Assessment of Atrial Fibrillation–Specific Symptoms Before and 2 Years After Atrial Fibrillation Ablation

Björkenheim, Anna; Brandes, Axel; Magnuson, Anders; Chemnitz, Alexander; Svedberg, Lena; Edvardsson, Nils; Poçi, Dritan

doi:10.1016/j.jacep.2017.04.003

Cited by 28 publications

(23 citation statements)

References 19 publications

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“… 8 , 9 , 16 The wide range can be explained due to varying AF definitions, observing intervals and efforts for AF diagnosis, and may include a temporal effect related to improved ablation techniques like pressure sensitive and irrigated ablation catheters or second-generation cryoballoon in our cohort. The improvement in AF-related symptoms in our cohort for patients with recurrence of AF is in line with previous reported improvement of symptoms 17 and quality of life. 18 …”

Section: Discussionsupporting

confidence: 92%

Predictors of recurrence of atrial fibrillation within the first 3 months after ablation

et al. 2020

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Aims Freedom from atrial fibrillation (AF) at 1 year can be achieved in 50–70% of patients undergoing catheter ablation. Recurrent AF early after ablation most commonly terminates spontaneously without further interventional treatment but is associated with later recurrent AF. The aim of this investigation is to identify clinical and procedural factors associated with recurrence of AF early after ablation. Methods and results We retrospectively analysed data for recurrence of AF within the first 3 months after catheter ablation from the randomized controlled AXAFA–AFNET 5 trial, which demonstrated that continuous anticoagulation with apixaban is as safe and as effective compared to vitamin K antagonists in 678 patients undergoing first AF ablation. The primary outcome of first recurrent AF within 90 days was observed in 163 (28%) patients, in which 78 (48%) patients experienced an event within the first 14 days post-ablation. After multivariable adjustment, a history of stroke/transient ischaemic attack [hazard ratio (HR) 1.54, 95% confidence interval (CI) 0.93–2.6; P = 0.11], coronary artery disease (HR 1.85, 95% CI 1.20–2.86; P = 0.005), cardioversion during ablation (HR 1.78, 95% CI 1.26–2.49; P = 0.001), and an age:sex interaction for older women (HR 1.01, 95% CI 1.00–1.01; P = 0.04) were associated with recurrent AF. The P-wave duration at follow-up was significantly longer for patients with AF recurrence (129 ± 31 ms vs. 122 ± 22 ms in patients without AF, P = 0.03). Conclusion Half of all early AF recurrences within the first 3 months post-ablation occurred within the first 14 days post-ablation. Vascular disease and cardioversion during the procedure are strong predictors of recurrent AF. P-wave duration at follow-up was longer in patients with recurrent AF. Trial registration Clinicaltrials.gov identifier NCT02227550, https://clinicaltrials.gov/ct2/show/NCT02227550?term=NCT02227550.&rank=1

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Section: Discussionsupporting

confidence: 92%

Predictors of recurrence of atrial fibrillation within the first 3 months after ablation

et al. 2020

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“…35 However, the EHRA symptom score is physician-assessed, reflecting how physicians weigh the symptoms of their AF patients rather than the patients' perception that may differ substantially. 36 In addition, the EHRA score cannot precisely differentiate between AF-related and concomitant comorbidity-related symptoms. Indeed, in symptomatic patients with underlying comorbidities, optimal management of concomitant diseases is necessary before proceeding with a symptomguided treatment decision for left atrial ablation, and the descriptor(s) of the symptom severity domain may change in the future to include the assessment of quality of life, patient-perceived burden of treatment, 37 and other features.…”

Section: The 4s-af Scheme Domainsmentioning

confidence: 99%

The 4S-AF Scheme (Stroke Risk; Symptoms; Severity of Burden; Substrate): A Novel Approach to In-Depth Characterization (Rather than Classification) of Atrial Fibrillation

et al. 2020

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Atrial fibrillation (AF) is a complex condition requiring holistic management with multiple treatment decisions about optimal thromboprophylaxis, symptom control (and prevention of AF progression), and identification and management of concomitant cardiovascular risk factors and comorbidity. Sometimes the information needed for treatment decisions is incomplete, as available classifications of AF mostly address a single domain of AF (or patient)-related characteristics. The most widely used classification of AF based on AF episode duration and temporal patterns (that is, the classification to first-diagnosed, paroxysmal, persistent/long-standing persistent, and permanent AF) has contributed to a better understanding of AF prevention and treatment but its limitations and the need for a multidimensional AF classification have been recognized as more complex treatment options became available. We propose a paradigm shift from classification toward a structured characterization of AF, addressing specific domains having treatment and prognostic implications to become a standard in clinical practice, thus aiming to streamline the assessment of AF patients at all health care levels facilitating communication among physicians, treatment decision-making, and optimal risk evaluation and management of AF patients. Specifically, we propose the 4S-AF structured pathophysiology-based characterization (rather than classification) scheme that includes four AF- and patient-related domains—Stroke risk, Symptoms, Severity of AF burden, and Substrate severity—and provide a hypothetical model for the use of 4S-AF characterization scheme to aid treatment decision making concerning the management of patients with AF in clinical practice.

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“…The episodes of palpitations documented by the participants may not have been caused by AF. The correlation between symptoms of AF and an actual arrhythmia is low 47 and it would thus have been useful to have recorded the ECG during symptoms.…”

Section: Limitationsmentioning

confidence: 99%

MediYoga as a part of a self-management programme among patients with paroxysmal atrial fibrillation – a randomised study

Wahlström

Rosenqvist

Medin

et al. 2019

European Journal of Cardiovascular Nursing

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Background: Paroxysmal atrial fibrillation is associated with impaired health-related quality of life. Yoga has been suggested to improve health-related quality of life among patients with heart failure and hypertension. Aim: The aim of the study was to evaluate the effects of MediYoga, in respect of health-related quality of life, blood pressure, heart rate, as well as N-terminal pro b-type natriuretic peptide, among patients with symptomatic paroxysmal atrial fibrillation, compared with standard therapy or relaxation. Methods: Patients with symptomatic paroxysmal atrial fibrillation, n=132, were stratified for gender and randomised to MediYoga, a relaxation group or a control group, 44 patients per group with a 12-week follow-up. Health-related quality of life, blood pressure, heart rate and N-terminal pro b-type natriuretic peptide were assessed. Results: After 12 weeks, there were no differences in health-related quality of life between the groups. There were improvements in Short-Form Health Survey bodily pain, general health, social function, mental health and mental component summary scores within the MediYoga group ( p=0.014, p=0.037, p=0.029, p=0.030, p=0.019, respectively). No change was seen in the relaxation and control groups. Systolic blood pressure decreased in the MediYoga group (134±18 to 127±13) compared with the control group (126±17 to 127±15, p=0.041); no difference compared with the relaxation group (131±17 to 125±12). Diastolic blood pressure decreased in the MediYoga group (79±9 to 74 ±9) compared with the control group (76±9 to 79±8, p=0.005); no difference compared with the relaxation group (76±9 to 77±8). There were no differences in heart rate and N-terminal pro b-type natriuretic peptide between the groups after 12 weeks. Conclusions: MediYoga improves health-related quality of life and decreases blood pressure in patients with paroxysmal atrial fibrillation. MediYoga may be used as a part of a self-management programme among patients with paroxysmal atrial fibrillation.

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Assessment of Atrial Fibrillation–Specific Symptoms Before and 2 Years After Atrial Fibrillation Ablation

Cited by 28 publications

References 19 publications

Predictors of recurrence of atrial fibrillation within the first 3 months after ablation

Predictors of recurrence of atrial fibrillation within the first 3 months after ablation

The 4S-AF Scheme (Stroke Risk; Symptoms; Severity of Burden; Substrate): A Novel Approach to In-Depth Characterization (Rather than Classification) of Atrial Fibrillation

MediYoga as a part of a self-management programme among patients with paroxysmal atrial fibrillation – a randomised study

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