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Circulation Journal : Official Journal... Mar 2019Landiolol, an ultra-short acting β-selective blocker, is more effective for controlling the heart rate (HR) than digoxin in patients with atrial tachyarrhythmias and...
BACKGROUND
Landiolol, an ultra-short acting β-selective blocker, is more effective for controlling the heart rate (HR) than digoxin in patients with atrial tachyarrhythmias and left ventricular (LV) dysfunction. The impact of the type of atrial tachyarrhythmias on the effectiveness of landiolol is uncertain. We evaluated the efficacy and safety of landiolol on tachycardiac atrial fibrillation (AF) and tachycardiac atrial flutter/atrial tachycardia (AFl/AT) in patients with reduced LV function. Methods and Results: Seventy-seven patients treated with landiolol were retrospectively analyzed. There were no significant differences in the baseline characteristics between the AF group (n=65) and AFl/AT group (n=12). Despite a higher dosage, the %change in HR from baseline to 12 and 24 h was only -10.2±12.7% and -16.1±19.4% in the AFl/AT group, while it was -28.3±13.2% and -31.3±11.3% in the AF group (P<0.02), respectively. The prevalence of the responders to landiolol treatment was much greater in the AF group than in the AFl/AT group (P<0.001). Alternative treatments such as i.v. amiodarone and electrical cardioversion were required in 83% of the AFl/AT patients.
CONCLUSIONS
Landiolol was ineffective in the majority of AFl/AT patients. An alternative management to prevent any worsening of heart failure might be considered in those patients.
Topics: Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Flutter; Humans; Male; Middle Aged; Morpholines; Retrospective Studies; Tachycardia; Urea; Ventricular Dysfunction, Left
PubMed: 30814430
DOI: 10.1253/circj.CJ-18-1131 -
Europace : European Pacing,... Feb 2024In patients with atrial flutter (AFL), ablation of the cavotricuspid isthmus (CTI) is a highly effective procedure to prevent AFL recurrence, but atrial fibrillation...
AIMS
In patients with atrial flutter (AFL), ablation of the cavotricuspid isthmus (CTI) is a highly effective procedure to prevent AFL recurrence, but atrial fibrillation (AF) may occur during follow-up. The presented FLUTFIB study was designed to identify the exact incidence, duration, timely occurrence, and associated symptoms of AF after CTI ablation using continuous cardiac monitoring via implantable loop recorders.
METHODS AND RESULTS
One hundred patients with AFL without prior AF diagnosis were included after CTI ablation (mean age 69.7 ± 9.7 years, 18% female) and received an implantable loop recorder for AF detection. After a median follow-up of 24 months 77 patients (77%) were diagnosed with AF episodes. Median time to first AF occurrence was 180 (43-298) days. Episodes lasted longer than 1 h in most patients (45/77, 58%). Forty patients (52%) had AF-associated symptoms.Patients with and without AF development showed similar baseline characteristics and neither HATCH- nor CHA2DS2-VASc scores were predictive of future AF episodes. Oral anticoagulation (OAC) was stopped during FU in 32 patients (32%) and was re-initiated after AF detection in 15 patients (15%). No strokes or transient ischaemic attack episodes were observed during follow-up.
CONCLUSION
This study represents the largest investigation using implantable loop recorders (ILRs) to detect AF after AFL ablation and shows a high incidence of AF episodes, most of them being asymptomatic and lasting longer than 1 h. In anticipation of trials determining the duration of AF episodes that should trigger OAC initiation, these results will help to guide anticoagulation management after CTI ablation.
Topics: Humans; Female; Middle Aged; Aged; Male; Atrial Fibrillation; Atrial Flutter; Incidence; Catheter Ablation; Anticoagulants; Treatment Outcome
PubMed: 38302192
DOI: 10.1093/europace/euad348 -
Europace : European Pacing,... Jul 2022Atrial flutter (AFlut) is a common re-entrant atrial tachycardia driven by self-sustainable mechanisms that cause excitations to propagate along pathways different from...
AIMS
Atrial flutter (AFlut) is a common re-entrant atrial tachycardia driven by self-sustainable mechanisms that cause excitations to propagate along pathways different from sinus rhythm. Intra-cardiac electrophysiological mapping and catheter ablation are often performed without detailed prior knowledge of the mechanism perpetuating AFlut, likely prolonging the procedure time of these invasive interventions. We sought to discriminate the AFlut location [cavotricuspid isthmus-dependent (CTI), peri-mitral, and other left atrium (LA) AFlut classes] with a machine learning-based algorithm using only the non-invasive signals from the 12-lead electrocardiogram (ECG).
METHODS AND RESULTS
Hybrid 12-lead ECG dataset of 1769 signals was used (1424 in silico ECGs, and 345 clinical ECGs from 115 patients-three different ECG segments over time were extracted from each patient corresponding to single AFlut cycles). Seventy-seven features were extracted. A decision tree classifier with a hold-out classification approach was trained, validated, and tested on the dataset randomly split after selecting the most informative features. The clinical test set comprised 38 patients (114 clinical ECGs). The classifier yielded 76.3% accuracy on the clinical test set with a sensitivity of 89.7%, 75.0%, and 64.1% and a positive predictive value of 71.4%, 75.0%, and 86.2% for CTI, peri-mitral, and other LA class, respectively. Considering majority vote of the three segments taken from each patient, the CTI class was correctly classified at 92%.
CONCLUSION
Our results show that a machine learning classifier relying only on non-invasive signals can potentially identify the location of AFlut mechanisms. This method could aid in planning and tailoring patient-specific AFlut treatments.
Topics: Atrial Flutter; Catheter Ablation; Electrocardiography; Heart Conduction System; Humans; Machine Learning
PubMed: 35045172
DOI: 10.1093/europace/euab322 -
European Heart Journal. Quality of Care... Sep 2023Standardized data definitions are essential for monitoring and assessment of care and outcomes in observational studies and randomized controlled trials (RCTs). The...
AIMS
Standardized data definitions are essential for monitoring and assessment of care and outcomes in observational studies and randomized controlled trials (RCTs). The European Unified Registries for Heart Care Evaluation and Randomized Trials (EuroHeart) project of the European Society of Cardiology aimed to develop contemporary data standards for atrial fibrillation/flutter (AF/AFL) and catheter ablation.
METHODS AND RESULTS
We used the EuroHeart methodology for the development of data standards and formed a Working Group comprising 23 experts in AF/AFL and catheter ablation registries, as well as representatives from the European Heart Rhythm Association and EuroHeart. We conducted a systematic literature review of AF/AFL and catheter ablation registries and data standard documents to generate candidate variables. We used a modified Delphi method to reach a consensus on a final variable set. For each variable, the Working Group developed permissible values and definitions, and agreed as to whether the variable was mandatory (Level 1) or additional (Level 2). In total, 70 Level 1 and 92 Level 2 variables were selected and reviewed by a wider Reference Group of 42 experts from 24 countries. The Level 1 variables were implemented into the EuroHeart IT platform as the basis for continuous registration of individual patient data.
CONCLUSION
By means of a structured process and working with international stakeholders, harmonized data standards for AF/AFL and catheter ablation for AF/AFL were developed. In the context of the EuroHeart project, this will facilitate country-level quality of care improvement, international observational research, registry-based RCTs, and post-marketing surveillance of devices and pharmacotherapies.
Topics: Humans; Atrial Fibrillation; Treatment Outcome; Randomized Controlled Trials as Topic; Atrial Flutter; Catheter Ablation
PubMed: 36243903
DOI: 10.1093/ehjqcco/qcac068 -
PloS One 2014Atrial flutter ablation is associated with a high rate of acute procedural success and symptom improvement. The relationship between ablation and other clinical outcomes... (Clinical Trial)
Clinical Trial
Atrial flutter ablation is associated with a high rate of acute procedural success and symptom improvement. The relationship between ablation and other clinical outcomes has been limited to small studies primarily conducted at academic centers. We sought to determine if catheter ablation of atrial flutter is associated with reductions in healthcare utilization, atrial fibrillation, or stroke in a large, real world population. California Healthcare Cost and Utilization Project databases were used to identify patients undergoing atrial flutter ablation between 2005 and 2009. The adjusted association between atrial flutter ablation and healthcare utilization, atrial fibrillation, or stroke was investigated using Cox proportional hazards models. Among 33,004 patients with a diagnosis of atrial flutter observed for a median of 2.1 years, 2,733 (8.2%) underwent catheter ablation. Atrial flutter ablation significantly lowered the adjusted risk of inpatient hospitalization (HR 0.88, 95% CI 0.84-0.92, p<0.001), emergency department visits (HR 0.60, 95% CI 0.54-0.65, p<0.001), and overall hospital-based healthcare utilization (HR 0.94, 95% CI 0.90-0.98, p = 0.001). Atrial flutter ablation was also associated with a statistically significant 11% reduction in the adjusted hazard of atrial fibrillation (HR 0.89, 95% CI 0.81-0.97, p = 0.01). Risk of acute stroke was not significantly reduced after ablation (HR 1.09, 95% CI 0.81-1.45, p = 0.57). In a large, real world population, atrial flutter ablation was associated with significant reductions in hospital-based healthcare utilization and a reduced risk of atrial fibrillation. These findings support the early use of catheter ablation for the treatment of atrial flutter.
Topics: Aged; Aged, 80 and over; Atrial Flutter; Catheter Ablation; Costs and Cost Analysis; Delivery of Health Care; Female; Humans; Male; Middle Aged; San Francisco
PubMed: 24983868
DOI: 10.1371/journal.pone.0100509 -
Journal of Cardiovascular... Mar 2021
Topics: Atrial Fibrillation; Atrial Flutter; COVID-19; Digoxin; Humans; SARS-CoV-2
PubMed: 33522637
DOI: 10.1111/jce.14894 -
Boletin Medico Del Hospital Infantil de... 2022Atrial flutter is a rare condition in pediatrics that usually occurs as a late complication after surgery for congenital heart diseases, although it can also appear in...
BACKGROUND
Atrial flutter is a rare condition in pediatrics that usually occurs as a late complication after surgery for congenital heart diseases, although it can also appear in structurally normal hearts.
CLINICAL CASES
We conducted a retrospective study of cases of atrial flutter with no structural heart disease diagnosed in a pediatric population (between 0 and 15 years of age) during 2015-2021 in a tertiary hospital. A total of seven cases were diagnosed, with a clear predominance of males (6/7). Of the seven patients, five debuted in the perinatal period: two were diagnosed at 20 and 36 hours of life, and three, prenatally. Among these perinatal cases, more than half (3/5) were preterm. The treatment was electrical cardioversion. The evolution was satisfactory in these cases, and there were no tachycardias in their subsequent development. In contrast, when the debut occurred at a later age (5-7 years), it was associated with channelopathy (Brugada syndrome and catecholaminergic polymorphic ventricular tachycardia), and electrical ablation of the ectopic focus was required due to poor response to pharmacological treatment.
CONCLUSIONS
This study confirms the low incidence of this pathology in pediatrics and the benignity and good prognosis of neonatal flutter in most cases. The prognosis worsens when atrial flutter is diagnosed in older children, and the probability of concomitant associated heart disease increases.
Topics: Male; Infant, Newborn; Pregnancy; Female; Child; Humans; Child, Preschool; Atrial Flutter; Retrospective Studies; Spain; Anti-Arrhythmia Agents; Treatment Outcome; Hospitals
PubMed: 36264896
DOI: 10.24875/BMHIM.21000202 -
JACC. Clinical Electrophysiology Jul 2018This analysis sought to systematically characterize trial-level patterns in atrial fibrillation/atrial flutter (AF/AFL) by using the ClinicalTrials.gov database.
OBJECTIVES
This analysis sought to systematically characterize trial-level patterns in atrial fibrillation/atrial flutter (AF/AFL) by using the ClinicalTrials.gov database.
BACKGROUND
Despite an abundance of clinical trials in this field, there is a lack of high-level evidence guiding management of AF/AFL.
METHODS
We queried all closed, phase II to IV interventional trials registered in the ClinicalTrials.gov database through October 2016 that enrolled patients known to have AF/AFL. Published trials were evaluated for methodological quality, using the 3-item Jadad scale (range: 0 to 5, where 5 = highest quality).
RESULTS
The initial search yielded 465 uniquely registered studies, of which 348 directly studied AF/AFL. Of those studies, 173 (50%) were published, enrolling a median of 190 patients from a median of 15 sites. The volume of published trials increased over time (7% prior to 2008 vs. 41% from 2014 to 2016; p < 0.001 for trend). Of the completed trials, 29% remain unpublished. Industry sources accounted for most funding (54%). Recurrence of AF/AFL was the most common endpoint (45%), whereas rates of primary clinical endpoints were low (13%). The mean Jadad score of published trials of pharmacological approaches (n = 112) was 4.0 ± 1.4. Of the 61 AF/AFL trials involving ablation or device therapies, 69% were randomized, 28% were single-arm studies, and patient, proceduralist, and event-ascertainment blinding was used in 16%, 4%, and 44%, respectively.
CONCLUSIONS
Contemporary trials of AF/AFL are often multicenter and modest in size. The primary study endpoint is commonly recurrence of arrhythmia, even in high-quality and late-phase trials. Although methodological quality is high in trials of pharmacologic approaches, trials of AF/AFL ablation and device therapies variably employ randomization and blinding.
Topics: Atrial Fibrillation; Atrial Flutter; Clinical Trials as Topic; Humans; Practice Guidelines as Topic
PubMed: 30025696
DOI: 10.1016/j.jacep.2018.04.008 -
Chest Jan 1992Atrial fibrillation and atrial flutter share a common reentrant mechanism. However, the relationship between these arrhythmias has not been systemically studied to date....
Atrial fibrillation and atrial flutter share a common reentrant mechanism. However, the relationship between these arrhythmias has not been systemically studied to date. To evaluate the degree to which these arrhythmias may alternate, consecutive Holter monitor recordings which showed fibrillation or flutter in 96 patients were reviewed. One half of the patients were studied after open-heart surgery and the other half for varying indications. One quarter of the patients had atrial flutter in addition to fibrillation, and this alternation with flutter was significantly associated with the use of a type 1A antiarrhythmic drug (p = 0.007), but not with the use of digoxin or beta blockers (p = NS for both). Furthermore, this alternation with flutter was more common in the postoperative group (p = 0.01). A history of embolization was less common in patients who were in the postoperative group (p = 0.003) and patients who had flutter in addition to fibrillation (p = 0.05).
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Flutter; Cardiac Surgical Procedures; Electrocardiography, Ambulatory; Embolism; Female; Heart Diseases; Humans; Male; Middle Aged; Postoperative Complications
PubMed: 1729105
DOI: 10.1378/chest.101.1.34 -
Archives of Cardiovascular Diseases Oct 2011Atrial flutter (AFL) and atrial fibrillation (AF) are "fellow-travellers". AF may be a stable, "isolated" rhythm, a bridge between sinus rhythm and AF, or both... (Comparative Study)
Comparative Study
BACKGROUND
Atrial flutter (AFL) and atrial fibrillation (AF) are "fellow-travellers". AF may be a stable, "isolated" rhythm, a bridge between sinus rhythm and AF, or both arrhythmias can coexist. Whether the characteristics of isolated AFL are different from those of patients with AFL combined with AF is still unclear.
AIM
To compare the clinical characteristics of patients with isolated AFL to those of patients with AFL combined with AF, in a series of patients referred for AFL ablation.
METHODS
Seventy-six consecutive patients (mean age 66.9±12.2 years; 53 men) with a history of electrocardiogram-documented paroxysmal or persistent AFL, referred for catheter ablation, underwent clinical work-up including bidimensional echocardiogram. Patients were subdivided into group I (44 with isolated AFL) and group II (32 with AFL and a history of AF).
RESULTS
Underlying heart disease was present in 62 patients (81.6%). Hypertension was the most common cardiac disorder (n=44, 57.9%) and was more prevalent in group II than in group I (75.0% vs 45.5%; P=0.01). Prevalence of prior cardiac surgery was higher in group I (22.7% vs 6.3%; P=0.04). AFL was persistent in 35 group I patients and 17 group II patients (79.5% vs 53.1%; P=0.01). Class I or III antiarrhythmic drug use was more frequent in group II (84.4% vs 45.5%; P=0.001).
CONCLUSION
This study showed significant differences between patients with isolated AFL and those with AFL combined with AF, in the prevalence of underlying heart disease and the use of antiarrhythmic medication, which were higher when both atrial arrhythmias were combined. In turn, the history of cardiac surgery (including atriotomy), was more common in patients with isolated AFL than in those with AFL combined with AF.
Topics: Adult; Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Atrial Fibrillation; Atrial Flutter; Cardiac Surgical Procedures; Catheter Ablation; Chi-Square Distribution; Comorbidity; Echocardiography; Electrocardiography; Female; France; Heart Diseases; Humans; Hypertension; Male; Middle Aged; Predictive Value of Tests; Prevalence; Retrospective Studies; Risk Factors
PubMed: 22044706
DOI: 10.1016/j.acvd.2011.07.003