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Economic Evaluation of Catheter Ablation Versus Medical Therapy for the Treatment of Atrial Fibrillation from the Perspective of the UK. 英国心房颤动导管消融与药物治疗的经济评价
IF 3
Arrhythmia & Electrophysiology Review Pub Date : 2022-04-01 DOI: 10.15420/aer.2021.46
Lisa Wm Leung, Zaki Akhtar, Christos Kontogiannis, Ryan J Imhoff, Hannah Taylor, Mark M Gallagher
{"title":"Economic Evaluation of Catheter Ablation Versus Medical Therapy for the Treatment of Atrial Fibrillation from the Perspective of the UK.","authors":"Lisa Wm Leung,&nbsp;Zaki Akhtar,&nbsp;Christos Kontogiannis,&nbsp;Ryan J Imhoff,&nbsp;Hannah Taylor,&nbsp;Mark M Gallagher","doi":"10.15420/aer.2021.46","DOIUrl":"https://doi.org/10.15420/aer.2021.46","url":null,"abstract":"<p><p>Randomised evidence supports an early rhythm control strategy as treatment for AF, and catheter ablation outperforms medical therapy in terms of effectiveness when studied as first- and second-line treatment. Despite evidence consistently showing that catheter ablation treatment is superior to medical therapy in most AF patients, only a small proportion receive ablation, in some cases after a prolonged trial of ineffective medical therapy. Health economics research in electrophysiology remains limited but is recognised as being important in influencing positive change to ensure early access to ablation services for all eligible patients. Such information has informed the updated recommendations from the recently published National Institute for Health and Care Excellence clinical guideline on the diagnosis and management of AF, but increased awareness is needed to drive real-world adoption and to ensure patients are quickly referred to specialists. In this article, economic evaluations of catheter ablation versus medical therapy are reviewed.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":" ","pages":"e13"},"PeriodicalIF":3.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/78/57/aer-11-e13.PMC9277614.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40514367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Mahaim Revisited. Mahaim Revisited .
IF 3
Arrhythmia & Electrophysiology Review Pub Date : 2022-04-01 DOI: 10.15420/aer.2022.12
Eduardo Back Sternick, Damian Sanchez-Quintana, Hein Jj Wellens, Robert H Anderson
{"title":"Mahaim Revisited.","authors":"Eduardo Back Sternick,&nbsp;Damian Sanchez-Quintana,&nbsp;Hein Jj Wellens,&nbsp;Robert H Anderson","doi":"10.15420/aer.2022.12","DOIUrl":"https://doi.org/10.15420/aer.2022.12","url":null,"abstract":"<p><p>The name Ivan Mahaim is well-known to electrophysiologists. However, alternative anatomical substrates can produce the abnormal rhythms initially interpreted on the basis of the pathways he first described. These facts have prompted suggestions that Mahaim should be deprived of his eponym. It is agreed that specificity is required when describing the pathways that produce the disordered cardiac conduction, and that the identified pathways should now be described in an attitudinally appropriate fashion. The authors remain to be convinced that understanding will be enhanced simply by discarding the term 'Mahaim physiology' from the lexicon. It is fascinating to look back at the history of accessory atrioventricular junctional conduction pathways outside the normal accessory atrioventricular conduction system, and their possible role in rhythm disturbances. It took both the anatomist and the clinical arrhythmologist quite some time to understand the complex anatomical architecture and the ensuing electrophysiological properties. Over the years, the name Mahaim was often mentioned in those discussions, although these pathways were not the ones that produced the eponym. The reason for this review, therefore, is to present relevant information about the person and what followed thereafter.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":" ","pages":"e14"},"PeriodicalIF":3.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d2/ff/aer-11-e14.PMC9376831.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40713910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
The ATLAS Randomised Clinical Trial: What do the Superiority Results Mean for Subcutaneous ICD Therapy and Sudden Cardiac Death Prevention as a Whole? ATLAS随机临床试验:皮下ICD治疗和预防心源性猝死的总体优势结果意味着什么?
IF 3
Arrhythmia & Electrophysiology Review Pub Date : 2022-04-01 DOI: 10.15420/aer.2022.11.S1
Roberto Rordorf
{"title":"The ATLAS Randomised Clinical Trial: What do the Superiority Results Mean for Subcutaneous ICD Therapy and Sudden Cardiac Death Prevention as a Whole?","authors":"Roberto Rordorf","doi":"10.15420/aer.2022.11.S1","DOIUrl":"https://doi.org/10.15420/aer.2022.11.S1","url":null,"abstract":"<p><p>This review sets out the key evidence comparing subcutaneous ICDs (S-ICDs) and transvenous ICDs and uses it to empower clinical cardiologists and those who implant ICDs to make optimum patient selections for S-ICD use. The evidence demonstrates that clinical trials performed until recently have proven the performance of S-ICDs. However, the latest data now available from the ATLAS randomised controlled trial have added new insights to this body of evidence. ATLAS demonstrates the superiority of S-ICDs over transvenous ICDs regarding lead-related complications, findings that point to promising opportunities for patients who are at risk of sudden cardiac death.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0c/0c/aer-11-suppl1.PMC9611761.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40458569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Association Between Left Atrial Appendage Morphology and Function and the Risk of Ischaemic Stroke in Patients with Atrial Fibrillation. 心房颤动患者左心耳形态和功能与缺血性脑卒中风险的关系
IF 3
Arrhythmia & Electrophysiology Review Pub Date : 2022-04-01 DOI: 10.15420/aer.2022.08
Katarzyna Dudziñska-Szczerba, Piotr Kułakowski, Ilona Michałowska, Jakub Baran
{"title":"Association Between Left Atrial Appendage Morphology and Function and the Risk of Ischaemic Stroke in Patients with Atrial Fibrillation.","authors":"Katarzyna Dudziñska-Szczerba,&nbsp;Piotr Kułakowski,&nbsp;Ilona Michałowska,&nbsp;Jakub Baran","doi":"10.15420/aer.2022.08","DOIUrl":"https://doi.org/10.15420/aer.2022.08","url":null,"abstract":"<p><p>AF is the most common cardiac arrhythmia and has been identified as an independent risk factor for stroke. The European Society of Cardiology guidelines recommend a thromboembolic event risk assessment based on the CHA<sub>2</sub>DS<sub>2</sub>-VASc score. However, stroke also occurs in some patients with a low CHA<sub>2</sub>DS<sub>2</sub>-VASc score. Therefore, it is necessary to find new factors to improve thromboembolic risk stratification in AF patients. Over 90% of embolic strokes are caused by thrombi originating from the left atrial appendage (LAA). Thus, certain anatomical or functional parameters of the LAA could potentially be used to predict cardioembolic stroke. Studies have suggested that some of these factors, such as LAA morphology, number of LAA lobes, LAA dimensions, LAA volume, distance from the LAA ostium to the first bend of LAA, LAA orifice diameter, extent of LAA trabeculations, LAA takeoff, LAA flow velocity and LAA strain rate, are independently associated with a higher risk of stroke in a population of patients with AF and improve the performance of the CHA<sub>2</sub>DS<sub>2</sub>-VASc score. However, the results are conflicting and, so far, no new parameter has been added to the CHA<sub>2</sub>DS<sub>2</sub>-VASc score.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":" ","pages":"e09"},"PeriodicalIF":3.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ef/09/aer-11-e09.PMC9272406.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40514365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
Catecholaminergic Polymorphic Ventricular Tachycardia. 儿茶酚胺能多形性室性心动过速。
IF 3
Arrhythmia & Electrophysiology Review Pub Date : 2022-04-01 DOI: 10.15420/aer.2022.09
Mohamed Abbas, Chris Miles, Elijah Behr
{"title":"Catecholaminergic Polymorphic Ventricular Tachycardia.","authors":"Mohamed Abbas,&nbsp;Chris Miles,&nbsp;Elijah Behr","doi":"10.15420/aer.2022.09","DOIUrl":"https://doi.org/10.15420/aer.2022.09","url":null,"abstract":"<p><p>Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited arrhythmia syndrome characterised by adenergically mediated bidirectional and/or polymorphic ventricular tachycardia. CPVT is a significant cause of autopsy-negative sudden death in children and adolescents, although it can also affect adults. It is often caused by pathogenic variants in the cardiac ryanodine receptor gene as well as other rarer genes. Early identification and risk stratification is of major importance. β-blockers are the cornerstone of therapy. Sodium channel blockers, specifically flecainide, have an additive role. Left cardiac sympathetic denervation is playing an increasing role in suppression of arrhythmia and symptoms. Concerns have been raised, however, about the efficacy of implantable cardioverter defibrillator therapy and the risk of catecholamine driven proarrhythmic storms. In this review, we summarise the clinical characteristics, genetics, and diagnostic and therapeutic strategies for CPVT and describe recent advances and challenges.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"11 ","pages":"e20"},"PeriodicalIF":3.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5d/5d/aer-11-e20.PMC9820193.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10527379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
Arrhythmogenic Mitral Valve Prolapse. 致心律失常二尖瓣脱垂。
IF 3
Arrhythmia & Electrophysiology Review Pub Date : 2022-04-01 DOI: 10.15420/aer.2021.28
Theofanis George Korovesis, Paraskevi Koutrolou-Sotiropoulou, Demosthenes George Katritsis
{"title":"Arrhythmogenic Mitral Valve Prolapse.","authors":"Theofanis George Korovesis,&nbsp;Paraskevi Koutrolou-Sotiropoulou,&nbsp;Demosthenes George Katritsis","doi":"10.15420/aer.2021.28","DOIUrl":"https://doi.org/10.15420/aer.2021.28","url":null,"abstract":"<p><p>Mitral valve prolapse (MVP) is a common condition present in 1-3% of the population. There has been evidence that a subset of MVP patients is at higher risk of sudden cardiac death. The arrhythmogenic mechanism is related to fibrotic changes in the papillary muscles caused by the prolapsing valve. ECG features include ST-segment depression, T wave inversion or biphasic T waves in inferior leads, and premature ventricular contractions arising from the papillary muscles and the fascicular system. Echocardiography can identify MVP and mitral annular disjunction, a feature that has significant negative prognostic value in MVP. Cardiac MRI is indicated for identifying fibrosis. Patients with high-risk features should be referred for further evaluation. Catheter ablation and mitral valve repair might reduce the risk of malignant arrhythmia. MVP patients with high-risk features and clinically documented ventricular arrhythmia may also be considered for an ICD.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":" ","pages":"e16"},"PeriodicalIF":3.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e7/e3/aer-11-e16.PMC9376835.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40713912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Global Substrate Mapping and Targeted Ablation with Novel Gold-tip Catheter in De Novo Persistent AF. 新型金尖端导管在新发持续性房颤中的全基底定位和靶向消融。
IF 3
Arrhythmia & Electrophysiology Review Pub Date : 2022-04-01 DOI: 10.15420/aer.2021.64
Michael Tb Pope, Timothy R Betts
{"title":"Global Substrate Mapping and Targeted Ablation with Novel Gold-tip Catheter in <i>De Novo</i> Persistent AF.","authors":"Michael Tb Pope,&nbsp;Timothy R Betts","doi":"10.15420/aer.2021.64","DOIUrl":"https://doi.org/10.15420/aer.2021.64","url":null,"abstract":"<p><p>Results from catheter ablation for persistent AF are suboptimal, with no strategy other than pulmonary vein isolation showing clear benefit. Recently employed empirical strategies beyond pulmonary vein isolation involve widespread atrial ablation in all patients and do not take into account patient-specific differences in AF mechanisms or phenotype. Charge density mapping using the non-contact AcQMap system (Acutus Medical) allows visualisation of whole-chamber activation during AF and reveals localised patterns of complex activation thought to represent important mechanisms for AF maintenance that can be targeted with focal ablation. In this review, the authors outline the fundamentals of this technology, the initial data exploring the mechanistic role of activation patterns seen and the application to ablation of persistent AF.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":" ","pages":"e06"},"PeriodicalIF":3.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3e/be/aer-11-e06.PMC9204651.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40400550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Chronicle of Hybrid Atrial Fibrillation Ablation Therapy: From Cox Maze to Convergent. 混合房颤消融治疗编年史:从考克斯迷宫到收敛。
IF 3
Arrhythmia & Electrophysiology Review Pub Date : 2022-04-01 DOI: 10.15420/aer.2022.05
Riyaz A Kaba, Omar Ahmed, Elijah Behr, Aziz Momin
{"title":"A Chronicle of Hybrid Atrial Fibrillation Ablation Therapy: From Cox Maze to Convergent.","authors":"Riyaz A Kaba,&nbsp;Omar Ahmed,&nbsp;Elijah Behr,&nbsp;Aziz Momin","doi":"10.15420/aer.2022.05","DOIUrl":"https://doi.org/10.15420/aer.2022.05","url":null,"abstract":"<p><p>The burden of AF is increasing in prevalence and healthcare resource usage in the UK and worldwide. It can result in impaired quality of life for affected patients, as well as increased risk of stroke, heart failure and mortality. A holistic, integrated approach to AF management is recommended, which may include a focus on reducing risk factors and on medical management with anticoagulation and anti-arrhythmic drugs. There are also various ablation strategies that may be considered when anti-arrhythmic drugs fail to alleviate symptoms and reduce AF burden. These ablation techniques range from standalone percutaneous endocardial catheter ablation to open surgical ablation procedures concomitant with cardiac surgery. More recently, hybrid ablation that combines aspects of both surgical and electrophysiologically targeted ablation has been described. This article reviews the evolution of ablation strategies, beginning with the origin of the Cox maze IV procedure and continuing to the recent hybrid convergent approach, and provides a summary of the associated outcomes.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":" ","pages":"e12"},"PeriodicalIF":3.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2f/b0/aer-11-e12.PMC9277617.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40514364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
What Cannot Be Missed: Important Publications on Electrophysiology in 2021. 不容错过:2021年关于电生理学的重要出版物。
IF 3
Arrhythmia & Electrophysiology Review Pub Date : 2022-04-01 DOI: 10.15420/aer.2022.04
Sanjiv M Narayan, Hugh Calkins, Andrew Grace, Gregory Yh Lip, Ken Ellenbogen, Pier D Lambiase, Demosthenes G Katritsis
{"title":"What Cannot Be Missed: Important Publications on Electrophysiology in 2021.","authors":"Sanjiv M Narayan,&nbsp;Hugh Calkins,&nbsp;Andrew Grace,&nbsp;Gregory Yh Lip,&nbsp;Ken Ellenbogen,&nbsp;Pier D Lambiase,&nbsp;Demosthenes G Katritsis","doi":"10.15420/aer.2022.04","DOIUrl":"https://doi.org/10.15420/aer.2022.04","url":null,"abstract":"Clinical Arrhythmias Atrial Fibrillation Lurie A, Wang J, Hinnegan KJ, et al. Prevalence of left atrial thrombus in anticoagulated patients with atrial fibrillation. J Am Coll Cardiol 2021;77:2875–86. https://doi.org/10.1016/j.jacc.2021.04.036; PMID: 34112315. • Left atrial thrombus prevalence is high in subgroups of anticoagulated patients with AF/atrial flutter, who may benefit from routine pre-procedural transoesophageal echocardiography before cardioversion or catheter ablation.","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"11 ","pages":"e01"},"PeriodicalIF":3.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/87/ef/aer-11-e01.PMC9014699.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9173419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Future Directions for Mapping Atrial Fibrillation. 心房颤动定位的未来方向。
IF 3
Arrhythmia & Electrophysiology Review Pub Date : 2022-04-01 DOI: 10.15420/aer.2021.52
Junaid Ab Zaman, Andrew A Grace, Sanjiv M Narayan
{"title":"Future Directions for Mapping Atrial Fibrillation.","authors":"Junaid Ab Zaman,&nbsp;Andrew A Grace,&nbsp;Sanjiv M Narayan","doi":"10.15420/aer.2021.52","DOIUrl":"https://doi.org/10.15420/aer.2021.52","url":null,"abstract":"Mapping for AF focuses on the identification of regions of interest that may guide management and – in particular – ablation therapy. Mapping may point to specific mechanisms associated with localised scar or fibrosis, or electrical features, such as localised repetitive, rotational or focal activation. In patients in whom AF is caused by disorganised waves with no spatial predilection, as proposed in the multiwavelet theory for AF, mapping would be of less benefit. The role of AF mapping is controversial at the current time in view of the debate over the underlying mechanisms. However, recent clinical expansions of mapping technologies confirm the importance of understanding the state of the art, including limitations of current approaches and potential areas of future development.","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"11 ","pages":"e08"},"PeriodicalIF":3.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c9/ff/aer-11-e08.PMC9194915.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10520102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
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