études sur la fibrillation auriculaire sous l’égide de
COEUR DE LA TOUR fondation pour la recherche Cardiovasculaire
RECHERCHE SUR LA FIBRILLATION AURICULAIRE BUTS • obtenir une meilleure connaissance de la FA • promouvoir l’application des recommandations • promouvoir l’information aux patients • réduire les complications thrombo-emboliques
Fondation de La Tour pour la recherche cardiovasculaire
concept de base
FIBRILLATION AURICULAIRE . caractéristiques cliniques dans une population générale . modes de présentation . prise en charge . respect des recommandations internationales . détermination des modes de survenue . suivi à long terme . nouvelles approches thérapeutiques . étude coût - efficacité . enseignement aux patients – site web
COEUR DE LA TOUR fondation pour la recherche
Cardiovasculaire
Introduction Several community-based studies have provided important data in the management of atrial fibrillation (AF), but most of them are older than 10 years and have focused on hospitalized patients. Only a few studies have targeted the out-of-hospital population and most of them took place before the release of ACC/AHA/ESC guidelines. We conducted a survey study on the outpatient management of AF by 23 cardiologists established in office practice in Canton of Geneva.
Objectives
Atrial fibrillation classification
Anticoagulation rate according to CHADS2 score
Stroke risk statification
% < 7 days
AFIB
>7 days < 3 months
1.44 ± 1.24
> 3 months
To assess AF management in a « real world » practice: prospective ambulatory setting
Heart rhythm strategy
(n=164)
(n=186)
(n=169)
(n=60)
(n=30)
(n=12)
(n=2)
followed by cardiologists Tight correlation between the risk of stroke according to the CHADS2 score and the anticoagulation rate.
Methods Enrollement started on Jan. 1, 2005 and finished on Dec. 31, 2005. Consecutive patients were included if they were >18 years and had an AF documented by an ECG during the office visit. At inclusion, rate or rhythm control strategies were to be assigned as well as the antiarrhythmic and antithrombotic treatments applied and the non-pharmacological procedures planned for restoring sinus rhythm.
Patient characteristics 622 patients enrolled, mean age 69.8±12 years, ♂/♀: 0.63
Anticoagulation according to age
Rate and rhythm control strategies were almost equally applied.
Antiarrhythmic treatment
Anticoagulation rate in eligible vs ineligible patients CHADS2 = 0
CHADS2 ≥ 1
%
underlying
cardiac disease / « lone AF » : 82 / 18 % hypertension: 56% valvular heart disease: 27% CAD:
18%
myocardial
diseases: 11% related to AF in 2/3 of patients: 49% palpitations: 45%
symptoms
dyspnea: HF:
11%
lightheadness
or syncope: 14%
No negative effect of age on the rate of anticoagulation prescription.
Conclusion COEUR DE LA TOUR fondation pour la recherche
Cardiovasculaire
AFIB Geneva: from a « real » to an « ideal world ». 1. Treatment strategy: in fair agreement with guidelines, 53% of the patients received a rat control strategy. 2. Antithrombotic treatment: - strong concordance between clinical practice and guideline recommendation - no significant underuse of anticoagulation, particularly in the elderly.
Oral anticoagulation was prescribed in 88% of the patients with a recognized indication according to the CHADS2 score and in 58% of the ineligible patients.
Etudes sur la FA sous l’égide de la fondation de la Tour pour la recherche cardiovasculaire 16. Hoffmann JL, Thorens JB, Zimmermann M. Apnées du sommeil et troubles du rythme cardiaque: quel rôle pour la stimulation cardiaque ? Rev Med Suisse 2007 ; 3 : 671-673 17. Burri H, Zimmermann M. Prise en charge de la fibrillation atriale. Rev Med Suisse 2008 ; 4 : S72-S73 18. Zimmermann M, Urban P. Le bon geste, au bon moment, pour le bon patient… (editorial). Rev Med Suisse 2009 ; 5 : 499-500 19. Meiltz A, Zimmermann M. Fibrillation auriculaire et respect des recommandations internationales au quotidien : mythe ou réalité ? Rev Med Suisse 2009 ; 4 : 520-525
COEUR DE LA TOUR fondation pour la recherche
Cardiovasculaire
COEUR DE LA TOUR fondation pour la recherche
Cardiovasculaire
Etudes sur la FA : résumés et présentations à des congrès
1. Meiltz A, Zimmermann M, Weber R, Halimi F, Defaye P, Boveda S, Tavernier R, Kalusche D. Permanent form of junctional reciprocating tachycardia in adults : peculiar features and results of radiofrequency catheter ablation (Abstr). Kardiovaskuläre Medizin 2005; 8 (suppl 8): S7 2. Kowsar A, Arentz T, Zimmermann M, Georger F, Defaye P, Boveda S, Lagrange P, Yldiz C, De Roy L, Blanc P. Delayed risk of development of atrioventricular block after slow pathway ablation : a multicentric retrospective study (Abstr). Heart Rhythm 2005; 2: S270 3. Meiltz A, Weber R, Halimi F, Defaye P, Boveda S, Tavernier R, Kalusche D, Zimmermann M. Permanent form of junctional reciprocating tachycardia in adults : peculiar features and results of radiofrequency catheter ablation (Abstr). Eur Heart J 2005; 26 (Abstr suppl): 17 4. Meiltz A, Zimmermann M. Atrioventricular nodal reentrant tachycardia in the elderly : efficacy and safety of radiofrequency catheter ablation (Abstr). Europace 2006; 8 (suppl. 1): 218P/7 5. Kowsar A, Arentz T, Zimmermann M, Georger F, Defaye P, Boveda S, Lagrange P, Yldiz C, De Roy L, Blanc P. Immediate and delayed pacemaker implantation after radiofrequency catheter ablation of slow pathway: a multicentric retrospective study (Abstr). Europace 2006; 8 (suppl. 1): 218P/9 6. Meiltz A on behalf of the Association of cardiologists of the Canton of Geneva. Adherence to guidelines for thromboembolism prophylaxis in atrial fibrillation : the Geneva experience (AFIB Geneva)(Abstr). Kardiovaskuläre Medizin 2006; 9 (suppl 12): 40S 7. Kowsar A, Labioche I, Arentz T, Zimmermann M, Georger F, Defaye P, Lagrange P, De Roy L, Blanc P, Boveda S, Virot P. Early and delayed pacemaker implantation after radiofrequency catheter ablation of slow pathway (Abstr). Heart Rhythm 2006; 3 (May suppl): S280 8. Dumont F, Blommaert D, Defaye P, Blanc P, Arentz T, Zimmermann M, DeRoy L. Indications, appropriate and inappropriate shocks in implantable cardioverter defibrillator recepients below the age of 50 (Abstr). Acta Cardiologica 2006; 61: 229 9. Dumont F, Blommaert D, Defaye P, Blanc P, Arentz T, Zimmermann M, DeRoy L. Indications and outcome in patients implanted with an internal cardioverter defibrillator (ICD) before the age of fifty (Abstr). PACE 2006; 29: S11 10. Labioche I, Lagrange A, Arentz T, Zimmermann M, Lagrange P, Gerger F. Defaye P, Boveda S. Deroy L, Blanc P. Delayed risk of atrioventricular block after slow pathway ablation: a multicentric retrospective study. Arch Mal Coeur Vaiss 2006; 99: 83
COEUR DE LA TOUR fondation pour la recherche
Cardiovasculaire
Etudes sur la FA : résumés et présentations à des congrès
11. Defaye P, Meiltz A, Weber R, Halimi F, Boveda S, Tavernier R, Kalusche D, Zimmermann M. Tachycardie jonctionnelle permanente par rythme réciproque (PJRT) chez l'adulte : Aspects particuliers et résultat de l'ablation par radiofréquence. Arch Mal Coeur Vaiss 2006 ; 99 : 59 12. Zimmermann M, Théraulaz D, Meiltz A, Bloch A. Value of the 12-lead resting ECG for the diagnosis of prior myocardial infarction in paced patients. Europace 2007; 9 (suppl 3): 125 13. Meiltz A, Zimmermann M. Intention to treat analysis of atrial fibrillation management by practice cardiologists: the geneva Experience (AFIB Geneva). Kardiovaskuläre Medizin 2007; 10 (suppl 13): 7S 14. Zimmermann M, Meiltz A, Urban P, Bloch A. Atrial fibrillation management by practice cardiologists: a prospective survey on adherence to guidelines in the real-world. Heart Rhythm 2008; 5 (suppl.5): S128 15. Meiltz A, Zimmermann M, Urban P, Bloch A. Atrial fibrillation management by practice cardiologists: a prospective survey on the adherence to guidelines in the real world. Kardiovaskuläre Medizin 2008; 11 (suppl 16): 13S 16. Schmutz M, Burri H, Zimmermann M. Feasibility and safety of radiofrequency catheter ablation on an outpatient basis. Kardiovaskuläre Medizin 2008; 11 (suppl 16): 45S 17. Zimmermann M, Burri H, Sunthorn H, Shah D. Fascicular ventricular tachycardia: methods of mapping and results of radiofrequency catheter ablation. Kardiovaskuläre Medizin 2008; 11 (suppl 16): 43S 18. Ntep M, Ndobo O, Meiltz A, Kingue S, Zimmermann M. Fibrillation auriculaire au Cameroun: caractéristiques cliniques et modalités thérapeutiques. Médecine Tropicale 2008 ; 68 : 4 19. Marijon E, Zimmermann M, Boveda S, Schmutz M, Combes N, Albenque JP. Feasibility and safety of same-day home discharge after radiofrequency catheter ablation for routine supraventricular arrhythmias – a multicenter prospective evaluation. Arch Cardiovasc Dis 2009; 102 (special issue): A13 20. Conti L, Meiltz A, Tran N. N’tep M, Kingue S, Zimmermann M .Is it always possible to follow the guidelines for the treatment of atrial fibrillation? Kardiovaskuläre Medizin 2009; 12 (5)(suppl 17): 49S 21. Tran N, Marijon E, Albenque JP, Boveda S, Jacob A, Bortone N, Combes N, Zimmermann M. Feasability and safety of same-day discharge after radiofrequency catheter ablation. Kardiovaskuläre Medizin 2009; 12 (5)(suppl 17): 53S 22. Derval N, Nogami A, Komiya N, Sacher F, Babuty D, Probst V, Yli-Mayry S, Defaye P, Aizawa Y, Frank R., Zimmermann M, Cappato R, Leenhardt A, Deisenhofer I, Arentz T, Pasquié JL, Wright M, Hocini M, Jaïs P, Bordachar P, Clementy J, Haïssaguerre M. Specific treatment of VF storms associated with infero-lateral early repolarization. Heart Rhythm 2009; 6 (No 5 suppl): S116
COEUR DE LA TOUR fondation pour la recherche
Cardiovasculaire
Etudes sur la FA : résumés et présentations à des congrès
23. Blanche C, N’tep-Gweth M, Kingue S, Zimmermann M. Prognosis of atrial fibrillation: different realities between Switzerland and Cameroon. Kardiovaskuläre Medizin 2010 24. Rigamonti F, Blanche C, Burri H, Zimmermann M. Characteristics of unsucessful radiofrequency catheter ablation for supraventricular arrhythmias. Kardiovaskuläre Medizin 2010
COEUR DE LA TOUR fondation pour la recherche
Cardiovasculaire
Etudes sur la FA : articles publiés
1. Meiltz A, Weber R, Halimi F, Defaye P, Boveda S, Tavernier R, Kalusche D, Zimmermann M. Permanent form of junctional reciprocating tachycardia in adults : peculiar features and results of radiofrequency catheter ablation. Europace 2006; 8: 21-28 2. Zimmermann M, Meiltz A, Fournet PC. Wide and narrow QRS complex tachycardia: what is the mechanism ? J Cardiovasc Electrophysiol 2006 ; 17 : 912-914 3. Lafitte MJ, Sauvageot OR, Fèvre-Gemoulaz M, Zimmermann M. Towards assessing the sympathovagal balance. Med Biol Eng Comput 2006; 44: 675-682 4. Meiltz A, Zimmermann M. Atrioventricular nodal reentrant tachycardia in the elderly: efficacy and safety of radiofrequency catheter ablation. PACE 2007 ; 30 : S103-S107 5. Schütz N, Zimmermann M, Schopfer P. Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia in a patient with dextrocardia. Kardiovaskuläre Medizin 2007; 10:334-336 6. Théraulaz D, Zimmermann M, Meiltz A, Bloch A. Value of the 12-lead resting electrocardiogram for the diagnosis of previous myocardial infarction in paced patients. J Electrocardiol 2007; 40:496-503
Etudes sur la FA sous l’égide de la fondation de la Tour pour la recherche cardiovasculaire 7. Meiltz A, Zimmermann M, Urban P, Bloch A. Atrial fibrillation management by practice cardiologists: a prospective survey on the adherence to guidelines in the real world. Europace 2008 ; 10 : 674-680 8. Zimmermann M, Testuz A, Schmutz M, Burri H. Narrow complex tachycardia with cycle length alternans: what is the mechanism ? Heart Rhythm 2009; 6: 1238-1239 9. Marijon E, Albenque JP, Boveda S, Jacob S, Schmutz M, Combes N, Bortone A, Donzeau JP, Zimmermann M, on behalf on the RETAC group. Feasibility and safety of same-day home discharge after radiofrequency catheter ablation for routine supraventricular arrhythmias – a multicenter prospective evaluation. Am J Cardiol 2009 ; 104 : 254-258 10. Burri H, Sunthorn H, Zimmermann M, Stettler C, Shah D. Backup right ventricular pacing with a 0.035’’ guidewire during implantation of left ventricular leads. PACE 2009 ; 32 : S12-S15