The Experts below are selected from a list of 321 Experts worldwide ranked by ideXlab platform
G M Ayers - One of the best experts on this subject based on the ideXlab platform.
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Atrial pacing for suppression of early reinitiation of atrial Fibrillation after successful internal cardioversion
European Heart Journal, 2000Co-Authors: G M AyersAbstract:Aims To evaluate the efficacy of atrial pacing in the suppression of early reinitiation of atrial Fibrillation after successful internal cardioversion. Methods and Results The efficacy of atrial pacing in suppressing early reinitiation of atrial Fibrillation was studied in 12 of 45 (29%) patients with early reinitiation of atrial Fibrillation after successful cardioversion. These patients were randomized to undergo either repeated deFibrillation alone or repeated deFibrillation followed by high right atrial pacing at 500ms in a crossover fashion. In patients with persistent early reinitiation of atrial Fibrillation despite atrial pacing at 500ms and repeated deFibrillation, atrial pacing at 300ms was tested. Lastly, if early reinitiation of atrial Fibrillation persisted, administration of intravenous sotalol (1·5mg.kg−1) was tested. Atrial pacing at 500ms after deFibrillation prevented early reinitiation of atrial Fibrillation in five of 12 (42%) patients, and was significantly more effective than repeated deFibrillation (0/9 patients, 0%, P
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atrial pacing for suppression of early reinitiation of atrial Fibrillation after successful internal cardioversion
European Heart Journal, 2000Co-Authors: G M AyersAbstract:Aims To evaluate the efficacy of atrial pacing in the suppression of early reinitiation of atrial Fibrillation after successful internal cardioversion. Methods and Results The efficacy of atrial pacing in suppressing early reinitiation of atrial Fibrillation was studied in 12 of 45 (29%) patients with early reinitiation of atrial Fibrillation after successful cardioversion. These patients were randomized to undergo either repeated deFibrillation alone or repeated deFibrillation followed by high right atrial pacing at 500ms in a crossover fashion. In patients with persistent early reinitiation of atrial Fibrillation despite atrial pacing at 500ms and repeated deFibrillation, atrial pacing at 300ms was tested. Lastly, if early reinitiation of atrial Fibrillation persisted, administration of intravenous sotalol (1·5mg.kg−1) was tested. Atrial pacing at 500ms after deFibrillation prevented early reinitiation of atrial Fibrillation in five of 12 (42%) patients, and was significantly more effective than repeated deFibrillation (0/9 patients, 0%, P <0·05). During atrial pacing at 500ms, the density of atrial premature depolarizations (APDs) was significantly decreased (2·4±2·4APDs.min−1vs 16·4±9·8APDs.min−1, P <0·05) and the coupling interval of atrial premature depolarization was significantly increased (420±32ms vs 398±19ms, P <0·05) as compared to no pacing. In the remaining seven (58%) patients, atrial pacing at 500ms failed to prevent early reinitiation of atrial Fibrillation, but significantly decreased the density of atrial premature depolarization (3·4±2·4APDs.min−1vs 14·2±4·8APDs.min−1, P <0·05) and delayed the onset of early reinitiation of atrial Fibrillation (33±17s vs 11±11s, P <0·05). Atrial pacing at 300ms decreased the coupling interval of atrial premature depolarization as compared to no pacing and during atrial pacing at 500ms ( P <0·05), but without early reinitiation of atrial Fibrillation suppression. Administration of intravenous sotalol was effective in preventing early reinitiation of atrial Fibrillation in five of seven (71%) patients where pacing failed to suppress early reinitiation of atrial Fibrillation. Conclusion The results of this study suggest that atrial pacing can be useful when combined with transvenous deFibrillation in patients with early reinitiation of atrial Fibrillation.
Hakan Oral - One of the best experts on this subject based on the ideXlab platform.
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Ablation of Atrial Fibrillation
Journal of Cardiovascular Electrophysiology, 2020Co-Authors: Hakan Oral, Fred MoradyAbstract:Recognition that the initiation of atrial Fibrillation often is dependent on arrhythmogenic foci within the pulmonary veins1 opened a new chapter in our understanding of the mechanisms of atrial Fibrillation, which in turn has led to dramatic improvements in our ability to ablate atrial Fibrillation. Based on experimental studies and clinical studies that used a variety of catheter and surgical ablation techniques, it is possible to postulate two major mechanisms for the initiation and perpetuation of atrial Fibrillation. 1. Primary drivers. Some types of atrial Fibrillation, particularly paroxysmal atrial Fibrillation, may be primarily dependent on tachycardias that initiate and drive the atrial Fibrillation.2 Although often located in the pulmonary veins, the drivers also may originate from within other thoracic veins,3 such as the superior vena cava, vein of Marshall, or coronary sinus, or within the left or right atrium. Furthermore, secondary tachycardias that also may function as drivers may develop in any of these arrhythmogenic sites, particularly the pulmonary veins,2 in response to the primary driver. Once the primary driver induces secondary drivers, the perpetuation of atrial Fibrillation may become more likely because even if the primary driver is extinguished, the other drivers may still function. Elegant studies by Jalife4 demonstrated that rotors with a very short cycle length exist during atrial Fibrillation and can play a critical role in the perpetuation of atrial Fibrillation. It appears that these rotors may have anchor points within the left atrium, near the pulmonary veins. In another experimental model, atrial Fibrillation was found to be caused by an atrial flutter with a very short cycle length that resulted in fibrillatory conduction throughout the atria.4 Based on this mechanism, successful ablation of atrial Fibrillation requires elimination of the primary and secondary drivers with strategies such as pulmonary vein isolation, isolation of the coronary sinus from the left atrium, or elimination of the rotors. 2. Multiple wavelet reentry. As described by Moe,5 the multiple wavelet hypothesis proposes that a critical number
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Postoperative Atrial Fibrillation
Medical Clinics of North America, 2020Co-Authors: Krit Jongnarangsin, Hakan OralAbstract:Atrial Fibrillation is a common arrhythmia after cardiac surgery. It is associated with an increase in morbidity, length of hospital stay, and mortality. Patients who are at higher risk of postoperative atrial Fibrillation should receive prophylactic treatment. Atrial Fibrillation usually resolves spontaneously after heart rate is controlled; however, if patients are highly symptomatic or hemodynamically unstable, sinus rhythm should be restored by electrical or pharmacologic cardioversion. Patients with atrial Fibrillation of more than 48 hours should receive antithrombotic therapy for thromboembolism prevention.
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effects of diltiazem and esmolol on cycle length and spontaneous conversion of atrial Fibrillation
Journal of Cardiovascular Pharmacology and Therapeutics, 2002Co-Authors: Christian Sticherling, Hakan Oral, Hiroshi Tada, Anton C Bares, Frank Pelosi, Bradley P Knight, Adam S Strickberger, Fred MoradyAbstract:Background: Calcium channel blocking agents have been shown to prolong the duration of atrial Fibrillation. This study compared the effects of intravenous diltiazem and esmolol on the cycle length and conversion rate of pacing-induced atrial Fibrillation.Methods and Results: In 41 adults without structural heart disease, atrial Fibrillation was induced by rapid atrial pacing. After 3 minutes, either diltiazem (n = 13), esmolol (n = 15), or saline (n = 13) was infused. In the diltiazem group, the atrial Fibrillation cycle length shortened by a mean of 43 milliseconds and became significantly shorter than in the control group, while the atrial Fibrillation cycle length in the esmolol group did not change. Spontaneous termination of atrial Fibrillation occurred significantly less often in the diltiazem group (23%) than in the esmolol (67%, P < 0.05) or placebo groups (77%, P = 0.01).Conclusions: Intravenous diltiazem shortens the atrial Fibrillation cycle length and lowers the probability of spontaneous conv...
Leif Spange Mortensen - One of the best experts on this subject based on the ideXlab platform.
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radiofrequency ablation as initial therapy in paroxysmal atrial Fibrillation
The New England Journal of Medicine, 2012Co-Authors: Jens Cosedis Nielsen, Arne Johannessen, Pekka Raatikainen, Ole Kongstad, Anders Englund, Steen Pehrson, Gerhard Hindricks, Hakan Walfridsson, Juha Hartikainen, Leif Spange MortensenAbstract:BackgroundThere are limited data comparing radiofrequency catheter ablation with antiarrhythmic drug therapy as first-line treatment in patients with paroxysmal atrial Fibrillation.MethodsWe randomly assigned 294 patients with paroxysmal atrial Fibrillation and no history of antiarrhythmic drug use to an initial treatment strategy of either radiofrequency catheter ablation (146 patients) or therapy with class IC or class III antiarrhythmic agents (148 patients). Follow-up included 7-day Holter-monitor recording at 3, 6, 12, 18, and 24 months. Primary end points were the cumulative and per-visit burden of atrial Fibrillation (i.e., percentage of time in atrial Fibrillation on Holter-monitor recordings). Analyses were performed on an intention-to-treat basis.ResultsThere was no significant difference between the ablation and drug-therapy groups in the cumulative burden of atrial Fibrillation (90th percentile of arrhythmia burden, 13% and 19%, respectively; P=0.10) or the burden at 3, 6, 12, or 18 months. At 24 months, the burden of atrial Fibrillation was significantly lower in the ablation group than in the drug-therapy group (90th percentile, 9% vs. 18%; P=0.007), and more patients in the ablation group were free from any atrial Fibrillation (85% vs. 71%, P=0.004) and from symptomatic atrial Fibrillation (93% vs. 84%, P=0.01). One death in the ablation group was due to a procedure-related stroke; there were three cases of cardiac tamponade in the ablation group. In the drug-therapy group, 54 patients (36%) underwent supplementary ablation.ConclusionsIn comparing radiofrequency ablation with antiarrhythmic drug therapy as first-line treatment in patients with paroxysmal atrial Fibrillation, we found no significant difference between the treatment groups in the cumulative burden of atrial Fibrillation over a period of 2 years.
Gregory M Marcus - One of the best experts on this subject based on the ideXlab platform.
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differences in anticoagulant therapy prescription in patients with paroxysmal versus persistent atrial Fibrillation
The American Journal of Medicine, 2015Co-Authors: Paul S Chan, Fengming Tang, Thomas M Maddox, Gregory M MarcusAbstract:Abstract Background Patients with paroxysmal and persistent atrial Fibrillation experience a similar risk of thromboembolism. Therefore, consensus guidelines recommend anticoagulant therapy in those at risk for thromboembolism irrespective of atrial Fibrillation classification. We sought to examine whether there are differences in rates of appropriate oral anticoagulant treatment among patients with paroxysmal vs persistent atrial Fibrillation in real-world cardiology practices. Methods We studied 71,316 outpatients with atrial Fibrillation and intermediate to high thromboembolic risk (CHADS 2 score ≥2) enrolled in the American College of Cardiology PINNACLE Registry between 2008 and 2012. Using hierarchical modified Poisson regression models adjusted for patient characteristics, we examined whether anticoagulant treatment rates differed between patients with paroxysmal vs persistent atrial Fibrillation. Results The majority of outpatients (78.4%, n = 55,905) had paroxysmal atrial Fibrillation. In both unadjusted and multivariable adjusted analyses, patients with paroxysmal atrial Fibrillation were less frequently prescribed oral anticoagulant therapy than those with persistent atrial Fibrillation (50.3% vs 64.2%; adjusted risk ratio [RR] 0.74; 95% confidence interval [CI], 0.72-0.76). Instead, patients with paroxysmal atrial Fibrillation were prescribed more frequently only antiplatelet therapy (35.1% vs 25.0%; adjusted RR 1.77; 95% CI, 1.69-1.86) or neither antiplatelet nor anticoagulant therapy (14.6% vs 10.8%; adjusted RR 1.35; 95% CI, 1.26-1.44; P Conclusions In a large, real-world cardiac outpatient population, patients with paroxysmal atrial Fibrillation with a moderate to high risk of stroke were less likely to be prescribed appropriate oral anticoagulant therapy and more likely to be prescribed less effective or no therapy for thromboembolism prevention.
Gerhard Hindricks - One of the best experts on this subject based on the ideXlab platform.
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2012 focused update of the esc guidelines for the management of atrial Fibrillation
European Heart Journal, 2012Co-Authors: John A Camm, Gerhard Hindricks, Gregory Y H Lip, Raffaele De Caterina, Irene Savelieva, Dan Atar, Stefan H Hohnloser, Paulus Kirchhof, Jeroen J Bax, H BaumgartnerAbstract:ACCF : American College of Cardiology Foundation ACCP : American College of Chest Physicians ACS : acute coronary syndrome ACT : Atrial arrhythmia Conversion Trial ADONIS : American–Australian–African trial with DronedarONe In atrial Fibrillation or flutter for the maintenance of Sinus rhythm AF : atrial Fibrillation AHA : American Heart Association ANDROMEDA : ANtiarrhythmic trial with DROnedarone in Moderate-to-severe congestive heart failure Evaluating morbidity DecreAse APHRS : Asia Pacific Heart Rhythm Society aPTT : activated partial thromboplastin time ARB : angiotensin-receptor blocker ARISTOTLE : Apixaban for Reduction In STroke and Other ThromboemboLic Events in atrial Fibrillation ATHENA : A placebo-controlled, double-blind, parallel arm Trial to assess the efficacy of dronedarone 400 mg b.i.d. for the prevention of cardiovascular Hospitalization or death from any cause in patiENts with Atrial Fibrillation/atrial flutter ATRIA : AnTicoagulation and Risk factors In Atrial Fibrillation AVERROES : Apixaban VErsus acetylsalicylic acid (ASA) to Reduce the Rate Of Embolic Stroke in atrial Fibrillation patients who have failed or are unsuitable for vitamin K antagonist treatment AVRO : A prospective, randomized, double-blind, Active-controlled, superiority study of Vernakalant vs. amiodarone in Recent Onset atrial Fibrillation b.i.d : bis in die (twice daily) b.p.m. : beats per minute CABANA : Catheter ABlation vs . ANtiarrhythmic drug therapy for Atrial Fibrillation CABG : coronary artery bypass graft CAP : Continued Access to Protect AF CHA2DS2-VASc : Congestive heart failure or left ventricular dysfunction Hypertension, Age ≥75 (doubled), Diabetes, Stroke (doubled)-Vascular disease, Age 65–74, Sex category (female) CHADS2 : Congestive heart failure, Hypertension, Age ≥75, Diabetes, Stroke (doubled) CI : confidence interval CRAFT : Controlled Randomized Atrial Fibrillation Trial CrCl : creatinine clearance DAFNE : Dronedarone Atrial Fibrillation study after Electrical cardioversion DIONYSOS : Randomized Double blind trIal to evaluate efficacy and safety of drOnedarone (400 mg b.i.d.) vs . amiodaroNe (600 mg q.d. for 28 daYS, then 200 mg qd thereafter) for at least 6 mOnths for the maintenance of Sinus rhythm in patients with atrial Fibrillation EAST : Early treatment of Atrial Fibrillation for Stroke prevention Trial EHRA : European Heart Rhythm Association ECG : electrocardiogram EMA : European Medicines Agency ERATO : Efficacy and safety of dRonedArone for The cOntrol of ventricular rate during atrial Fibrillation EURIDIS : EURopean trial In atrial Fibrillation or flutter patients receiving Dronedarone for the maIntenance of Sinus rhythm FAST : atrial Fibrillation catheter Ablation vs . Surgical ablation Treatment FDA : Food and Drug Administration Flec-SL : Flecainide Short-Long trial HAS-BLED : Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/alcohol concomitantly HF-PEF : heart failure with preserved ejection fraction HF-REF : heart failure with reduced ejection fraction HR : hazard ratio HRS : Heart Rhythm Society ICH : intracranial haemorrhage INR : international normalized ratio i.v. : intravenous J-RHYTHM : Japanese RHYTHM management trial for atrial Fibrillation LAA : left atrial appendage LoE : level of evidence LVEF : left ventricular ejection fraction MANTRA-PAF : Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation NICE : National Institute for Health and Clinical Excellence NOAC : novel oral anticoagulant NSAID : non-steroidal anti-inflammatory drug NYHA : New York Heart Association OAC : oral anticoagulant or oral anticoagulation o.d. : omni die (every day) PALLAS : Permanent Atrial Fibrillation outcome Study using dronedarone on top of standard therapy PCI : percutaneous coronary intervention PREVAIL : Prospective Randomized EVAluation of the LAA closure device In patients with atrial Fibrillation v s. Long-term warfarin therapy PROTECT AF : WATCHMAN LAA system for embolic PROTECTion in patients with Atrial Fibrillation PT : prothrombin time RAAFT : Radio frequency Ablation Atrial Fibrillation Trial RE-LY : Randomized Evaluation of Long-term anticoagulant therapY with dabigatran etexilate ROCKET-AF : Rivaroxaban Once daily oral direct factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in atrial Fibrillation RRR : relative risk reduction TE : thromboembolism TIA : transient ischaemic attack t.i.d. : ter in die (three times daily) TOE : transoesophageal echocardiogram TTR : time in therapeutic range VKA : vitamin K antagonist Guidelines summarize and evaluate all currently available evidence on a particular issue with the aim of assisting physicians in selecting the best management strategy for an individual patient suffering from a given condition, taking into account the impact on …
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radiofrequency ablation as initial therapy in paroxysmal atrial Fibrillation
The New England Journal of Medicine, 2012Co-Authors: Jens Cosedis Nielsen, Arne Johannessen, Pekka Raatikainen, Ole Kongstad, Anders Englund, Steen Pehrson, Gerhard Hindricks, Hakan Walfridsson, Juha Hartikainen, Leif Spange MortensenAbstract:BackgroundThere are limited data comparing radiofrequency catheter ablation with antiarrhythmic drug therapy as first-line treatment in patients with paroxysmal atrial Fibrillation.MethodsWe randomly assigned 294 patients with paroxysmal atrial Fibrillation and no history of antiarrhythmic drug use to an initial treatment strategy of either radiofrequency catheter ablation (146 patients) or therapy with class IC or class III antiarrhythmic agents (148 patients). Follow-up included 7-day Holter-monitor recording at 3, 6, 12, 18, and 24 months. Primary end points were the cumulative and per-visit burden of atrial Fibrillation (i.e., percentage of time in atrial Fibrillation on Holter-monitor recordings). Analyses were performed on an intention-to-treat basis.ResultsThere was no significant difference between the ablation and drug-therapy groups in the cumulative burden of atrial Fibrillation (90th percentile of arrhythmia burden, 13% and 19%, respectively; P=0.10) or the burden at 3, 6, 12, or 18 months. At 24 months, the burden of atrial Fibrillation was significantly lower in the ablation group than in the drug-therapy group (90th percentile, 9% vs. 18%; P=0.007), and more patients in the ablation group were free from any atrial Fibrillation (85% vs. 71%, P=0.004) and from symptomatic atrial Fibrillation (93% vs. 84%, P=0.01). One death in the ablation group was due to a procedure-related stroke; there were three cases of cardiac tamponade in the ablation group. In the drug-therapy group, 54 patients (36%) underwent supplementary ablation.ConclusionsIn comparing radiofrequency ablation with antiarrhythmic drug therapy as first-line treatment in patients with paroxysmal atrial Fibrillation, we found no significant difference between the treatment groups in the cumulative burden of atrial Fibrillation over a period of 2 years.
