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  • 1. Aganauskiene, J
    et al.
    Sornmo, L
    Atarius, R
    Blomstrom-Lundqvist, C
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Reproducibility of the signal-averaged electrocardiogram using individual lead analysis.1995In: European Heart Journal, Vol. 16, p. 1244-Article in journal (Refereed)
  • 2. Ahmed, Fozia Z.
    et al.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Bloom, Heather
    Cooper, Christopher
    Ellis, Christopher
    Goette, Andreas
    Greenspon, Arnold J.
    Love, Charles J.
    Johansen, Jens Brock
    Philippon, Francois
    Tarakji, Khaldoun G.
    Holbrook, Reece
    Sherfesee, Lou
    Xia, Ying
    Seshadri, Swathi
    Lexcen, Daniel R.
    Krahn, Andrew D.
    Use of healthcare claims to validate the Prevention of Arrhythmia Device Infection Trial cardiac implantable electronic device infection risk score2021In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 23, no 9, p. 1446-1455Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

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

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  • 4. 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.

  • 5. Andersson, B
    et al.
    Blomström-Lundqvist, C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Hedner, T
    Waagstein, F
    Exercise hemodynamics and myocardial metabolism during long-term beta-adrenergic blockade in severe heart failure1991In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 18, no 4, p. 1059-1066Article in journal (Refereed)
    Abstract [en]

    Hemodynamics and myocardial metabolism at rest and during exercise were investigated in 21 patients with heart failure. The patients were evaluated before and after long-term treatment (14 +/- 7 months) with the beta-adrenergic blocking agent metoprolol. Clinical improvement with increased functional capacity occurred during treatment. Maximal work load increased by 25% (104 to 130 W; p less than 0.001). Hemodynamic data showed an increased cardiac index (3.8 to 4.6 liters/min per m2; p less than 0.02) during exercise. Pulmonary capillary wedge pressure decreased at rest (20 to 13 mm Hg; p less than 0.01) and during exercise (32 to 28 mm Hg; p = NS). Stroke volume index (30 to 39 g.m/m2; p less than 0.006) and stroke work index (28 to 46 g.m/m2; p less than 0.006) increased during exercise and long-term metoprolol treatment. The arterial norepinephrine concentration decreased at rest (3.72 to 2.19 nmol/liter; p less than 0.02) but not during exercise (13.2 to 11.1 nmol/liter; p = NS). The arterial-coronary sinus norepinephrine difference suggested a decrease in myocardial spillover during metoprolol treatment (-0.28 to -0.13 nmol/liter; p = NS at rest and -1.13 to -0.27 nmol/liter; p less than 0.05 during exercise). Coronary sinus blood flow was unchanged during treatment. Four patients produced myocardial lactate before the study, but none produced lactate after beta-blockade (p less than 0.05). There was no obvious improvement in a subgroup of patients with ischemic cardiomyopathy. In summary, there were signs of increased myocardial work load without higher metabolic costs after treatment with metoprolol.

  • 6.
    Anselmino, Matteo
    et al.
    Univ Turin, Citta Salute & Sci TorinoHosp, Dept Med Sci, Div Cardiol, Turin, Italy..
    Ballatore, Andrea
    Univ Turin, Citta Salute & Sci TorinoHosp, Dept Med Sci, Div Cardiol, Turin, Italy..
    Saglietto, Andrea
    Univ Turin, Citta Salute & Sci TorinoHosp, Dept Med Sci, Div Cardiol, Turin, Italy..
    Stabile, Giuseppe
    Clin Montevergine, Mercogliano, Italy..
    De Ponti, Roberto
    Casa Cura San Michele, Maddaloni, Italy.;Univ Insubria, Dept Heart & Vessels, Osped Circolo, Varese, Italy..
    Grimaldi, Massimo
    Osped Gen Reg F Muilli, Dept Cardiol, Acquaviva Delle Fonti, Italy..
    Agricola, Pietro M. G.
    Casa Cura Privata Piacenza, Unita Operat Cardiol, Piacenza, Italy..
    Della Bella, Paolo
    Ist Sci San Raffaele, Electrophysiol Lab, Milan, Italy.;Ist Sci San Raffaele, Arrhythmia Unit, Milan, Italy..
    Tritto, Massimo
    Ist Clin Humanitas Mater Domini, Castellanza, Italy..
    Pappone, Carlo
    IRCCS Policlin San Donato, Arrhythmol Dept, Milan, Italy..
    Calo, Leonardo
    Policlin Casilino, Div Cardiol, Rome, Italy..
    Bongiorni, Maria G.
    Univ Hosp Pisa, CardioThorac & Vasc Dept, Div Cardiol & Arrhythmol, Pisa, Italy..
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Gaita, Fiorenzo
    Clin Pinna Pintor, Cardiol Dept, I-10129 Turin, Italy..
    De Ferrari, Gaetano M.
    Univ Turin, Citta Salute & Sci TorinoHosp, Dept Med Sci, Div Cardiol, Turin, Italy..
    Atrial fibrillation ablation long-term ESC-EHRA EORP AFA LT registry: in-hospital and 1-year follow-up findings in Italy2020In: Journal of Cardiovascular Medicine, ISSN 1558-2027, E-ISSN 1558-2035, Vol. 21, no 10, p. 740-748Article in journal (Refereed)
    Abstract [en]

    Aim: To report the Italian data deriving from the European Society of Cardiology-EURObservational Research Program atrial fibrillation ablation long-term registry.

    Methods and results: Ten Italian centers enrolled up to 50 consecutive patients undergoing atrial fibrillation ablation. Of the 318 patients included, 5 (1.6%) did not undergo catheter ablation, 1 had ablation partially done and 62 were lost at 1-year follow-up. Women were less represented (23.6%) and the median age was 60.0 years. A total of 195 patients (62.3%) suffered paroxysmal atrial fibrillation, whereas only 9 (2.9%) had long-standing persistent atrial fibrillation. Most Italian patients (92.3%) were symptomatic but suffering fewer symptomatic events than patients enrolled in other countries (median of two events in the month preceding the ablation vs. three, respectively; P<0.0001). The main finding of the study is that the success rate at 1 year, with and without antiarrhythmic drugs, was 76.4%, consistently with other participating countries (73.4%). This result was obtained however, with a significantly lower prevalence of 1-year adverse events (7.3 vs. 16.6%, P<0.0001). Procedure duration and fluoroscopy total time resulted as being shorter in Italy (145 vs. 160, P=0.0005 and 16.9 vs. 20.0 min, P=0.0018, respectively); however, the radiation dose per BSA was greater (37.5 vs. 26.0mGy/cm(2), P=0.0022).

    Conclusion: The demographic characteristics of patients undergoing atrial fibrillation ablation are similar to those reported in other countries. The success rate in Italy is consistent with those in other countries, whereas the complications rate is lower.

  • 7.
    Arbelo, Elena
    et al.
    Univ Barcelona, Hosp Clin Barcelona, Cardiovasc Inst, Dept Cardiol, Barcelona, Spain..
    Brugada, Josep
    Univ Barcelona, Hosp Clin Barcelona, Cardiovasc Inst, Dept Cardiol, Barcelona, Spain..
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Laroche, Cecile
    European Soc Cardiol, EURObservat Res Programme, Sophia Antipolis, France..
    Kautzner, Josef
    Inst Clin & Expt Med, Dept Cardiol, Prague, Czech Republic..
    Pokushalov, Evgeny
    State Res Inst Circulat Pathol, Arrhythmia Dept, Novosibirsk, Russia.;State Res Inst Circulat Pathol, EP Lab, Novosibirsk, Russia..
    Raatikainen, Pekka
    Tampere Univ Hosp, Heart Ctr Co, Tampere, Finland..
    Efremidis, Michael
    Evangelismos Gen Hosp Athens, Lab Cardiac Electrophysiol, Dept Cardiol 2, Athens, Greece..
    Hindricks, Gerhard
    Univ Leipzig, Ctr Heart, Dept Electrophysiol, Leipzig, Germany..
    Barrera, Alberto
    Univ Hosp Virgen de la Victoria, Dept Cardiol, Arrhythmia Unit, Malaga, Spain..
    Maggioni, Aldo
    European Soc Cardiol, EURObservat Res Programme, Sophia Antipolis, France.;Assoc Nazl Med Cardiol Osped Res Ctr AMCO Res Ctr, Florence, Italy..
    Tavazzi, Luigi
    Maria Cecilia Hosp, ES Hlth Sci Fdn, GVM Care & Res, Cotignola, Italy..
    Dagres, Nikolaos
    Univ Leipzig, Ctr Heart, Dept Electrophysiol, Leipzig, Germany..
    Contemporary management of patients undergoing atrial fibrillation ablation: in-hospital and 1-year follow-up findings from the ESC-EHRA atrial fibrillation ablation long-term registry2017In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 38, no 17, p. 1303-1316Article in journal (Refereed)
    Abstract [en]

    Aims The ESC-EHRA Atrial Fibrillation Ablation Long-Term registry is a prospective, multinational study that aims at providing an accurate picture of contemporary real-world ablation for atrial fibrillation (AFib) and its outcome. Methods and results A total of 104 centres in 27 European countries participated and were asked to enrol 20-50 consecutive patients scheduled for first and re-do AFib ablation. Pre-procedural, procedural and 1-year follow-up data were captured on a web-based electronic case record form. Overall, 3630 patients were included, of which 3593 underwent an AFib ablation (98.9%). Median age was 59 years and 32.4% patients had lone atrial fibrillation. Pulmonary vein isolation was attempted in 98.8% of patients and achieved in 95-97%. AFib-related symptoms were present in 97%. Inhospital complications occurred in 7.8% and one patient died due to an atrioesophageal fistula. One-year follow-up was performed in 3180 (88.6%) at a median of 12.4 months (11.9-13.4) after ablation: 52.8% by clinical visit, 44.2% by telephone contact and 3.0% by contact with the general practitioner. At 12-months, the success rate with or without antiarrhythmic drugs (AADs) was 73.6%. A significant portion (46%) was still on AADs. Late complications included 14 additional deaths (4 cardiac, 4 vascular, 6 other causes) and 333 (10.7%) other complications. Conclusion AFib ablation in clinical practice is mostly performed in symptomatic, relatively young and otherwise healthy patients. Overall success rate is satisfactory, but complication rate remains considerable and a significant portion of patients remain on AADs. Monitoring after ablation shows wide variations. Antithrombotic treatment after ablation shows insufficient guideline-adherence.

  • 8.
    Arvanitis, Panagiotis
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Biering-Sørensen, Tor
    Linde, Cecilia
    Malmborg, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Poole, Jeanne E.
    Sridhar, Arun R.
    Boyle, Patrick M.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Risk factors and electrocardiographic predictors associated with new-onset atrial fibrillation in hospitalized Covid-19 patients. Evaluation of a novel P-wave index.Manuscript (preprint) (Other academic)
  • 9.
    Arvanitis, Panagiotis
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia. Uppsala University Hospital.
    Johannson, Anna-Karin
    Frick, Mats
    Malmborg, Helena
    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. Uppsala University Hospital.
    Gerovasileiou, Spyridon
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University Hospital.
    Larsson, Elna-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology. Uppsala University Hospital.
    Blomström-Lundqvist, Carina
    Uppsala University Hospital.
    Serial Magnetic Resonance Imaging after Electrical Cardioversion of Recent Onset Atrial Fibrillation in Anticoagulant-Naïve Patients –: A Prospective Study Exploring Clinically Silent Cerebral Lesions2020In: Journal of Atrial Fibrillation, ISSN 1941-6911, Vol. 13, no 2Article in journal (Refereed)
  • 10.
    Arvanitis, Panagiotis
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Johansson, A. K.
    Frick, Mats
    Malmborg, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Gerovasileiou, Spyridon
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Larsson, Elna-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Timing and degree of left atrial stunning and reverse functional remodeling following electrical cardioversion in patients with recent onset atrial fibrillation2020In: European Heart Journal, Supplement, ISSN 1520-765X, E-ISSN 1554-2815, Vol. 41, no Supplement_2, article id ehaa946.0465Article in journal (Other academic)
    Abstract [en]

    Background

    Atrial fibrillation (AF) results in left atrial electrical, structural and functional remodeling. Restoration of sinus rhythm hallmarks the beginning of reverse remodeling, the extent of which may depend on the type of AF.

    Purpose

    The aim of the study was to assess resumption of left atrial function after electric cardioversion in patients with recent onset AF and to explore the association between reverse remodeling and the type of atrial fibrillation.

    Methods

    Patients with AF duration <48 hours were prospectively included. Trans-thoracic echocardiography was performed prior, immediately after (2–4 hours) and 7–10 days following CV. Left atrial volume index (LAVI), left atrial global longitudinal strain during reservoir (LAGLS-res), conduit (LAGLS-cond) and contractile (LAGLS-contr) phases, left atrial ejection fraction (LAEF) and left ventricular ejection fraction (LVEF) were measured.

    Results

    Forty-three patients (84% males) aged 55±9.6 years, (mean±SD), with median CHA2DS2-VASc score 1 (interquartile range 0–1) were included. Repeated measure analysis of variance revealed a statistically significant overall change for LAGLS-res F(2,78)=55.4, p<0,001, LAGLS-cond F(2,78)=23.3, p<0,001, LAGLS-contr F(2,78)=39.7, p<0,001, LAEF F(2,80)=28.5, p<0.001 and LVEF F(2,80)=8.4, p<0.001. At 7–10 days, LAGLS-contr 12±4%, LAEF 53±9% and LVEF 60±6 (mean±SD) return within normal reference intervals. Notably left atrial recovery seems to precede left ventricular recovery. No statistical significant interaction with the type of atrial fibrillation could be shown.

    Conclusion

    Left atrial functional reverse remodeling occurs within ten days after successful electric cardioversion of patients with recent onset atrial fibrillation.

  • 11.
    Arvanitis, Panagiotis
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Johansson, Anna-Karin
    Frick, Mats
    Malmborg, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Gerovasileiou, Spyridon
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Larsson, Elna-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Recent-onset atrial fibrillation: a study exploring the elements of Virchow's triad after cardioversion2022In: Journal of Interventional Cardiac Electrophysiology, ISSN 1383-875X, E-ISSN 1572-8595, Vol. 64, no 1, p. 49-58Article in journal (Refereed)
    Abstract [en]

    Purpose

    Atrial fibrillation (AF) imposes an inherent risk for stroke and silent cerebral emboli, partly related to left atrial (LA) remodeling and activation of inflammatory and coagulation systems. The aim was to explore the effects of cardioversion (CV) and short-lasting AF on left atrial hemodynamics, inflammatory, coagulative and cardiac biomarkers, and the association between LA functional recovery and the presence of a prior history of AF.

    Methods

    Patients referred for CV within 48 h after AF onset were prospectively included. Echocardiography and blood sampling were performed immediately prior, 1–3 h after, and at 7–10 days after CV. The presence of chronic white matter hyperintensities (WMH) on magnetic resonance imaging was related to biomarker levels.

    Results

    Forty-three patients (84% males), aged 55±9.6 years, with median CHA2DS2-VASc score 1 (IQR 0–1) were included. The LA emptying fraction (LAEF), LA peak longitudinal strain during reservoir, conduit, and contractile phases improved significantly after CV. Only LAEF normalized within 10 days. Interleukin-6, high-sensitivity cardiac-troponin-T (hs-cTNT), N-terminal-pro-brain-natriuretic peptide, prothrombin-fragment 1+2 (PTf1+2), and fibrinogen decreased significantly after CV. There was a trend towards higher C-reactive protein, hs-cTNT, and PTf1+2 levels in patients with WMH (n=21) compared to those without (n=22). At 7–10 days, the LAEF was significantly lower in patients with a prior history of AF versus those without.

    Conclusion

    Although LA stunning resolved within 10 days, LAEF remained significantly lower in patients with a prior history of AF versus those without. Inflammatory and coagulative biomarkers were higher before CV, but subsided after 7–10 days, which altogether might suggest an enhanced thrombogenicity, even in these low-risk patients.

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  • 12.
    Arvanitis, Panagiotis
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Mörtsell, David
    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. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Novel P-wave indices and machine learning predict atrial fibrillation recurrence after rhythm control interventionsManuscript (preprint) (Other academic)
  • 13. Asplund, A
    et al.
    Beerman, B
    Bergfeldt, L
    Blomström, Per
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences. Medicinska vetenskaper.
    Blomström-Lundqvist, Carina
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences. Medicinska vetenskaper.
    Treatment of atrial fibrillation. Recommendations from a workshop arranged by the Medical Products Agency (Uppsala, Sweden) and the Swedish Society of Cardiology1993In: European Heart Journal, no 14, p. 1427-33Article in journal (Refereed)
  • 14.
    Atar, Dan
    et al.
    Oslo Univ Hosp Ullevaal, Dept Cardiol, Kirkeveien 166, N-0450 Oslo, Norway.;Univ Oslo, Inst Clin Med, Kirkeveien 166,Soesterhjemmet, N-0450 Oslo, Norway..
    Auricchio, Angelo
    Inst Cardioctr Ticino, Div Cardiol, Clin Electrophysiol Unit, Lugano, Switzerland..
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia. Örebro Univ, Fac Med & Hlth, Sch Med Sci, Dept Cardiol, Örebro, Sweden..
    Cardiac device infection: removing barriers to timely and adequate treatment2023In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 44, no 35, p. 3323-3326Article in journal (Other academic)
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  • 15.
    Auricchio, Angelo
    et al.
    ivision of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
    Gasparini, Maurizio
    Department of Cardiology, Humanitas Research Hospital IRCCS, Rozzano, Italy.
    Linde, Cecilia
    Heart and Vascular Theme, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
    Dobreanu, Dan
    Institute of Cardiovascular Disease and Transplant, University of Medicine and Pharmacy, Tîrgu Mureș, Romania.
    Cano, Óscar
    Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
    Sterlinski, Maciej
    Heart Rhythm Department, Institute of Cardiology, Warsaw, Poland.
    Bogale, Nigussie
    Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
    Stellbrink, Christoph
    Department of Cardiology, Klinikum Bielefeld, Bielefeld, Germany.
    Refaat, Marwan M
    Division of Cardiology, Department of Internal Medicine, Faculty of Medicine and Medical Center, American University of Beirut, Beirut, Lebanon.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Lober, Christiane
    Department of Statistics, IHF GmbH, Ludwigshafen, Germany.
    Dickstein, Kenneth
    Department of Cardiology, Stavanger University Hospital, Stavanger, Norway; Institute of Internal Medicine, University of Bergen, Bergen, Norway.
    Normand, Camilla
    Department of Cardiology, Stavanger University Hospital, Stavanger, Norway; Institute of Internal Medicine, University of Bergen, Bergen, Norway.
    Sex-Related Procedural Aspects and Complications in CRT Survey II: A Multicenter European Experience in 11,088 Patients2019In: JACC: Clinical Electrophysiology, ISSN 2405-500X, E-ISSN 2405-5018, Vol. 5, no 9, p. 1048-1058Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: This study sought to compare sex difference for procedural aspects and complications in the European Society of Cardiology CRT Survey II, exploring whether adverse events were related to the type of CRT device implanted.

    BACKGROUND: Sex-related differences in procedural aspects and complications in patients undergoing cardiac resynchronization therapy (CRT) implantation has not been explored in a real-life population.

    METHODS: A post-hoc analysis of procedural data and complications in different sexes and factors associated with events was performed from data collected in the European Society of Cardiology CRT Survey II.

    RESULTS: Of all patients (n = 11,088) included, 24.3% were women. The mean age (70 years of age) of male and female recipients was similar. Female patients more frequently had an idiopathic cardiomyopathy (67.4% vs. 44.1%) and fewer comorbidities, including atrial fibrillation (34.8% vs. 42.8%), diabetes (29.1% vs. 32.1%), chronic obstructive lung disease (10.3% vs. 12.6%), and renal failure (28.7% vs. 31.9%), compared with men. More women compared with men had a pacemaker (56.6% vs. 46.3%) and much less often an implantable cardioverter-defibrillator (CRT-D) (19.0% vs. 34.7%) implant. Periprocedural event rate was the highest in women with CRT with defibrillator (7.1% vs. 4.8% in men), followed by women with a CRT with pacing (5.5% vs. 4.4% in men). The higher periprocedural event rate in CRT-D women was attributable primarily to the occurrence of pneumothorax (1.4%), coronary sinus dissection (2.1%), and pericardial tamponade (0.3%). The rate of in-hospital major adverse events (6.0%) and complications necessitating reoperation (4.0%) was not different among sex and device type.

    CONCLUSIONS: Women are more likely to experience adverse procedure-related events during CRT implantation. Thus, preventive strategies should be employed to minimize complication rate.

  • 16.
    Baensch, Dietmar
    et al.
    Univ Hosp Rostock, Dept Internal Med 1, Div Cardiol, Heart Ctr Rostock, D-18057 Rostock, Germany..
    Bonnemeier, Hendrik
    Univ Hosp Schleswig Holstein, Dept Internal Med Cardiol & Angiol 3, Kiel, Germany..
    Brandt, Johan
    Skane Univ Hosp, Arrhythmia Dept, Lund, Sweden..
    Bode, Frank
    Univ Hosp Schleswig Holstein, Med Clin Cardiol Angiol & Intens Care Med 2, Lubeck, Germany..
    Svendsen, Jesper Hastrup
    Copenhagen Univ Hosp, Rigshosp, Dept Cardiol, Ctr Heart, Copenhagen, Denmark.;Univ Copenhagen, Danish Arrhythmia Res Ctr, Copenhagen, Denmark..
    Taborsky, Milos
    Fac Hosp Olomouc, Dept Internal Med Cardiol 1, Olomouc, Czech Republic..
    Kuster, Stefan
    DRK Hosp Molln Ratzeburg, Dept Internal Med, Cardiol, Ratzeburg, Germany..
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Felk, Angelika
    Biotronik, Berlin, Germany..
    Hauser, Tino
    Biotronik, Berlin, Germany..
    Suling, Anna
    Univ Med Ctr Hamburg Eppendorf, Dept Med Biometry & Epidemiol, Hamburg, Germany..
    Wegscheider, Karl
    Univ Med Ctr Hamburg Eppendorf, Dept Med Biometry & Epidemiol, Hamburg, Germany..
    Intra-operative defibrillation testing and clinical shock efficacy in patients with implantable cardioverter-defibrillators: the NORDIC ICD randomized clinical trial2015In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, no 37, p. 2500-2507Article in journal (Refereed)
    Abstract [en]

    Aims This trial was designed to test the hypothesis that shock efficacy during follow-up is not impaired in patients implanted without defibrillation (DF) testing during first implantable cardioverter-defibrillator (ICD) implantation. Methods and results Between February 2011 and July 2013, 1077 patients were randomly assigned (1 : 1) to first time ICD implantation with (n = 540) or without (n = 537) DF testing. The intra-operative DF testing was standardized across all participating centres, and all ICD shocks were programmed to 40 J irrespective of DF test results. The primary end point was the average first shock efficacy (FSE) for all true ventricular tachycardia and fibrillation (VT/VF) episodes during follow-up. The secondary end points included procedural data, serious adverse events, and mortality. During a median follow-up of 22.8 months, the model-based FSE was found to be non-inferior in patients with an ICD implanted without a DF test, with a difference in FSE of 3.0% in favour of the no DF test [confidence interval (CI) -3.0 to 9.0%, Pnon-inferiority <0.001 for the pre-defined non-inferiority margin of 210%). A total of 112 procedure-related serious adverse events occurred within 30 days in 94 patients (17.6%) tested compared with 89 events in 74 patients (13.9%) not tested (P = 0.095). Conclusion Defibrillation efficacy during follow-up is not inferior in patients with a 40 J ICD implanted without DF testing. Defibrillation testing during first time ICD implantation should no longer be recommended for routine left-sided ICD implantation.

  • 17.
    Bagge, Louise
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Blomström, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Jidéus, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Lönnerholm, Stefan
    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.
    Left atrial function after epicardial pulmonary vein isolation in patients with atrial fibrillation2017In: Journal of Interventional Cardiac Electrophysiology, ISSN 1383-875X, E-ISSN 1572-8595, Vol. 50, no 2, p. 195-201Article in journal (Refereed)
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  • 18.
    Bagge, Louise
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Surgical ablation for atrial fibrillation in mitral valve disease: impact of the maze procedure-authors' response2018In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 20, no FI_3, p. f458-f459Article in journal (Refereed)
  • 19.
    Bagge, Louise
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Probst, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    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.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Quality of Life Is Not Significantly Improved by Adding Epicardial Left Atrial Cryoablation to Mitral Valve Surgery Than if Performed Alone2017In: Cardiovascular Electrophysiology, ISSN 1045-3873, E-ISSN 1540-8167, Vol. 28, no 5, p. 589-590, article id MA19Article in journal (Other academic)
  • 20.
    Bagge, Louise
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Probst, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Jensen, Steen M
    Faculty of Medicine, Department of Public Health and Clinical Medicine (Heart centre) Umeå University, SE-901 87 Umeå, Sweden.
    Blomström, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Thelin, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Holmgren, Anders
    Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology, Umeå University, SE-901 87 Umeå, Sweden.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Quality of life is not improved after mitral valve surgery combined with epicardial left atrial cryoablation as compared with mitral valve surgery alone: a substudy of the double blind randomized SWEDish Multicentre Atrial Fibrillation study (SWEDMAF)2018In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 20, no FI_3, p. f343-f350Article in journal (Refereed)
    Abstract [en]

    Aims

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

    Methods and results

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

    Conclusion

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

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

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

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

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

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

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

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  • 23. Bianchi, Stefano
    et al.
    Rossi, Pietro
    Schauerte, Patrick
    Elvan, Arif
    Blomström Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Kornet, Lilian
    Gal, Pim
    Mörtsell, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Wouters, Griet
    Gemein, Christopher
    Increase of Ventricular Interval During Atrial Fibrillation by Atrioventricular Node Vagal Stimulation: Chronic Clinical Atrioventricular-Nodal Stimulation Download Study2015In: Circulation: Arrhythmia and Electrophysiology, ISSN 1941-3149, E-ISSN 1941-3084, Vol. 8, no 3, p. 562-568Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: -Patients with a high ventricular rate during atrial fibrillation (AF) are at increased risk of receiving inappropriate implantable cardioverter defibrillator (ICD) shocks. The objective was to demonstrate the feasibility of high frequency atrioventricular-nodal stimulation (AVNS) to reduce the ventricular rate during AF to prevent inappropriate ICD shocks.

    METHODS AND RESULTS: -Patients with a new atrial lead placement as part of a CRT-D implant and a history of paroxysmal or persistent AF were eligible. If proper atrial lead position was confirmed, AVNS software was uploaded to the CRT device, tested and optimized. AVNS was delivered via a right atrial pacing lead positioned in the posterior right atrium. Software allowed initiation of high frequency bursts triggered on rapidly conducted AF. Importantly, the efficacy was evaluated during spontaneous AF episodes between 1 and 6 months after implant. Forty-four patients were enrolled in 4 centers. Successful atrial lead placement occurred in 74%. Median implant time of the AVNS lead was 37 minutes. In 26 (81%) patients, manual AVNS tests increased the ventricular interval by > 25%. Between 1 and 6 months, automatic AVNS activations occurred in 4 patients with rapidly conducted AF, and in 3 patients, AVNS slowed the ventricular rate out of the ICD shock zone. No adverse events were associated with the AVNS software.

    CONCLUSIONS: -The present study demonstrated the feasibility of implementation of AVNS in a CRT-D system. AVNS increased ventricular interval > 25% in 81% of patients. AVNS did not influence the safety profile of the CRT-D system.

  • 24.
    Blomstrom-Lundqvist, Carina
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Non-pharmacological rate or rhythm control--it is time for randomized studies.2005In: J Cardiovasc Electrophysiol, ISSN 1045-3873, Vol. 16, no 5, p. 462-4Article in journal (Refereed)
  • 25.
    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.

  • 26.
    Blomström, P
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Blomström-Lundqvist, C
    Olsson, S B
    Fåhraeus, T
    Lährs, C
    Indikation för utredning och behandling av patient med Wolff-Parkinson-Whites syndrom1990In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 87, no 1-2, p. 31-34Article in journal (Refereed)
  • 27.
    Blomström, P
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Edvardsson, N
    Blomström-Lundqvist, C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Olsson, S B
    Precision of preoperative electrophysiological study in predicting the intraoperatively defined location of single left-sided accessory pathways1987In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 8, no 5, p. 510-520Article in journal (Refereed)
    Abstract [en]

    In 34 patients with a left-side anomalous pathway (AP) considered for arrhythmia surgery, the atrial insertion of the anomalous pathway in the preoperative investigation was determined by using three different techniques. The atrial activation sequence during orthodromic tachycardia or ventricular stimulation was recorded in the coronary sinus by using either (a) unipolar leads from an eight-polar electrode catheter with an interelectrode distance of 1 cm, (b) bipolar leads from consecutively positioned pairs of electrodes on the same electrode catheter or (c) bipolar leads recorded at one centimeter intervals by withdrawal of the electrode catheter. The corresponding location at surgery was obtained by atrial epicardial mapping during ventricular stimulation. Each way of recording the atrial activation sequence in the coronary sinus during orthodromic tachycardia or ventricular stimulation was compared with regard to their predictive value in assessing the corresponding location by intraoperative mapping. At surgery, a visual grid system was used to define the anatomical landmarks which were located 20 mm apart.

    When the unipolar technique was used to assess the anomalous pathway location, there was a difference corresponding to a distance of 2–2.5 anatomical landmarks (48 mm) between the preoperative and intraoperative assessments. With the bipolar technique the difference was up to 3 anatomical landmarks (60 mm) while it was up to 4.5 anatomical landmarks (90 mm) when the withdrawal technique was employed. The unipolar technique was superior in differentiating a left lateral from a left posterior or a septal location.

  • 28.
    Blomström, Per
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Berglin-William-Olsson, E
    Olsson, S B
    Pre- and intraoperative identification of multiple accessory pathways. Experience of 19 pathways in 9 patients1989In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 76, no 1, p. 42-52Article in journal (Refereed)
    Abstract [en]

    The pre- and intraoperative electrophysiological studies in 9 patients with two or more accessory pathways are described. The presence of multiple accessory pathways was clinically suspected in only 2 patients. During the preoperative electrophysiological study two accessory pathways were identified in 7 patients and a single pathway in 2 patients. At operation, additionally three accessory pathways were identified in 3 patients. One out of two pathways, found preoperatively, could not be confirmed in 1 patient. It is concluded that the clinical or preoperative electrophysiological evidence of only one accessory pathway should not distract one's attention from considering multiple accessory pathways in patients presenting only one type of tachycardia.

  • 29.
    Blomström-Lundqvist, C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Late potentials--a clinical update1992In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 12, no 3, p. 319-323Article in journal (Refereed)
  • 30.
    Blomström-Lundqvist, C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Beckman-Suurkäla, M
    Wallentin, I
    Jonsson, R
    Olsson, S B
    Ventricular dimensions and wall motion assessed by echocardiography in patients with arrhythmogenic right ventricular dysplasia1988In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 9, no 12, p. 1291-1302Article in journal (Refereed)
    Abstract [en]

    Twenty patients with arrhythmogenic right ventricular dysplasia (ARVD) and 20 healthy volunteers underwent cross-sectional echocardiographic examination for the assessment of ventricular dimensions and wall motion. Right ventricular cavity diameters and wall segments were selected from the inflow and outflow tracts and the right ventricular body. The measurement error for measuring cavity dimensions was low throughout and the reproducibility of wall motion scoring was high in both the normal subjects and the patients. All except one patient had increased dimensions and/or abnormal wall motion in the right ventricle. The right ventricular inflow tract was dilated in nine patients, the outflow tract in 11 patients and the short- or long-axis diameters of the right ventricular body were increased in seven patients. Right ventricular wall motion abnormalities, being the most frequent finding, ranged from mild hypokinesia only to dyskinesia or sacculations, and were fairly evenly distributed among the segments studied. Left ventricular abnormalities, found in eight patients, were generally mild. Cross-sectional echocardiography thus provides highly reproducible measurements of right ventricular size and contraction patterns even in patients with wall shape deformities, and is therefore a feasible non-invasive method for the evaluation of right-sided myocardial abnormalities in patients with ARVD. The diagnostic accuracy of this technique warrants further clarification.

  • 31.
    Blomström-Lundqvist, C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Blomström, P
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Beckman-Suurkäa, M
    Incessant ventricular tachycardia with a right bundle-branch block pattern and left axis deviation abolished by catheter manipulation1990In: Pacing and Clinical Electrophysiology, ISSN 0147-8389, E-ISSN 1540-8159, Vol. 13, no 1, p. 11-16Article in journal (Refereed)
    Abstract [en]

    A 22-year-old man underwent electrophysiological evaluation for incessant wide QRS complex tachycardia with a pattern of right bundle-branch block and left axis deviation. The right and left ventricles were enlarged and hypokinetic consistent with dilated cardiomyopathy. Ventricular tachycardia was diagnosed by demonstrating capture and fusion beats, atrioventricular dissociation, and His potential activation that began after the onset of each QRS complex. Atrial extrastimuli and rapid atrial pacing failed to terminate the tachycardia and, although ventricular stimulation was successful, the tachycardia spontaneously restarted after one or two sinus beats. The tachycardia was unexpectedly abolished during catheter manipulation in the left ventricle and has not recurred during three-years of follow-up. The picture of a cardiomyopathy resolved. The ease with which the tachycardia was abolished by catheter manipulation implicate a therapeutic potential for catheter ablation of this type of tachycardia.

  • 32.
    Blomström-Lundqvist, C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Caidahl, K
    Olsson, S B
    Rudin, A
    Electrocardiographic findings and frequency of arrhythmias in Bartter's syndrome1989In: British Heart Journal, ISSN 0007-0769, Vol. 61, no 3, p. 274-279Article in journal (Refereed)
    Abstract [en]

    Twenty four hour electrocardiograms in 20 patients with Bartter's syndrome, a disorder associated with chronic potassium deficiency, were analysed for atrial and ventricular extrasystoles, pauses (RR interval greater than 2 s), and heart rate. The 12 lead resting electrocardiogram was also evaluated. There were slight electrocardiographic changes with ST segment depression (greater than or equal to - 0.5 mm) in seven patients, flat or low amplitude T waves in seven, and U waves (greater than or equal to + 1.0 mm) in three patients. The QT interval was prolonged in 18 patients. Nine patients had one or more ventricular extrasystoles in 24 hours. Only two patients had more than 200 ventricular extrasystoles in 24 hours. No patient had ventricular tachycardia. A total of nine patients had one or more atrial extrasystoles in 24 hours, but only one patient had more than 200 in 24 hours. One patient had an attack of non-sustained supraventricular tachycardia. No patient had pauses. Dangerous tachycardia was rare in these patients with chronic potassium deficiency caused by Bartter's syndrome. The general pattern of slight electrocardiographic changes may reflect an adaptation of the myocardium to hypokalaemia. Further studies are, however, needed to determine whether these findings are relevant to long term prognosis.

  • 33.
    Blomström-Lundqvist, C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Edvardsson, N
    Transesophageal versus intracardiac atrial stimulation in assessing electrophysiologic parameters of the sinus and AV nodes and of the atrial myocardium1987In: Pacing and Clinical Electrophysiology, ISSN 0147-8389, E-ISSN 1540-8159, Vol. 10, no 5, p. 1081-1095Article in journal (Refereed)
    Abstract [en]

    Electrophysiological porameters of the sinus and AV nodes and of the atrial myocardium were assessed with both transesophageal atrial stimulation (TAS) and intracardiac atrial stimulation (ICS) in the same patient during the same study. The study group was comprised of nine men and seven women, aged 45 to 79 years, referred for the evaluation of syncope of possible arrhythmogenic origin. Twelve patients were included for analysis. Autonomic inhibition (AI) was obtained in five patients. The most striking result was the significantly longer AERP with TAS (mean 286 ± 9 ms) than with ICS (mean 244 ± 12 ms; p < 0.02). After AI, the AERP was even more prolonged with TAS (mean 332 ± 20 ms) than with ICS (mean 237 ± 8 ms; p < 0.01). Intraatrial and AV nodal conduction times assessed at multiple paced cycle lengths were significantly shorter with TAS than with ICS. There was no difference between TAS and ICS with regard to AVERP, Wenckebach periodicity and H-V intervals. Although a tendency towards shorter sinus node recovery time (SNRT) and sinoatrial conduction time (SACT) was observed with TAS, the difference was not statistically significant. Possible mechanisms of the differences are discussed. It seemed clear that the site of origin of an atrial impulse can have definite effects upon excitability and conduction properties of atrial and AV nodal fibers. Enhanced sympathetic activity during TAS was also suggested. The electrophysiological properties inherent in the TAS technique warrant further elucidation.

  • 34.
    Blomström-Lundqvist, C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Hirsch, I
    Olsson, S B
    Edvardsson, N
    Quantitative analysis of the signal-averaged QRS in patients with arrhythmogenic right ventricular dysplasia1988In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 9, no 3, p. 301-312Article in journal (Refereed)
    Abstract [en]

    Temporal signal averaging of the surface QRS (VI + V3 + V5) was performed in 16 patients with arrhythmogenic right ventricular dysplasia and in 16 normal subjects. The differences between ARVD patients and normals were large for the filtered QRS duration (FQRSd) (146.2±18.9 vs. 91.8±4.1ms, P<000001), the late potential duration (LPd) (83.5±23.3 ms vs. 23.6±4.6ms, P< 0.00001), the LPd/ FQRSd ratio (53.9± 10.1% vs. 25.8±5.1%, P <0.00001), the filtered QRS amplitude (234.0±61.1μV vs. 429±942 fiV, P <0001), and the root mean square voltage of the signals in the terminal 40 and 50 ms of the FQRS (RMS40 and RMS50) (18.4± 10.0μV vs. 118.4±49.8p.V, P<0.0005 and 27.9± 19.2μV vs. 217.0±66.3fiV, P<0000002). RMS50 <40μV discriminated best between ARVD and normals (81% sensitivity and 100% specificity). The right-sided predominance of the abnormalities in ARVD was demonstrated by the significantly longer FQRSd and LPd, and the higher ratio LPd/FQRSd in right than in left precordial leads. The arrhythmia susceptibility did not seem to influence the presence of or properties ofLP in the ARVD group. Patients with multiple QRS morphologies during ventricular tachycardia (VT) had, compared with patients with only one type of VT, longer LPd (108.3 ±46.4 ms vs. 64.2 ±31.7 ms, P<0.02) and lower RMS40 voltage (9.4±9.9 μV vs. 25.4±21.6 μV, P<0.05). The relative heart volume was positively correlated with delayed activity, but an enlarged heart was not apre-requisitefor the presence ofLP. The method thus identifies changes which are specific to ARVD. The findings indicate that certain electrical or morphological conditions are required for the occurrence of arrhythmias.

  • 35.
    Blomström-Lundqvist, C
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences.
    Noor, A M
    Eskilsson, J
    Persson, S
    Safety of transvenous right ventricular endomyocardial biopsy guided by two-dimensional echocardiography.1993In: Clin Cardiol, ISSN 0160-9289, Vol. 16, no 6, p. 487-92Article in journal (Refereed)
  • 36.
    Blomström-Lundqvist, C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Olsson, S B
    Eneström, S
    Arytmogen högerkammardysplasi - ofta förbisedd genes till ventrikulära arytmier1986In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 83, no 41, p. 3427-3430Article in journal (Other academic)
  • 37.
    Blomström-Lundqvist, C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Sabel, K G
    Olsson, S B
    A long term follow up of 15 patients with arrhythmogenic right ventricular dysplasia1987In: British Heart Journal, ISSN 0007-0769, Vol. 58, no 5, p. 477-488Article in journal (Refereed)
    Abstract [en]

    The clinical course in 15 patients with features consistent with arrhythmogenic right ventricular dysplasia is described. At referral seven patients had abnormal physical findings, nine had abnormal electrocardiograms with non-specific right-sided abnormalities, and seven patients had increased heart size or prominent right ventricles on chest x ray. During long term follow up (mean 8.8 years, range 1.5 to 28 years) 11 patients had abnormal physical findings, 11 had electrocardiographic changes, and nine had increased heart size. Recurrent sustained right ventricular tachycardia was the most common arrhythmia (10 patients). Two patients experienced ventricular fibrillation. Seven patients suffered from over 10 episodes of ventricular tachycardia, nine required cardioversions, and 10 patients had associated serious symptoms such as syncope, severe hypotension, or cardiac arrest. Four patients required operation to correct the arrhythmia and three patients developed right heart failure. Two out of three deaths were sudden. These data suggest that in arrhythmogenic right ventricular dysplasia right ventricular abnormalities may be progressive and that the condition may affect the left ventricle. The course of the ventricular arrhythmias was highly variable and could not be predicted in individual patients. The potential for lethal ventricular arrhythmias is evident and warrants intensive diagnostic efforts to identify patients with adverse prognostic features.

  • 38.
    Blomström-Lundqvist, C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Selin, K
    Jonsson, R
    Johansson, S R
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Schlossman, D
    Olsson, S B
    Cardioangiographic findings in patients with arrhythmogenic right ventricular dysplasia1988In: British Heart Journal, ISSN 0007-0769, Vol. 59, no 5, p. 556-563Article in journal (Refereed)
    Abstract [en]

    The dimension, contractility, and regional wall motion of the right and left ventricles were scored on the angiograms of 13 patients with arrhythmogenic right ventricular dysplasia. In 10 patients the right ventricle was enlarged, in eight the contractility of the right ventricle was reduced, and in all but one patient there were regional wall motion abnormalities of the right ventricle. The most common abnormality of regional wall motion was mild hypokinesia. There were bulging or dyskinetic areas in seven patients. Regional wall motion abnormalities of the left ventricle were found in five patients, two of whom also had bulging or dyskinetic areas. The reproducibility of right ventricular dimension, contractility, and regional wall motion scores was generally fair but varied unexpectedly both within and between two observers (Kendall's Tau 0.38-0.92). The score values of regional wall motion for some of the segments differed considerably within and between observers. One of the observers consistently gave higher scores than the other. These data suggest that a more objective approach is needed for evaluating angiographic changes in arrhythmogenic right ventricular dysplasia.

  • 39.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Atrial fibrillation: from atrial extrasystoles to atrial cardiomyopathy - what have we learned from basic science and interventional procedures?2016In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 279, no 5, p. 406-411Article in journal (Other academic)
  • 40.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    CABANA Trial, another favourable view2018In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, no 30, p. 2771-2772Article in journal (Other academic)
  • 41.
    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.
    Effects of COVID-19 lockdown strategies on management of atrial fibrillation2020In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 41, no 32, p. 3080-3082Article in journal (Refereed)
  • 42.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    The safety of reusing ablation catheters with temperature control and the need for a validation protocol and guidelines for reprocessing1998In: Pacing and Clinical Electrophysiology, ISSN 0147-8389, E-ISSN 1540-8159, Vol. 21, no 12, p. 2563-2570Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to evaluate the safety of reusing ablation catheters with temperature control, which has not previously been reported. A review of previously conducted studies on the feasibility of reusing electrode catheters is also presented. From September 1994 to December 1997, 74 deflectable ablation catheters with temperature control (Cordis-Websters and Osypkas) were used during mean 7.6 +/- 8.0 ablation sessions. The catheter tests included visual inspection for surface defects using a magnification glass, impedance measurements, evaluation of the catheter deflection capability, and the integrity of the thermistor and thermocouple. The catheters were sterilized by Sterrad after each use. A total of 41 catheters were rejected after an average 9.1 +/- 8.8 uses (range 1-31). The main reasons for rejection were inaccurate temperature measurements by the thermistor or thermocouple (19%), breakage of or defect in the internal pulling wire (12%), loss or disturbance of electrogram (9%), and loss of deflection capability (8%). The reuse of the catheters has not resulted in any major catheter failures or any major adverse clinical complications. There were no local or systemic infections. It can be concluded that these types of ablation catheters will sustain repeated uses and resterilizations without untoward harm to the patient provided that a thorough validation protocol and guidelines for quality control and rejection of catheters are used. There seems to be no rational for setting a limit for the number of reuses, since most failures occurred at any time of reuse.

  • 43.
    Blomström-Lundqvist, Carina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Blomström, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Safety and efficacy of pharmacological cardioversion of atrial fibrillation using intravenous vernakalant, a new antiarrhythmic drug with atrial selectivity2012In: Expert Opinion on Drug Safety, ISSN 1474-0338, E-ISSN 1744-764X, Vol. 11, no 4, p. 671-679Article in journal (Refereed)
    Abstract [en]

    Introduction:

    Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia that due to its frequent hospitalizations and increased complication rates imposes a significant health economic burden. Many patients with recurrent AF are admitted to the hospital for cardioversion to restore sinus rhythm. Given this knowledge, it is clearly important to identify a feasible and effective approach for cardioversion of these patients. Cardioversion always requires careful assessment of potential complications, which apart from thromboembolic risks, include proarrhythmias and those related to the deep sedation required for electrical cardioversion. Even though electrical cardioversion is proven to be safe and effective, the need for anesthesia makes alternative strategies more attractive.

    Areas covered:

    The research discussed is the alternative strategies for cardioversion, including electrical cardioversion and the new relatively atrial-selective antiarrhythmic drug, vernakalant. The literature search methodology undertaken included search in PubMed (cardioversion, vernakalant, conversion as key words).

    Expert opinion:

    Vernakalant is shown to have good conversion rates, an apparently safe antiarrhythmic profile and is well tolerated in patients with a history of ischemic heart disease. In most cases of recent-onset AF, pharmacological cardioversion can provide a probably more cost-effective and safer alternative to electrical cardioversion, which can then be used as a second option for those who failed the first attempt of cardioversion.

  • 44.
    Blomström-Lundqvist, Carina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Blomström, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Rosenqvist, M
    Implanterbar defibrillator ett framsteg i behandlingen av kammararytmier1990In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 87, no 34, p. 2573-2578Article in journal (Refereed)
  • 45.
    Blomström-Lundqvist, Carina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Dohnal, M
    Hirsch, I
    Lindblad, A
    Hjalmarson, A
    Olsson, S B
    Edvardsson, N
    Effect of long term treatment with metoprolol and sotalol on ventricular repolarisation measured by use of transoesophageal atrial pacing1986In: British Heart Journal, ISSN 0007-0769, Vol. 55, no 2, p. 181-186Article in journal (Refereed)
    Abstract [en]

    The effects of long term (4 weeks) treatment with oral metoprolol (100 mg twice daily) and sotalol (160 mg twice daily) on ventricular repolarisation time were compared in a double blind crossover study in 20 patients post-infarction. For QT interval studies transoesophageal atrial pacing was performed at a cycle length of 800 ms. Sotalol prolonged the QT interval by 5-7% compared with metoprolol. The prolongation reflects a change in the repolarisation time because there was no change in the QS interval. Measurements of heart rate at rest and during bicycle exercise indicated that metoprolol and sotalol in the doses selected were equipotent as beta blockers. Transoesophageal atrial pacing is a simple non-invasive method with few and mild side effects that is well suited to drug studies.

  • 46.
    Blomström-Lundqvist, Carina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Gizurarson, Sigfus
    Univ Gothenburg, Sahlgrenska Acad, Dept Mol & Clin Med Cardiol, Inst Med, Gothenburg, Sweden;Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden.
    Schwieler, Jonas
    Karolinska Univ Hosp, Heart & Vasc Theme, Stockholm, Sweden.
    Jensen, Steen M
    Umea Univ, Ctr Heart, Umea, Sweden;Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden.
    Bergfeldt, Lennart
    Univ Gothenburg, Sahlgrenska Acad, Dept Mol & Clin Med Cardiol, Inst Med, Gothenburg, Sweden;Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden.
    Kennebäck, Göran
    Karolinska Univ Hosp, Heart & Vasc Theme, Stockholm, Sweden.
    Rubulis, Aigars
    Univ Gothenburg, Sahlgrenska Acad, Dept Mol & Clin Med Cardiol, Inst Med, Gothenburg, Sweden;Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden.
    Malmborg, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Raatikainen, Pekka
    Tampere Univ Hosp, Dept Cardiol, Ctr Heart, Tampere, Finland.
    Lönnerholm, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Höglund, Niklas
    Umea Univ, Ctr Heart, Umea, Sweden;Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden.
    Mörtsell, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Effect of Catheter Ablation vs Antiarrhythmic Medication on Quality of Life in Patients With Atrial Fibrillation: The CAPTAF Randomized Clinical Trial2019In: JAMIA Journal of the American Medical Informatics Association, ISSN 1067-5027, E-ISSN 1527-974X, Vol. 321, no 11, p. 1059-1068Article in journal (Refereed)
    Abstract [en]

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

  • 47.
    Blomström-Lundqvist, Carina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Johansson, Birgitta
    Berglin, Eva
    Nilsson, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Jensen, Steen M
    Thelin, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Holmgren, Anders
    Edvardsson, Nils
    Källner, Göran
    Blomström, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    A randomized double-blind study of epicardial left atrial cryoablation for permanent atrial fibrillation in patients undergoing mitral valve surgery: the SWEDish Multicentre Atrial Fibrillation study (SWEDMAF)2007In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 28, no 23, p. 2902-2908Article in journal (Refereed)
    Abstract [en]

    AIMS: The efficacy of epicardial left atrial (LA) cryoablation in eliminating atrial fibrillation (AF) in patients undergoing mitral valve surgery (MVS) is unknown. We hypothesized that MVS combined with LA cryoablation is superior to MVS alone. METHODS AND RESULTS: Sixty-nine patients with permanent AF, included at four centres, underwent MVS with or without epicardial LA cryoablation. The primary endpoint was regained sinus rhythm. Risk factors for failed AF cryoablation were elucidated. Sixty-five out of 69 patients reached the primary endpoint. At 6 and 12 months follow-up, 73.3% of patients who underwent cryoablation had regained sinus rhythm at both follow-ups, compared with 45.7 and 42.9% of patients, respectively, who underwent MVS alone (group differences, at 6 months P = 0.024, after 12 months P = 0.013). The in-hospital complication rate was 11.4% in the MVS group and 26.5% in the cryoablation group (P = 0.110). Risk factors for failed elimination of AF by cryoablation were duration of permanent AF (P = 0.012) and presence of coronary artery disease (P = 0.047), according to multiple logistic regression analysis. CONCLUSION: This first prospective randomized study showed that combining MVS with epicardial LA cryoablation is significantly better in eliminating pre-operative permanent AF than MVS alone.

  • 48.
    Blomström-Lundqvist, Carina
    et al.
    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.
    Marrouche, Nassir
    Connolly, Stuart
    Corp Dit Genti, Valérie
    Wieloch, Mattias
    Koren, Andrew
    Hohnloser, Stefan H
    Efficacy and safety of dronedarone by atrial fibrillation history duration: Insights from the ATHENA study.2020In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 43, no 12, p. 1469-1477Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Atrial fibrillation/atrial flutter (AF/AFL) burden increases with increasing duration of AF/AFL history.

    HYPOTHESIS: Outcomes with dronedarone may also be impacted by duration of AF/AFL history.

    METHODS: In this post hoc analysis of ATHENA, efficacy and safety of dronedarone vs placebo were assessed in groups categorized by time from first known AF/AFL episode to randomization (ie, duration of AF/AFL history): <3 months (short), 3 to <24 months (intermediate), and ≥ 24 months (long).

    RESULTS: Of 2859 patients with data on duration of AF/AFL history, 45.3%, 29.6%, and 25.1% had short, intermediate, and long histories, respectively. Patients in the long history group had the highest prevalence of structural heart disease and were more likely to be in AF/AFL at baseline. Placebo-treated patients in the long history group also had the highest incidence of AF/AFL recurrence and cardiovascular (CV) hospitalization during the study. The risk of first CV hospitalization/death from any cause was lower with dronedarone vs placebo in patients with short (hazard ratio, 0.79 [95% confidence interval: 0.65-0.96]) and intermediate (0.72 [0.56-0.92]) histories; a trend favoring dronedarone was also observed in patients with long history (0.84 [0.66-1.07]). A similar pattern was observed for first AF/AFL recurrence. No new drug-related safety issues were identified.

    CONCLUSIONS: Patients with long AF/AFL history had the highest burden of AF/AFL at baseline and during the study. Dronedarone significantly improved efficacy vs placebo in patients with short and intermediate AF/AFL histories. While exploratory, these results support the potential value in initiating rhythm control treatment early in patients with AF/AFL.

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  • 49.
    Blomström-Lundqvist, Carina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia. Örebro Univ, Fac Med & Hlth, Sch Med Sci, Dept Cardiol, SE-70182 Örebro, Sweden..
    Naccarelli, Gerald, V
    Penn State Univ Coll Med, Penn State Hershey Heart & Vasc Inst, 500 Univ Dr, Hershey, PA 17033 USA..
    McKindley, David S.
    Sanofi, 55 Corp Dr, Bridgewater, NJ 08807 USA..
    Bigot, Gregory
    IVIDATA Life Sci, 79 Rue Baudin, F-92300 Paris, Levallois Perre, France..
    Wieloch, Mattias
    Sanofi, Rue Boetie 54-56, F-75008 Paris, France.;Lund Univ, Dept Coagulat Disorders, Jan Waldenstroms Gata 14, S-20502 Lund, Sweden..
    Hohnloser, Stefan H.
    Goethe Univ Frankfurt, Dept Cardiol, Div Clin Electrophysiol, Theodor Stern Kai 7, D-60590 Frankfurt, Germany..
    Effect of dronedarone vs. placebo on atrial fibrillation progression: a post hoc analysis from ATHENA trial2023In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 25, no 3, p. 845-854Article in journal (Refereed)
    Abstract [en]

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

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

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

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  • 50.
    Blomström-Lundqvist, Carina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Olsson, S B
    Edvardsson, N
    Follow-up by repeated signal-averaged surface QRS in patients with the syndrome of arrhythmogenic right ventricular dysplasia1989In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 10, no suppl D, p. 54-60Article in journal (Refereed)
    Abstract [en]

    Repeated signal-averaged surface electrocardiograms were recorded with a mean interval of 32·5 months (range 14 to 55 months) in 12 patients with the syndrome of arrhythmogenic right ventricular dysplasia (ARVD). The mean differences in the amplitude and duration of the filtered QRS complex (FQRS), the root mean square voltage of the last 40 ms of the FQRS and the duration of the terminal potentials of less than 25 µV were not statistically significant between the recordings. A wide spectrum of changes in the voltage and duration of the terminal potentials was observed, irrespective of the clinical susceptibility to ventricular tachycardia. Three patients developed changes suggesting a progression, with a decreased voltage and prolonged duration of the terminal potentials, and four patients showed the opposite pattern. In five patients the signals were stationary.

    It is concluded that the properties of late potentials may change with time in patients with ARVD. Follow-up by repeated signal-averaged QRS does not appear to be useful in predicting the susceptibility to ventricular tachycardia in ARVD. Its application in predicting and following progressive right ventricular morphological changes remains to be determined.

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