The aim of this analysis was to provide comprehensive information on invasive cardiac arrhythmia therapies in the European Society of Cardiology (ESC) area over the past 10 years.
The European Heart ...Rhythm Association (EHRA) has collected data on invasive arrhythmia therapies since 2008. This year 53 of the 56 ESC member countries provided data for the EHRA White Book. Here we present updated data on procedure rates together with information on demographics, economy, vital statistics, local healthcare systems and training activities. Considerable heterogeneity in the access to invasive arrhythmia therapies still exists across the five geographical ESC regions. In 2016, the device implantation rates per million population were 3-6 times higher in the Western region than in the non-European and Eastern ESC member countries. Catheter ablation activity was highest in the Western countries followed by the Northern and Southern areas. In the non-European countries, atrial fibrillation ablation rate was more than tenfold lower than in the European countries. On the other hand, the growth rate over the past ten years was highest in the non-European and Eastern countries. In some Eastern European countries with relative low gross domestic product the procedure rates exceeded the average values.
It was encouraging to note that during the past decade the growth in invasive arrhythmia therapies was greatest in the areas historically with relatively low activity. Nevertheless, there is substantial disparity and continued efforts are needed to improve harmonization of cardiac arrhythmia therapies in the ESC area.
To identify genetic variation underlying atrial fibrillation, the most common cardiac arrhythmia, we performed a genome-wide association study of >1,000,000 people, including 60,620 atrial ...fibrillation cases and 970,216 controls. We identified 142 independent risk variants at 111 loci and prioritized 151 functional candidate genes likely to be involved in atrial fibrillation. Many of the identified risk variants fall near genes where more deleterious mutations have been reported to cause serious heart defects in humans (GATA4, MYH6, NKX2-5, PITX2, TBX5)
, or near genes important for striated muscle function and integrity (for example, CFL2, MYH7, PKP2, RBM20, SGCG, SSPN). Pathway and functional enrichment analyses also suggested that many of the putative atrial fibrillation genes act via cardiac structural remodeling, potentially in the form of an 'atrial cardiomyopathy'
, either during fetal heart development or as a response to stress in the adult heart.
The number of cardiac implantable electronic device (CIED) implantations has increased over recent years as a result of population growth, increasing life expectancy, adoption of guidelines, and ...better access to healthcare. Transvenous lead extraction (TLE), as a part of an overall lead management strategy, has also been increasing, not only as a consequence of this growth, but also because of increasing rates of infection, lead failure, awareness of indications for lead management, and development of extraction tools. Clinical research is essential for understanding efficacy and risks of TLE, which has important implications regarding decision-making and therapeutic strategies in patients who are candidates for this procedure. Data on TLE have mainly come from retrospective series, with variable reporting of endpoints. Recently, the ELECTRa registry conducted by the European Heart Rhythm Association (EHRA), has reported the largest prospective experience on lead extraction published to date in 3555 patients recruited from 19 European countries. There remain unresolved issues, which is a strong incentive for conducting further specifically-designed clinical trials to answer important questions in this area. In addition to clinical studies, national registries are potentially useful for evaluating epidemiology of TLE as well as for quality control and understanding resource implications. Standardization of definitions and reporting of parameters are paramount in order to analyse, compare, and pool data for scientific purposes. Expert consensus statements on lead extraction have been published by the Heart Rhythm Society (HRS) in 2009 and 2017, and by EHRA in 2012. Experience from the ELECTRa registry has been valuable for identifying challenges faced with conducting scientific studies in this field, and provides a framework for future endeavours.
This writing group has been commissioned by EHRA to provide recommendations for designing scientific studies, reports and registries relating to lead extraction.
Abstract
Aims
Atrial fibrillation (AF) has been associated with reduced brain volume, cognitive impairment, and reduced cerebral blood flow. The causes of reduced cerebral blood flow in AF are ...unknown, but no reduction was seen in individuals without the arrhythmia in a previous study. The aim of this study was to test the hypothesis that brain perfusion, measured with magnetic resonance imaging (MRI), improves after cardioversion of AF to sinus rhythm (SR).
Methods and results
All patients undergoing elective cardioversion at our institution were invited to participate. A total of 44 individuals were included. Magnetic resonance imaging studies were done before and after cardioversion with both brain perfusion and cerebral blood flow measurements. However, 17 did not complete the second MRI as they had a recurrence of AF during the observation period (recurrent AF group), leaving 17 in the SR group and 10 in the AF group to complete both measurements. Brain perfusion increased after cardioversion to SR by 4.9 mL/100 g/min in the whole brain (P < 0.001) and by 5.6 mL/100 g/min in grey matter (P < 0.001). Cerebral blood flow increased by 58.6 mL/min (P < 0.05). Both brain perfusion and cerebral blood flow remained unchanged when cardioversion was unsuccessful.
Conclusion
In this study of individuals undergoing elective cardioversion for AF, restoration, and maintenance of SR for at least 10 weeks after was associated with an improvement of brain perfusion and cerebral blood flow measured by both arterial spin labelling and phase contrast MRI. In those individuals where cardioversion was unsuccessful, there was no change in perfusion or blood flow.
Abstract
Aims
Atrial fibrillation (AF) has been associated with cognitive impairment. Additionally, brain volume may be reduced in individuals with AF. Potential causes may include cerebral ...micro-embolism or reduced stroke volume due to the beat-to-beat variation in AF. The aims of this study were to measure cerebral blood flow and estimate whole brain perfusion in elderly individuals with and without AF.
Methods and results
Blood flow in the cervical arteries was measured with phase contrast MRI and brain perfusion estimated in a large cohort from the AGES-Reykjavik Study. Individuals were divided into three groups at the time of the MRI: persistent AF, paroxysmal AF, and no history of AF. Of 2291 participants (mean age 79.5 years), 117 had persistent AF and 78 had paroxysmal AF but were in sinus rhythm at the time of imaging AF. Those with persistent AF had lower cholesterol and used more anti-hypertensive medication and warfarin. The three groups were similar with regard to other cardiovascular risk factors. Those in the persistent AF group had significantly lower total cerebral blood flow on average, 472.1 mL/min, both when compared with the paroxysmal AF group, 512.3 mL/min (P < 0.05) and the no AF group, 541.0 mL/min (P < 0.001). Brain perfusion was lowest in the persistent AF group, 46.4 mL/100 g/min compared with the paroxysmal AF group, 50.9 mL/100 g/min in (P < 0.05) and those with no AF, 52.8 mL/100 g/min (P < 0.001).
Conclusion
Persistent AF decreases blood flow to the brain as well as perfusion of brain tissue compared with sinus rhythm.
Aims
Data are scarce on the epidemiology of atrial fibrillation (AF) in Europe. The aim of this study was to examine recent trends in the incidence and prevalence of AF and project the prevalence to ...the year 2050.
Methods and results
From 1991 to 2008 a total of 4905 residents of Reykjavik, Iceland were diagnosed with AF at the city's main health care centre. The age-standardized incidence of AF increased in women (0.9% per year, 95% CI 0.1-1.8) but not in men (0.1% per year, 95% CI −0.6 to 0.9). The age-standardized prevalence increased per year by 1.8% (95% CI 1.3-2.3) in men and 2.3% (95% CI 1.7-2.9) in women from 1998 to 2008. The number of adults with AF in Iceland is projected to increase from 4495 (prevalence 2.0%) in 2008 to 11 088 (prevalence 3.5%) in 2050, if the incidence of AF and mortality remain constant beyond 2008. However, if the incidence continues to increase as it has and mortality decreases according to projections for the general population, the projected number will rise to 13 583 (prevalence 4.3%).
Conclusion
In this study in a northern European population, the incidence of AF increased in women but not men from 1991 to 2008. The prevalence of AF is currently high and the number of patients with AF is expected to triple in the next four decades. AF is already a serious public health problem and the burden of this disease could reach epidemic proportions in the coming years.
Nonalcoholic fatty liver (NAFL) and its sequelae are growing health problems. We performed a genome-wide association study of NAFL, cirrhosis and hepatocellular carcinoma, and integrated the findings ...with expression and proteomic data. For NAFL, we utilized 9,491 clinical cases and proton density fat fraction extracted from 36,116 liver magnetic resonance images. We identified 18 sequence variants associated with NAFL and 4 with cirrhosis, and found rare, protective, predicted loss-of-function variants in MTARC1 and GPAM, underscoring them as potential drug targets. We leveraged messenger RNA expression, splicing and predicted coding effects to identify 16 putative causal genes, of which many are implicated in lipid metabolism. We analyzed levels of 4,907 plasma proteins in 35,559 Icelanders and 1,459 proteins in 47,151 UK Biobank participants, identifying multiple proteins involved in disease pathogenesis. We show that proteomics can discriminate between NAFL and cirrhosis. The present study provides insights into the development of noninvasive evaluation of NAFL and new therapeutic options.
PDF
