The development of AF over time in patients with permanent pacemakers: objective assessment with pacemaker diagnostics demonstrates distinct patterns of AF

Sugihara, Conn; Veasey, Rick A.; Freemantle, Nick; Podd, Steve; Furniss, Stephen S.; Sulke, Neil

doi:10.1093/europace/euv032

Cited by 19 publications

(19 citation statements)

References 19 publications

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“… 920 This incidence was similar to a separate survey of members of the Heart Rhythm Society. In this survey, an AEF was reported in 6 of 20 , 425 patients (0.03%). 1168 All six of these patients experienced major cerebrovascular events, and five (83%) died.…”

Section: Section 10: Complicationsmentioning

confidence: 67%

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation

et al. 2017

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Section: Section 10: Complicationsmentioning

confidence: 67%

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation

et al. 2017

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“…The 2016 European Society of Cardiology guideline recommends that rhythm control reduces rather than eliminates the recurrence of AF, so AADs might be considered as a temporizing rather than a curative treatment . The ATHENA study demonstrated that dronedarone could prevent cardiovascular hospitalization in nonpermanent AF .…”

Section: Discussionmentioning

confidence: 99%

Relations between baseline burden, maximum duration, and relative reduction of atrial fibrillation: Insights from continuous monitoring in rhythm control

Lin

Huang

et al. 2019

Cardiovasc electrophysiol

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Introduction: Cardiac implantable electronic devices (CIEDs) can measure atrial fibrillation (AF) early; however, the timing for administering antiarrhythmic drugs (AADs) to suppress AF remains unclear. This study aimed to investigate the association between baseline values and changes after AAD in terms of relative reduction of AF burden (RRAB) and maximum AF duration (RRMD).Methods: This multicenter retrospective study screened all patients with nonpermanent AF who had dual-chamber pacemakers and only enrolled those receiving a naive AAD between September 2009 and December 2014. AF burden and maximum duration were calculated using CIED at 0 and 3 to 6 months after starting rhythm control. All the enrolled patients were divided into four groups according to baseline AF burden. RRAB and RRMD were monitored using CIEDs.Results: Overall, 145 eligible subjects received a naive AAD for nonpermanent AF.The mean RRAB in the four groups (AF burden <1%, 1%-4%, 4%-18%, and ≥18%) were −65.3%, −46.4%, −34.7%, and −27.9% (P = 0.005), respectively. Mean RRMD were −26.8%, −12.4%, 4.2%, and 6.0%, respectively (P = 0.006). Multivariate analysis revealed that the lowest baseline AF burden (<1%) was significantly associated with greater RRAB, which was not observed in the RRMD model. Conclusions:Lower baseline AF burden was associated with greater RRAB by AADs.Our finding suggests that rhythm control should be started in the early stage to achieve better responses to AADs.

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“…There is also marked clinical variability within paroxysmal AF, with some patients having very few short-lived episodes, whilst others have longer periods of AF and short periods of sinus rhythm. However, the cumulative time spent in AF, termed the 'AF density' 15 , has been difficult to accurately measure, given that most outpatient investigations provide only a 'snapshot' view of the heart's rhythm 15 16,17 , but these methods are not applicable to the global population of AF patients.…”

Section: Current Af Classificationmentioning

confidence: 99%

Temporal pattern/episode duration-based classification of atrial fibrillation as paroxysmal vs. persistent: is it time to develop a more integrated prognostic score to optimize management?

2017

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Atrial fibrillation (AF) is a clinically heterogeneous arrhythmia that is currently classified according to the variety of temporal rhythm based manifestations observed clinically, including 'first detected episode', 'paroxysmal', 'persistent', or 'permanent' AF. Despite being widely adopted by the most recent consensus guidelines, the utility of this classification system to stratify patients into distinct and clinically useful groups that have different outcomes including mortality, morbidity, specific cardiovascular outcomes, and quality of life (QoL), remains questionable. This is particularly true regarding the distinction between paroxysmal and persistent AF. Here, we demonstrate there is limited and conflicting evidence that this distinction is useful in predicting mortality, morbidity (including stroke and heart failure), symptom burden and QoL, although there is convincing evidence that patients with paroxysmal AF have favourable outcomes following electrical cardioversion and have better ablation procedural outcomes. Risk stratification schemes including the CHA2DS2VASc score are widely used to help clinicians stratify patients at high risk of stroke, whilst a number of newer, potentially superior, competitors have also recently been developed. A range of parameters including left atrial (LA) size, LA morphology, LA fibrosis [assessed by magnetic resonance imaging (MRI)] LA appendage morphology and LA function (assessed by echo) have all been recently suggested to identify higher risk patients and may, perhaps in combination with validated risk stratification scores and emerging genetic data, provide clinicians with the information necessary to more accurately stratify patients to ensure better outcomes of specific AF treatments and prevent adverse events.

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The development of AF over time in patients with permanent pacemakers: objective assessment with pacemaker diagnostics demonstrates distinct patterns of AF

Abstract: NCT02016950, http://clinicaltrials.gov/show/NCT02016950.

Cited by 19 publications

References 19 publications

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation

Relations between baseline burden, maximum duration, and relative reduction of atrial fibrillation: Insights from continuous monitoring in rhythm control

Temporal pattern/episode duration-based classification of atrial fibrillation as paroxysmal vs. persistent: is it time to develop a more integrated prognostic score to optimize management?

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