigavon Area Hosp, Portadown, Arm, North Ireland..
    Oldgren, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Connolly, Stuart J.
    McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada..
    Ezekowitz, Michael
    Thomas Jefferson Med Coll & Heart Ctr, Wynnewood, PA USA..
    Healey, Jeff S.
    McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada..
    Short-term dabigatran interruption before cardiac rhythm device implantation: multi-centre experience from the RE-LY trial2017In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 19, no 10, p. 1630-1636Article in journal (Refereed)
    Abstract [en]

    Aims: Cardiac implantable electronic device (CIED) surgery is commonly performed in patients with atrial fibrillation (AF). The current analysis was undertaken to compare peri-operative anticoagulation management, bleeding, and thrombotic events in AF patients treated with dabigatran vs. warfarin.

    Methods and results: This study included 611 patients treated with dabigatran vs. warfarin who underwent CIED surgery during the RE-LY trial. Among 201 warfarin-treated patients, warfarin was interrupted a median of 144 (inter-quartile range, IQR: 120-216) h, and 37 (18.4%) patients underwent heparin bridging. In dabigatran-treated patients (216 on 110 mg bid and 194 on 150 mg bid), the duration of dabigatran interruption was a median of 96 (IQR: 61-158) h. Pocket hematomas occurred in 9 (2.20%) patients on dabigatran and 8 (3.98%) patients on warfarin (P = 0.218). The occurrence of pocket hematomas was lower with dabigatran compared with warfarin with heparin bridging (RD: -8.62%, 95% CI: -24.15 to - 0.51%, P = 0.034) but not when compared with warfarin with no bridging (P = 0.880). Ischemic stroke occurred in 2 (0.3%) patients; one in the warfarin group (without bridging) and one in the dabigatran 150 mg bid group (P = 0.735).

    Conclusion: In patients treated with dabigatran undergoing CIED surgery, interruption of dabigatran is associated with similar or lower incidence of pocket hematoma, when compared with warfarin interruption without or with heparin bridging, respectively. Whether uninterrupted dabigatran can reduce pocket hematoma or ischemic stroke remains to be evaluated.

  • 43. Estner, Heidi L
    et al.
    Chen, Jian
    Potpara, Tatjana
    Proclemer, Alessandro
    Todd, Derick
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Personnel, equipment, and facilities for electrophysiological and catheter ablation procedures in Europe: results of the European Heart Rhythm Association Survey2014In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 16, no 7, p. 1078-1082Article in journal (Refereed)
    Abstract [en]

    Clinical electrophysiology (EP) and catheter ablation of arrhythmias are rapidly evolving in recent years. More than 50 000 catheter ablations are performed every year in Europe. Emerging indications, an increasing number of procedures, and an expected high quality require national and international standards as well as trained specialists. The purpose of this European Heart Rhythm Association (EHRA) survey was to assess the practice of requirements for EP personnel, equipment, and facilities in Europe. Responses to the questionnaire were received from 52 members of the EHRA research network. The survey involved high-, medium-, and low-volume EP centres, performing >400, 100-399, and under 100 implants per year, respectively. The following topics were explored: (i) EP personnel issues including balance between female and male operators, responsibilities within the EP department, age profiles, role and training of fellows, and EP nurses, (ii) the equipments available in the EP laboratories, (iii) source of patient referrals, and (iv) techniques used for ablation for different procedures including sedation, and peri-procedural use of anticoagulation and antibiotics. The survey reflects the current EP personnel situation characterized by a high training requirement and specialization. Arrhythmia sections are still most often part of cardiology departments and the head of cardiology is seldom a heart rhythm specialist. Currently, the vast majority of EP physicians are men, although in the subgroup of physicians younger than 40 years, the proportion of women is increasing. Uncertainty exists regarding peri-procedural anticoagulation, antibiotic prophylaxis, and the need for sedation during specific procedures.

  • 44. Estner, Heidi L
    et al.
    Grazia Bongiorni, Maria
    Chen, Jian
    Dagres, Nikolaos
    Hernandez-Madrid, Antonio
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Use of fluoroscopy in clinical electrophysiology in Europe: results of the European Heart Rhythm Association Survey2015In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 7, p. 1149-1152Article in journal (Refereed)
    Abstract [en]

    Despite the advent of non-fluoroscopic technologies, fluoroscopy remains the cornerstone of imaging in most interventional electrophysiological procedures, from diagnostic studies to ablation interventions and device implantation. The purpose of the European Heart Rhythm Association survey was to provide an insight into regulatory policies and physicians' clinical practice when using fluoroscopy during ablation procedures and device implantation. The survey has shown that only 50% of the participating centres worked with low frame rates (3-6 frames per second) and that the left anterior oblique projection, with higher radiation exposure for the physician, is used for nearly every ablation target. Although three-dimensional imaging systems may reduce the radiation exposure, most centres never used these systems for standard ablation procedures and a trend is that non-fluoroscopy technologies are even less frequently used than in 2012, when the use of robotic systems was still rare. Even less costly equipment such as lead gloves, lead glass cabins, or radiation absorbing pads are still not routinely used.

  • 45.
    Ezekowitz, Michael D.
    et al.
    Thomas Jefferson Univ, Sidney Kimmel Med Coll, 1999 Sproul Rd, Philadelphia, PA 19107 USA.;Lankenau Med Ctr, Wynnewood, PA USA..
    Eikelboom, John
    McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada.;Hamilton Hlth Sci, Hamilton, ON, Canada..
    Oldgren, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Reilly, Paul A.
    Boehringer Ingelheim Pharmaceut Inc, Ridgefield, CT USA..
    Brueckmann, Martina
    Boehringer Ingelheim GmbH & Co KG, Ingelheim, Germany.;Heidelberg Univ, Fac Med Mannheim, Mannheim, Germany..
    Kent, Anthony P.
    Thomas Jefferson Univ, Sidney Kimmel Med Coll, 1999 Sproul Rd, Philadelphia, PA 19107 USA..
    Pogue, Janice
    McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada.;Hamilton Hlth Sci, Hamilton, ON, Canada..
    Spahr, Judith
    Lankenau Inst Med Res, Wynnewood, PA USA..
    Clemens, Andreas
    Boehringer Ingelheim GmbH & Co KG, Ingelheim, Germany..
    Noack, Herbert
    Boehringer Ingelheim GmbH & Co KG, Ingelheim, Germany..
    Diener, Hans-Christoph
    Univ Hosp Essen, Dept Neurol, Essen, Germany..
    Wallentin, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Yusuf, Salim
    McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada.;Hamilton Hlth Sci, Hamilton, ON, Canada..
    Connolly, Stuart J.
    McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada.;Hamilton Hlth Sci, Hamilton, ON, Canada..
    Long-term evaluation of dabigatran 150 vs. 110 mg twice a day in patients with non-valvular atrial fibrillation2016In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 18, no 7, p. 973-978Article in journal (Refereed)
    Abstract [en]

    Aims The Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial allowed patients who completed the trial receiving their assigned dabigatran 150 mg (D150) or 110 mg (D110) twice a day to continue into the Long-term Multicenter Extension of Dabigatran Treatment in Patients with Atrial Fibrillation (RELY-ABLE) trial. This permitted assessment of outcomes over a median of 4.6 and a maximum of 6.7 years, respectively. Methods and results The analysed population included only those patients who completed RE-LY on dabigatran and continued into RELYABLE without interruption of assigned dabigatran. Cumulative risk was expressed as Kaplan-Meier plots. Outcomes were compared using Cox proportional hazard modelling. Stroke or systemic embolization rates were 1.25 and 1.54% per year (D150 and D110, respectively); hazard ratio (HR) 0.81 [95% confidence interval (CI): 0.68-0.96] (P = 0.02). Ischaemic stroke was 1.03 (D150) and 1.29%/year (D110); HR 0.79 (95% CI: 0.66-0.95) (P = 0.01). Haemorrhagic stroke rates were 0.11 (D150) and 0.13%/year (D110); HR 0.91 (95% CI: 0.51-1.62) (P = 0.75). Rates of major haemorrhage were 3.34 (D150) and 2.76%/year (D110); HR 1.22 (95% CI: 1.08-1.37) (P = 0.0008). Intracranial haemorrhage rates were 0.32 (D150) and 0.23%/year (D110); HR 1.37 (95% CI: 0.93-2.01) (P = 0.11). Mortality was 3.43 (D150) and 3.55%/year (D110); HR 0.97 (95% CI: 0.87-1.08) (P = 0.54). Conclusion Annualized rates of all outcomes were constant with better efficacy of D150, less major bleeding with D110, and low intracerebral haemorrhage rates for both doses. There were no additional safety concerns. This is the longest continuous randomized experience of a novel anticoagulant.

  • 46.
    Fabritz, Larissa
    et al.
    Univ Birmingham, Inst Cardiovasc Sci, Birmingham, W Midlands, England; Univ Hosp Birmingham, Dept Cardiol, Birmingham, W Midlands, England.
    Crijns, Harry J. G. M.
    Maastricht Univ, Sch Cardiovasc Dis, Med Ctr, Maastricht, Netherlands.
    Guasch, Eduard
    Univ Barcelona, Hosp Clin, CIBERCV, IDIBAPS, Barcelona, Spain.
    Goette, Andreas
    St Vincenz Hosp, Med Clin 2, Paderborn, Germany; Atrial Fibrillat NETwork AFNET, Munster, Germany.
    Häusler, Karl Georg
    Univ Hosp Wurzburg, Dept Neurol, Wurzburg, Germany.
    Kotecha, Dipak
    Univ Birmingham, Inst Cardiovasc Sci, Birmingham, W Midlands, England.
    Lewalter, Thorsten
    Atrial Fibrillat NETwork AFNET, Munster, Germany; Internist Klinikum Munchen Sud, Munich, Germany.
    Meyer, Christian
    Univ Hosp Hamburg Eppendorf, Univ Heart Ctr, Hamburg, Germany.
    Potpara, Tatjana S.
    Univ Belgrade, Clin Ctr Serbia, Sch Med, Belgrade, Serbia.
    Rienstra, Michiel
    Univ Med Ctr Groningen, Groningen, Netherlands.
    Schnabel, Renate B.
    Atrial Fibrillat NETwork AFNET, Munster, Germany; Univ Hosp Hamburg Eppendorf, Univ Heart Ctr, Hamburg, Germany.
    Willems, Stephan
    Atrial Fibrillat NETwork AFNET, Munster, Germany; Asklepios Klin St Georg, Dept Cardiol, Hamburg, Germany.
    Breithardt, Guenter
    Atrial Fibrillat NETwork AFNET, Munster, Germany; Asklepios Klin St Georg, Dept Cardiol, Hamburg, Germany; Univ Hosp Munster, Dept Cardiovasc Med, Munster, Germany.
    Camm, A. John
    Univ London, St Georges Hosp, Med Sch, London, England.
    Chan, Anthony
    Pfizer, Mississauga, ON, Canada.
    Chua, Winnie
    Univ Birmingham, Inst Cardiovasc Sci, Birmingham, W Midlands, England.
    de Melis, Mirko
    Medtronic, Dublin, Ireland.
    Dimopoulou, Christina
    European Soc Cardiol, Sophia Antipolis, France.
    Dobrev, Dobromir
    Univ Hosp Essen, Dept Cardiol, Essen, Germany.
    Easter, Christina
    Univ Birmingham, Inst Cardiovasc Sci, Birmingham, W Midlands, England.
    Eckardt, Lars
    Atrial Fibrillat NETwork AFNET, Munster, Germany; Univ Hosp Munster, Dept Cardiovasc Med, Munster, Germany.
    Haase, Doreen
    Atrial Fibrillat NETwork AFNET, Munster, Germany.
    Hatem, Stephane
    Sorbonne Univ, Pitie Salpetriere Hosp, AP HP, Dept Cardiol,Fac Med UPMC, Paris, France.
    Healey, Jeff S.
    Populat Hlth Res Inst Hamilton, Hamilton, ON, Canada.
    Heijman, Jordi
    Univ Hosp Birmingham, Dept Cardiol, Birmingham, W Midlands, England.
    Hohnloser, Stefan H.
    Goethe Univ Frankfurt, Dept Cardiol, Frankfurt, Germany.
    Huebner, Thomas
    Preventicus, Jena, Germany.
    Ilyas, Bushra Saeed
    Pfizer, Mississauga, ON, Canada.
    Isaacs, Aaron
    Maastricht Univ, Sch Cardiovasc Dis, Med Ctr, Maastricht, Netherlands.
    Kutschka, Ingo
    Atrial Fibrillat NETwork AFNET, Munster, Germany; Univ Hosp Gottingen, Klin Thorax Herz & Gefasschirurg, Gottingen, Germany.
    Leclercq, Christophe
    Univ Rennes, INSERM, CHU Rennes, LTSI,UMR 1099, F-35000 Rennes, France.
    Lip, Gregory Y. H.
    Univ Liverpool, Liverpool Ctr Cardiovasc Sci, Liverpool, Merseyside, England.
    Marinelli, Elena Andreassi
    Daiichi Sankyo Europe, Munich, Germany.
    Merino, Jose L.
    La Paz Univ Hosp, Arrhythmia & Robot EP Unit, Madrid, Spain.
    Mont, Lluís
    Univ Barcelona, Hosp Clin, Barcelona, Catalonia, Spain.
    Nabauer, Michael
    Atrial Fibrillat NETwork AFNET, Munster, Germany; Univ Hosp Munich, Med Klin & Poliklin 1, Munich, Germany.
    Oldgren, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR).
    Pürerfellner, Helmut
    Ordensklinikum Linz, Dept Rhythmol & Elektrophysiol, Linz, Austria.
    Ravens, Ursula
    Atrial Fibrillat NETwork AFNET, Munster, Germany; Univ Herzentrum Freiburg, Inst Expt Kardiovaskulare Med, Bad Krozingen, Germany.
    Savelieva, Irina
    St Georges Univ London, London, England.
    Sinner, Moritz F.
    Univ Hosp Munich, Med Klin & Poliklin 1, Munich, Germany.
    Sitch, Alice
    Univ Birmingham, Inst Cardiovasc Sci, Birmingham, W Midlands, England.
    Smolnik, Rüdiger
    Daiichi Sankyo Europe, Munich, Germany.
    Steffel, Jan
    Univ Heart Ctr Zurich, Zurich, Switzerland.
    Stein, Kenneth
    Boston Sci, Boston, MA USA.
    Stoll, Monika
    Maastricht Univ, Sch Cardiovasc Dis, Med Ctr, Maastricht, Netherlands.
    Svennberg, Emma
    Karolinska Inst, Danderyds Hosp Stockholm, Dept Clin Sci, Div Cardiovasc Med, Stockholm, Sweden.
    Thomas, Dierk
    Atrial Fibrillat NETwork AFNET, Munster, Germany; Med Univ Hosp Heidelberg, Dept Internal Med Cardiol Angiol & Pneumonol 3, Heidelberg, Germany.
    Van Gelder, Isabelle C.
    Univ Groningen, Univ Med Ctr Groningen, Dept Cardiol, Groningen, Netherlands.
    Vardar, Burcu
    Bayer Healthcare, Machelen, Belgium.
    Wakili, Reza
    Atrial Fibrillat NETwork AFNET, Munster, Germany; Univ Hosp Essen, Dept Cardiol, Essen, Germany.
    Wieloch, Mattias
    Sanofi, Paris, France.
    Zeemering, Stef
    Univ Groningen, Univ Med Ctr Groningen, Dept Cardiol, Groningen, Netherlands.
    Ziegler, Paul D.
    Medtronic, Dublin, Ireland.
    Heidbuchel, Hein
    Antwerp Univ, Univ Hosp, Dept Cardiol, Antwerp, Belgium.
    Hindricks, Gerhard
    Univ Leipzig, Heart Ctr Leipzig, Dept Electrophysiol, Leipzig, Germany.
    Schotten, Ulrich
    Maastricht Univ, Sch Cardiovasc Dis, Med Ctr, Maastricht, Netherlands; Atrial Fibrillat NETwork AFNET, Munster, Germany; Univ Groningen, Univ Med Ctr Groningen, Dept Cardiol, Groningen, Netherlands.
    Kirchhof, Paulus
    Univ Birmingham, Inst Cardiovasc Sci, Birmingham, W Midlands, England; Atrial Fibrillat NETwork AFNET, Munster, Germany; Univ Hosp Hamburg Eppendorf, Univ Heart Ctr, Hamburg, Germany.
    Dynamic risk assessment to improve quality of care in patients with atrial fibrillation: the 7th AFNET/EHRA Consensus Conference2021In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 23, no 3, p. 329-344Article in journal (Refereed)
    Abstract [en]

    Aims

    The risk of developing atrial fibrillation (AF) and its complications continues to increase, despite good progress in preventing AF-related strokes.

    Methods and results

    This article summarizes the outcomes of the 7th Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA) held in Lisbon in March 2019. Sixty-five international AF specialists met to present new data and find consensus on pressing issues in AF prevention, management and future research to improve care for patients with AF and prevent AF-related complications. This article is the main outcome of an interactive, iterative discussion between breakout specialist groups and the meeting plenary. AF patients have dynamic risk profiles requiring repeated assessment and risk-based therapy stratification to optimize quality of care. Interrogation of deeply phenotyped datasets with outcomes will lead to a better understanding of the cardiac and systemic effects of AF, interacting with comorbidities and predisposing factors, enabling stratified therapy. New proposals include an algorithm for the acute management of patients with AF and heart failure, a call for a refined, data-driven assessment of stroke risk, suggestions for anticoagulation use in special populations, and a call for rhythm control therapy selection based on risk of AF recurrence.

    Conclusion

    The remaining morbidity and mortality in patients with AF needs better characterization. Likely drivers of the remaining AF-related problems are AF burden, potentially treatable by rhythm control therapy, and concomitant conditions, potentially treatable by treating these conditions. Identifying the drivers of AF-related complications holds promise for stratified therapy.

  • 47. Ginks, Matthew R.
    et al.
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Karlsson, Andreas
    Gustafsson, John
    Hamid, Shoaib
    Bostock, Julian
    Simon, Marcus
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Rinaldi, C. Aldo
    Relationship between intracardiac impedance and left ventricular contractility in patients undergoing cardiac resynchronization therapy2011In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 13, no 7, p. 984-991Article in journal (Refereed)
    Abstract [en]

    Aims Cardiac resynchronization therapy (CRT) has dramatically improved the symptoms and prognosis of patients with heart failure in large randomized clinical trials. Optimization of device settings may maximize benefit on an individual basis, although the best method for this is not yet established. We evaluated the use of cardiogenic impedance measurements (derived from intracardiac impedance signals) in CRT device optimization, using invasive left ventricular (LV) dP/dt(max) as the reference. Methods and results Seventeen patients underwent invasive haemodynamic assessment using a pressure wire placed in the LV cavity at the time of CRT device implantation. Intracardiac impedance measurements were made at different atrioventricular (AV) and interventricular (VV) delays and compared with LV dP/dt(max). We assessed the performance of patient-specific and generic impedance-based models in predicting acute haemodynamic response to CRT. In two patients, LV catheterization with the pressure wire was unsuccessful and in two patients LV lead delivery was unsuccessful; therefore, data were acquired for 13 out of 17 patients. Left ventricular dP/dt(max) was 919 +/- 182 mmHg/s at baseline and this increased acutely (by 24%) to 1121 +/- 226 mmHg/s as a result of CRT. The patient-specific impedance-based model correctly predicted the optimal haemodynamic response (to within 5% points) for AV and VV delays in 90 and 92% of patients, respectively. Conclusion Cardiogenic impedance measurements are capable of correctly identifying the maximum achievable LV dP/dt(max) as measured by invasive haemodynamic assessment. This study suggests that cardiogenic impedance can potentially be used for CRT optimization and may have a role in ambulatory assessment of haemodynamics.

  • 48. Gorenek, Bulent
    et al.
    Bax, Jeroen
    Boriani, Giuseppe
    Chen, Shih-Ann
    Glotzer, Taya V
    Dagres, Nikolaos
    Healey, Jeff S
    Israel, Carsten W
    Kudaiberdieva, Gulmira
    Levin, Lars-Åke
    Lip, Gregory Y H
    Martin, David
    Okumura, Ken
    Svendsen, Jesper H
    Tse, Hung-Fat
    Botto, Giovanni L
    Blomström Lundqvist, Carina
    Device-detected subclinical atrial tachyarrhythmias: definition, implications and management-an European Heart Rhythm Association (EHRA) consensus document, endorsed by Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE).2017In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 19, no 9, p. 1556-1578Article in journal (Refereed)
  • 49.
    Gorenek, Bulent
    et al.
    Eskisehir Osmangazi Univ, Eskisehir, Turkey.
    Boriani, Giuseppe
    Univ Modena & Reggio Emilia, Cardiol Div, Dept Diagnost, Clin & Publ Hlth Med,Policlin Modena, Modena, Italy.
    Dan, Gheorge-Andrei
    Univ Med & Pharm Carol Davila, Colentina Univ Hosp, Bucharest, Romania;Univ Tours, Tours, France.
    Fauchier, Laurent
    CHU Tours, Tours, France;Hosp Israelita Albert Einstein, Sao Paulo, Brazil.
    Fenelon, Guilherme
    Huang, He
    Wuhan Univ, Renmin Hosp, Wuhan, Peoples R China.
    Kudaiberdieva, Gulmira
    Ctr Postgrad Educ & Res, Bishkek, Kyrgyzstan.
    Lip, Gregory Y. H.
    Univ Birmingham, Inst Cardiovasc Sci, Birmingham, W Midlands, England;Aalborg Univ, Dept Clin Med, Aalborg Thrombosis Res Unit, Aalborg, Denmark.
    Mahajan, Rajiv
    Univ Adelaide, Lyell McEwin Hosp, Royal Adelaide Hosp & SAHMRI, Adelaide, SA, Australia.
    Potpara, Tatjana
    Univ Belgrade, Sch Med, Cardiol Clin, Clin Ctr Serbia, Belgrade, Serbia.
    Ramirez, Juan David
    Clin CardioVid Medellin, Antioquia, Colombia.
    Vos, Marc A.
    Umc Utrecht, Utrecht, Netherlands.
    Marin, Francisco
    HU Virgen Arrixaca, Murcia, Spain.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Rinaldi, Aldo
    St Thomas Hosp, London, England.
    Bongiorni, Maria Grazia
    Santa Chiara Univ, Hosp Pisa, Pisa, Italy.
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Nielsen, Jens Cosedis
    Aarhus Univ Hosp, Aarhus, Denmark.
    Lewalter, Thorsten
    Peter Osypka Heart Ctr, Munich, Germany.
    Zhang, Shu
    Beijing Fuwai Hosp, Beijing, Peoples R China.
    Gutierrez, Oswaldo
    Hosp Clin Bblica, San Jose, Costa Rica.
    Fuenmayor, Abdel
    Univ Hosp Andes, Cardiovasc Res Inst, Elect & Arrhythmia Sect, Avenida 16 Septiembre, Merida 5101, Venezuela.
    European Heart Rhythm Association (EHRA) position paper on arrhythmia management and device therapies in endocrine disorders, endorsed by Asia Pacific Heart Rhythm Society (APHRS) and Latin American Heart Rhythm Society (LAHRS)2018In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 20, no 6, p. 895-+Article in journal (Refereed)
    Abstract [en]

    Endocrine disorders are associated with various tachyarrhythmias, including atrial fibrillation (AF), ventricular tachycardia (VT), ventricular fibrillation (VF), and bradyarrhythmias. Along with underlying arrhythmia substrate, electrolyte disturbances, glucose, and hormone levels, accompanying endocrine disorders contribute to development of arrhythmia. Arrhythmias may be life-threatening, facilitate cardiogenic shock development and increase mortality. The knowledge on the incidence of tachy-and bradyarrhythmias, clinical and prognostic significance as well as their management is limited; it is represented in observational studies and mostly in case reports on management of challenging cases. It should be also emphasized, that the topic is not covered in detail in current guidelines. Therefore, cardiologists and multidisciplinary teams participating in care of such patients do need the evidence-based, or in case of limited evidence expert-opinion based recommendations, how to treat arrhythmias using contemporary approaches, prevent their complications and recurrence in patients with endocrine disorders. In recognizing this close relationship between endocrine disorders and arrhythmias, the European Heart Rhythm Association (EHRA) convened a Task Force, with representation from Asia-Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE), with the remit of comprehensively reviewing the available evidence and publishing a joint consensus document on endocrine disorders and cardiac arrhythmias, and providing up-to-date consensus recommendations for use in clinical practice.

  • 50. Gorog, Diana A
    et al.
    Gue, Ying X
    Chao, Tze-Fan
    Fauchier, Laurent
    Ferreiro, Jose Luis
    Huber, Kurt
    Konstantinidis, Stavros V
    Lane, Deirdre A
    Marin, Francisco
    Oldgren, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Potpara, Tatjana
    Roldan, Vanessa
    Rubboli, Andrea
    Sibbing, Dirk
    Tse, Hung-Fat
    Vilahur, Gemma
    Lip, Gregory Y H
    Assessment and mitigation of bleeding risk in atrial fibrillation and venous thromboembolism: A Position Paper from the ESC Working Group on Thrombosis, in collaboration with the European Heart Rhythm Association, the Association for Acute CardioVascular Care and the Asia-Pacific Heart Rhythm Society2022In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 24, no 11, p. 1844-1871Article in journal (Refereed)
    Abstract [en]

    Whilst there is a clear clinical benefit of oral anticoagulation (OAC) in patients with atrial fibrillation (AF) and venous thromboembolism (VTE) in reducing the risks of thromboembolism, major bleeding events (especially intracranial bleeds) may still occur and be devastating. The decision to initiate and continue anticoagulation is often based on a careful assessment of both the thromboembolism and bleeding risk. The more common and validated bleeding risk factors have been used to formulate bleeding risk stratification scores, but thromboembolism and bleeding risk factors often overlap. Also, many factors that increase bleeding risk are transient and modifiable, such as variable international normalized ratio values, surgical procedures, vascular procedures, or drug-drug and food-drug interactions. Bleeding risk is also not a static 'one off' assessment based on baseline factors but is dynamic, being influenced by ageing, incident comorbidities, and drug therapies. In this Consensus Document, we comprehensively review the published evidence and propose a consensus on bleeding risk assessments in patients with AF and VTE, with the view to summarizing 'best practice' when approaching antithrombotic therapy in these patients. We address the epidemiology and size of the problem of bleeding risk in AF and VTE, review established bleeding risk factors, and summarize definitions of bleeding. Patient values and preferences, balancing the risk of bleeding against thromboembolism are reviewed, and the prognostic implications of bleeding are discussed. We propose consensus statements that may help to define evidence gaps and assist in everyday clinical practice.

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