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  • 1. 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.

  • 2.
    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. 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. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    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)2017In: Europace, ISSN 1099-5129, E-ISSN 1532-2092Article in journal (Refereed)
  • 3.
    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.

  • 4. 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.

  • 5. 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.

  • 6. 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.

  • 7. 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.

  • 8. 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)
  • 9. 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.

  • 10. 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)
  • 11. 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)
  • 12. 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.

  • 13. 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.

  • 14. 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.

  • 15. 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.

  • 16. 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.

  • 17. 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.

  • 18. 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.

  • 19. 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.

  • 20. 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)
  • 21.
    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.

  • 22. 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.

  • 23. 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.

  • 24. 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.

  • 25.
    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.

  • 26. 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.

  • 27. 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.

  • 28.
    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.

  • 29. 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.

  • 30. 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)
  • 31. Grazia Bongiorni, Maria
    et al.
    Dagres, Nikolaos
    Estner, Heidi
    Pison, Laurent
    Todd, Derick
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Management of malfunctioning and recalled pacemaker and defibrillator leads: results of the European Heart Rhythm Association survey2014In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 16, no 11, p. 1674-1678Article in journal (Refereed)
    Abstract [en]

    The aim of this survey was to describe the different strategies regarding the management of malfunctioning and recalled pacemaker and defibrillator leads across Europe. A questionnaire has been designed to assess the current practice and physician's approach to the management of leads which are faulty, unnecessary, and/or recalled. Responses to the questionnaire were received from 34 hospitals-members of the European Heart Rhythm Association (EHRA) electrophysiology (EP) research network. The survey involved both very high and low volume implanting centres, with 85% of the responding centres performing lead extraction. The survey provides a panoramic view of operator's decision making in the field of malfunctioning, recalled, and redundant leads and outlines a common point of view on lead abandonment and factors influencing the decision about lead extraction. The main factors strongly influencing the decision making were patient's age (59%), the presence of the damaged leads (44%), and the lead dwelling time (44%). Regarding the lead abandonment, the main concern (61%) was the potential greater difficulty associated with lead extraction in the future. High volume extracting centres showed a greater propensity to removing the malfunctioning or recalled leads compared with low volume or non-extracting centres. This EP Wire survey gives a snapshot of the operators' approaches and options regarding redundant, malfunctioning, and recalled lead management and may form the basis for future prospective research on this topic.

  • 32.
    Haugaa, Kristina H.
    et al.
    Natl Hosp Norway, Oslo Univ Hosp, Inst Surg Res, Dept Cardiol,Ctr Cardiol Innovat, Sognsvannsveien 20, N-0372 Oslo, Norway.;Univ Oslo, Inst Clin Med, POB 4950, N-0424 Oslo, Norway..
    Tilz, Roland
    Univ Hosp Schleswig Holstein, Univ Heart Ctr Lubeck, Med Clin Cardiol Angiol Intens Care Med 2, Lubeck, Germany..
    Boveda, Serge
    Clin Pasteur, Cardiac Arrhythmias Management Dept, Dept Cardiol, Toulouse, France..
    Dobreanu, Dan
    Univ Med & Pharm, Emergency Inst Cardiovasc Dis & Transplant, Cardiol Clin, Targu Mures, Romania..
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Mansourati, Jacques
    Univ Hosp Brest, Brest, France.;EA 4324 ORPHY UBO, Brest, France..
    Papiashvili, Giorgi
    Jo Ann Med Centre Tbilisi, 21 Ljubljana St, Tbilisi, Rep of Georgia..
    Dagres, Nikolaos
    Univ Leipzig, Dept Electrophysiol, Ctr Heart, Leipzig, Germany..
    Implantable cardioverter defibrillator use for primary prevention in ischaemic and non-ischaemic heart disease-indications in the post-DANISH trial era: results of the European Heart Rhythm Association survey2017In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 19, no 4, p. 660-664Article in journal (Refereed)
    Abstract [en]

    Implantable cardioverter-defibrillator (ICD) is the standard of care for prevention of sudden cardiac death (SCD) in high-risk patients. For primary prevention of SCD, in patients with ischaemic heart disease, there is more robust data on the effect of ICD therapy compared with patients with non-ischaemic heart disease, but current real-life practice may differ substantially. The aim of this European Heart Rhythm Association survey was to evaluate the clinical practice regarding implantation of ICD for primary prevention among European countries in patients with non-ischaemic and ischaemic heart disease. Furthermore, we wanted to investigate the impact of the results of the recently published DANISH trial on clinical practice among European countries. In total, 48 centres from 17 different countries responded to the questionnaire. The majority did not implant ICD for primary prevention on a regular basis in patients with non-ischaemic heart disease despite current guidelines. Also, centres have changed their indications after the recent report on the efficacy of ICD in these patients. In patients with ischaemic heart disease, the guidelines for primary prevention ICD were followed on a regular basis, and no relevant change in indications were reported.

  • 33.
    Haugaa, Kristina Hermann
    et al.
    Oslo Univ Hosp, Ctr Cardiol Innovat, Dept Cardiol, Rikshosp, Oslo, Norway.;Oslo Univ Hosp, Ctr Cardiol Innovat, Inst Surg Res, Rikshosp, Oslo, Norway.;Univ Oslo, Inst Clin Med, Oslo, Norway..
    Potpara, Tatjana S.
    Univ Belgrade, Sch Med, Belgrade, Serbia.;Univ Belgrade, Sch Med, Belgrade, Serbia.;Clin Ctr Serbia, Cardiol Clin, Belgrade, Serbia..
    Boveda, Serge
    Clin Pasteur, Div Cardiol, Cardiac Arrhythmias Management Dept, Toulouse, France..
    Deharo, Jean-Calude
    Hop Timone Adultes, Serv Cardiol, F-13385 Marseille 05, France..
    Chen, Jian
    Haukeland Hosp, Dept Heart Dis, N-5021 Bergen, Norway.;Univ Bergen, Dept Clin Sci, N-5021 Bergen, Norway..
    Dobreanu, Dan
    Univ Med & Pharm, Emergency Inst Cardiovasc Dis & Transplant, Cardiol Clin, Targu Mures, Romania..
    Fumagalli, Stefano
    Univ Florence, Expt & Clin Med Dept, Geriatr Cardiol & Med Div, Intens Care Unit, Florence, Italy.;AOU Careggi, Florence, Italy..
    Lenarczyk, Radoslaw
    Silesian Med Univ, Silesian Ctr Heart Dis, Dept Cardiol, Congenital Heart Dis & Electrotherapy, Zabrze, Poland..
    Hernandez Madrid, Antonio
    Alcala Univ, Ramon y Cajal Hosp, Cardiol Dept, Madrid 28034, Spain..
    Larsen, Torben Bjerregaard
    Aalborg Univ Hosp, Thrombosis & Drug Res Unit, Dept Cardiol, Aalborg, Denmark..
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Taborsky, Milos
    Palacky Univ, Dept Internal Med Cardiol 1, Olomouc, Czech Republic..
    Tilz, Roland Richard
    Univ Hosp Schleswig Holstein, Med Clin Cardiol Angiol Intens Care Med 2, Univ Heart Ctr Lubeck, Ratzeburger Allee 160, D-23538 Lubeck, Germany..
    Pieragnoli, Paolo
    Univ Florence, Unita Aritmol, Dipartimento Cardiotoracovasc, Florence, Italy..
    Przybylski, Andrzej
    KSW 2, Cardiol, Rzeszow, Poland.;Univ Rzeszow, Fac Med, Rzeszow, Poland..
    Dagres, Nikolaos
    Univ Leipzig, Dept Electrophysiol, Heart Ctr, D-04289 Leipzig, Germany..
    Patients' knowledge and attitudes regarding living with implantable electronic devices: results of a multicentre, multinational patient survey conducted by the European Heart Rhythm Association2018In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 20, no 2, p. 386-391Article in journal (Refereed)
    Abstract [en]

    The purpose of this patient survey was to analyse the knowledge, experiences, and attitudes regarding cardiac implantable electronic devices (CIED) in patients with pacemakers, implantable cardioverter-defibrillators (ICDs), or cardiac resynchronization devices. Of the 1644 patients with CIEDs from seven European countries, 88% were over 50 years of age. Most patients (90%) knew what device they were implanted with and felt sufficiently informed about the indications for therapy. As many as 42% of patients needed additional information on the battery replacement and limitations in physical activity. The self-reported incidence of complications was 9%, and among these, a quarter of the respondents felt insufficiently informed about the possibility of complications and their management. The majority of patients (83%) were followed by face-to-face visits, which was the most commonly preferred follow-up strategy by the patients. Nearly 75% of the patients reported improved quality of life after device implantation, but about 40% had worries about their device. Less than 20% had discussed with their physician or thought about device handling in the end-of-life circumstances or end-stage disease. Notably, almost 20% of the ICD patients did not wish to answer the question regarding what they wanted to be done with their ICD in case of end-stage disease, indicating the challenges in approaching these issues.

  • 34.
    Heidbuchel, Hein
    et al.
    Hasselt Univ, Dept Cardiol Arrhythmol, B-3500 Hasselt, Belgium.;Jessa Hosp, Ctr Heart, B-3500 Hasselt, Belgium..
    Verhamme, Peter
    Univ Leuven, Dept Cardiovasc Sci, Louvain, Belgium..
    Alings, Marco
    Amphia Ziekenhuis, Dept Cardiol, Breda, Netherlands..
    Antz, Matthias
    Klinikum Oldenburg, Dept Cardiol, Oldenburg, Germany..
    Diener, Hans-Christoph
    Univ Duisburg Essen, Univ Hosp Essen, Dept Neurol, Essen, Germany..
    Hacke, Werner
    Heidelberg Univ, Dept Neurol, Heidelberg, 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, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Sinnaeve, Peter
    Univ Leuven, Dept Cardiovasc Sci, Louvain, Belgium..
    Camm, A. John
    St Georges Univ, Clin Cardiol, London, England..
    Kirchhof, Paulus
    Univ Birmingham, Ctr Cardiovasc Sci, Birmingham, W Midlands, England.;Univ Munster, Dept Cardiol & Angiol, Munster, Germany..
    Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation2015In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 10, p. 1467-1507Article in journal (Refereed)
    Abstract [en]

    The current manuscript is an update of the original Practical Guide, published in June 2013[Heidbuchel H, Verhamme P, Alings M, Antz M, Hacke W, Oldgren J, et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with nonvalvular atrial fibrillation. Europace 2013; 15: 625-51; Heidbuchel H, Verhamme P, Alings M, Antz M, HackeW, Oldgren J, et al. EHRA practical guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation: executive summary. Eur Heart J 2013; 34: 2094-106]. Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with non-valvular atrial fibrillation (AF). Both physicians and patients have to learn how to use these drugs effectively and safely in clinical practice. Many unresolved questions on how to optimally use these drugs in specific clinical situations remain. The European Heart Rhythm Association set out to coordinate a unified way of informing physicians on the use of the different NOACs. A writing group defined what needs to be considered as 'non-valvular AF' and listed 15 topics of concrete clinical scenarios for which practical answers were formulated, based on available evidence. The 15 topics are (i) practical start-up and follow-up scheme for patients on NOACs; (ii) how to measure the anticoagulant effect of NOACs; (iii) drug-drug interactions and pharmacokinetics of NOACs; (iv) switching between anticoagulant regimens; (v) ensuring adherence of NOAC intake; (vi) how to deal with dosing errors; (vii) patients with chronic kidney disease; (viii) what to do if there is a (suspected) overdose without bleeding, or a clotting test is indicating a risk of bleeding?; (xi) management of bleeding complications; (x) patients undergoing a planned surgical intervention or ablation; (xi) patients undergoing an urgent surgical intervention; (xii) patients with AF and coronary artery disease; (xiii) cardioversion in a NOAC-treated patient; (xiv) patients presenting with acute stroke while onNOACs; and (xv) NOACs vs. VKAs in AF patients with a malignancy. Additional information and downloads of the text and anticoagulation cards in >16 languages can be found on an European Heart Rhythm Association web site (www.NOACforAF.eu).

  • 35. Heidbuchel, Hein
    et al.
    Verhamme, Peter
    Alings, Marco
    Antz, Matthias
    Hacke, Werner
    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.
    Sinnaeve, Peter
    Camm, A John
    Kirchhof, Paulus
    Author reply: To PMID 236259422014In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 16, no 1, p. 151-152Article in journal (Refereed)
  • 36. Heidbuchel, Hein
    et al.
    Verhamme, Peter
    Alings, Marco
    Antz, Matthias
    Hacke, Werner
    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.
    Sinnaeve, Peter
    Camm, A John
    Kirchhof, Paulus
    Authors' response: from monitoring to vigilance about patient adherence to new oral anticoagulants2014In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 16, no 1, p. 149-150Article in journal (Refereed)
  • 37. Heidbuchel, Hein
    et al.
    Verhamme, Peter
    Alings, Marco
    Antz, Matthias
    Hacke, Werner
    Oldgren, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Sinnaeve, Peter
    Camm, A. John
    Kirchhof, Paulus
    European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation2013In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 15, no 5, p. 625-651Article in journal (Refereed)
    Abstract [en]

    New oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with non-valvular atrial fibrillation (AF). Both physicians and patients will have to learn how to use these drugs effectively and safely in clinical practice. Many unresolved questions on how to optimally use these drugs in specific clinical situations remain. The European Heart Rhythm Association set out to coordinate a unified way of informing physicians on the use of the different NOACs. A writing group listed 15 topics of concrete clinical scenarios and formulated as practical answers as possible based on available evidence. The 15 topics are: (1) Practical start-up and follow-up scheme for patients on NOACs; (2) How to measure the anticoagulant effect of NOACs; (3) Drugdrug interactions and pharmacokinetics of NOACs; (4) Switching between anticoagulant regimens; (5) Ensuring compliance of NOAC intake; (6) How to deal with dosing errors; (7) Patients with chronic kidney disease; (8) What to do if there is a (suspected) overdose without bleeding, or a clotting test is indicating a risk of bleeding? (9) Management of bleeding complications; (10) Patients undergoing a planned surgical intervention or ablation; (11) Patients undergoing an urgent surgical intervention; (12) Patients with AF and coronary artery disease; (13) Cardioversion in a NOAC-treated patient; (14) Patients presenting with acute stroke while on NOACs; (15) NOACs vs. VKAs in AF patients with a malignancy. Since new information is becoming available at a rapid pace, an EHRA Web site with the latest updated information accompanies this text (www.NOACforAF.eu).

  • 38.
    Hernandez Madrid, Antonio
    et al.
    Alcala Univ, Hosp Ramon y Cajal, Dept Cardiol, Ctra Colmenar Viejo,Km 9,100, Madrid 28034, Spain..
    Potpara, Tatjana S.
    Univ Belgrade, Sch Med, Belgrade, Serbia.;Clin Ctr Serbia, Cardiol Clin, Belgrade, Serbia..
    Dagres, Nikolaos
    Univ Athens, Attikon Univ Hosp, Cardiol Dept 2, Athens, Greece..
    Chen, Jian
    Haukeland Hosp, Dept Heart Dis, Haukeland, Norway.;Univ Bergen, Dept Clin Sci, Bergen, Norway..
    Larsen, Torben B.
    Aalborg Univ Hosp, AF Study Grp, Dept Cardiol, Aalborg, Denmark..
    Estner, Heidi
    Univ Munich, Med Klin 1, Dept Cardiol, Campus Grosshadern, D-81377 Munich, Germany..
    Todd, Derick
    Manchester Heart Ctr, Manchester, Lancs, England..
    Bongiorni, Maria G.
    Univ Hosp Pisa, Cardiol Dept 2, Pisa, Italy..
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Proclemer, Alessandro
    IRCAB Fdn Udine, Univ Hosp S Maria Misericordia, Div Cardiol, Udine, Italy..
    Cheggour, Saida
    CH Avignon, Avignon, France..
    Amara, Walid
    Grp Hosp Le Raincy Montfermeil, Dept Cardiol, Montfermeil, France..
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Differences in attitude, education, and knowledge about oral anticoagulation therapy among patients with atrial fibrillation in Europe: result of a self-assessment patient survey conducted by the European Heart Rhythm Association2016In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 18, no 3, p. 463-467Article in journal (Refereed)
    Abstract [en]

    The purpose of this patient survey was to analyse the knowledge about blood thinning medications relative to gender, age, education, and region of residence in patients with atrial fibrillation (AF). A total of 1147 patients with AF [mean age 66 +/- 13 years, 529 (45%) women] from eight European countries responded to this survey. Most patients understood that the indication for anticoagulation therapy was to 'thin the blood', but 8.1% responded that the purpose of the medication was to treat the arrhythmia. Patients with college or university grades reported less frequent deviations from their target INR range compared with those without schooling (2.8% vs. 5.1%, P < 0.05). The awareness of anticoagulation-related risk of bleedings was lowest in patients without schooling (38.5%) and highest in those with college and university education (57.0%), P < 0.05. The same pattern was also observed regarding patient's awareness of non-vitamin K antagonist oral anticoagulants (NOACs): 56.5% of the patients with university education and only 20.5% of those without schooling (P < 0.05) knew about NOACs, indicating that information about new anticoagulation therapies remains well below the target. Bleeding events were statistically less frequent in patients on NOACs compared with vitamin K antagonists. The education level and patients' knowledge have a direct influence on the global management of the anticoagulation.

  • 39. Hernandez-Madrid, Antonio
    et al.
    Chen, Jian
    Potpara, Tatjana
    Pison, Laurent
    Bjerregaard Larsen, Torben
    Estner, Heidi L
    Todd, Derick
    Grazia Bongiorni, Maria
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Management of paediatric arrhythmias in Europe: authors' reply.2015In: Europace, ISSN 1099-5129, E-ISSN 1532-2092Article in journal (Refereed)
  • 40. Hernandez-Madrid, Antonio
    et al.
    Hocini, Meleze
    Chen, Jian
    Potpara, Tatjana
    Pison, Laurent
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    How are arrhythmias managed in the paediatric population in Europe?: Results of the European Heart Rhythm survey2014In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 16, no 12, p. 1852-1856Article in journal (Refereed)
    Abstract [en]

    The aim of this survey was to provide insight into current practice regarding the management of paediatric arrhythmias in Europe. The survey was based on a questionnaire sent via the Internet to the European Heart Rhythm Association (EHRA) electrophysiology research network centres. The following topics were explored: patient and treatment selection, techniques and equipment, treatment outcomes and complications. The vast majority of paediatric arrhythmias concerns children older than 1 year and patients with grown-up congenital heart disease. In 65% of the hospitals there is a specialized paediatric centre, and the most commonly observed arrhythmias include Wolff-Parkinson-White syndrome and atrioventricular nodal re-entry tachycardias (90.24%). The medical staff performing paediatric catheter ablations in Europe are mainly adult electrophysiology teams (82.05% of the centres). Radiofrequency is the preferred energy source used for paediatric arrhythmia ablation. Catheter ablation is only chosen if two or more antiarrhythmic drugs have failed (94.59% of the centres). The majority of the centres use flecainide (37.8%) or atenolol (32.4%) as their first choice drug for prevention of recurrent supraventricular arrhythmias. While none of the centres performed catheter ablation in asymptomatic infants with pre-excitation, 29.7% recommend ablation in asymptomatic children and adolescents. The preferred choice for pacemaker leads in infants less than 1 year old is implantation of epicardial leads in 97.3% of the centres, which continues to be the routine even in patients between 1 and 5 years of age as reported by 75.68% of the hospitals. Almost all centres (94.59%) report equally small number of complications of catheter ablation in children (aged 1-14 years) as observed in adults.

  • 41. Hernández-Madrid, A
    et al.
    Lewalter, T
    Proclemer, A
    Pison, L
    Lip, GY
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Remote monitoring of cardiac implantable electronic devices in Europe: results of the European Heart Rhythm Association survey2014In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 16, no 1, p. 129-132Article in journal (Refereed)
    Abstract [en]

    The aim of this European Heart Rhythm Association survey was to provide an insight into the current use of remote monitoring for cardiac implantable electronic devices in Europe. The following topics were explored: use of remote monitoring, infrastructure and organization, patient selection and benefits. Centres using remote monitoring reported performing face-to-face visits less frequently. In many centres (56.9%), a nurse reviews all the data and forwards them to the responsible physician. The majority of the centres (91.4%) stated that remote monitoring is best used in patients with implantable cardioverter-defibrillators and those live far from the hospital (76.6% top benefit). Supraventricular and ventricular arrhythmias were reported to be the major events detected earlier by remote monitoring. Remote monitoring will have a significant impact on device management.

  • 42. Hernández-Madrid, Antonio
    et al.
    Svendsen, Jesper Hastrup
    Lip, Gregory Y H
    Van Gelder, Isabelle C
    Dobreanu, Dan
    Blomstrom-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Cardioversion for atrial fibrillation in current European practice: results of the European Heart Rhythm Association survey2013In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 15, no 6, p. 915-918Article in journal (Refereed)
    Abstract [en]

    This survey was conducted to provide an insight into the current clinical practice regarding the use of cardioversion for atrial fibrillation (AF) in Europe. Responses were received from 57 centres across Europe, 71.9% of which were university hospitals. For electrical cardioversion, general anaesthesia was managed by an anaesthesiologist in 73.9% of centres and by a cardiologist in 37%. In the majority of centres, electrical cardioversion was performed using a biphasic defibrillator (85.1%). Antiarrhythmic drugs were routinely prescribed prior to electrical cardioversion by 54.3% of hospitals. For pharmacological cardioversion in patients with no or minimal heart disease, the majority of centres (63.1%) chose intravenous flecainide or propafenone, whereas vernakalant was used by 35% of centres in patients with no or minimal-to-moderate structural heart disease. Most centres (71.7%) used a mandatory strategy of 3 weeks of oral anticoagulation prior to elective cardioversion in patients AF > 48 h, but 28.3% performed immediate cardioversion after a transoesophageal echocardiogram. Many centres are now performing electrical cardioversion on treatment with novel oral anticoagulants (up to 23.6% of cardioversions).

  • 43. Hocini, Meleze
    et al.
    Pison, Laurent
    Proclemer, Alessandro
    Larsen, Torben Bjerregaard
    Madrid, Antonio
    Blomstrom-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Diagnosis and management of patients with inherited arrhythmia syndromes in Europe: results of the European Heart Rhythm Association Survey2014In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 16, no 4, p. 600-603Article in journal (Refereed)
    Abstract [en]

    Inherited arrhythmia disorders associated with structurally normal heart (i.e. long and short QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, early repolarization syndrome, idiopathic ventricular fibrillation) cause 10 of 1.1 million sudden deaths in Europe and the USA. The purpose of this European Heart Rhythm Association (EHRA) electrophysiology wire survey was to assess the European clinical practice adopted for the diagnosis and management of these disorders. The survey was based on an electronic questionnaire sent out to the EHRA Research Network centres. Responses were received from 50 centres in 23 countries. The results of the survey show that inherited arrhythmia syndromes have a relatively low burden and are diagnosed and managed in accordance with the current guidelines. However, more than 50 of centres do not participate in any existing registry underlining the need for establishing a pan-European registry of these disorders.

  • 44. Katritsis, Demosthenes G
    et al.
    Boriani, Giuseppe
    Cosio, Francisco G
    Hindricks, Gerhard
    Jaïs, Pierre
    Josephson, Mark E
    Keegan, Roberto
    Kim, Young-Hoon
    Knight, Bradley P
    Kuck, Karl-Heinz
    Lane, Deirdre A
    Lip, Gregory Y H
    Malmborg, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Oral, Hakan
    Pappone, Carlo
    Themistoclakis, Sakis
    Wood, Kathryn A
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Gorenek, Bulent
    Dagres, Nikolaos
    Dan, Gheorge-Andrei
    Vos, Marc A
    Kudaiberdieva, Gulmira
    Crijns, Harry
    Roberts-Thomson, Kurt
    Lin, Yenn-Jiang
    Vanegas, Diego
    Caorsi, Walter Reyes
    Cronin, Edmond
    Rickard, Jack
    European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE)2017In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 19, no 3, p. 465-511Article in journal (Refereed)
  • 45. Kirchhof, Paulus
    et al.
    Bax, Jeroen
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine.
    Calkins, Hugh
    Camm, A. John
    Cappato, Ricardo
    Cosio, Francisco
    Crijns, Harry
    Diener, Hans-Christian
    Goette, Andreas
    Israel, Carsten W.
    Kuck, Karl-Heinz
    Lip, Gregory Y. H.
    Nattel, Stanley
    Page, Richard L.
    Ravens, Ursula
    Schotten, Ulrich
    Steinbeck, Gerhard
    Vardas, Panos
    Waldo, Albert
    Wegscheider, Karl
    Willems, Stephan
    Breithardt, Günter
    Early and comprehensive management of atrial fibrillation: proceedings from the 2nd AFNET/EHRA consensus conference on atrial fibrillation entitled 'research perspectives in atrial fibrillation'2009In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 11, no 7, p. 860-885Article in journal (Refereed)
  • 46. Kirchhof, Paulus
    et al.
    Breithardt, Guenter
    Aliot, Etienne
    Al Khatib, Sana
    Apostolakis, Stavros
    Auricchio, Angelo
    Bailleul, Christophe
    Bax, Jeroen
    Benninger, Gerlinde
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Boersma, Lucas
    Boriani, Giuseppe
    Brandes, Axel
    Brown, Helen
    Brueckmann, Martina
    Calkins, Hugh
    Casadei, Barbara
    Clemens, Andreas
    Crijns, Harry
    Derwand, Roland
    Dobrev, Dobromir
    Ezekowitz, Michael
    Fetsch, Thomas
    Gerth, Andrea
    Gillis, Anne
    Gulizia, Michele
    Hack, Guido
    Haegeli, Laurent
    Hatem, Stephane
    Haeusler, Karl Georg
    Heidbuechel, Hein
    Hernandez-Brichis, Jessica
    Jais, Pierre
    Kappenberger, Lukas
    Kautzner, Joseph
    Kim, Steven
    Kuck, Karl-Heinz
    Lane, Deirdre
    Leute, Angelika
    Lewalter, Thorsten
    Meyer, Ralf
    Mont, Lluis
    Moses, Gregory
    Mueller, Markus
    Muenzel, Felix
    Naebauer, Michael
    Nielsen, Jens Cosedis
    Oeff, Michael
    Oto, Ali
    Pieske, Burkert
    Pisters, Ron
    Potpara, Tatjana
    Rasmussen, Lars
    Ravens, Ursula
    Reiffel, James
    Richard-Lordereau, Isabelle
    Schaefer, Herbert
    Schotten, Ulrich
    Stegink, Wim
    Stein, Kenneth
    Steinbeck, Gerhard
    Szumowski, Lukasz
    Tavazzi, Luigi
    Themistoclakis, Sakis
    Thomitzek, Karen
    Van Gelder, Isabelle C.
    von Stritzky, Berndt
    Vincent, Alphons
    Werring, David
    Willems, Stephan
    Lip, Gregory Y. H.
    Camm, A. John
    Personalized management of atrial fibrillation: Proceedings from the fourth Atrial Fibrillation competence NETwork/European Heart Rhythm Association consensus conference2013In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 15, no 11, p. 1540-1556Article in journal (Refereed)
    Abstract [en]

    The management of atrial fibrillation (AF) has seen marked changes in past years, with the introduction of new oral anticoagulants, new antiarrhythmic drugs, and the emergence of catheter ablation as a common intervention for rhythm control. Furthermore, new technologies enhance our ability to detect AF. Most clinical management decisions in AF patients can be based on validated parameters that encompass type of presentation, clinical factors, electrocardiogram analysis, and cardiac imaging. Despite these advances, patients with AF are still at increased risk for death, stroke, heart failure, and hospitalizations. During the fourth Atrial Fibrillation competence NETwork/European Heart Rhythm Association (AFNET/EHRA) consensus conference, we identified the following opportunities to personalize management of AF in a better manner with a view to improve outcomes by integrating atrial morphology and damage, brain imaging, information on genetic predisposition, systemic or local inflammation, and markers for cardiac strain. Each of these promising avenues requires validation in the context of existing risk factors in patients. More importantly, a new taxonomy of AF may be needed based on the pathophysiological type of AF to allow personalized management of AF to come to full fruition. Continued translational research efforts are needed to personalize management of this prevalent disease in a better manner. All the efforts are expected to improve the management of patients with AF based on personalized therapy.

  • 47.
    Kirchhof, Paulus
    et al.
    Univ Birmingham, Birmingham, W Midlands, England.;Univ Hosp Munster, Dept Cardiovasc Med, Munster, Germany.;Atrial Fibrillat Network AFNET, Munster, Germany..
    Breithardt, Guenter
    Univ Hosp Munster, Dept Cardiovasc Med, Munster, Germany.;Atrial Fibrillat Network AFNET, Munster, Germany..
    Bax, Jeroen
    Leiden Univ, Med Ctr, Leiden, Netherlands..
    Benninger, Gerlinde
    Atrial Fibrillat Network AFNET, Munster, Germany..
    Blomstrom-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Boriani, Giuseppe
    Univ Bologna, DIMES Dept, Bologna, Italy..
    Brandes, Axel
    Odense Univ Hosp, DK-5000 Odense, Denmark..
    Brown, Helen
    Meda Pharma SAS, Paris, France..
    Brueckmann, Martina
    Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany.;Heidelberg Univ, Fac Med Mannheim, Mannheim, Germany..
    Calkins, Hugh
    Johns Hopkins Univ Hosp, Baltimore, MD 21287 USA..
    Calvert, Melanie
    Christoffels, Vincent
    Univ Amsterdam, Amsterdam, Netherlands..
    Crijns, Harry
    Univ Hosp Maastricht, Maastricht, Netherlands..
    Dobrev, Dobromir
    Univ Duisburg Essen, Essen, Germany..
    Ellinor, Patrick
    Harvard Univ, Boston, MA 02115 USA..
    Fabritz, Larissa
    Univ Birmingham, Birmingham, W Midlands, England.;Univ Hosp Munster, Dept Cardiovasc Med, Munster, Germany..
    Fetsch, Thomas
    CRI, Munich, Germany..
    Freedman, S. Ben
    Univ Sydney, Sydney, NSW 2006, Australia..
    Gerth, Andrea
    Atrial Fibrillat Network AFNET, Munster, Germany.;Univ Munich, Munich, Germany..
    Goette, Andreas
    Atrial Fibrillat Network AFNET, Munster, Germany.;St Vincenz Hosp, Paderborn, Germany..
    Guasch, Eduard
    Univ Barcelona, Hosp Clin, Barcelona, Catalonia, Spain..
    Hack, Guido
    Bristol Myers Squibb GmbH & Co KGaA, Munich, Germany..
    Haegeli, Laurent
    Univ Zurich Hosp, CH-8091 Zurich, Switzerland..
    Hatem, Stephane
    INSERM, Inst Cardiometab & Nutr, UMR S 1166, Paris, France..
    Haeusler, Karl Georg
    Atrial Fibrillat Network AFNET, Munster, Germany.;Charite, D-13353 Berlin, Germany..
    Heidbuechel, Hein
    Hasselt Univ & Heart Ctr, Hasselt, Belgium..
    Heinrich-Nols, Jutta
    Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany..
    Hidden-Lucet, Francoise
    Hop La Pitie Salpetriere, AP HP, Paris, France..
    Hindricks, Gerd
    Univ Hosp Leipzig, Leipzig, Germany..
    Juul-Moeller, Steen
    Cardiome Pharma Corp, Vancouver, BC, Canada..
    Kaeaeb, Stefan
    Univ Munich, Munich, Germany.;DZHK German Ctr Cardiovasc Re, Munich Heart Alliance, Munich, Germany..
    Kappenberger, Lukas
    Univ Lausanne, Lausanne, Switzerland..
    Kespohl, Stefanie
    Bayer HealthCare, Berlin, Germany..
    Kotecha, Dipak
    Univ Birmingham, Birmingham, W Midlands, England..
    Lane, Deirdre A.
    Univ Birmingham, Birmingham, W Midlands, England..
    Leute, Angelika
    Atrial Fibrillat Network AFNET, Munster, Germany..
    Lewalter, Thorsten
    Atrial Fibrillat Network AFNET, Munster, Germany.;Isarclin Munich, Isar Heart Ctr, Munich, Germany..
    Meyer, Ralf
    Medtron Int Trading Sarl, Tolochenaz, Switzerland..
    Mont, Lluis
    Univ Barcelona, Hosp Clin, Barcelona, Catalonia, Spain..
    Muenzel, Felix
    Daiichi Sankyo Europe GmbH, Munich, Germany..
    Nabauer, Michael
    Atrial Fibrillat Network AFNET, Munster, Germany.;Univ Munich, Munich, Germany..
    Nielsen, Jens C.
    Aarhus Univ Hosp, DK-8000 Aarhus, Denmark..
    Oeff, Michael
    Atrial Fibrillat Network AFNET, Munster, Germany.;Stadt Klinikum Brandenburg, Brandenburg, Germany..
    Oldgren, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Oto, Ali
    Mem Ankara Hosp, Dept Cardiol, Ankara, Turkey..
    Piccini, Jonathan P.
    Duke Univ, Med Ctr, Durham, NC USA..
    Pilmeyer, Art
    Boston Sci, St Paul, MN USA..
    Potpara, Tatjana
    Univ Belgrade, Sch Med, Clin Ctr Serbia, Belgrade, Serbia..
    Ravens, Ursula
    Atrial Fibrillat Network AFNET, Munster, Germany.;Tech Univ Dresden, Dresden, Germany..
    Reinecke, Holger
    Univ Hosp Munster, Dept Cardiovasc Med, Munster, Germany..
    Rostock, Thomas
    Atrial Fibrillat Network AFNET, Munster, Germany.;Univ Med Mainz, Mainz, Germany..
    Rustige, Joerg
    Cardiome Pharma Corp, Vancouver, BC, Canada..
    Savelieva, Irene
    Univ London St Georges Hosp, Sch Med, London SW17 0RE, England..
    Schnabel, Renate
    Univ Heart Ctr Hamburg, Hamburg, Germany..
    Schotten, Ulrich
    Atrial Fibrillat Network AFNET, Munster, Germany.;Univ Hosp Maastricht, Maastricht, Netherlands..
    Schwichtenberg, Lars
    Bayer HealthCare, Berlin, Germany..
    Sinner, Moritz F.
    Univ Munich, Munich, Germany..
    Steinbeck, Gerhard
    Atrial Fibrillat Network AFNET, Munster, Germany.;Zentrum Kardiol Klinikum Starnberg, Starnberg, Germany..
    Stoll, Monika
    Univ Munster, Inst Human Genet, Genet Epidemiol, Munster, Germany.;Maastricht Univ, CARIM Res Sch Cardiovasc Dis, NL-6200 MD Maastricht, Netherlands..
    Tavazzi, Luigi
    Ettore Sansavini Hlth Sci Fdn, Cotignola, Italy..
    Themistoclakis, Sakis
    Osped DellAngelo, Mestre Venice, Italy..
    Tse, Hung Fat
    Univ Hong Kong, Hong Kong, Hong Kong, Peoples R China..
    Van Gelder, Isabelle C.
    Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands..
    Vardas, Panagiotis E.
    Herakl Univ Hosp, Iraklion, Crete, Greece..
    Varpula, Timo
    VTT Tech Res Ctr, Espoo, Finland..
    Vincent, Alphons
    Medtron Int Trading Sarl, Tolochenaz, Switzerland..
    Werring, David
    UCL, Inst Neurol, Dept Brain Repair & Rehabil, Stroke Res Grp, London, England.;Natl Hosp Neurol & Neurosurg, London, England..
    Willems, Stephan
    Univ Heart Ctr Hamburg, Hamburg, Germany..
    Ziegler, Andre
    Roche Diagnost Int Ltd, Rotkreuz, Switzerland..
    Lip, Gregory Y. H.
    Univ Birmingham, Birmingham, W Midlands, England..
    Camm, A. John
    Univ London St Georges Hosp, Sch Med, London SW17 0RE, England..
    A roadmap to improve the quality of atrial fibrillation management: proceedings from the fifth Atrial Fibrillation Network/European Heart Rhythm Association consensus conference2016In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 18, no 1, p. 37-50Article in journal (Refereed)
    Abstract [en]

    At least 30 million people worldwide carry a diagnosis of atrial fibrillation (AF), and many more suffer from undiagnosed, subclinical, or 'silent' AF. Atrial fibrillation-related cardiovascular mortality and morbidity, including cardiovascular deaths, heart failure, stroke, and hospitalizations, remain unacceptably high, even when evidence-based therapies such as anticoagulation and rate control are used. Furthermore, it is still necessary to define how best to prevent AF, largely due to a lack of clinical measures that would allow identification of treatable causes of AF in any given patient. Hence, there are important unmet clinical and research needs in the evaluation and management of AF patients. The ensuing needs and opportunities for improving the quality of AF care were discussed during the fifth Atrial Fibrillation Network/European Heart Rhythm Association consensus conference in Nice, France, on 22 and 23 January 2015. Here, we report the outcome of this conference, with a focus on (i) learning from our 'neighbours' to improve AF care, (ii) patient-centred approaches to AF management, (iii) structured care of AF patients, (iv) improving the quality of AF treatment, and (v) personalization of AF management. This report ends with a list of priorities for research in AF patients.

  • 48. Kirchhof, Paulus
    et al.
    Lip, Gregory Y H
    Van Gelder, Isabelle C
    Bax, Jeroen
    Hylek, Elaine
    Kaab, Stefan
    Schotten, Ulrich
    Wegscheider, Karl
    Boriani, Giuseppe
    Brandes, Axel
    Ezekowitz, Michael
    Diener, Hans
    Haegeli, Laurent
    Heidbuchel, Hein
    Lane, Deirdre
    Mont, Luis
    Willems, Stephan
    Dorian, Paul
    Aunes-Jansson, Maria
    Blomstrom-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Borentain, Maria
    Breitenstein, Stefanie
    Brueckmann, Martina
    Cater, Nilo
    Clemens, Andreas
    Dobrev, Dobromir
    Dubner, Sergio
    Edvardsson, Nils G
    Friberg, Leif
    Goette, Andreas
    Gulizia, Michele
    Hatala, Robert
    Horwood, Jenny
    Szumowski, Lukas
    Kappenberger, Lukas
    Kautzner, Josef
    Leute, Angelika
    Lobban, Trudie
    Meyer, Ralf
    Millerhagen, Jay
    Morgan, John
    Muenzel, Felix
    Nabauer, Michael
    Baertels, Christoph
    Oeff, Michael
    Paar, Dieter
    Polifka, Juergen
    Ravens, Ursula
    Rosin, Ludger
    Stegink, W
    Steinbeck, Gerhard
    Vardas, Panos
    Vincent, Alphons
    Walter, Maureen
    Breithardt, Günter
    Camm, A John
    Comprehensive risk reduction in patients with atrial fibrillation: emerging diagnostic and therapeutic options - a report from the 3rd Atrial Fibrillation Competence NETwork/European Heart Rhythm Association consensus conference2012In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 14, no 1, p. 8-27Article, review/survey (Refereed)
    Abstract [en]

    While management of atrial fibrillation (AF) patients is improved by guideline-conform application of anticoagulant therapy, rate control, rhythm control, and therapy of accompanying heart disease, the morbidity and mortality associated with AF remain unacceptably high. This paper describes the proceedings of the 3rd Atrial Fibrillation NETwork (AFNET)/European Heart Rhythm Association (EHRA) consensus conference that convened over 60 scientists and representatives from industry to jointly discuss emerging therapeutic and diagnostic improvements to achieve better management of AF patients. The paper covers four chapters: (i) risk factors and risk markers for AF; (ii) pathophysiological classification of AF; (iii) relevance of monitored AF duration for AF-related outcomes; and (iv) perspectives and needs for implementing better antithrombotic therapy. Relevant published literature for each section is covered, and suggestions for the improvement of management in each area are put forward. Combined, the propositions formulate a perspective to implement comprehensive management in AF.

  • 49.
    Kotecha, Dipak
    et al.
    University of Birmingham, Birmingham, UK.
    Breithardt, Günter
    University Hospital Münster, Münster, Germany.
    Camm, A John
    St George's University of London, London, UK.
    Lip, Gregory Y H
    Schotten, Ulrich
    School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
    Ahlsson, Anders
    Örebro University Hospital, Örebro, Sweden.
    Arnar, David
    The National University Hospital, Reykjavik, Iceland.
    Atar, Dan
    Oslo University Hospital, Oslo, Norway.
    Auricchio, Angelo
    Fondazione Cardiocentro Ticino, Lugano, Switzerland.
    Bax, Jeroen
    Leiden University Medical Center, Leiden, The Netherlands.
    Benussi, Stefano
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Borggrefe, Martin
    Boriani, Giuseppe
    Brandes, Axel
    Odense University Hospital, Odense, Denmark.
    Calkins, Hugh
    Casadei, Barbara
    Castellá, Manuel
    Universitat de Barcelona, Barcelona, Spain.
    Chua, Winnie
    Crijns, Harry
    Dobrev, Dobromir
    Fabritz, Larissa
    Feuring, Martin
    Freedman, Ben
    Gerth, Andrea
    Goette, Andreas
    Guasch, Eduard
    Haase, Doreen
    Hatem, Stephane
    Haeusler, Karl Georg
    Charité—Universitätsmedizin Berlin, Berlin, Germany.
    Heidbuchel, Hein
    Hendriks, Jeroen
    Hunter, Craig
    Kääb, Stefan
    Kespohl, Stefanie
    Landmesser, Ulf
    Lane, Deirdre A
    Lewalter, Thorsten
    Mont, Lluís
    Nabauer, Michael
    Nielsen, Jens C
    Oeff, Michael
    Oldgren, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Oto, Ali
    Pison, Laurent
    Potpara, Tatjana
    School of Medicine, University of Belgrade, Clinical Centre of Serbia, Belgrade, Serbia.
    Ravens, Ursula
    Richard-Lordereau, Isabelle
    Rienstra, Michiel
    Savelieva, Irina
    Schnabel, Renate
    Sinner, Moritz F
    Sommer, Philipp
    Themistoclakis, Sakis
    Van Gelder, Isabelle C
    Vardas, Panagiotis E
    Heraklion University Hospital, Heraklion, Crete, Greece.
    Verma, Atul
    Wakili, Reza
    Weber, Evelyn
    Werring, David
    Willems, Stephan
    Ziegler, André
    Hindricks, Gerhard
    Kirchhof, Paulus
    Integrating new approaches to atrial fibrillation management: the 6th AFNET/EHRA Consensus Conference.2018In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 20, no 3, p. 395-407Article in journal (Refereed)
    Abstract [en]

    There are major challenges ahead for clinicians treating patients with atrial fibrillation (AF). The population with AF is expected to expand considerably and yet, apart from anticoagulation, therapies used in AF have not been shown to consistently impact on mortality or reduce adverse cardiovascular events. New approaches to AF management, including the use of novel technologies and structured, integrated care, have the potential to enhance clinical phenotyping or result in better treatment selection and stratified therapy. Here, we report the outcomes of the 6th Consensus Conference of the Atrial Fibrillation Network (AFNET) and the European Heart Rhythm Association (EHRA), held at the European Society of Cardiology Heart House in Sophia Antipolis, France, 17-19 January 2017. Sixty-two global specialists in AF and 13 industry partners met to develop innovative solutions based on new approaches to screening and diagnosis, enhancing integration of AF care, developing clinical pathways for treating complex patients, improving stroke prevention strategies, and better patient selection for heart rate and rhythm control. Ultimately, these approaches can lead to better outcomes for patients with AF.

  • 50. Lane, Deirdre A
    et al.
    Aguinaga, Luis
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Boriani, Giuseppe
    Dan, Gheorge-Andrei
    Hills, Mellanie True
    Hylek, Elaine M
    LaHaye, Stephen A
    Lip, Gregory Y H
    Lobban, Trudie
    Mandrola, John
    McCabe, Pamela J
    Pedersen, Susanne S
    Pisters, Ron
    Stewart, Simon
    Wood, Kathryn
    Potpara, Tatjana S
    Gorenek, Bulent
    Conti, Jamie Beth
    Keegan, Roberto
    Power, Suzannah
    Hendriks, Jeroen
    Ritter, Philippe
    Calkins, Hugh
    Violi, Francesco
    Hurwitz, Jodie
    Cardiac tachyarrhythmias and patient values and preferences for their management: the European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE).2015In: Europace, ISSN 1099-5129, E-ISSN 1532-2092Article in journal (Refereed)
    Abstract [en]

    Cardiac tachyarrhythmias are recurrent or chronic and in some cases life-threatening conditions. Heart rhythm disturbances are often highly symptomatic and the psychological impact of the disease can be significant. Patients' beliefs and knowledge about their health (and illness), medications, and healthcare they receive are important determinants of whether or not they accept recommended treatments; influence their coping responses to their illness and treatment; adherence to recommended therapy; and ultimately affects health outcomes. Incorporation of patients' values and preferences for therapy should now be considered as an integral part of the decision-making process and treatment strategy.

    It is important to acknowledge and understand the impact of cardiac tachyarrhythmias on the patient. To address this issue, a Task Force was convened by the European Heart Rhythm Association (EHRA), and endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE), with the remit to comprehensively review the published evidence available, to publish a joint consensus document on patient values and preferences for the management of cardiac tachyarrhythmias, and to provide up-to-date consensus recommendations for use in clinical practice.

    Hence this unique consensus document focuses on patients, summarizing the available literature on patients' experiences of living with various cardiac tachyarrhythmias and their treatment preferences, and identifies gaps in knowledge which will help to inform clinical practice and future research. The document will also summarize key points for discussions with patients during consultations regarding their condition, treatment options, disease trajectory, treatment goals, and outcomes. Finally, this document provides links to useful resources and patient advocacy groups and organizations and professional societies relevant to each group of cardiac tachyarrhythmias.

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