The State of Atrial Fibrillation in 2020

Doshi, Rahul N.

doi:10.19102/icrm.2021.120105

Cited by 3 publications

(3 citation statements)

References 17 publications

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“…As a consequence of multiple conditions (2), it is frequently a marker of underlying cardiac or vascular disease. Associated with the risk of stroke, heart failure, dementia, and mortality (3), it requires treatment to restore sinus rhythm, control heart rate, and reduce embolism by using antiplatelet (AP) or anticoagulant therapy (4,5). Guidelines in anticoagulant treatment of AF (6)(7)(8) have established recommendations about when to start, drugs to be used, dose, and monitoring.…”

Section: Introductionmentioning

confidence: 99%

Real-World Data of Anticoagulant Treatment in Non-valvular Atrial Fibrillation

Calderón

Martínez

Diaz

et al. 2022

Front. Cardiovasc. Med.

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AimsTo assess the impact of anticoagulant treatment on risk for stroke and all-cause mortality of patients with atrial fibrillation using real-world data (RWD).MethodsPatients with prevalent or incident atrial fibrillation were selected throughout a study period of 5 years. Stroke, transitory ischemic attack, hemorrhagic stroke, and all-cause mortality were identified in the claims of the electronic health records (EHRs). Subjects were classified according to the anticoagulant treatment in four groups: untreated, vitamin K antagonists (VKAs), New Oral Anticoagulants (NOACs), and antiplatelet (AP). Risk of events and protection with anticoagulant therapy were calculated by Cox proportional hazard models adjusted by potential confounders.ResultsFrom a total population of 3,799,884 patients older than 18,123,227 patients with incident or prevalent atrial fibrillation (AF) were identified (mean age 75.2 ± 11.5 years old; 51.9% women). In a follow-up average of 3.2 years, 17,113 patients suffered from an ischemic stroke and transitory ischemic attack (TIA), 780 hemorrhagic stroke, and 42,558 all-cause death (incidence of 46, 8, 2, and 120 per 1,000 patients/year, respectively). Among CHA2DS2, VASc Score equal or >2, 11.7% of patients did not receive any anticoagulant therapy, and a large proportion of patients, 47%, shifted from one treatment to another. Although all kinds of anticoagulant treatments were significantly protective against the events and mortality, NOAC treatment offered significantly better protection compared to the other groups.ConclusionIn the real world, the use of anticoagulant treatments is far from guidelines recommendations and is characterized by variability in their use. NOACs offered better protection compared with VKAs.

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Section: Introductionmentioning

confidence: 99%

Real-World Data of Anticoagulant Treatment in Non-valvular Atrial Fibrillation

Calderón

Martínez

Diaz

et al. 2022

Front. Cardiovasc. Med.

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“…Multiple feasibility studies using monophasic or biphasic waveforms have been presented, typically using energy sources that disrupt the cell membrane [7]. This disruption leads to an ablation of the LAA cells [8], [9]. The field of electroporation has been an area of research since about 1950 [10], and has recently received increased attention as a modality for the manipulation of tissue cells [2], [11]- [13].…”

Section: Introductionmentioning

confidence: 99%

Design of a Tetrapolar Probe for Electrical Characterization of the Left Atrial Appendage From 0.1 Hz to 100 kHz

Benchakroun

Ištuk

Dunne³

et al. 2023

IEEE Sensors J.

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Recently, non-thermal pulsed-fieldablation using electroporation has generated a lot of interest as a potential treatment for Atrial Fibrillation. The electrical properties, and specially the conductivity of cardiac tissues, are used in the in treatment planning of non-thermal pulsed field ablation. However, there is no standard approach to measure the conductivity, particularly for the left atrial appendage (LAA). Electrical conductivity characterization studies, focusing on cardiac tissues, have used different probe typologies with different electrodes sizes. Furthermore, no study has investigated the effect of the probe design on the acquired conductivity. In this study, common leading probe typologies with different electrode size are compared in terms of accuracy and measurement repeatability. Using liquid phantoms, differences in term of measurement accuracy and repeatability are observed between the probe designs which suggests that the measurement probe design influences the data acquisition quality.Based on these results, a custom probe design is proposed suitable for the characterization of the conductivity of the LAA. The probe is tested using ten ex vivo bovine tissue samples between 0.1 Hz and 100 kHz. The mean conductivity of the LAA acquired from the ten samples is 2.5 mS/cm with a standard deviation of 0.24 mS/cm which is in line with conductivity of cardiac tissues in the literature. The conductivity values of the left atrial appendage may be useful in electroporation treatment planning, furthermore this study suggests that adapting the probe design to the tissue under study can be important.

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“…Non-thermal pulsed-field ablation causes changes in the cell wall of the targeted tissue using bursts (order of ns to µs) of high voltage pulses (order of kV). Depending on the applied pulses, pulsed-field ablation can cause permanent ablation of the tissue, which can be used to remove aberrant conduction pathways in the heart to help treat AF [ 40 , 41 ]. Therefore, the treatment planning for non-thermal pulsed-field ablation often exploits knowledge of LAA conductivity at lower frequencies.…”

Section: Introductionmentioning

confidence: 99%

Probe Contact Force Monitoring during Conductivity Measurements of the Left Atrial Appendage to Support the Design of Novel Diagnostic and Therapeutic Procedures

Benchakroun

Ištuk

Dunne

et al. 2022

Sensors

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The electrical properties of many biological tissues are freely available from the INRC and the IT’IS databases. However, particularly in lower frequency ranges, few studies have investigated the optimal measurement protocol or the key confounders that need to be controlled, monitored, and reported. However, preliminary work suggests that the contact force of the measurement probe on the tissue sample can affect the measurements. The aim of this paper is to investigate the conductivity change due to the probe contact force in detail. Twenty ex vivo bovine heart samples are used, and conductivity measurements are taken in the Left Atrial Appendage, a common target for medical device developments. The conductivity measurements reported in this work (between 0.14 S/m and 0.24 S/m) align with the literature. The average conductivity is observed to change by −21% as the contact force increases from 2 N to 10 N. In contrast, in conditions where the fluid concentration in the measurement area is expected to be lower, very small changes are observed (less than 2.5%). These results suggest that the LAA conductivity is affected by the contact force due to the fluid concentration in the tissue. This work suggests that contact force should be controlled for in all future experiments.

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The State of Atrial Fibrillation in 2020

Cited by 3 publications

References 17 publications

Real-World Data of Anticoagulant Treatment in Non-valvular Atrial Fibrillation

Real-World Data of Anticoagulant Treatment in Non-valvular Atrial Fibrillation

Design of a Tetrapolar Probe for Electrical Characterization of the Left Atrial Appendage From 0.1 Hz to 100 kHz

Probe Contact Force Monitoring during Conductivity Measurements of the Left Atrial Appendage to Support the Design of Novel Diagnostic and Therapeutic Procedures

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