2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)

Hindricks, Gerhard; Potpara, Tatjana; Dagres, Nikolaos; Arbelo, Elena; Bax, Jeroen J.; Blomström‐Lundqvist, Carina; Boriani, Giuseppe; Castellà, Manuel; Dan, Gheorghe‐Andrei; Dilaveris, Polychronis; Fauchier, Laurent; Filippatos, Gerasimos; Kalman, Jonathan M.; Meir, Mark La; Lane, Deirdre A.; Lebeau, Jean‐Pierre; Lettino, Maddalena; Lip, Gregory Y.H.; Pinto, Fausto J.; Thomas, G. Neil; Valgimigli, Marco; Gelder, Isabelle C. Van; Putte, Bart P. van; Watkins, Caroline L

doi:10.1016/j.rec.2021.03.009

Cited by 277 publications

(696 citation statements)

References 734 publications

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“…Ablation is an effective strategy in treating symptomatic AF in selected elderly patients as a stand-alone therapy or as hybrid therapy with anti-arrhythmic medication, and is associated with decreased healthcare resource utilization in all age groups (19,20). The current guidelines recommended ablation strategy for patients with symptomatic AF associated with heart failure and not specific comment of ablation strategy for the elderly patients (7,8). Traditionally, the definition of elderly was aged 60 or 65 years and over (31).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the elderly patients with AF tend to have a large left atrium with electrical and structural remodeling and fibrosis, which also reduce the efficacy of pharmacological treatment (5,6). Catheter ablation has recently emerged as an important therapeutic strategy to achieve and maintain a normal sinus rhythm in symptomatic patients with AF (7,8). Moreover, catheter ablation for AF has been reported to reduce mortality and HF readmission in patients with heart failure (HF) (9).…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Ablation for Symptomatic Atrial Fibrillation in Elderly Patients: A Meta-Analysis

Lee

Chen

et al. 2021

Front. Cardiovasc. Med.

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Background: Age affects the efficacy of pharmacological treatment for atrial fibrillation (AF). Catheter ablation, including radiofrequency (RF) or cryoballoon ablation, is an effective strategy for symptomatic AF. This meta-analysis aimed to analyze the efficacy and safety of AF ablation in elderly patients with AF compared to non-elderly patients with AF.Methods: We searched several databases for articles published between January 1, 2008 and March 31, 2020. Eighteen observational studies with 21,039 patients were analyzed. Data including recurrence of AF or atrial tachyarrhythmia (ATA), complications, procedural time, and fluoroscopic time were compared between the elderly and non-elderly groups.Results: The elderly patients had significantly higher incidences of recurrent AF or ATA after AF ablation compared to the non-elderly patients (<60 years old) (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.11–1.33). The elderly patients had significantly higher incidences of complications of AF ablation compared to the non-elderly patients (OR, 1.37; 95% CI, 1.14–1.64). However, elderly AF patients with age ≥75 years old had similar incidence of recurrent AF or ATA and complication after AF ablation compared to non-elderly patients with AF.Conclusions: The elderly patients had significantly higher incidences of recurrent AF or ATA and complications after ablation for non-paroxysmal AF compared to non-elderly patients with AF (<60 years old), except in patients ≥75 years old.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Ablation for Symptomatic Atrial Fibrillation in Elderly Patients: A Meta-Analysis

Lee

Chen

et al. 2021

Front. Cardiovasc. Med.

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“…Atrial fibrillation (AF) is the most common heart rhythm disorder found in clinical practice, and it is highly correlated with stroke (Wolf et al, 1991). Guidelines for the management of AF episodes lasting more than 30 s are available (Hindricks et al, 2020). However, less information is known for episodes shorter than 30 s, frequently known as brief AF.…”

Section: Introductionmentioning

confidence: 99%

“…Atrial fibrillation is a progressive arrhythmia for which even brief episodes could represent a risk factor for thrombus formation and stroke (Healey et al, 2012). Additionally, in case of delayed management of such brief episodes, they may evolve into longer AF episodes (Hindricks et al, 2020). For this reason, it is a clinical recommendation to monitor stroke patients with long-term ECG recordings to assess the presence of brief AF episodes (Hindricks et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, in case of delayed management of such brief episodes, they may evolve into longer AF episodes (Hindricks et al, 2020). For this reason, it is a clinical recommendation to monitor stroke patients with long-term ECG recordings to assess the presence of brief AF episodes (Hindricks et al, 2020). However, manual revision of large amounts of ECG data is highly time-consuming, might be influenced by reviewers' subjectivity, and represents a significant financial burden in healthcare (Lee et al, 2008;Kim et al, 2011;Ball et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

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Detection of Brief Episodes of Atrial Fibrillation Based on Electrocardiomatrix and Convolutional Neural Network

Martinez

Bie²,

Marzocchi³

et al. 2021

Front. Physiol.

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Background: Brief episodes of atrial fibrillation (AF) may evolve into longer AF episodes increasing the chances of thrombus formation, stroke, and death. Classical methods for AF detection investigate rhythm irregularity or P-wave absence in the ECG, while deep learning approaches profit from the availability of annotated ECG databases to learn discriminatory features linked to different diagnosis. However, some deep learning approaches do not provide analysis of the features used for classification. This paper introduces a convolutional neural network (CNN) approach for automatic detection of brief AF episodes based on electrocardiomatrix-images (ECM-images) aiming to link deep learning to features with clinical meaning.Materials and Methods: The CNN is trained using two databases: the Long-Term Atrial Fibrillation and the MIT-BIH Normal Sinus Rhythm, and tested on three databases: the MIT-BIH Atrial Fibrillation, the MIT-BIH Arrhythmia, and the Monzino-AF. Detection of AF is done using a sliding window of 10 beats plus 3 s. Performance is quantified using both standard classification metrics and the EC57 standard for arrhythmia detection. Layer-wise relevance propagation analysis was applied to link the decisions made by the CNN to clinical characteristics in the ECG.Results: For all three testing databases, episode sensitivity was greater than 80.22, 89.66, and 97.45% for AF episodes shorter than 15, 30 s, and for all episodes, respectively.Conclusions: Rhythm and morphological characteristics of the electrocardiogram can be learned by a CNN from ECM-images for the detection of brief episodes of AF.

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Reply to “Prior Anticoagulation in Patients with Ischemic Stroke and Atrial Fibrillation”

Meinel

Seiffge

2021

Annals of Neurology

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colleagues 1 reported the effect of prior anticoagulation with vitamin K antagonists or direct oral anticoagulants (DOACs) on subsequent stroke severity, utilization of intravenous thrombolysis (IVT), safety of IVT, and 3-month outcomes in patients with ischemic stroke and atrial fibrillation (AF). Prior DOAC therapy was significantly associated with decreased admission stroke severity and a lower rate of IVT. In addition, the adjusted odds ratio (OR; 95% confidence interval [CI]) of DOAC pretreatment for a favorable 3-month outcome was 1.24 (95% CI = 1.01-1.51). I have some concerns on their study.First, Jung and colleagues 2 conducted a prospective study to investigate the preceding antithrombotic medication use in patients with AF with acute ischemic stroke and its association with initial stroke severity and in-hospital outcomes. The OR (95% CI) of antiplatelet and anticoagulant users for a mild initial neurological deficit were 1.23 (95% CI = 1.09-1.38) and 1.31 (95% CI = 1.15-1.50), respectively. As a large portion of patients with AF still did not receive antithrombotic medication before an ischemic stroke event, they recommended prehospitalization use of antithrombotic medication to keep a mild initial neurological deficit and favorable outcome at discharge. I think that subanalysis by classifying anticoagulants into vitamin K antagonists and DOACs might lead to the advantage of DOACs for keeping safety and effectiveness on clinical outcomes.Second, Freixa-Pamias and colleagues 3 conducted a retrospective study to evaluate the association of AF-related ischemic stroke with the prescription patterns of antithrombotic treatment. The adjusted OR (95% CI) of patients with antiplatelet versus control medications with vitamin K antagonists or DOACs for ischemic stroke was 1.89 (95% CI = 1.52-2.37), and risk reduction for ischemic stroke by vitamin K antagonists or DOACs treatment was remarkable. To specify the superiority between vitamin K antagonists and DOACs, an intervention study is recommended.Finally, Kimura and colleagues 4 conducted a prospective study to evaluate safety and effectiveness of oral anticoagulants (OACs) for preventing secondary ischemic stroke in patients with ischemic stroke and AF. As the risk of acute recurrence of ischemic stroke was high in patients with AF, they recommended OAC treatment as early as possible. The OACs include vitamin K antagonists and DOACs. Chan and colleagues 5 conducted a meta-analysis and DOACs had greater effectiveness and safety compared to vitamin K antagonists for stroke prevention in patients with AF. Regarding safety, Kattoor and colleagues 6 reported that the risk of gastrointestinal bleeding and stroke was similar between vitamin K antagonist and DOAC users, and there was a trend toward lower intracranial hemorrhage in the DOAC users. In any case, standard treatment protocol by DOACs should be presented by considering comorbidity and hemorrhagic risk in each individual.

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2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)

Abstract: The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC

Cited by 277 publications

References 734 publications

Efficacy and Safety of Ablation for Symptomatic Atrial Fibrillation in Elderly Patients: A Meta-Analysis

Efficacy and Safety of Ablation for Symptomatic Atrial Fibrillation in Elderly Patients: A Meta-Analysis

Detection of Brief Episodes of Atrial Fibrillation Based on Electrocardiomatrix and Convolutional Neural Network

Reply to “Prior Anticoagulation in Patients with Ischemic Stroke and Atrial Fibrillation”

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