IntroductionCardiac tamponade (CT) is a life-threatening complication of radiofrequency ablation (RFA). The course and outcome of CT in low-to-medium volume electrophysiology centers are underreported.MethodsWe analyzed the incidence, management and outcomes of CT in 1500 consecutive RFAs performed in our center during 2011–2016.ResultsOf 1500 RFAs performed in 1352 patients (age 55 years, interquartile range: 41–63), 569 were left-sided procedures (n = 406 with transseptal access). Conventional RFA or irrigated RFA was performed in 40.9% and 59.1% of procedures, respectively. Ablation was performed mostly for atrioventricular nodal reentrant tachycardia (25.4%), atrial fibrillation (AF; 18.5%), atrial flutter (18.4%), accessory pathway (16.5%) or idiopathic ventricular arrhythmia (VA; 12.3%), and rarely for structural VA (2.1%). CT occurred in 12 procedures (0.8%): 10 AF ablations, 1 idiopathic VA and 1 typical atrial flutter ablation. Factors significantly associated with CT were older age, pre-procedural oral anticoagulation, left-sided procedures, transseptal access, AF ablation, irrigated RFA and longer fluoroscopy time (on univariate analysis), and AF ablation (on multivariable analysis). The perforation site was located in the left atrium (n = 7), right atrium (n = 3), or in the left ventricle or coronary sinus (n = 1 each). Upon pericardiocentesis, two patients underwent urgent cardiac surgery because of continued bleeding. There was no fatal outcome. During the follow-up of 19 ± 14 months, eight patients were arrhythmia free.ConclusionIncidence of RFA-related CT in our medium-volume center was low and significantly associated with AF ablation. The outcome of CT was mostly favorable after pericardiocentesis, but readily accessible cardiothoracic surgery back-up should be mandatory in RFA centers.
Aims The 4S-AF classification scheme comprises of four domains: stroke risk (St), symptoms (Sy), severity of atrial fibrillation (AF) burden (Sb), and substrate (Su). We sought to examine the implementation of the 4S-AF scheme in the EORP-AF General Long-Term Registry and compare outcomes in AF patients according to the 4S-AF-led decision-making process. Methods and results Atrial fibrillation patients from 250 centres across 27 European countries were included. A 4S-AF score was calculated as the sum of each domain with a maximum score of 9. Of 6321 patients, 8.4% had low (St), 47.5% EHRA I (Sy), 40.5% newly diagnosed or paroxysmal AF (Sb), and 5.1% no cardiovascular risk factors or left atrial enlargement (Su). Median follow-up was 24 months. Using multivariable Cox regression analysis, independent predictors of all-cause mortality were (St) [adjusted hazard ratio (aHR) 8.21, 95% confidence interval (CI): 2.60–25.9], (Sb) (aHR 1.21, 95% CI: 1.08–1.35), and (Su) (aHR 1.27, 95% CI: 1.14–1.41). For CV mortality and any thromboembolic event, only (Su) (aHR 1.73, 95% CI: 1.45–2.06) and (Sy) (aHR 1.29, 95% CI: 1.00–1.66) were statistically significant, respectively. None of the domains were independently linked to ischaemic stroke or major bleeding. Higher 4S-AF score was related to a significant increase in all-cause mortality, CV mortality, any thromboembolic event, and ischaemic stroke but not major bleeding. Treatment of all 4S-AF domains was associated with an independent decrease in all-cause mortality (aHR 0.71, 95% CI: 0.55–0.92). For each 4S-AF domain left untreated, the risk of all-cause mortality increased substantially (aHR 1.35, 95% CI: 1.16–1.56). Conclusion Implementation of the novel 4S-AF scheme is feasible, and treatment decisions based on this scheme improve mortality rates in AF.
Aims Treatment burden (TB) refers to self-perceived cumulative work patients do to manage their health. Using validated tools, TB has been documented in several chronic conditions, but not atrial fibrillation (AF). We measured TB and analysed its determinants and impact on quality of life (QoL) in an AF cohort. Methods and results A single-centre study prospectively included consecutive adult AF patients and non-AF controls managed from 1 April to 21 June 2019, who voluntarily and anonymously answered the TB questionnaire (TBQ) and 5-item EQ-5D QoL questionnaire; TB was calculated as a sum of TBQ points (maximum 170) and expressed as proportion of the maximum value. Of 514 participants, 331 (64.4%) had AF. The mean self-reported TB was 27.6% among AF patients and 24.3% among controls, P = 0.011. The mean TB was significantly higher in patients taking vitamin K antagonists (VKAs) vs. those taking non-VKA antagonist oral anticoagulants (NOAC; 29.5% vs. 24.7%, P = 0.006). The highest item-specific TB was reported for healthcare system organization-related items (e.g. visit appointment), diet, and physical activity modifications. On multivariable analyses, female sex, younger age, and permanent AF were associated with a higher TB, whereas NOACs and electrical AF cardioversion exhibited an inverse association; TB was an independent predictor of decreased QoL (all P < 0.05). Conclusion Our study provided clinically relevant insights into self-perceived TB among AF patients. Approximately one in four patients with AF have a high TB. Specific AF treatments and optimization of healthcare system-required patient activities may reduce the self-perceived TB in AF patients.
Funding Acknowledgements Type of funding sources: None. Background Amiodarone is the most prescribed antiarrhythmic drug, but drug-related side effects sometimes result in drug discontinuation. Not infrequently, physicians discontinue amiodarone without a medical reason. We explored the determinants of such permanent drug discontinuation. Methods A single-centre, longitudinal study included consecutive patients newly prescribed or already taking amiodarone when first seen in our health centre from January 2013 to December 2017. Baseline data were retrieved from the hospital electronic database and patients were scheduled for a follow-up visit in January to March 2019. Results Of 1212 patients taking amiodarone (mean age 64.2 ±11.2 yrs; female n= 358, 29.5%; median follow-up 22.5 months), the drug was permanently discontinued in 489 (40.3 %), see Figure. On univariate Cox regression analysis, female sex (HR 1.55; 95%CI 1.0-2.3; p = 0.032), non-multimorbidity (2.9; 2.0-4.3; p < 0.001), LV EF (1.0; 1.0-1.1; p < 0.001), NOAC therapy (1.9; 1.2-3.0; p = 0.003) and AF ablation (2.7; 1.5-4.6; P < 0.001) were associated with amiodarone discontinuation. Age (0.9; 0.9-0.9; p < 0.001), CAD (0.3; 0.2-0.5; p < 0.001), HF (0.5; 0.3-0.9; p = 0.020), ventricular arrhythmias (0.1; 0.0-0.3; p < 0.001), stroke (0.2; 0.1-0.9; p = 0.045), CKD (0.5; 0.3-0.9; p = 0.011), ICD (0.1; 0.0-0.6; P = 0.014), LV diastolic (0.9; 0.9-0.9; p = 0.001) and systolic diameter (0.9; 0.9-0.9; p < 0.001), polypharmacy (0.5; 0.3-0.7; P < 0.001), VKA therapy (0.6; 0.4-0.9; p = 0.027), aspirin (0.57; 0.4-0.9; p = 0.011), loop diuretic (0.5; 0.3-0.7; p < 0.001), spironolactone (0.4; 0.2-0.7; p < 0.001) and statin (0.6; 0.4-0.9; p = 0.009) therapy were associated with drug continuation. Multivariable risk factors for amiodarone discontinuation are showed in Table. Conclusion Study showed that within the first two years of treatment, despite persistent indication, amiodarone was discontinued in 1 out of 10 patients in the absence of side effects, mostly in younger patients with less comorbidities, which may not always be justified. There is a need for qualitative research to elucidate the reasons for such physicians’ decisions. Table.Multivariable Cox Proportional HAZARD Regression analysis of permanent Amiodarone discontinuation due to physician decisionVariableHR95% CIP valueAge0.9700.95-0.990.003VT/VF/electrical storm0.1390.04-0.450.001VKA therapy0.5980.38-0.940.026Ablation of AF2.5391.38-4.690.003Number of comorbidities ≤32.0241.26-3.270.004VT ventricular tachycardia; VF: ventricular fibrillation.Abstract Figure.
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