Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Zweiker, D.
Prevention of atrial fibrillation and its sequelae after cardiac interventions.
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Graz Medical University; 2020. pp. 172
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- Autor*innen der Med Uni Graz:
- Zweiker David
- Betreuer*innen:
- Rainer Peter
- Scherr Daniel
- Altmetrics:
- Abstract:
- This dissertation comprises of three different aspects of atrial fibrillation (AF) in the context of cardiovascular interventions and/or devices, addressing (1) the evaluation of an AF prediction algorithms in patients with cardiovascular implantable electronic devices (CIEDs), (2) the impact of AF on patients undergoing transcatheter aortic valve implantation (TAVI), and (3) left atrial appendage closure (LAAC) in AF patients who cannot receive oral anticoagulation (OAC). Evaluation of an AF prediction algorithm With evolving technology, current CIEDs are already able to document cardiac arrhythmias. They detect atrial high rate episodes which can precede for AF and are associated with elevated stroke risk. Since there are many indications for implantable pacemakers and implantable cardioverter defibrillators, patients with CIEDs may serve as ideal population for studying the efficacy of AF prediction algorithms. In cooperation with our institution, Hayn et al. of the Austrian Institute of Technology (AIT) developed an algorithm to predict the probability of future AF episodes from surface ECG. This “AF initiation algorithm” assesses P wave morphology features of premature supraventricular beats and compares it to “regular” P waves. To allow further development of the algorithm, we initiated a prospective study including patients with CIEDs. AF and TAVI AF influences the outcome of structural cardiac interventions, and vice versa. For example, transcatheter aortic valve implantation has emerged as an alternative to conservative treatment in in operable high-risk patients and to conventional surgical aortic valve replacement in intermediate risk patients. Pre-existing AF has been shown to worsen the outcome after TAVI and is therefore included in recent risk evaluation scores. However, while AF may newly develop after TAVI, there is conflicting evidence of the effect of new-onset AF on long-term outcome. A retrospective study of TAVI patients at our centre significantly improved the understanding of the association between new-onset AF and outcome after TAVI. Non-pharmacological stroke prevention in AF patients Some patients are not suitable to receive OAC due to elevated bleeding risk. LAAC has been developed in recent years as an option for those patients and has been shown to be non-inferior to traditional OAC therapy. A national registry has been established to assess the efficacy and safety of LAAC in daily clinical practice. With my dissertation, I aimed at contributing to a better understanding of AF from its diagnosis, to its outcome and therapy. I describe the frequency of AF, difficulties in the diagnostic pathway, its effect on outcome after cardiac interventions, and invasive interventions to prevent further complications.