Rationale, considerations, and goals for atrial fibrillation centers of excellence: A Heart Rhythm Society perspective

Piccini, Jonathan P.; Allred, James; Bunch, T. Jared; Deering, Thomas F.; Biase, Luigi Di; Hussein, Ayman A.; Lewis, William R.; Mittal, Suneet; Natale, Andrea; Osorio, José; Packer, Douglas L.; Ruff, Christian T.; Russo, Andrea M.; Sanders, Prashanthan; Seiler, Amber; Slotwiner, David J.; Hills, Mellanie True; Turakhia, Mintu P.; Gelder, Isabelle C. Van; Varosy, Paul D.; Verma, Atul; Volgman, Annabelle Santos; Wood, Kathryn A.; Deneke, Thomas

doi:10.1016/j.hrthm.2020.04.033

Cited by 44 publications

(20 citation statements)

References 166 publications

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“…Recent professional society statements advocate equitable care but do not include more substantive approaches to identify, accommodate, and address social determinants of health [47] . Our study indicates the substantive contribution of income and education towards adverse outcomes and their role as social determinants, and the vital importance of bringing tailored approaches for socially socioeconomically disadvantaged patients into guideline-based care.…”

Section: Discussionmentioning

confidence: 99%

Association of income and educational attainment in hospitalization events in atrial fibrillation

Tertulien

Chen

Althouse

et al. 2021

American Journal of Preventive Cardiology

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Highlights Investigation of social determinants and atrial fibrillation (AF) is limited. We measured income, education, and hospitalizations in a cohort (n = 339) with AF. Social determinants were related to hospitalization events over median 2.6-years. Addressing social determinants of health may reduce adverse events in AF.

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Section: Discussionmentioning

confidence: 99%

Association of income and educational attainment in hospitalization events in atrial fibrillation

Tertulien

Chen

Althouse

et al. 2021

American Journal of Preventive Cardiology

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“…Real-AF requires that each individual investigator, on average, exceeds this volume. This contrasting approach means that results and outcomes may be more generalizable to high experience centers [33]. In addition, with high volume centers, we expect more rapid adoption of these newer techniques and technologies, allowing for more rapid and discernable impact of these changes in ablation practice.…”

Section: Discussionmentioning

confidence: 99%

A prospective multi-site registry of real-world experience of catheter ablation for treatment of symptomatic paroxysmal and persistent atrial fibrillation (Real-AF): design and objectives

Varley

Kreidieh

Godfrey

et al. 2021

J Interv Card Electrophysiol

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Purpose Catheter ablation has become a mainstay therapy for atrial fibrillation (AF) with rapid innovation over the past decade. Variability in ablation techniques may impact efficiency, safety, and efficacy; and the ideal strategy is unknown. Real-world evidence assessing the impact of procedural variations across multiple operators may provide insight into these questions. The Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal (PAF) and Persistent (PsAF) Atrial Fibrillation registry (Real-AF) is a multicenter prospective registry that will enroll patients at high volume centers, including academic institutions and private practices, with operators performing ablations primarily with low fluoroscopy when possible. The study will also evaluate the contribution of advent in technologies and workflows to real-world clinical outcomes. Methods Patients presenting at participating centers are screened for enrollment. Data are collected at the time of procedure, 10-12 weeks, and 12 months post procedure and include patient and detailed procedural characteristics, with short and long-term outcomes. Arrhythmia recurrences are monitored through standard of care practice which includes continuous rhythm monitoring at 6 and 12 months, event monitors as needed for routine care or symptoms suggestive of recurrence, EKG performed at every visit, and interrogation of implanted device or ILR when applicable. Results Enrollment began in January 2018 with a single site. Additional sites began enrollment in October 2019. Through May 2021, 1,243 patients underwent 1,269 procedures at 13 institutions. Our goal is to enroll 4000 patients. Discussion Real-AF's multiple data sources and detailed procedural information, emphasis on high volume operators, inclusion of low fluoroscopy operators, and use of rigorous standardized follow-up methodology allow systematic documentation of clinical outcomes associated with changes in ablation workflow and technologies over time. Timely data sharing may enable real-time quality improvements in patient care and delivery. Trial registration Clinicaltrials.gov: NCT04088071

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“…14.6% of patients in the usual care group too received the rhythm control therapy to mitigate their symptoms. Given that patients in the early rhythm control group underwent an intense, structured follow-up, the positive results may have been influenced by better treatment of risk factor and comorbidities in the intervention arm [44]. As shown in Table 3, there are important differences between the AFFIRM and EAST-AFNET4 trials, which may explain the different headline results.…”

Section: Early Rhythm Controlmentioning

confidence: 99%

Clinical outcomes following rhythm control for atrial fibrillation: is early better?

Kotalczyk

Ding

Gupta

et al. 2021

Expert Review of Cardiovascular Therapy

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Introduction: An integral aspect of atrial fibrillation (AF) management involves better symptom control, incorporating a rate control, rhythm control, or a combination strategy. The 2020 ESC Guidelines suggest that rhythm control strategy should be recommended for symptomatic patients, to mitigate their symptoms and improve the quality of life. However, adequately powered randomized control trials and prospective 'real-world' registries are needed to fully assess the impact of early rhythm control strategies on clinical outcomes in patients with AF. Objective: In this narrative review, we discuss clinical outcomes following rhythm management approach among patients with AF, considering the effectiveness of an early intervention strategy. Expert opinion: Patients involvement and shared decision-making are crucial when deciding the optimal management strategy among patients with AF. For those with newly diagnosed symptomatic AF, an early invasive approach such as catheter ablation may have a role in preventing AF progression and subsequent pathophysiological changes.

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Rationale, considerations, and goals for atrial fibrillation centers of excellence: A Heart Rhythm Society perspective

Cited by 44 publications

References 166 publications

Association of income and educational attainment in hospitalization events in atrial fibrillation

Association of income and educational attainment in hospitalization events in atrial fibrillation

A prospective multi-site registry of real-world experience of catheter ablation for treatment of symptomatic paroxysmal and persistent atrial fibrillation (Real-AF): design and objectives

Clinical outcomes following rhythm control for atrial fibrillation: is early better?

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