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

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

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

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

  • 3. Chen, Jian
    et al.
    Dagres, Nikolaos
    Hocini, Melece
    Fauchier, Laurent
    Bongiorni, Maria Grazia
    Defaye, Pascal
    Hernandez-Madrid, Antonio
    Estner, Heidi
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Catheter ablation for atrial fibrillation: results from the first European Snapshot Survey on Procedural Routines for Atrial Fibrillation Ablation (ESS-PRAFA) Part II2015In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 11, p. 1727-1732Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

  • 6.
    Deharo, Jean-Claude
    et al.
    Univ Hosp La Timone, Dept Cardiol, Marseilles, France..
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Leclercq, Christophe
    Univ Hosp Pontchaillou, Dept Cardiol, CIC IT 804, INSERM 1099, Rennes, France..
    Amara, Walid
    GHI Le Raincy Montfermeil, Dept Cardiol, Montfermeil, France..
    Doering, Michael
    Univ Leipzig, Ctr Heart, Dept Electrophysiol, D-04109 Leipzig, Germany..
    Bongiorni, Maria G.
    Univ Hosp Pisa, Cardiol Dept 2, Pisa, Italy..
    Chen, Jian
    Haukeland Hosp, Dept Heart Dis, N-5021 Bergen, Norway.;Univ Bergen, Dept Clin Sci, Bergen, Norway..
    Dagres, Nicolaus
    Univ Leipzig, Ctr Heart, Dept Electrophysiol, D-04109 Leipzig, Germany..
    Estner, Heidi
    Univ Munich, Dept Cardiol, Med Klin 1, Campus Grosshadern,Marchioninistr 15, D-81377 Munich, Germany..
    Larsen, Torben B.
    Aalborg Univ Hosp, AF Study Grp, Dept Cardiol, Aalborg, Denmark..
    Johansen, Jens B.
    Odense Univ Hosp, Dept Cardiol, DK-5000 Odense, Denmark..
    Potpara, Tatjana S.
    Univ Belgrade, Sch Med, Cardiol Clin, Clin Ctr Serbia, Belgrade, Serbia..
    Proclemer, Alessandro
    IRCAB Fdn Udine, Univ Hosp S Maria della Misericordia, Dept Cardiol, Udine, Italy..
    Pison, Laurent
    Maastricht Univ, Med Ctr, Dept Cardiol, Maastricht POB 5800, NL-6200 MD Maastricht, Netherlands.;Cardiovasc Res Inst, Maastricht POB 5800, Amsterdam, Netherlands..
    Brunet, Caroline
    Univ Hosp La Timone, Dept Cardiol, Marseilles, France..
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Perioperative management of antithrombotic treatment during implantation or revision of cardiac implantable electronic devices: the European Snapshot Survey on Procedural Routines for Electronic Device Implantation (ESS-PREDI)2016In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 18, no 5, p. 778-784Article in journal (Refereed)
    Abstract [en]

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

  • 7. Gal, Pim
    et al.
    Elvan, Arif
    Rossi, Pietro
    Schauerte, Patrick
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Kornet, Lilian
    Bonizzi, Teena
    Gemein, Christopher
    Bianchi, Stefano
    Effect of parasympathetic nerve stimulation on atrial and atrioventricular nodal electrophysiological characteristics2016In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 205, p. 83-85Article in journal (Refereed)
  • 8.
    Gorenek, Bulent
    et al.
    Eskisehir Osmangazi Univ, Eskisehir, Turkey.
    Boriani, Giuseppe
    Univ Modena & Reggio Emilia, Cardiol Div, Dept Diagnost, Clin & Publ Hlth Med,Policlin Modena, Modena, Italy.
    Dan, Gheorge-Andrei
    Univ Med & Pharm Carol Davila, Colentina Univ Hosp, Bucharest, Romania;Univ Tours, Tours, France.
    Fauchier, Laurent
    CHU Tours, Tours, France;Hosp Israelita Albert Einstein, Sao Paulo, Brazil.
    Fenelon, Guilherme
    Huang, He
    Wuhan Univ, Renmin Hosp, Wuhan, Peoples R China.
    Kudaiberdieva, Gulmira
    Ctr Postgrad Educ & Res, Bishkek, Kyrgyzstan.
    Lip, Gregory Y. H.
    Univ Birmingham, Inst Cardiovasc Sci, Birmingham, W Midlands, England;Aalborg Univ, Dept Clin Med, Aalborg Thrombosis Res Unit, Aalborg, Denmark.
    Mahajan, Rajiv
    Univ Adelaide, Lyell McEwin Hosp, Royal Adelaide Hosp & SAHMRI, Adelaide, SA, Australia.
    Potpara, Tatjana
    Univ Belgrade, Sch Med, Cardiol Clin, Clin Ctr Serbia, Belgrade, Serbia.
    Ramirez, Juan David
    Clin CardioVid Medellin, Antioquia, Colombia.
    Vos, Marc A.
    Umc Utrecht, Utrecht, Netherlands.
    Marin, Francisco
    HU Virgen Arrixaca, Murcia, Spain.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Rinaldi, Aldo
    St Thomas Hosp, London, England.
    Bongiorni, Maria Grazia
    Santa Chiara Univ, Hosp Pisa, Pisa, Italy.
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Nielsen, Jens Cosedis
    Aarhus Univ Hosp, Aarhus, Denmark.
    Lewalter, Thorsten
    Peter Osypka Heart Ctr, Munich, Germany.
    Zhang, Shu
    Beijing Fuwai Hosp, Beijing, Peoples R China.
    Gutierrez, Oswaldo
    Hosp Clin Bblica, San Jose, Costa Rica.
    Fuenmayor, Abdel
    Univ Hosp Andes, Cardiovasc Res Inst, Elect & Arrhythmia Sect, Avenida 16 Septiembre, Merida 5101, Venezuela.
    European Heart Rhythm Association (EHRA) position paper on arrhythmia management and device therapies in endocrine disorders, endorsed by Asia Pacific Heart Rhythm Society (APHRS) and Latin American Heart Rhythm Society (LAHRS)2018In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 20, no 6, p. 895-+Article in journal (Refereed)
    Abstract [en]

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

  • 9.
    Haugaa, Kristina H.
    et al.
    Natl Hosp Norway, Oslo Univ Hosp, Inst Surg Res, Dept Cardiol,Ctr Cardiol Innovat, Sognsvannsveien 20, N-0372 Oslo, Norway.;Univ Oslo, Inst Clin Med, POB 4950, N-0424 Oslo, Norway..
    Tilz, Roland
    Univ Hosp Schleswig Holstein, Univ Heart Ctr Lubeck, Med Clin Cardiol Angiol Intens Care Med 2, Lubeck, Germany..
    Boveda, Serge
    Clin Pasteur, Cardiac Arrhythmias Management Dept, Dept Cardiol, Toulouse, France..
    Dobreanu, Dan
    Univ Med & Pharm, Emergency Inst Cardiovasc Dis & Transplant, Cardiol Clin, Targu Mures, Romania..
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Mansourati, Jacques
    Univ Hosp Brest, Brest, France.;EA 4324 ORPHY UBO, Brest, France..
    Papiashvili, Giorgi
    Jo Ann Med Centre Tbilisi, 21 Ljubljana St, Tbilisi, Rep of Georgia..
    Dagres, Nikolaos
    Univ Leipzig, Dept Electrophysiol, Ctr Heart, Leipzig, Germany..
    Implantable cardioverter defibrillator use for primary prevention in ischaemic and non-ischaemic heart disease-indications in the post-DANISH trial era: results of the European Heart Rhythm Association survey2017In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 19, no 4, p. 660-664Article in journal (Refereed)
    Abstract [en]

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

  • 10.
    Haugaa, Kristina Hermann
    et al.
    Oslo Univ Hosp, Ctr Cardiol Innovat, Dept Cardiol, Rikshosp, Oslo, Norway.;Oslo Univ Hosp, Ctr Cardiol Innovat, Inst Surg Res, Rikshosp, Oslo, Norway.;Univ Oslo, Inst Clin Med, Oslo, Norway..
    Potpara, Tatjana S.
    Univ Belgrade, Sch Med, Belgrade, Serbia.;Univ Belgrade, Sch Med, Belgrade, Serbia.;Clin Ctr Serbia, Cardiol Clin, Belgrade, Serbia..
    Boveda, Serge
    Clin Pasteur, Div Cardiol, Cardiac Arrhythmias Management Dept, Toulouse, France..
    Deharo, Jean-Calude
    Hop Timone Adultes, Serv Cardiol, F-13385 Marseille 05, France..
    Chen, Jian
    Haukeland Hosp, Dept Heart Dis, N-5021 Bergen, Norway.;Univ Bergen, Dept Clin Sci, N-5021 Bergen, Norway..
    Dobreanu, Dan
    Univ Med & Pharm, Emergency Inst Cardiovasc Dis & Transplant, Cardiol Clin, Targu Mures, Romania..
    Fumagalli, Stefano
    Univ Florence, Expt & Clin Med Dept, Geriatr Cardiol & Med Div, Intens Care Unit, Florence, Italy.;AOU Careggi, Florence, Italy..
    Lenarczyk, Radoslaw
    Silesian Med Univ, Silesian Ctr Heart Dis, Dept Cardiol, Congenital Heart Dis & Electrotherapy, Zabrze, Poland..
    Hernandez Madrid, Antonio
    Alcala Univ, Ramon y Cajal Hosp, Cardiol Dept, Madrid 28034, Spain..
    Larsen, Torben Bjerregaard
    Aalborg Univ Hosp, Thrombosis & Drug Res Unit, Dept Cardiol, Aalborg, Denmark..
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Taborsky, Milos
    Palacky Univ, Dept Internal Med Cardiol 1, Olomouc, Czech Republic..
    Tilz, Roland Richard
    Univ Hosp Schleswig Holstein, Med Clin Cardiol Angiol Intens Care Med 2, Univ Heart Ctr Lubeck, Ratzeburger Allee 160, D-23538 Lubeck, Germany..
    Pieragnoli, Paolo
    Univ Florence, Unita Aritmol, Dipartimento Cardiotoracovasc, Florence, Italy..
    Przybylski, Andrzej
    KSW 2, Cardiol, Rzeszow, Poland.;Univ Rzeszow, Fac Med, Rzeszow, Poland..
    Dagres, Nikolaos
    Univ Leipzig, Dept Electrophysiol, Heart Ctr, D-04289 Leipzig, Germany..
    Patients' knowledge and attitudes regarding living with implantable electronic devices: results of a multicentre, multinational patient survey conducted by the European Heart Rhythm Association2018In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 20, no 2, p. 386-391Article in journal (Refereed)
    Abstract [en]

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

  • 11.
    Jansson, Victoria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Bergfeldt, Lennart
    Schwieler, Jonas
    Kennebäck, Göran
    Rubulis, Aigars
    Jensen, Steen M.
    Raatikainen, Pekka
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Atrial fibrillation burden, episode duration and frequency in relation to quality of life in patients with implantable cardiac monitor2021In: IJC Heart & Vasculature, E-ISSN 2352-9067, Vol. 34, article id 100791Article in journal (Refereed)
    Abstract [en]

    Aims: To assess the relation between atrial fibrillation (AF) characteristics and health-related quality of life (QoL), and which AF characteristic had the greatest impact.

    Method: The AF characteristics burden (percentage of time in AF), duration and number of AF episodes/month were obtained from implantable cardiac monitors during the 2-month run-in period in 150 patients included in the randomized CAPTAF trial comparing early ablation and antiarrhythmic drug therapy. The QoL was measured by the General Health and Vitality dimensions of the 36-Item Short-Form Health Survey. AF characteristics were analysed continuously and in quartiles (Q1-Q4).

    Results: Greater AF burden (p = 0.003) and longer AF episodes (p = 0.013) were associated with impaired QoL (Vitality score only) in simple linear regression analyses. Greater AF burden was, however, the only AF characteristic associated with lower QoL, when adjusted for sex, type of AF, hypertension, heart rate above 110 beats per minute during AF, and beta-blocker use in multiple linear regression analyses. For every 10% increase in AF burden there was a 1.34-point decrease of Vitality score (95% confidence interval (CI) -2.67 to -0.02, p = 0.047). The Vitality score was 12 points lower (95% CI -22.73 to -1.27, p = 0.03) in patients with an AF burden > 33% (Q4) versus those with < 0.45% (Q1), but only in unadjusted analysis.

    Conclusion: AF burden had a greater impact on QoL (Vitality), than the duration and number of AF episodes, corroborating that AF burden may be the preferred outcome measure of rhythm control in trials including relatively healthy AF populations.

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  • 12.
    Jansson, Victoria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Schwieler, Jonas
    Bergfeldt, Lennart
    Kennebäck, Göran
    Jensen, Steen M
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    The results of health-related quality of life assessment depend on the prevailing rhythm at the assessment: Experience from the CAPTAF trial (Catheter Ablation Compared with Pharmacological Therapy for Atrial Fibrillation)2021In: Cardiovascular Electrophysiology, ISSN 1045-3873, E-ISSN 1540-8167, Vol. 32, no 8, p. 2159-2164Article in journal (Refereed)
    Abstract [en]

    AIMS: To assess whether the prevailing rhythm at the time of replying to symptom and health-related quality of life (HR-QoL) questionnaires impacts the findings.

    METHOD: A total of 150 patients from the randomized Catheter Ablation Compared with Pharmacological Therapy for Atrial Fibrillation-trial, comparing atrial fibrillation (AF) ablation versus drugs, were included. The effect of the prevailing rhythm on the outcome results of the HR-QoL 36-Item Short-Form Health Survey, the symptom severity questionnaire (SSQ), and the European Heart Rhythm Association (EHRA) score for classification of AF-related symptoms was assessed.

    RESULTS: AF as the prevailing rhythm was independently associated with a significantly lower Vitality score; 18.4 points lower (95% confidence interval -32.7 to -4.1, p = .01) compared with sinus rhythm when adjusted for AF burden, median duration of episode, number of episodes, beta-blocker use, type of AF, and sex. The presence of AF did not affect the General Health score compared with sinus rhythm, nor did it influence symptoms assessed by the SSQ or EHRA score.

    CONCLUSION: The observation that the presence of AF versus sinus rhythm when conducting HR-QoL tests had a negative impact on its outcome, leaving symptom-related questionnaires unaffected, implies that the prevailing rhythm should be taken into account when results of HR-QoL questionnaires are interpreted.

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  • 13.
    Kommata, Varvara
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Elshafie, Marwa
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Electrical Engineering, Solid-State Electronics.
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Perez, Mauricio D.
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Electrical Engineering, Solid-State Electronics.
    Augustine, Robin
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Electrical Engineering, Solid-State Electronics.
    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.
    QRS dispersion detected in ARVC patients and healthy gene carriers using 252-leads body surface mapping: an explorative study of a potential diagnostic tool for arrhythmogenic right ventricular cardiomyopathy2021In: Pacing and Clinical Electrophysiology, ISSN 0147-8389, E-ISSN 1540-8159, Vol. 44, no 8, p. 1355-1364Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The diagnosis of ARVC remains complex requiring both imaging and electrocardiographic (ECG) techniques. The purpose was therefore to investigate whether QRS dispersion assessed by body surface mapping (BSM) could be used to detect early signs of ARVC, particularly in gene carriers.

    METHODS: ARVC patients, gene carriers without a history of arrhythmias or structural cardiac changes and healthy controls underwent 12-lead resting ECG, signal-averaged ECG, echocardiographic examination, 24-hours Holter monitoring, and BSM with electrocardiographic imaging. All 252-leads BSM recordings and 12-leads ECG recordings were manually analyzed for QRS durations and QRS dispersion.

    RESULTS: Eight controls, 12 ARVC patients with definite ARVC and 20 healthy gene carriers were included. The ECG-QRS dispersion was significantly greater in ARVC patients (42 vs. 25 ms, p < .05), but failed to fully differentiate them from controls. The BSM-derived QRS dispersion was also significantly greater in ARVC patients versus controls (65 vs. 29 ms, p < .05) and distinguished 11/12 cases from controls using the cut-off 40msec. The BSM derived QRS dispersion was abnormal (> 40 ms) in 4/20 healthy gene carriers without signs of ARVC, which may indicate early depolarization changes.

    CONCLUSIONS: QRS dispersion, when assessed by BSM versus 12-lead ECG, seem to better distinguish ARVC patients from controls, and could potentially be used to detect early ARVC in gene carriers. Further studies are required to confirm the value of BSM-QRS dispersion in this respect.

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  • 14.
    Kommata, Varvara
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia. Örebro Univ, Fac Med & Hlth, Sch Med Sci, Dept Cardiol, Örebro, Sweden..
    Epicardial conduction abnormalities in patients with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) and mutation positive healthy family members – a study using electrocardiographic imaging2023In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 1, article id e0280111Article in journal (Refereed)
    Abstract [en]

    Background: The diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) in early stages is challenging. The aim was therefore to study whether electrocardiographic imaging (ECGI) can detect epicardial depolarization changes in ARVC patients and healthy mutation-carriers (M-carriers).

    Method: Twelve ARVC patients, 20 M-carriers and 8 controls underwent 12-lead ECG, signal-averaged ECG, 2-dimensional echocardiography, 24-hours Holter monitoring and ECGI (body surface mapping and computer tomography with offline analysis of reconstructed epicardial signals). Total and Right Ventricular Activation Time (tVAT and RVAT respectively), area of Ventricular Activation during the terminal 20 milliseconds (aVAte20) and the activation patterns were compared between groups.

    Results: In ARVC patients the locations of aVAte20 were scattered or limited to smaller RV parts versus in controls, in whom aVAte20 was confined to RVOT and LV base (+/- RV base). ARVC patients had smaller aVAte20 (35cm2 vs 87cm2, p<0.05), longer tVAT (99msec vs 58msec, p<0.05) and longer RVAT (66msec vs 43msec, p<0.05) versus controls. In 50% of M-carriers, the locations of aVAte20 were also eccentric. This sub-group presented smaller aVAte20 (53cm2 vs 87cm2, p= 0.009), longer RVAT (55msec vs 48msec, p=0.043), but similar tVAT (65msec vs 60msec, p=0.529) compared with the M-carriers with normal activation pattern.

    Conclusions: The observation of localized delayed epicardial conduction in the RV in M-carriers suggests an early stage of ARVC and may be a useful diagnostic marker enhancing an early detection of the disease.

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  • 15.
    Kommata, Varvara
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Repolarisation abnormalities unmasked with a 252-lead BSM system in patients with ARVC and healthy Gene Carriers2022In: Pacing and Clinical Electrophysiology, ISSN 0147-8389, E-ISSN 1540-8159, Vol. 45, no 4, p. 509-518Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Diagnosing Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) at an early stage can be challenging even after ECG recording and a combination of several imaging techniques. The purpose of this study was to explore if a Body Surface Mapping (BSM) system with 252-leads could identify repolarization abnormalities and thereby diagnose early stages of ARVC.

    METHODS: ARVC patients, gene carriers without signs of ARVC and controls underwent a 12 lead resting ECG, signal-averaged ECG, echocardiography, 24-hours Holter monitoring and BSM with electrocardiographic imaging (ECGI). All 252-leads, divided into four quadrants of the vest, were analyzed regarding concordances between T wave polarity and QRS main vector.

    RESULTS: Of 40 patients included there were 12 ARVC patients, 20 gene carriers and 8 controls. The ARVC patients had two different repolarization patterns, one with more pronounced negative T waves at the lower left panel and another with mixed changes that clearly differed from the controls, all of whom had a normal 12 lead ECGs and consistent repolarization patterns on their BSM recordings. The patterns observed in ARVC patients were also present in 5/20 (25%) gene carriers, three of whom had normal resting ECG. A novel repolarization index successfully detected all ARVC patients and 88% of gene carriers with pathologic repolarization pattern.

    CONCLUSIONS: The finding that abnormal repolarization patterns could be unmasked by BSM in 25% of healthy gene carriers, suggests that it may potentially be a useful tool for identifying early manifestations of ARVC. Further and larger studies are warranted to assess its diagnostic accuracy.

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  • 16. Larsen, Torben Bjerregaard
    et al.
    Potpara, Tatjana
    Dagres, Nikolaos
    Proclemer, Alessandro
    Sciarrafia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Blomström-Lundqvist, Carina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Preference for oral anticoagulation therapy for patients with atrial fibrillation in Europe in different clinical situations: results of the European Heart Rhythm Association Survey2015In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 5, p. 819-824Article in journal (Refereed)
    Abstract [en]

    The purpose of this European Heart Rhythm Association Survey was to assess the clinical practice in relation to the use of oral anticoagulation therapy for patients with atrial fibrillation (AF) in Europe. Of special interest were patients undergoing percutaneous coronary intervention (PCI), cardioversion procedures, catheter ablation, surgery, and those suffering from anticoagulation-related bleeding. Of 38 responding centres, non-vitamin K antagonist oral anticoagulants (NOACs) were used for stroke prophylaxis and were preferred (33.3%) or considered equal (48.5%) to vitamin K antagonists (VKAs). Only 3% did not use NOACs at all. There were some practice differences regarding the use of NOACs in combination with dual antiplatelet therapy in AF patients undergoing PCI, and only 12% preferred using NOACs in this setting. Bare metal stents were preferred rather than drug-eluting stents in AF patients at high bleeding risk. There were clear practice differences between centres regarding the use of triple therapy. Most of the major bleeding events would be handled using symptomatic and supportive measures (e.g. mechanical compression, fluid replacement, blood transfusion, prothrombin complex concentrate, or recombinant Factor VIIa). More than 80% of the centres offer either VKA or NOAC for at least 3 weeks before and after cardioversion and 70% offer either VKA or NOAC before and after AF catheter ablation. Patients treated with an NOAC were routinely re-assed in most centres.

  • 17.
    Lenarczyk, Radoslaw
    et al.
    Silesian Med Univ, Silesian Ctr Heart Dis, Dept Cardiol Congenital Heart Dis & Electrotherap, Curie Sklodowskiej 9, PL-41800 Zabrze, Poland..
    Potpara, Tatjana S.
    Univ Belgrade, Sch Med, Cardiol Clin, Clin Ctr Serbia, Belgrade, Serbia..
    Haugaa, Kristina H.
    Univ Oslo, Rikshosp, Oslo Univ Hosp, Dept Cardiol, N-0027 Oslo, Norway..
    Hernandez-Madrid, Antonio
    Hosp Ramon & Cajal, Dept Cardiol, E-28034 Madrid, Spain..
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Dagres, Nikolaos
    Heart Ctr Leipzig, Dept Electrophysiol, Leipzig, Germany..
    The use of wearable cardioverter-defibrillators in Europe: results of the European Heart Rhythm Association survey2016In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 18, no 1, p. 146-150Article in journal (Refereed)
    Abstract [en]

    The aim of this European Heart Rhythm Association (EHRA) survey was to collect data on the use of wearable cardioverter-defibrillators (WCDs) among members of the EHRA electrophysiology research network. Of the 50 responding centres, 23 (47%) reported WCD use. Devices were fully reimbursed in 17 (43.6%) of 39 respondents, and partially reimbursed in 3 centres (7.7%). Eleven out of 20 centres (55%) reported acceptable patients' compliance (WCD worn for > 90% of time). The most common indications for WCD (8 out of 10 centres; 80%) were covering the period until re-implantation of ICD explanted due to infection, in patients with left ventricular impairment due to myocarditis or recent myocardial infarction and those awaiting heart transplantation. Patient life expectancy of < 12 months and poor compliance were the most commonly reported contraindications for WCD (24 of 46 centres, 52.2%). The major problems encountered by physicians managing patients with WCD were costs (8 of 18 centres, 44.4%), non-compliance, and incorrect use of WCD. Four of 17 centres (23.5%) reported inappropriate WCD activations in < 5% of patients. The first shock success rate in terminating ventricular arrhythmias was 95-100% in 6 of 15 centres (40%), 85-95% in 4 (26.7%), 75-85% in 2 (13.3%), and < 75% in 3 centres (20%). The survey has shown that the use of WCD in Europe is still restricted and depends on reimbursement. Patients' compliance remains low. Heterogeneity of indications for WCD among centres underscores the need for further research and a better definition of indications for WCD in specific patient groups.

  • 18.
    Normand, Camilla
    et al.
    Stavanger Univ Hosp, Div Cardiol, Stavanger, Norway;Univ Bergen, Inst Internal Med, Bergen, Norway.
    Linde, Cecilia
    Karolinska Univ Hosp, Heart & Vasc Theme, Stockholm, Sweden;Karolinska Inst, Stockholm, Sweden.
    Bogale, Nigussie
    Stavanger Univ Hosp, Div Cardiol, Stavanger, Norway.
    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.
    Auricchio, Angelo
    Fdn Cardioctr Ticino, Clin Electrophysiol Unit, Lugano, Switzerland.
    Stellbrink, Christoph
    Klinikum Bielefeld, Dept Cardiol, Bielefeld, Germany.
    Witte, Klaus K
    Univ Leeds, Leeds Inst Cardiovasc & Metab Med, Leeds, W Yorkshire, England.
    Mullens, Wilfried
    Ziekenhuis Oost Limburg, Dept Cardiol, Genk, Belgium;Hasselt Univ, Biomed Res Inst, Fac Med & Life Sci, Diepenbeek, Belgium.
    Sticherling, Christian
    Univ Basel, Univ Basel Hosp, Basel, Switzerland.
    Marinskis, Germanas
    Vilnius Univ, Clin Heart Dis, Vilnius, Lithuania.
    Sciaraffia, Elena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
    Papiashvili, Giorgi
    Helsicore Israeli Georgian Med Res Clin, Arrhythmia Dept, Tbilisi, Georgia.
    Iovev, Svetoslav
    St Ekaterina Univ Multiprofile Hosp Act Treatment, Cardiostimulat & Electrophysiol Sect, Sofia, Bulgaria.
    Dickstein, Kenneth
    Stavanger Univ Hosp, Div Cardiol, Stavanger, Norway;Univ Bergen, Inst Internal Med, Bergen, Norway.