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Barmano, N., Charitakis, E., Kronstrand, R., Walfridsson, U., Karlsson, J.-E., Walfridsson, H. & Nyström, F. H. (2019). The association between alcohol consumption, cardiac biomarkers, left atrial size and re-ablation in patients with atrial fibrillation referred for catheter ablation. PLoS ONE, 14(4), Article ID e0215121.
Open this publication in new window or tab >>The association between alcohol consumption, cardiac biomarkers, left atrial size and re-ablation in patients with atrial fibrillation referred for catheter ablation
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2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 4, article id e0215121Article in journal (Refereed) Published
Abstract [en]

Background

Information on alcohol consumption in patients undergoing radiofrequency ablation (RFA) of atrial fibrillation (AF) is often limited by the reliance on self-reports. The aim of this study was to describe the long-term alcohol consumption, measured as ethyl glucuronide in hair (hEtG), in patients undergoing RFA due to AF, and to examine potential associations with cardiac biomarkers, left atrial size and re-ablation within one year after the initial RFA.

Methods

The amount of hEtG was measured in patients referred for RFA, and a cut-off of 7 pg/mg was used. N-terminal pro B-type natriuretic peptide (NT-proBNP) and the mid-regional fragment of pro atrial natriuretic peptide (MR-proANP) were examined and maximum left atrium volume index (LAVI) was measured. The number of re-ablations was examined up to one year after the initial RFA. Analyses were stratified by gender, and adjusted for age, systolic blood pressure, body mass index, presence of heart failure and heart rhythm for analyses regarding NT-proBNP, MR-proANP and LAVI and heart rhythm being replaced by type of AF for analyses regarding re-ablation.

Results

In total, 192 patients were included in the study. Median (25th– 75th percentile) NT-proBNP in men with hEtG ≥ 7 vs. < 7 pg/mg was 250 (96–695) vs. 130 (49–346) pg/ml (p = 0.010), and in women it was 230 (125–480) vs. 230 (125–910) pg/ml (p = 0.810). Median MR-proANP in men with hEtG ≥ 7 vs. < 7 pg/mg was 142 (100–224) vs. 117 (83–179) pmol/l (p = 0.120) and in women it was 139 (112–206) vs. 153 (93–249) pmol/l (p = 0.965). The median of maximum LAVI was 30.1 (26.7–33.9) vs. 25.8 (21.4–32.0) ml/m2 (p = 0.017) in men, and 25.0 (18.9–29.6) vs. 25.7 (21.7–34.6) ml/m2 (p = 0.438) in women, with hEtG ≥ 7 vs. < 7 pg/ml, respectively. Adjusted analyses showed similar results, except for MR-proANP turning out significant in men with hEtG ≥ 7 vs. < 7 pg/mg (p = 0.047). The odds ratio of having a re-ablation was 3.5 (95% CI 1.3–9.6, p = 0.017) in men with hEtG ≥ 7 vs. < 7 pg/mg, while there was no significant difference in women.

Conclusions

In male patients with AF and hEtG ≥ 7 pg/mg, NT-proBNP and MR-proANP were higher, LA volumes larger, and there was a higher rate of re-ablations, as compared to men with hEtG < 7 pg/mg. This implies that men with an alcohol consumption corresponding to an hEtG-value ≥ 7, have a higher risk for LA remodelling that could potentially lead to a deterioration of the AF situation.

Place, publisher, year, edition, pages
San Francisco, CA, United States: Public Library of Science, 2019
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-157020 (URN)10.1371/journal.pone.0215121 (DOI)000463992600055 ()30970005 (PubMedID)2-s2.0-85064164504 (Scopus ID)
Note

Funding agencies: County Council of Ostergotland [LIO-280731, LIO-445511]; Carldavid Jonsson Research Foundation; Linkoping University; Biosense Webster; Johnson Johnson; Heart Foundation

Available from: 2019-05-23 Created: 2019-05-23 Last updated: 2019-06-12Bibliographically approved
Hansen, P. S., Sanchez, R. & Walfridsson, H. (2016). Safety of novel oral anticoagulants in catheter ablation of atrial fibrillation. Danish Medical Journal, 63(2), A5186
Open this publication in new window or tab >>Safety of novel oral anticoagulants in catheter ablation of atrial fibrillation
2016 (English)In: Danish Medical Journal, E-ISSN 2245-1919, Vol. 63, no 2, p. A5186-Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Limited data are available regarding safety of catheter ablation of atrial fibrillation (AF) in patients using novel oral anticoagulants (NOAC) before and after pulmonary vein isolation. We aimed to assess the safety of a simple anticoagulation protocol in consecutive patients -presenting for catheter ablation of AF. METHODS: From November 2011 to December 2014, we prospectively included 234 patients referred for catheter ablation of AF who had already received NOAC treatment. NOAC was continued for a minimum of three months after ablation. We assessed procedure-related bleeding or thromboembolic complications, bleeding or thromboembolic complications during a three-month follow-up period and patient-reported adherence to NOAC therapy. The study has not received financial support from external resources. The study was registered with ClinTrials.gov as NCT02569255. RESULTS: A total of 171 patients were treated with dabigatran (94% 150 mg twice daily), 38 with rivaroxaban (100% 20 mg daily) and 25 with apixaban (100% 5 mg twice daily). NOACs were interrupted for 24 hours before and re-administered two hours after the ablation procedure, without bridging with low molecular weight heparin (LMWH). No periprocedural thromboembolic complications and no bleeding complications were registered except for one pericardial effusion which was percutaneously drained without further complications. No thromboembolic or bleeding complications during follow-up were registered. All patients continued the same NOAC during follow-up as before ablation. CONCLUSIONS: Anticoagulation with NOAC with a short period of periprocedural interruption without bridging with LMWH seems safe and well-tolerated.

Place, publisher, year, edition, pages
Copenhagen, Denmark: Danish Medical Association, 2016
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:liu:diva-125816 (URN)000369635000008 ()26836793 (PubMedID)
Available from: 2016-03-08 Created: 2016-03-04 Last updated: 2017-04-24Bibliographically approved
Barmano, N., Walfridsson, U., Walfridsson, H. & Karlsson, J.-E. (2016). Structured care of patients with atrial fibrillation improves guideline adherence. Journal of Atrial Fibrillation, 9(4)
Open this publication in new window or tab >>Structured care of patients with atrial fibrillation improves guideline adherence
2016 (English)In: Journal of Atrial Fibrillation, ISSN 1941-6911, Vol. 9, no 4Article in journal (Refereed) Published
Abstract [en]

There are many reports of lack of guideline adherence in the treatment of patients with atrial fibrillation (AF), and AF affects health-related quality of life (HRQoL) negatively. The aim of this study was to investigate whether structured care compared to standard care of a general AF population could improve guideline adherence and HRQoL, and reduce symptoms,anxiety and depression.

Methods

In total, 176 patients were recruited to the intervention and 146 patients to the control group.The intervention consisted of a structured follow-up program, while patients serving as controls received standard care. The primary outcome was guideline adherence evaluated through: appropriate use of oral anticoagulants (OAC) and antiarrhythmics, whether echocardiogram and thyroid lab tests were performed, and patient-reported outcome measures (PROMs), assessed with the questionnaires SF-36, EQ-5D, HADS and ASTA at baseline and after one year.

Results

Guideline adherence was significantly better in the intervention group, 91% vs. 63% (p < 0.01), mainly due to appropriate OAC treatment 94% vs. 74% (p < 0.01). Symptoms assessed with ASTA were less frequent and the negative impact of AF was reduced in the intervention group after one year/ at follow-up. Five scales in SF-36, and the visual analogue scale for current health status in EQ-5D (EQ-VAS), improved significantly in both groups.

Conclusion

Structured care of patients with AF significantly improved guideline adherence and patients reported fewer symptoms and a reduced negative impact on disease-specific HRQoL compared to standard care at one year follow-up.

Place, publisher, year, edition, pages
Overland Park, KS, United States: CardioFront LLC, 2016
Keywords
Atrial fibrillation, Guideline Adherence, Anticoagulants, Health-related Quality of life, Symptoms, Anxiety.
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-157019 (URN)10.4022/jafib.1498 (DOI)
Available from: 2019-05-23 Created: 2019-05-23 Last updated: 2019-06-12Bibliographically approved
Walfridsson, H., Anfinsen, O.-G., Berggren, A., Frison, L., Jensen, S., Linhardt, G., . . . Carlsson, L. (2015). Is the acetylcholine-regulated inwardly rectifying potassium current a viable antiarrhythmic target? Translational discrepancies of AZD2927 and A7071 in dogs and humans. Europace, 17(3), 473-482
Open this publication in new window or tab >>Is the acetylcholine-regulated inwardly rectifying potassium current a viable antiarrhythmic target? Translational discrepancies of AZD2927 and A7071 in dogs and humans
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2015 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 3, p. 473-482Article in journal (Refereed) Published
Abstract [en]

AIMS: We aimed at examining the acetylcholine-dependent inward-rectifier current (IKAch) as a target for the management of atrial fibrillation (AF).

METHODS AND RESULTS: The investigative agents AZD2927 and A7071 concentration-dependently blocked IKACh in vitro with minimal off-target activity. In anaesthetized dogs (n = 17) subjected to 8 weeks of rapid atrial pacing (RAP), the left atrial effective refractory period (LAERP) was maximally increased by 50 ± 7.4 and 50 ± 4.8 ms following infusion of AZD2927 and A7071. Ventricular refractoriness and the QT interval were unaltered. During sustained AF, both drugs significantly reduced AF frequency and effectively restored sinus rhythm. AZD2927 successfully restored sinus rhythm at 10/10 conversion attempts and A7071 at 14/14 attempts, whereas saline converted 4/17 episodes only (P<0.001 vs. AZD2927 and A7071). In atrial flutter patients (n = 18) undergoing an invasive investigation, AZD2927 did not change LAERP, the paced QT interval, or ventricular refractoriness when compared with placebo. To address the discrepancy on LAERP by IKACh blockade in man and dog and the hypothesis that atrial electrical remodelling is a prerequisite for IKACh blockade being efficient, six dogs were studied after 8 weeks of RAP followed by sinus rhythm for 4 weeks to reverse electrical remodelling. In these dogs, both AZD2927 and A7071 were as effective in increasing LAERP as in the dogs studied immediately after the 8-week RAP period.

CONCLUSION: Based on the present series of experiments, an important role of IKACh in human atrial electrophysiology, as well as its potential as a viable target for effective management of AF, may be questioned.

Place, publisher, year, edition, pages
Oxford University Press, 2015
Keywords
Antiarrhythmic agents; Arrhythmia; Electrophysiology; Ion channels; Remodelling
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-110995 (URN)10.1093/europace/euu192 (DOI)000351605000024 ()25082948 (PubMedID)
Note

This work was supported by AstraZeneca R&D, CVMD Innovative Medicine, Molndal, Sweden.

Available from: 2014-10-02 Created: 2014-10-02 Last updated: 2017-12-05
Walfridsson, H., Walfridsson, U., Cosedis Nielsen, J., Johannessen, A., Raatikainen, P., Janzon, M., . . . Hansen, P. S. (2015). Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation: results on health-related quality of life and symptom burden. The MANTRA-PAF trial. Europace, 17(2), 215-221
Open this publication in new window or tab >>Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation: results on health-related quality of life and symptom burden. The MANTRA-PAF trial
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2015 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 2, p. 215-221Article in journal (Refereed) Published
Abstract [en]

Aims The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) trial assessed the long-term efficacy of an initial strategy of radiofrequency ablation (RFA) vs. antiarrhythmic drug therapy (AAD) as first-line treatment for patients with PAF. In this substudy, we evaluated the effect of these treatment modalities on the Health-Related Quality of Life (HRQoL) and symptom burden of patients at 12 and 24 months. Methods and results During the study period, 294 patients were enrolled in the MANTRA-PAF trial and randomized to receive AAD (N = 148) or RFA (N = 146). Two generic questionnaires were used to assess the HRQoL [Short Form-36 (SF-36) and EuroQol-five dimensions (EQ-5D)], and the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA) was used to evaluate the symptoms appearing during the trial. All comparisons were made on an intention-to-treat basis. Both randomization groups showed significant improvements in assessments with both SF-36 and EQ-5D, at 24 months. Patients randomized to RFA showed significantly greater improvement in four physically related scales of the SF-36. The three most frequently reported symptoms were breathlessness during activity, pronounced tiredness, and worry/anxiety. In both groups, there was a significant reduction in ASTA symptom index and in the severity of seven of the eight symptoms over time. Conclusion Both AAD and RFA as first-line treatment resulted in substantial improvement of HRQoL and symptom burden in patients with PAF. Patients randomized to RFA showed greater improvement in physical scales (SF-36) and the EQ-visual analogue scale.

Place, publisher, year, edition, pages
Oxford University Press (OUP): Policy B - Oxford Open Option B - CC-BY, 2015
Keywords
Atrial fibrillation; Catheter ablation; Antiarrhythmic drug treatment; First-line therapy; Quality of life
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-117391 (URN)10.1093/europace/euu342 (DOI)000351601600009 ()25567068 (PubMedID)
Note

Funding Agencies|Danish Heart Foundation (Copenhagen, Denmark) [05-4-B284-A46622237]; Carldavid Jonsson Research Foundation; ALF-grants; County Council of Ostergotland; Finnish Foundation for Cardiovascular Research; Biosense-Webster (Diegem, Belgium)

Available from: 2015-04-24 Created: 2015-04-24 Last updated: 2017-12-04
Pekka Raatikainen, M. J., Hakalahti, A., Uusimaa, P., Cosedis Nielsen, J., Johannessen, A., Hindricks, G., . . . Steen Hansen, P. (2015). Radiofrequency catheter ablation maintains its efficacy better than antiarrhythmic medication in patients with paroxysmal atrial fibrillation: On-treatment analysis of the randomized controlled MANTRA-PAF trial. International Journal of Cardiology, 198, 108-114
Open this publication in new window or tab >>Radiofrequency catheter ablation maintains its efficacy better than antiarrhythmic medication in patients with paroxysmal atrial fibrillation: On-treatment analysis of the randomized controlled MANTRA-PAF trial
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2015 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 198, p. 108-114Article in journal (Refereed) Published
Abstract [en]

Background: The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) is a randomized trial comparing radiofrequency catheter ablation (RFA) to antiarrhythmic drugs (AADs) as first-line treatment of paroxysmal atrial fibrillation (PAF). In order to eliminate the clouding effect of crossover we performed an on-treatment analysis of the data. Methods and results: Patients (n = 294) were divided into three groups: those receiving only the assigned therapy (RFA and AAD groups) and those receiving both therapies (crossover group). The primary end points were AF burden in 7-day Holter recordings at 3, 6, 12, 18, and 24 months and cumulative AF burden in all recordings. At 24 months, AF burden was significantly lower in the RFA (n = 110) than in the AAD (n = 92) and the crossover (n = 84) groups (90th percentile 1% vs. 10% vs. 16%, P = 0.007), and more patients were free from any AF (89% vs. 73% vs. 74%, P = 0.006). In the RFA, AAD and the crossover groups 63%, 59% and 21% (P less than 0.001) of the patients had no AF episodes in any Holter recording, respectively. Quality of life improved significantly in all groups. There were no differences in serious adverse events between the RFA, AAD and crossover groups (19% vs. 8% vs. 23%) (P = 0.10). Conclusions: In the treatment of antiarrhythmic therapy naive patients with PAF long-term efficacy of RFA was superior to AAD therapy. Thus, it is reasonable to offer RFA as first-line treatment for highly symptomatic patients who accept the risks of the procedure and are aware of frequent need for reablation(s). (C) 2015 Elsevier Ireland Ltd. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2015
Keywords
Atrial fibrillation; Catheter ablation; Antiarrhythmic drug; On-treatment analysis; Long-term efficacy
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-121421 (URN)10.1016/j.ijcard.2015.06.160 (DOI)000360319900036 ()26163901 (PubMedID)
Note

Funding Agencies|Danish Heart Foundation [05-4-B284-A466-22237]; Finnish Foundation for Cardiovascular Research; Biosense Webster

Available from: 2015-09-18 Created: 2015-09-18 Last updated: 2017-12-04
Charitakis, E., Walfridsson, U., Nyström, F. H., Nylander, E., Strömberg, A., Alehagen, U. & Walfridsson, H. (2015). Symptom burden, Metabolic profile, Ultrasound findings, Rhythm, neurohormonal activation, haemodynamics and health-related quality of life in patients with atrial Fibrillation (SMURF): a protocol for an observational study with a randomised interventional component. BMJ Open, 5(12), Article ID e008723.
Open this publication in new window or tab >>Symptom burden, Metabolic profile, Ultrasound findings, Rhythm, neurohormonal activation, haemodynamics and health-related quality of life in patients with atrial Fibrillation (SMURF): a protocol for an observational study with a randomised interventional component
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2015 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 12, article id e008723Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Atrial fibrillation (AF) is the most common cardiac arrhythmia, with an estimated prevalence of 1.5-2%. It is an independent risk factor for ischaemic stroke and is estimated to cause about 20-25% of all stroke cases. AF has a great impact on health-related quality of life (HRQoL); however, one unresolved issue related to AF is the wide variation in its symptoms.

METHODS AND ANALYSIS: The symptom burden, metabolic profile, ultrasound findings, rhythm, neurohormonal activation, haemodynamics and HRQoL in patients with AF (Symptom burden, Metabolic profile, Ultrasound findings, Rhythm, neurohormonal activation, haemodynamics and health-related quality of life in patients with atrial Fibrillation, SMURF) study is a prospective observational, cohort study, with a randomised interventional part. The aim of the study is to investigate, in patients with AF, the relationship between symptom burden and metabolic aspects, atrial function and different neurohormones, and the effect of radiofrequency ablation (RFA). The interventional part of the study will give an insight into the neurohormonal and intracardiac pressure changes directly after initiation of AF. Consecutive patients with symptomatic AF accepted for treatment with RFA for the first time at Linköping University Hospital are eligible for participation. The enrolment started in January 2012, and a total of 200 patients are to be included into the study, with 45 of them being enrolled into the interventional study with initiation of AF. The sample size of the interventional study is based on a small pilot study with 5 patients induced to AF while 2 served as controls. The results indicated that, in order to find a statistically significant difference, there was a need to include 28 patients; for safety reasons, 45 patients will be included.

ETHICS AND DISSEMINATION: The SMURF study is approved by the Regional Ethical Review Board at the Faculty of Health Sciences, Linköping, Sweden. The results will be presented through peer-review journals and conference presentation.

TRIAL REGISTRATION NUMBER: NCT01553045; Pre-results.

Place, publisher, year, edition, pages
BMJ Publishing Group, 2015
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-124290 (URN)10.1136/bmjopen-2015-008723 (DOI)000368839100047 ()26692555 (PubMedID)
Note

Funding agencies: ALF grants (County Council of Ostergotland); Carldavid Jonsson Research Foundation; Heart Foundation; Linkoping University; Biosense Webster; Johnson and Johnson

Available from: 2016-01-25 Created: 2016-01-25 Last updated: 2017-11-30
Aronsson, M., Walfridsson, H., Janzon, M., Walfridsson, U., Nielsen, J. C., Hansen, P. S., . . . Levin, L.-Å. (2015). The cost-effectiveness of radiofrequency catheter ablation as first-line treatment for paroxysmal atrial fibrillation: results from a MANTRA-PAF substudy.. Europace, 17(1), 48-55
Open this publication in new window or tab >>The cost-effectiveness of radiofrequency catheter ablation as first-line treatment for paroxysmal atrial fibrillation: results from a MANTRA-PAF substudy.
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2015 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 1, p. 48-55Article in journal (Refereed) Published
Abstract [en]

AIM: The aim of this prospective substudy was to estimate the cost-effectiveness of treating paroxysmal atrial fibrillation (AF) with radiofrequency catheter ablation (RFA) compared with antiarrhythmic drugs (AADs) as first-line treatment.

METHODS AND RESULTS: A decision-analytic Markov model, based on MANTRA-PAF (Medical Antiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation) study data, was developed to study long-term effects and costs of RFA compared with AADs as first-line treatment. Positive clinical effects were found in the overall population, a gain of an average 0.06 quality-adjusted life years (QALYs) to an incremental cost of €3033, resulting in an incremental cost-effectiveness ratio of €50 570/QALY. However, the result of the subgroup analyses showed that RFA was less costly and more effective in younger patients. This implied an incremental cost-effectiveness ratio of €3434/QALY in ≤50-year-old patients respectively €108 937/QALY in >50-year-old patients.

CONCLUSION: Radiofrequency catheter ablation as first-line treatment is a cost-effective strategy for younger patients with paroxysmal AF. However, the cost-effectiveness of using RFA as first-line therapy in older patients is uncertain, and in most of these AADs should be attempted before RFA (MANTRA-PAF ClinicalTrials.gov number; NCT00133211).

National Category
Clinical Medicine Basic Medicine
Identifiers
urn:nbn:se:liu:diva-113397 (URN)10.1093/europace/euu188 (DOI)000351603900011 ()25341739 (PubMedID)
Available from: 2015-01-17 Created: 2015-01-17 Last updated: 2018-01-11
Aronsson, M., Janzon, M., Walfridsson, H., Walfridsson, U. & Levin, L.-Å. (2013). Cost-effectivesness of catheter ablation as first-line treatment for paroxysmal atrial fibrillation. In: : . Paper presented at On behalf of the MANTRA-RAP study Group.
Open this publication in new window or tab >>Cost-effectivesness of catheter ablation as first-line treatment for paroxysmal atrial fibrillation
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2013 (English)Conference paper, Published paper (Refereed)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-103484 (URN)
Conference
On behalf of the MANTRA-RAP study Group
Available from: 2014-01-20 Created: 2014-01-20 Last updated: 2014-02-03
Walfridsson, H., Cosedis Nielsen, J., Johannessen, A., Raatikainen, P., Hartikainen, J., Walfridsson, U., . . . Hansen, P. S. (2013). Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation: results on health-related quality of life and symptom burden. In: : . Paper presented at ESC Congress 2013, 31 August - 04 September 2013, Amsterdam, Netherlands.
Open this publication in new window or tab >>Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation: results on health-related quality of life and symptom burden
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2013 (English)Conference paper, Published paper (Refereed)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-103485 (URN)
Conference
ESC Congress 2013, 31 August - 04 September 2013, Amsterdam, Netherlands
Available from: 2014-01-20 Created: 2014-01-20 Last updated: 2014-02-03
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3059-4404

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