Background Congestive heart failure and atrial fibrillationoften coexist, and each adversely affects the other with respectto management and prognosis. We prospectively evaluated theeffect of catheter ablation for atrial fibrillation on leftventricular function in patients with heart failure.
Methods We studied 58 consecutive patients with congestive heartfailure and a left ventricular ejection fraction of less than45 percent who were undergoing catheter ablation for atrialfibrillation. We selected as controls 58 patients without congestiveheart failure who were undergoing ablation for atrial fibrillation,matched according to age, sex, and classification of atrialfibrillation. We evaluated the patients' left ventricular functionand dimensions, symptom score, exercise capacity, and qualityof life at baseline and at months 1, 3, 6, and 12.
Results After a mean (±SD) of 12±7 months, 78percent of the patients with congestive heart failure and 84percent of the controls remained in sinus rhythm (P=0.34) (69percent and 71 percent, respectively, were in sinus rhythm withoutthe administration of antiarrhythmic drugs). The patients withcongestive heart failure had significant improvement in leftventricular function (increases in the ejection fraction andfractional shortening of 21±13 percent and 11±7percent, respectively; P<0.001 for both comparisons), leftventricular dimensions (decreases in the diastolic and systolicdiameters of 6±6 mm and 8±7 mm, respectively;P=0.03 and P<0.001, respectively), exercise capacity, symptoms,and quality of life. The ejection fraction improved significantlynot only in patients without concurrent structural heart disease(24±10 percent, P<0.001) and those with inadequaterate control before ablation (23±10 percent, P<0.001),but also in those with coexisting heart disease (16±14percent, P<0.001) and adequate rate control before ablation(17±15 percent, P<0.001).
Conclusions Restoration and maintenance of sinus rhythm by catheterablation without the use of drugs in patients with congestiveheart failure and atrial fibrillation significantly improvecardiac function, symptoms, exercise capacity, and quality oflife.
Congestive heart failure and atrial fibrillation, the two "epidemics"of cardiovascular disease,1 are major health problems. Theyoften coexist, and the intersection of the two conditions createsa vicious circle, with congestive heart failure promoting thedevelopment of atrial fibrillation and vice versa.2,3 In addition,each increases the morbidity and mortality associated with theother.4,5
Among patients with congestive heart failure, maintaining sinusrhythm with the use of antiarrhythmic drugs is challenging,owing to the limited efficacy and potentially deleterious effectsof the drugs.6,7,8,9,10 This finding has led to renewed interestin rate control, stimulated by reports on several importantstudies,11,12,13 particularly the Atrial Fibrillation Follow-upInvestigation of Rhythm Management (AFFIRM)11 and the Rate Controlversus Electrical Cardioversion (RACE)12 trials, both of whichsuggested an equivalent outcome for strategies involving pharmacologicrhythm and rate control. However, recent evidence from the AFFIRMinvestigators, in addition to confirming the adverse prognosticeffects of congestive heart failure, highlights the potentialbenefit of maintaining sinus rhythm if it could be achievedwithout the adverse effects of antiarrhythmic drugs.14
Curative catheter ablation for atrial fibrillation has beenestablished as an effective therapeutic option for atrial fibrillationthat is resistant to pharmacologic rhythm or rate control, withsuccessful long-term maintenance of sinus rhythm in the absenceof treatment with antiarrhythmic drugs reported in the majorityof patients.15,16,17,18 We evaluated the effects of restorationand maintenance of sinus rhythm by catheter ablation for atrialfibrillation on left ventricular function in patients with congestiveheart failure.
Methods
Study Population
In this prospective study, we enrolled 58 consecutive patientswith congestive heart failure from any cause who were undergoingcurative ablation for atrial fibrillation that was resistantto at least two antiarrhythmic drugs. All patients with symptomaticcongestive heart failure, defined as New York Heart Association(NYHA) class II or higher that was associated with a left ventricularejection fraction of less than 45 percent, were included. Thedefinition and classification of atrial fibrillation used inthis study were based on published guidelines from the AmericanCollege of Cardiology–American Heart Association and theEuropean Society of Cardiology.6 No patients meeting the abovecriteria were excluded. In the case of patients with hypotensionor NYHA class IV symptoms, the procedure was performed afterthe patients' condition stabilized. Fifty-eight patients, matchedfor age, sex, and classification of atrial fibrillation, wereselected as procedural controls from a total of 591 patientswithout congestive heart failure who underwent ablation duringthe same period. Written informed consent was obtained fromall patients, and the study protocol was approved by the researchcommittee at our institution. The study took place from March2001 to March 2004.
Baseline Evaluation and Data Collection
Patients were routinely admitted two days before the ablationprocedure for baseline evaluation. Treatment with oral anticoagulants,taken by all the patients, was stopped on admission, and treatmentwith all antiarrhythmic drugs, except amiodarone, was stoppedfor an appropriate period before ablation. Heart rate and rhythmwere monitored with the use of 48-hour ambulatory electrocardiography.Transesophageal echocardiography was performed to rule out atrialthrombi, and transthoracic echocardiography was performed toevaluate cardiac structure and function. Echocardiographic measurementof the left ventricular ejection fraction was standardized withthe use of Simpson's biplane method for all patients duringthe initial hospitalization and subsequent visits. Arrhythmia-relatedsymptoms were assessed with the Symptom Checklist–Frequencyand Severity Scale,19 and health-related quality of life wasassessed with the 36-item Short-Form General Health Survey (SF-36)questionnaire.20
Electrophysiological Study and Radiofrequency Catheter Ablation
The ablation procedure, based on electrical isolation of thepulmonary veins in all patients,16 with additional left atriallinear ablation when necessary, has been described previously.21In brief, after the administration of heparin to maintain anticoagulation,pulmonary-vein isolation was performed, guided by a circumferentialdeca-polar mapping catheter (Lasso, Biosense Webster) positionedwithin the target pulmonary vein. Radiofrequency energy, withpower and temperature limited to 25 to 30 W and 50°C, respectively,was delivered proximal to the pulmonary-vein ostia with theuse of a 4-mm ablation catheter with an irrigated tip (CelsiusThermocool, Biosense Webster). The end point of ablation waselectrical isolation of all the pulmonary veins, manifestedby the disappearance or dissociation of pulmonary-vein potentials.Then linear ablation, with power limited to 40 W or less, wasperformed in most patients. This procedure involved the creationof one or more linear lesions bridging the two superior pulmonaryveins or extending from a pulmonary vein to the mitral annulusto form a complete obstacle to electrical conduction, as demonstratedby established electrophysiological criteria.21
After ablation, anticoagulation therapy was reinitiated, andambulatory electrocardiographic monitoring continued for atleast three days in the hospital. In the absence of concurrentindications, all antiarrhythmic-drug treatment was stopped.In the event of an early recurrence of atrial fibrillation oratrial flutter, patients were offered either further ablationduring their index hospitalization or a trial of antiarrhythmicdrugs. A bicycle-ergometer stress test, with the use of a standardprotocol of 30-W increments in exercise intensity every threeminutes, was performed within three days after the procedurein order to assess baseline exercise capacity.
Follow-up
Patients were rehospitalized 1, 3, 6, and 12 months after thelast procedure for follow-up evaluation involving clinical interviews,48-hour ambulatory electrocardiographic monitoring, transthoracicechocardiography, and exercise testing. Anticoagulation therapywas stopped if sinus rhythm had been maintained for three tosix months, unless otherwise indicated. Symptoms and qualityof life were reevaluated at 3 and 12 months. If patients remainedin sinus rhythm after 12 months, they were discharged to theirown cardiologists for further follow-up.
Definitions and Outcomes
Before ablation, adequate rate control was defined in patientswith persistent and permanent atrial fibrillation as a meanventricular rate of less than 80 beats per minute at rest,6the mean ventricular rate being the average of the number ofventricular beats per minute during the 48-hour electrocardiographicmonitoring period before the procedure was performed. Ablationwas considered to be successful if sinus rhythm was maintainedwith no symptomatic or documented episodes of atrial fibrillationor atrial flutter. A marked improvement in left ventricularfunction was defined as an increase of 20 percent or more inthe left ventricular ejection fraction or a value of 55 percentor more.
Statistical Analysis
Continuous variables, expressed as means ±SD, and theirdistribution were analyzed with the Shapiro–Wilks testof normality. A comparison between the groups was performedwith Student's t-test or the nonparametric Wilcoxon rank-sumtest, as appropriate. Sequential data measurements were analyzedby repeated-measures analysis of variance, and differences betweenmeasures were evaluated with Fisher's least-significant-differencetest for post hoc comparisons. Categorical variables, expressedas numbers and percentages, were compared with Fisher's exacttest. The relationship between clinical variables and significantimprovement in left ventricular function was assessed with adescending stepwise Cox proportional-hazards model, and theresults are reported as relative risks with 95 percent confidenceintervals. All tests of significance were two-tailed, and aP value of less than 0.05 was considered to indicate statisticalsignificance.
Results
Patients and Procedural Outcome
The characteristics of the patients and the procedural outcomesare presented in Table 1. All patients with congestive heartfailure had symptoms in NYHA class II or higher, despite treatmentwith angiotensin-converting–enzyme or angiotensin II–receptorblockers in 72 percent of the patients, beta-blockers in 97percent, and digoxin in 29 percent. Nine patients (16 percent)had had at least one episode of class IV symptoms within theprevious six months. Treatment with amiodarone was initiatedin 93 percent of the patients but because of adverse effectsor intolerance was continued in only 71 percent at the timeof ablation. Fifty-three patients (91 percent) had persistentor permanent atrial fibrillation, and 38 (66 percent) had aleft ventricular ejection fraction of less than 40 percent.Three patients awaiting cardiac transplantation were referredfor ablation of atrial fibrillation to ameliorate symptoms.
Table 1. Baseline Characteristics of the Patients with and Those without Congestive Heart Failure.
During a mean of 12±7 months of follow-up (range, 3 to34 months) after the final procedure (50 percent of patientswith congestive heart failure and 47 percent of patients inthe control group underwent a second procedure), 78 percentof patients with congestive heart failure and 84 percent ofpatients in the control group were in sinus rhythm (P=0.34);among the patients who were not taking antiarrhythmic drugs,69 percent of those with congestive heart failure and 71 percentof those in the control group were in sinus rhythm. Pericardialtamponade requiring percutaneous drainage occurred in one patientin each group, and one patient with congestive heart failurehad a stroke during the procedure. One patient with severe congenitalheart disease and congestive heart failure who was being consideredfor heart transplantation had a recurrence of atrial fibrillationone month after ablation and died after three months from worseningcongestive heart failure. The condition of the other two patientswho were being evaluated for transplantation improved sufficientlyto merit their removal from the transplant waiting list (i.e.,the symptoms of both patients improved by one NYHA class, andthe left ventricular ejection fraction increased by 8 percentin one patient and 12 percent in the other).
Symptoms, Quality of Life, and Exercise Capacity
In the group with congestive heart failure, the NYHA class improvedfrom a mean of 2.3±0.5 before ablation to 1.4±0.5at 1 month and remained close to the 1-month level at 12 months(P<0.001). No changes were observed in the control group.The Symptom Checklist–Frequency and Severity scores andSF-36 quality-of-life measures improved significantly in bothgroups. In patients with congestive heart failure, the SF-36summary scores on the physical component and the mental componentincreased by 24±21 and 21±19 points, respectively(P<0.001 for both comparisons); for patients in the controlgroup, the scores on the two components increased by 18±17(P=0.003) and 14±19 (P=0.004), respectively.
Exercise time and capacity also increased significantly in bothgroups. In the group with congestive heart failure, exercisetime increased from 11±4 to 14±5 minutes (P<0.001)and maximal capacity from 123±44 to 144±55 W (P<0.001),whereas in the control group, the numbers increased from 14±4to 16±5 minutes (P=0.001) and from 145±44 to 158±52W (P<0.001) during the follow-up period.
Left Ventricular Function
Changes in left ventricular function and dimensions in the patientswith congestive heart failure are shown in Figure 1. The leftventricular ejection fraction increased by a mean of 21±13percent and left ventricular fractional shortening by 11±7percent (P<0.001 for both comparisons), with the greatestimprovement observed within the first three months. Concurrently,left ventricular dilatation was reduced: end-diastolic diameterby 6±6 mm (P=0.03), and end-systolic diameter by 8±7mm (P<0.001).
Figure 1. Improvement in Left Ventricular (LV) Function and Dimensions after Ablation in Patients with Congestive Heart Failure.
Plotted values are means ±SD. P values, which are for the comparison with baseline data, were determined with the use of Fisher's least-significant-difference test. The numbers of patients included at each time point were as follows: 0 month, 58; 1 month, 55; 3 months, 48; 6 months, 40 ; and 12 months, 34.
Marked improvement of the left ventricular ejection fraction(i.e., an increase of 20 percent or more or to a value of 55percent or more) was observed in 42 patients (72 percent). Recurrenceof arrhythmia despite the use of antiarrhythmic drugs was theonly variable negatively affecting the recovery of the leftventricular ejection fraction (Table 2). However, among the12 patients in whom arrhythmia recurred despite the use of drugs,left ventricular function was still significantly improved in4 patients in whom ablation had converted permanent atrial fibrillationto paroxysmal fibrillation.
Table 2. Variables Affecting Marked Improvement in Left Ventricular Function in Patients with Congestive Heart Failure.
Concurrent Structural Heart Disease
The presence of concurrent structural heart disease other thanisolated dilated cardiomyopathy did not significantly affectthe outcome of ablation. Sinus rhythm was maintained in 73 percentof patients with coexisting heart disease (66 percent withoutantiarrhythmic therapy), as compared with 81 percent of patientswith isolated dilated cardiomyopathy (73 percent without antiarrhythmictherapy) (P=0.46). The left ventricular function increased significantlyin both groups after ablation (Figure 2A and Figure 2B). Inthe absence of concurrent structural heart disease, the leftventricular ejection fraction increased by 24±10 percent(P<0.001), and 28 of 32 patients who were studied (88 percent)had a marked increase (i.e., an increase of 20 percent or moreor to a value of 55 percent or more). Three of the four patientswithout improvement had a recurrence of persistent atrial fibrillation;of those, two had suboptimal rate control despite drug therapy(mean ventricular rate, 94 and 98 beats per minute). In patientswith concurrent structural heart disease, the left ventricularejection fraction increased by 16±14 percent (P<0.001),and 14 of 26 patients who were studied (54 percent) had a markedincrease in the left ventricular ejection fraction (P=0.007for the comparison with those without concurrent heart disease).
Figure 2. Effect of Concurrent Structural Heart Disease and Rate Control before Ablation on Left Ventricular (LV) Function after Ablation among Patients with Congestive Heart Failure.
Plotted values are means ±SD. P values are for the comparison with baseline data.
Preablation Rate Control and Tachycardia-Mediated Cardiomyopathy
The characteristics of the subgroup of 53 patients with persistentor permanent atrial fibrillation and congestive heart failureare shown in Table 3. Seventy-five percent of patients in whomrate control was adequate had concurrent structural heart disease.Both groups had significant improvement in left ventricularfunction after ablation (Figure 2C and Figure 2D), with theleft ventricular ejection fraction increasing by a mean of 23±10percent in patients with poor rate control (P<0.001) andby 17±15 percent in those with adequate rate control(P<0.001). No statistically significant differences wereobserved between the groups. A marked increase in the left ventricularejection fraction was observed in 86 percent of patients withpoor rate control, as compared with 54 percent of those withadequate rate control (P=0.02).
Table 3. Characteristics of the Patients with Congestive Heart Failure, According to the Adequacy of Ventricular Rate Control.
Regardless of the presence or absence of concurrent heart diseaseor rate-controlled arrhythmia, the left ventricular ejectionfraction improved significantly, with the greatest improvement(24±8 percent) in patients with poor rate control whodid not have coexisting heart disease. In this group, in whichcongestive heart failure could be attributed to tachycardia-mediatedcardiomyopathy alone, 92 percent of the patients had markedimprovement in the left ventricular ejection fraction.
Discussion
This study presents new information on the detrimental effectsof atrial fibrillation in patients with congestive heart failureand the treatment of these patients. After catheter ablationfor atrial fibrillation, long-term restoration of sinus rhythm,without the use of antiarrhythmic drugs in most patients, resultedin significant improvement in left ventricular function, exercisecapacity, symptoms, and quality of life, even in the presenceof concurrent structural heart disease and adequate ventricularrate control before ablation.
Cardiomyopathy due to a rapid ventricular response has beenimplicated as the main mechanism by which atrial fibrillationresults in congestive heart failure.22 However, impaired atrialcontractile function, loss of atrioventricular synchrony, andan irregular ventricular rhythm have also been shown to haveadverse effects on cardiac output.2,22,23,24 In our study, restorationof sinus rhythm resulted in an overall increase in the leftventricular ejection fraction of 21 percent in patients withcongestive heart failure. More modest improvements in the leftventricular ejection fraction were observed in studies usingthe clinically proven and effective "ablate and pace" strategyfor rate control, comprising creation of atrioventricular blockby catheter ablation, followed by permanent implantation ofa pacemaker.25,26,27,28,29 Though this strategy provides effectiverate control and regularization of ventricular rhythm, it doesnot restore atrial contraction or atrioventricular or interventricularsynchrony. In addition, the benefit of rhythm regularizationis negated by the adverse hemodynamic effects of right ventricularpacing, which is commonly used in such patients.28 The use ofleft ventricular or biventricular pacing, associated with amore favorable hemodynamic profile,30 may circumvent this problem,as demonstrated clinically by the recently completed Post AVNode Ablation Evaluation (PAVE) trial.31
The striking improvement in left ventricular function afterrestoration of sinus rhythm in 92 percent of the patients inour study who had inadequate rate control without coexistingheart disease suggests that congestive heart failure was attributableprimarily to tachycardia-mediated cardiomyopathy in this groupof patients. This high incidence suggests that in previous studies,tachycardia-related cardiomyopathy in association with atrialfibrillation may have been underestimated, possibly becauseof the use of antiarrhythmic drugs.29,32 Patients with adequaterate control and coexisting heart disease, including some withsevere congestive heart failure who were being considered forcardiac transplantation, also benefited from ablation, thoughto a lesser extent, a finding that demonstrates the additionalhemodynamic benefits of the restoration of sinus rhythm as comparedwith pharmacologic rate control. These results highlight theimportant contribution of atrial contraction and atrioventricularsynchrony to the total cardiac output and their role, in additionto a rapid ventricular rate, in the pathogenesis of left ventriculardysfunction in atrial fibrillation.
A recent retrospective study examined the effect of catheterablation of atrial fibrillation on left ventricular functionin 94 patients with impaired left ventricular function. Thestudy showed a nonsignificant overall increase of 5 percentin the left ventricular ejection fraction after ablation, onthe basis of a single echocardiographic examination performedapproximately six months after the initial ablation procedure.33The smaller improvement that was observed in this recent studycould be attributed to differences in the study design and alsoin the patient population, since a preponderance of the patientshad paroxysmal atrial fibrillation and concurrent structuralheart disease. However, most patients with concurrent heartdisease in our study also had significant improvement in leftventricular function after restoration of sinus rhythm.
Our study was not powered to assess mortality, owing to thesmall number of patients with congestive heart failure, whichreflects the current pattern of referrals for ablation in mostcenters. However, several randomized trials have shown improvedsurvival among patients with congestive heart failure and atrialfibrillation who had a reversion to sinus rhythm.34,35 Sincea reduced left ventricular ejection fraction is an importantpredictor of mortality,36 the significant improvement in leftventricular function after ablation could be important in improvingsurvival. In the recently reported substudy of the AFFIRM trial,restoration and maintenance of sinus rhythm were associatedwith a 47 percent reduction in the risk of death, as comparedwith that of patients who were in atrial fibrillation, whereasthe use of antiarrhythmic drugs and the presence of congestiveheart failure significantly increased the risk of death, by49 percent and 57 percent, respectively, thereby reversing thebenefit of the restoration of sinus rhythm.14 The maintenanceof sinus rhythm without antiarrhythmic drugs may thus be ofcritical importance and can now be achieved through curativeablation with the use of catheter or surgical techniques.
Our study is limited by the relatively small sample and thenonrandomized design, partly imposed by the characteristicsof patients referred for atrial fibrillation ablation. We triedto minimize bias by including a control group of patients withoutcongestive heart failure who were matched for age, sex, andclassification of atrial fibrillation. All clinical characteristicsexcept those related to cardiac function were also identical.Since no patients with symptomatic congestive heart failurefrom any cause were excluded, the results, including proceduralrates of success and complications, are likely to representthe clinical situation and be applicable to most patients withcongestive heart failure and atrial fibrillation.
Though the results of catheter ablation for atrial fibrillationhave been steadily improving, with the rate of success oftenreported as more than 80 percent for paroxysmal atrial fibrillation,16,17,18ablation of permanent atrial fibrillation has been more difficultand has required more extensive atrial ablation and often multipleprocedures.18,37 Complications have been infrequent (usuallyoccurring in less than 1 percent of patients) but have includedpericardial tamponade and stroke. The results can be expectedto improve with a better understanding of the substrate maintainingatrial fibrillation and with the development of more effectivetechniques.
Curative ablation for atrial fibrillation offers the uniqueopportunity to maintain sinus rhythm without antiarrhythmicdrugs, which can have deleterious effects. Our study shows thatrestoration and long-term maintenance of sinus rhythm are associatedwith significant improvement in cardiac function, symptoms,exercise capacity, and quality of life in patients with congestiveheart failure, even in the presence of concurrent heart diseaseand adequate rate control.
Dr. Hsu is the recipient of a Health Manpower Development Programfellowship funded by the Ministry of Health, Singapore. Dr.Sanders is the recipient of a Neil Hamilton Fairley and RalphReader Fellowship, jointly funded by the National Health andMedical Research Council and the National Heart Foundation ofAustralia. Dr. Rotter is the recipient of a grant from the SwissNational Foundation for Scientific Research, Bern.
Dr. Hsu reports having received lecture fees from Biosense Webster;Dr. Jaïs having received consulting and lecture fees fromBiosense Webster; Dr. Sanders having served on the advisoryboard of and having received lecture fees from Biosense Websterand Endocardial Solutions; Dr. Garrigue having received consultingfees from Medtronic, St. Jude Medical, and Sorin and lecturefees from St. Jude Medical and Sorin; Dr. Hocini having receivedlecture fees from Biosense Webster and Bard Electrophysiology;Dr. Pasquié having received consulting fees from Medtronic;and Dr. Haïssaguerre having received consulting and lecturefees from Biosense Webster. A U.S. patent entitled "CatheterHaving Mapping Assembly (6711428)" was issued on March 23, 2004;Dr. Haïssaguerre is one of the inventors. The patent isowned by Biosense Webster. A European patent entitled "SteerableCatheter with Fixed Curve (EPO 839547)" was issued on September24, 2003; Dr. Haïssaguerre is one of the inventors. Thepatent is owned by Bard Electrophysiology.
Source Information
From Hôpital Cardiologique du Haut-Lévêque and Université Victor Ségalen, Bordeaux II, Bordeaux-Pessac, France.
Address reprint requests to Dr. Jaïs at Hôpital Cardiologique du Haut-Lévêque, Ave. de Magellan 33604, Bordeaux-Pessac, France, or at pierre.jais{at}chu-bordeaux.fr.
References
Braunwald E. Shattuck Lecture -- cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities. N Engl J Med 1997;337:1360-1369. [Free Full Text]
Stevenson WG, Stevenson LW. Atrial fibrillation in heart failure. N Engl J Med 1999;341:910-911. [Free Full Text]
Ehrlich JR, Nattel S, Hohnloser SH. Atrial fibrillation and congestive heart failure: specific considerations at the intersection of two common and important cardiac disease sets. J Cardiovasc Electrophysiol 2002;13:399-405. [CrossRef][ISI][Medline]
Middlekauff HR, Stevenson WG, Stevenson LW. Prognostic significance of atrial fibrillation in advanced heart failure: a study of 390 patients. Circulation 1991;84:40-48. [Free Full Text]
Wang TJ, Larson MG, Levy D, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation 2003;107:2920-2925. [Free Full Text]
Fuster V, Ryden LE, Asinger RW, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients with Atrial Fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology. Circulation 2001;104:2118-2150. [Free Full Text]
Torp-Pedersen C, Møller M, Bloch-Thomsen PE, et al. Dofetilide in patients with congestive heart failure and left ventricular dysfunction. N Engl J Med 1999;341:857-865. [Free Full Text]
Roy D, Talajic M, Dorian P, et al. Amiodarone to prevent recurrence of atrial fibrillation. N Engl J Med 2000;342:913-920. [Free Full Text]
Falk RH. Atrial fibrillation. N Engl J Med 2001;344:1067-1078. [Erratum, N Engl J Med 2001;344:1876.] [Free Full Text]
The AFFIRM First Antiarrhythmic Drug Substudy Investigators. Maintenance of sinus rhythm in patients with atrial fibrillation: an AFFIRM substudy of the first antiarrhythmic drug. J Am Coll Cardiol 2003;42:20-29. [Free Full Text]
The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002;347:1825-1833. [Free Full Text]
Van Gelder IC, Hagens VE, Bosker HA, et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 2002;347:1834-1840. [Free Full Text]
Hohnloser SH, Kuck KH, Lilienthal J. Rhythm or rate control in atrial fibrillation -- Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomized trial. Lancet 2000;356:1789-1794. [CrossRef][ISI][Medline]
Corley SD, Epstein AE, DiMarco JP, et al. Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study. Circulation 2004;109:1509-1513. [Free Full Text]
Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998;339:659-666. [Free Full Text]
Haissaguerre M, Jais P, Shah DC, et al. Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci. Circulation 2000;101:1409-1417. [Free Full Text]
Pappone C, Oreto G, Rosanio S, et al. Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation 2001;104:2539-2544. [Free Full Text]
Oral H, Knight BP, Tada H, et al. Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation 2002;105:1077-1081. [Free Full Text]
Bubien RS, Knotts-Dolson SM, Plumb VJ, Kay GN. Effect of radiofrequency catheter ablation on health-related quality of life and activities of daily living in patients with recurrent arrhythmias. Circulation 1996;94:1585-1591. [Free Full Text]
Ware JE. SF-36 physical and mental summary scales: a user's manual. Boston: Health Institute, New England Medical Center, 1994.
Jais P, Hocini M, Hsu LF, et al. Technique and result of linear ablation at the mitral isthmus. Circulation 2004;110:2996-3002. [Free Full Text]
Shinbane JS, Wood MA, Jensen DN, Ellenbogen KA, Fitzpatrick AP, Scheinman MM. Tachycardia-induced cardiomyopathy: a review of animal models and clinical studies. J Am Coll Cardiol 1997;29:709-715. [Abstract]
Pozzoli M, Cioffi G, Traversi E, Pinna GD, Cobelli F, Tavazzi L. Predictors of primary atrial fibrillation and concomitant clinical and hemodynamic changes in patients with chronic heart failure: a prospective study in 344 patients with baseline sinus rhythm. J Am Coll Cardiol 1998;32:197-204. [Free Full Text]
Clark DM, Plumb VJ, Epstein AE, Kay GN. Hemodynamic effects of an irregular sequence of ventricular cycle lengths during atrial fibrillation. J Am Coll Cardiol 1997;30:1039-1045. [Abstract]
Kay GN, Ellenbogen KA, Giudici M, et al. The Ablate and Pace Trial: a prospective study of catheter ablation of the AV conduction system and permanent pacemaker implantation for treatment of atrial fibrillation. J Interv Card Electrophysiol 1998;2:121-135. [CrossRef][ISI][Medline]
Ozcan C, Jahangir A, Friedman PA, et al. Long-term survival after ablation of the atrioventricular node and implantation of a permanent pacemaker in patients with atrial fibrillation. N Engl J Med 2001;344:1043-1051. [Free Full Text]
Wood MA, Brown-Mahoney C, Kay GN, Ellenbogen KA. Clinical outcomes after ablation and pacing therapy for atrial fibrillation: a meta-analysis. Circulation 2000;101:1138-1144. [Free Full Text]
Brignole M, Menozzi C, Gianfranchi L, et al. Assessment of atrioventricular junction ablation and VVIR pacemaker versus pharmacological treatment in patients with heart failure and chronic atrial fibrillation: a randomized, controlled study. Circulation 1998;98:953-960. [Free Full Text]
Ozcan C, Jahangir A, Friedman PA, et al. Significant effects of atrioventricular node ablation and pacemaker implantation on left ventricular function and long-term survival in patients with atrial fibrillation and left ventricular dysfunction. Am J Cardiol 2003;92:33-37. [CrossRef][ISI][Medline]
Leon AR, Greenberg JM, Kanuru N, et al. Cardiac resynchronization in patients with congestive heart failure and chronic atrial fibrillation: effect of upgrading to biventricular pacing after chronic right ventricular pacing. J Am Coll Cardiol 2002;39:1258-1263. [Free Full Text]
Doshi R, Daoud E, Fellows C, Turk K, Duran A, Hamdan M. PAVE: the first prospective, randomized study evaluating biventricular pacing after ablate and pace therapy. Presented at the American College of Cardiology Annual Scientific Session 2004, New Orleans, March 7–10, 2004. (Accessed November 3, 2004, at http://www.acc04online.org.)
Redfield MM, Kay GN, Jenkins LS, Mianulli M, Jensen DN, Ellenbogen KA. Tachycardia-related cardiomyopathy: a common cause of ventricular dysfunction in patients with atrial fibrillation referred for atrioventricular ablation. Mayo Clin Proc 2000;75:790-795. [ISI][Medline]
Chen MS, Marrouche NF, Khaykin Y, et al. Pulmonary vein isolation for the treatment of atrial fibrillation in patients with impaired systolic function. J Am Coll Cardiol 2004;43:1004-1009. [Free Full Text]
Pedersen OD, Bagger H, Keller N, Marchant B, Kober L, Torp-Pedersen C. Efficacy of dofetilide in the treatment of atrial fibrillation-flutter in patients with reduced left ventricular function: a Danish Investigations of Arrhythmia and Mortality ON Dofetilide (DIAMOND) substudy. Circulation 2001;104:292-296. [Free Full Text]
Deedwania PC, Singh BN, Ellenbogen K, Fisher S, Fletcher R, Singh SN. Spontaneous conversion and maintenance of sinus rhythm by amiodarone in patients with heart failure and atrial fibrillation: observations from the Veterans Affairs Congestive Heart Failure Survival Trial of Antiarrhythmic Therapy (CHF-STAT). Circulation 1998;98:2574-2579. [Free Full Text]
Vasan RS, Larson MG, Benjamin EJ, Evans JC, Reiss CK, Levy D. Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population-based cohort. J Am Coll Cardiol 1999;33:1948-1955. [Free Full Text]
Kanagaratnam L, Tomassoni G, Schweikert R, et al. Empirical pulmonary vein isolation in patients with chronic atrial fibrillation using a three-dimensional nonfluoroscopic mapping system: long-term follow-up. Pacing Clin Electrophysiol 2001;24:1774-1779. [CrossRef][Medline]
Knecht, S., Hocini, M., Wright, M., Lellouche, N., O'Neill, M. D., Matsuo, S., Nault, I., Chauhan, V. S., Makati, K. J., Bevilacqua, M., Lim, K.-T., Sacher, F., Deplagne, A., Derval, N., Bordachar, P., Jais, P., Clementy, J., Haissaguerre, M.
(2008). Left atrial linear lesions are required for successful treatment of persistent atrial fibrillation. Eur Heart J
0: ehn302v1-8
[Abstract][Full Text]
Leclercq, C., Mabo, P.
(2008). Cardiac resynchronization therapy and atrial fibrillation. Do we have a final answer?. Eur Heart J
29: 1597-1599
[Full Text]
Roy, D., Talajic, M., Nattel, S., Wyse, D. G., Dorian, P., Lee, K. L., Bourassa, M. G., Arnold, J. M. O., Buxton, A. E., Camm, A. J., Connolly, S. J., Dubuc, M., Ducharme, A., Guerra, P. G., Hohnloser, S. H., Lambert, J., Le Heuzey, J.-Y., O'Hara, G., Pedersen, O. D., Rouleau, J.-L., Singh, B. N., Stevenson, L. W., Stevenson, W. G., Thibault, B., Waldo, A. L., the Atrial Fibrillation and Congestive Heart Failu,
(2008). Rhythm Control versus Rate Control for Atrial Fibrillation and Heart Failure. NEJM
358: 2667-2677
[Abstract][Full Text]
Savelieva, I., Camm, J.
(2008). Anti-arrhythmic drug therapy for atrial fibrillation: current anti-arrhythmic drugs, investigational agents, and innovative approaches. Europace
10: 647-665
[Abstract][Full Text]
Lutomsky, B. A., Rostock, T., Koops, A., Steven, D., Mullerleile, K., Servatius, H., Drewitz, I., Ueberschar, D., Plagemann, T., Ventura, R., Meinertz, T., Willems, S.
(2008). Catheter ablation of paroxysmal atrial fibrillation improves cardiac function: a prospective study on the impact of atrial fibrillation ablation on left ventricular function assessed by magnetic resonance imaging. Europace
10: 593-599
[Abstract][Full Text]
Lubitz, S. A, Fischer, A., Fuster, V.
(2008). Catheter ablation for atrial fibrillation. BMJ
336: 819-826
[Full Text]
Nademanee, K., Schwab, M. C., Kosar, E. M., Karwecki, M., Moran, M. D., Visessook, N., Michael, A. D., Ngarmukos, T.
(2008). Clinical Outcomes of Catheter Substrate Ablation for High-Risk Patients With Atrial Fibrillation. J Am Coll Cardiol
51: 843-849
[Abstract][Full Text]
Cosio, F. G., Aliot, E., Botto, G. L., Heidbuchel, H., Geller, C. J., Kirchhof, P., De Haro, J.-C., Frank, R., Villacastin, J. P., Vijgen, J., Crijns, H.
(2008). Delayed rhythm control of atrial fibrillation may be a cause of failure to prevent recurrences: reasons for change to active antiarrhythmic treatment at the time of the first detected episode. Europace
10: 21-27
[Abstract][Full Text]
Donal, E., Sallach, J. A., Murray, R. D., Drinko, J. K., Jasper, S. E., Thomas, J. D., Klein, A. L.
(2008). Contrast-enhanced tissue Doppler imaging of the left atrial appendage is a new quantitative measure of spontaneous echocardiographic contrast in atrial fibrillation. Eur J Echocardiogr
9: 5-11
[Abstract][Full Text]
Padeletti, L., Pieragnoli, P., Jentzen, V., Schuchert, A.
(2007). The comorbidity of atrial fibrillation and heart failure: a challenge for electrical therapies. Eur Heart J Suppl
9: I81-I86
[Abstract][Full Text]
Arrantes, L., Gaita, F., Lim, K.-t., Scaglione, M., Jais, P., Hocini, M., Matsuo, S., Knecht, S., Haissaguerre, M.
(2007). Atrial fibrillation ablation: evolution of the curative approach. Eur Heart J Suppl
9: I129-I135
[Abstract][Full Text]
Kirchhof, P., Auricchio, A., Bax, J., Crijns, H., Camm, J., Diener, H.-C., Goette, A., Hindricks, G., Hohnloser, S., Kappenberger, L., Kuck, K.-H., Lip, G. Y.H., Olsson, B., Meinertz, T., Priori, S., Ravens, U., Steinbeck, G., Svernhage, E., Tijssen, J., Vincent, A., Breithardt, G.
(2007). Outcome parameters for trials in atrial fibrillation: executive summary: Recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eur Heart J
28: 2803-2817
[Abstract][Full Text]
Neuberger, H.-R., Mewis, C., van Veldhuisen, D. J., Schotten, U., van Gelder, I. C., Allessie, M. A., Bohm, M.
(2007). Management of atrial fibrillation in patients with heart failure. Eur Heart J
28: 2568-2577
[Abstract][Full Text]
Kirchhof, P., Auricchio, A., Bax, J., Crijns, H., Camm, J., Diener, H.-C., Goette, A., Hindricks, G., Hohnloser, S., Kappenberger, L., Kuck, K.-H., Lip, G. Y.H., Olsson, B., Meinertz, T., Priori, S., Ravens, U., Steinbeck, G., Svernhage, E., Tijssen, J., Vincent, A., Breithardt, G.
(2007). Outcome parameters for trials in atrial fibrillation: Recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork and the European Heart Rhythm Association. Europace
9: 1006-1023
[Abstract][Full Text]
Katritsis, D. G., Camm, A. J.
(2007). Catheter ablation of atrial fibrillation: do we know what we are doing?. Europace
9: 1002-1005
[Full Text]
Tanaka, K., Zlochiver, S., Vikstrom, Karen. L., Yamazaki, M., Moreno, J., Klos, M., Zaitsev, Alexey. V., Vaidyanathan, R., Auerbach, D. S., Landas, S., Guiraudon, G., Jalife, J., Berenfeld, O., Kalifa, J.
(2007). Spatial Distribution of Fibrosis Governs Fibrillation Wave Dynamics in the Posterior Left Atrium During Heart Failure. Circ. Res.
101: 839-847
[Abstract][Full Text]
Leon, A. R.
(2007). The Class I Cardiac Resynchronization Therapy Effect?. J Am Coll Cardiol
50: 1252-1253
[Full Text]
O'Neill, M. D., Jais, P., Hocini, M., Sacher, F., Klein, G. J., Clementy, J., Haissaguerre, M.
(2007). Catheter Ablation for Atrial Fibrillation. Circulation
116: 1515-1523
[Full Text]
Jais, P., Packer, D. L.
(2007). Ablation vs. drug use for atrial fibrillation. Eur Heart J Suppl
9: G26-G34
[Abstract][Full Text]
Calkins, H., Brugada, J., Packer, D. L., Cappato, R., Chen, S.-A., Crijns, H. J.G., Damiano, R. J. Jr, Davies, D. W., Haines, D. E., Haissaguerre, M., Iesaka, Y., Jackman, W., Jais, P., Kottkamp, H., Kuck, K. H., Lindsay, B. D., Marchlinski, F. E., McCarthy, P. M., Mont, J. L., Morady, F., Nademanee, K., Natale, A., Pappone, C., Prystowsky, E., Raviele, A., Ruskin, J. N., Shemin, R. J., TASK FORCE MEMBERS, , Calkins, H., Brugada, J., Section Chairs, , Atrial Fibrillation: Definitions, Mechanisms, and, , Chen, S.-A., Indications for Ablation and Patient Selection, , Prystowsky, E. N., Techniques and Endpoints for Atrial Fibrillation, , Kuck, K. H., Technologies and Tools, , Natale, A., Other Technical Aspects, , Haines, D. E., Follow-up Considerations, , Marchlinski, F. E., Outcomes and Efficacy of Catheter Ablation of Atri, , Calkins, H., Complications of Atrial Fibrillation Ablation, , Davies, D. W., Training Requirements and Competencies, , Lindsay, B. D., Surgical Ablation of Atrial Fibrillation, , McCarthy, P. M., Clinical Trial Considerations, , Packer, D. L., Co-Authors, , Cappato, R., Crijns, H. J.G., Damiano, R. J. Jr, Haissaguerre, M., Jackman, W. M., Jais, P., Iesaka, Y., Kottkamp, H., Mont, L., Morady, F., Nademanee, K., Pappone, C., Raviele, A., Ruskin, J. N., Shemin, R. J.
(2007). HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation Developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and Approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society.. Europace
9: 335-379
[Full Text]
Takahashi, Y., O'Neill, M. D., Hocini, M., Reant, P., Jonsson, A., Jais, P., Sanders, P., Rostock, T., Rotter, M., Sacher, F., Laffite, S., Roudaut, R., Clementy, J., Haissaguerre, M.
(2007). Effects of Stepwise Ablation of Chronic Atrial Fibrillation on Atrial Electrical and Mechanical Properties. J Am Coll Cardiol
49: 1306-1314
[Abstract][Full Text]
Dzau, V. J., Antman, E. M., Black, H. R., Hayes, D. L., Manson, J. E., Plutzky, J., Popma, J. J., Stevenson, W.
(2006). The Cardiovascular Disease Continuum Validated: Clinical Evidence of Improved Patient Outcomes: Part II: Clinical Trial Evidence (Acute Coronary Syndromes Through Renal Disease) and Future Directions. Circulation
114: 2871-2891
[Full Text]
Willems, S., Klemm, H., Rostock, T., Brandstrup, B., Ventura, R., Steven, D., Risius, T., Lutomsky, B., Meinertz, T.
(2006). Substrate modification combined with pulmonary vein isolation improves outcome of catheter ablation in patients with persistent atrial fibrillation: a prospective randomized comparison. Eur Heart J
27: 2871-2878
[Abstract][Full Text]
Wazni, O. M., Tsao, H.-M., Chen, S.-A., Chuang, H.-H., Saliba, W., Natale, A., Klein, A. L.
(2006). Cardiovascular Imaging in the Management of Atrial Fibrillation. J Am Coll Cardiol
48: 2077-2084
[Abstract][Full Text]
Wong, J. W.W., Mak, K.-H.
(2006). Impact of Maze and Concomitant Mitral Valve Surgery on Clinical Outcomes. Ann. Thorac. Surg.
82: 1938-1947
[Abstract][Full Text]
Van Gelder, I. C., Hemels, M. E.W.
(2006). The progressive nature of atrial fibrillation: a rationale for early restoration and maintenance of sinus rhythm. Europace
8: 943-949
[Abstract][Full Text]
Writing Committee Members, , Fuster, V., Ryden, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., Olsson, S. B., Prystowsky, E. N., Tamargo, J. L., Wann, S., ACC/AHA Task Force Members, , Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Anderson, J. L., Antman, E. M., Halperin, J. L., Hunt, S. A., Nishimura, R., Ornato, J. P., Page, R. L., Riegel, B., ESC Committee for Practice Guidelines, , Priori, S. G., Blanc, J.-J., Budaj, A., Camm, A. J., Dean, V., Deckers, J. W., Despres, C., Dickstein, K., Lekakis, J., McGregor, K., Metra, M., Morais, J., Osterspey, A., Tamargo, J. L., Zamorano, J. L.
(2006). ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace
8: 651-745
[Full Text]
Betts, T R
(2006). Rhythm control strategies for "symptomatic" persistent atrial fibrillation: is achieving sinus rhythm enough?. Heart
92: 1189-1190
[Abstract][Full Text]
Fuster, V., Ryden, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., Olsson, S. B., Prystowsky, E. N., Tamargo, J. L., Wann, S.
(2006). ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society . J Am Coll Cardiol
48: 854-906
[Full Text]
Fuster, V., Ryden, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., Olsson, S. B., Prystowsky, E. N., Tamargo, J. L., Wann, S.
(2006). ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society . J Am Coll Cardiol
48: e149-e246
[Full Text]
Gasparini, M., Auricchio, A., Regoli, F., Fantoni, C., Kawabata, M., Galimberti, P., Pini, D., Ceriotti, C., Gronda, E., Klersy, C., Fratini, S., Klein, H. H.
(2006). Four-Year Efficacy of Cardiac Resynchronization Therapy on Exercise Tolerance and Disease Progression: The Importance of Performing Atrioventricular Junction Ablation in Patients With Atrial Fibrillation. J Am Coll Cardiol
48: 734-743
[Abstract][Full Text]
Fuster, V., Ryden, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., Olsson, S. B., Prystowsky, E. N., Tamargo, J. L., Wann, S., ACC/AHA TASK FORCE MEMBERS, , Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Anderson, J. L., Antman, E. M., Halperin, J. L., Hunt, S. A., Nishimura, R., Ornato, J. P., Page, R. L., Riegel, B., ESC COMMITTEE FOR PRACTICE GUIDELINES, , Priori, S. G., Blanc, J.-J., Budaj, A., Camm, A. J., Dean, V., Deckers, J. W., Despres, C., Dickstein, K., Lekakis, J., McGregor, K., Metra, M., Morais, J., Osterspey, A., Tamargo, J. L., Zamorano, J. L.
(2006). ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation
114: e257-e354
[Full Text]
Fuster, V., Ryden, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., Olsson, S. B., Prystowsky, E. N., Tamargo, J. L., Wann, S., ACC/AHA TASK FORCE MEMBERS, , Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Anderson, J. L., Antman, E. M., Halperin, J. L., Hunt, S. A., Nishimura, R., Ornato, J. P., Page, R. L., Riegel, B., ESC COMMITTEE FOR PRACTICE GUIDELINES, , Priori, S. G., Blanc, J.-J., Budaj, A., Camm, A. J., Dean, V., Deckers, J. W., Despres, C., Dickstein, K., Lekakis, J., McGregor, K., Metra, M., Morais, J., Osterspey, A., Tamargo, J. L., Zamorano, J. L.
(2006). ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation
114: 700-752
[Full Text]
Authors/Task Force Members, , Fuster, V., Ryden, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., Olsson, S. B., Prystowsky, E. N., Tamargo, J. L., Wann, S., ESC Committee for Practice Guidelines, , Priori, S. G., Blanc, J.-J., Budaj, A., Camm, A. J., Dean, V., Deckers, J. W., Despres, C., Dickstein, K., Lekakis, J., McGregor, K., Metra, M., Morais, J., Osterspey, A., Tamargo, J. L., Zamorano, J. L., ACC/AHA (Practice Guidelines) Task Force Members, , Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Anderson, J. L., Antman, E. M., Halperin, J. L., Hunt, S. A., Nishimura, R., Ornato, J. P., Page, R. L., Riegel, B.
(2006). ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Eur Heart J
27: 1979-2030
[Full Text]
Marchlinski, F. E., Jessup, M.
(2006). Timing the Implantation of Implantable Cardioverter-Defibrillators in Patients With Nonischemic Cardiomyopathy. J Am Coll Cardiol
47: 2483-2485
[Full Text]
Calo, L., Lamberti, F., Loricchio, M. L., De Ruvo, E., Colivicchi, F., Bianconi, L., Pandozi, C., Santini, M.
(2006). Left Atrial Ablation Versus Biatrial Ablation for Persistent and Permanent Atrial Fibrillation: A Prospective and Randomized Study. J Am Coll Cardiol
47: 2504-2512
[Abstract][Full Text]
Rienstra, M., Van Gelder, I. C., Hagens, V. E., Veeger, N. J.G.M., Van Veldhuisen, D. J., Crijns, H. J.G.M., for the RACE Investigators,
(2006). Mending the rhythm does not improve prognosis in patients with persistent atrial fibrillation: a subanalysis of the RACE study. Eur Heart J
27: 357-364
[Abstract][Full Text]
Earley, M. J, Schilling, R. J
(2006). Catheter and surgical ablation of atrial fibrillation. Heart
92: 266-274
[Full Text]
Hall, M C S, Todd, D M
(2006). Modern management of arrhythmias. Postgrad. Med. J.
82: 117-125
[Abstract][Full Text]
Tang, W.H. W., Francis, G. S.
(2005). The Year in Heart Failure. J Am Coll Cardiol
46: 2125-2133
[Full Text]
Quinn, F R, Rankin, A C
(2005). Atrial fibrillation ablation in the real world. Heart
91: 1507-1508
[Abstract][Full Text]
Ouyang, F., Ernst, S., Chun, J., Bansch, D., Li, Y., Schaumann, A., Mavrakis, H., Liu, X., Deger, F. T., Schmidt, B., Xue, Y., Cao, J., Hennig, D., Huang, H., Kuck, K.-H., Antz, M.
(2005). Electrophysiological Findings During Ablation of Persistent Atrial Fibrillation With Electroanatomic Mapping and Double Lasso Catheter Technique. Circulation
112: 3038-3048
[Abstract][Full Text]
Reant, P., Lafitte, S., Jais, P., Serri, K., Weerasooriya, R., Hocini, M., Pillois, X., Clementy, J., Haissaguerre, M., Roudaut, R.
(2005). Reverse Remodeling of the Left Cardiac Chambers After Catheter Ablation After 1 Year in a Series of Patients With Isolated Atrial Fibrillation. Circulation
112: 2896-2903
[Abstract][Full Text]
Shah, M., Akar, F. G., Tomaselli, G. F.
(2005). Molecular Basis of Arrhythmias. Circulation
112: 2517-2529
[Abstract][Full Text]
Donal, E., Yamada, H., Leclercq, C., Herpin, D.
(2005). The Left Atrial Appendage, a Small, Blind-Ended Structure: A Review of Its Echocardiographic Evaluation and Its Clinical Role. Chest
128: 1853-1862
[Abstract][Full Text]
Crijns, H. I.G.M., Tieleman, R. G., Van Gelder, I. C., Gehi, A. K., Mehta, D., Hsu, L.-F., Haissaguerre, M., Jais, P.
(2005). Ablation for Atrial Fibrillation in Congestive Heart Failure. NEJM
352: 1148-1149
[Full Text]
Malik, I.
(2005). JournalScan. Heart
91: 271-272
[Full Text]
(2005). Catheter Ablation for Patients with Afib and Heart Failure?. Journal Watch Cardiology
2005: 1-1
[Full Text]
(2005). Catheter Ablation Improves LV Function in Patients with AF and Heart Failure. JWatch General
2005: 2-2
[Full Text]
Page, R. L.
(2004). Newly Diagnosed Atrial Fibrillation. NEJM
351: 2408-2416
[Full Text]
Stevenson, W. G., Stevenson, L. W.
(2004). Atrial Fibrillation and Heart Failure -- Five More Years. NEJM
351: 2437-2440
[Full Text]
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