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Heart, Lung and Circulation

Atrial Fibrillation Clinics: The Way of the Future

  • Juliana Kanawati
    Affiliations
    Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
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  • Saurabh Kumar
    Correspondence
    Corresponding author at: Associate Professor Saurabh Kumar, Cardiology Department, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Cnr Hawkesbury and Darcy Roads, Westmead, NSW 2145, Australia.
    Affiliations
    Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
    Search for articles by this author
  • Author Footnotes
    1 Rate Control versus Electrical Cardioversion Trial 7–Acute Cardioversion versus Wait and See.
      In this edition of Heart, Lung and Circulation, Al-Busaidi et al. [
      • Al-Busaidi I.S.
      • Clare G.C.
      • Joyce L.R.
      • Pearson S.
      • Lainchbury J.
      • Than M.
      • et al.
      Presentation, treatment and long-term outcomes of a multidisciplinary acute atrial fibrillation pathway: a 12-month follow-up study.
      ] present the long-term outcomes of patients managed through their atrial fibrillation (AF) clinical pathway with early review at an outpatient AF clinic following discharge from the emergency department. The pathway was aimed at reducing unnecessary hospital admissions and improving adherence to guideline-based AF treatment. AF is the most common sustained arrhythmia and is associated with increased risk of cardiovascular morbidity, stroke, dementia, and death [
      • Michaud G.F.
      • Stevenson W.G.
      Atrial fibrillation.
      ]. It carries a huge economic burden and accounts for approximately 0.5% of all emergency presentations in the United States [
      • Rozen G.
      • Hosseini S.M.
      • Kaadan M.I.
      • Biton Y.
      • Heist E.K.
      • Vangel M.
      • et al.
      Emergency Department visits for atrial fibrillation in the United States: trends in admission rates and economic burden from 2007 to 2014.
      ].

      Keywords

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      References

        • Al-Busaidi I.S.
        • Clare G.C.
        • Joyce L.R.
        • Pearson S.
        • Lainchbury J.
        • Than M.
        • et al.
        Presentation, treatment and long-term outcomes of a multidisciplinary acute atrial fibrillation pathway: a 12-month follow-up study.
        Heart Lung Circ. 2022; 31: 216-223
        • Michaud G.F.
        • Stevenson W.G.
        Atrial fibrillation.
        N Engl J Med. 2021; 384: 353-361
        • Rozen G.
        • Hosseini S.M.
        • Kaadan M.I.
        • Biton Y.
        • Heist E.K.
        • Vangel M.
        • et al.
        Emergency Department visits for atrial fibrillation in the United States: trends in admission rates and economic burden from 2007 to 2014.
        J Am Heart Assoc. 2018; 7: e009024
        • Haïssaguerre M.
        • Jaïs P.
        • Shah D.C.
        • Takahashi A.
        • Hocini M.
        • Quiniou G.
        • et al.
        Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins.
        N Engl J Med. 1998; 339: 659-666
        • Lau D.H.
        • Schotten U.
        • Mahajan R.
        • Antic N.A.
        • Hatem S.N.
        • Pathak R.K.
        • et al.
        Novel mechanisms in the pathogenesis of atrial fibrillation: practical applications.
        Eur Heart J. 2016; 37: 1573-1581
        • Brieger D.
        • Amerena J.
        • Attia J.
        • Bajorek B.
        • Chan K.H.
        • Connell C.
        • et al.
        National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.
        Heart Lung Circ. 2018; 27: 1209-1266
        • Pathak R.K.
        • Middeldorp M.E.
        • Meredith M.
        • Mehta A.B.
        • Mahajan R.
        • Wong C.X.
        • et al.
        Long-term effect of goal-directed weight management in an atrial fibrillation cohort: a long-term follow-up study (LEGACY).
        J Am Coll Cardiol. 2015; 65: 2159-2169
        • Pathak R.K.
        • Elliott A.
        • Middeldorp M.E.
        • Meredith M.
        • Mehta A.B.
        • Mahajan R.
        • et al.
        Impact of CARDIOrespiratory FITness on arrhythmia recurrence in obese individuals with atrial fibrillation.
        J Am Coll Cardiol. 2015; 66: 985-996
        • Pathak R.K.
        • Middeldorp M.E.
        • Lau D.H.
        • Mehta A.B.
        • Mahajan R.
        • Twomey D.
        • et al.
        Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study.
        J Am Coll Cardiol. 2014; 64: 2222-2231
        • Voskoboinik A.
        • Kalman J.M.
        • De Silva A.
        • Nicholls T.
        • Costello B.
        • Nanayakkara S.
        • et al.
        Alcohol abstinence in drinkers with atrial fibrillation.
        N Engl J Med. 2020; 382: 20-28
        • Dimitri H.
        • Ng M.
        • Brooks A.G.
        • Kuklik P.
        • Stiles M.K.
        • Lau D.H.
        • et al.
        Atrial remodeling in obstructive sleep apnea: implications for atrial fibrillation.
        Heart Rhythm. 2012; 9: 321-327
        • Kirchhof P.
        • Benussi S.
        • Kotecha D.
        • Ahlsson A.
        • Atar D.
        • Casadei B.
        • et al.
        • ESC Scientific Document Group
        2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS.
        Eur Heart J. 2016; 37: 2893-2962
        • Abadie B.Q.
        • Hansen B.
        • Walker J.
        • Deyo Z.
        • Biese K.
        • Armbruster T.
        • et al.
        An atrial fibrillation transitions of care clinic improves atrial fibrillation quality metrics.
        JACC Clin Electrophysiol. 2020; 6: 45-52
        • Lane D.A.
        • Lip G.Y.H.
        Integrated care for the management of atrial fibrillation: what are the key components and important outcomes?.
        Europace. 2019; 21: 1759-1761
        • Hendriks J.M.L.
        • Tieleman R.G.
        • Vrijhoef H.J.M.
        • Wijtvliet P.
        • Gallagher C.
        • Prins M.H.
        • et al.
        Integrated specialized atrial fibrillation clinics reduce all-cause mortality: post hoc analysis of a randomized clinical trial.
        Europace. 2019; 21: 1785-1792
        • Hendriks J.
        • Tomini F.
        • van Asselt T.
        • Crijns H.
        • Vrijhoef H.
        Cost-effectiveness of a specialized atrial fibrillation clinic vs. usual care in patients with atrial fibrillation.
        Europace. 2013; 15: 1128-1135
        • Pluymaekers N.A.H.A.
        • Dudink E.A.M.P.
        • Luermans J.G.L.M.
        • Meeder J.G.
        • Lenderink T.
        • Widdershoven J.
        • et al.
        RACE 7 ACWAS Investigators. Early or delayed cardioversion in recent-onset atrial fibrillation.
        N Engl J Med. 2019; 380: 1499-1508
        • Scheuermeyer F.X.
        • Grafstein E.
        • Stenstrom R.
        • Innes G.
        • Heslop C.
        • MacPhee J.
        • et al.
        Thirty-day and 1-year outcomes of Emergency Department patients with atrial fibrillation and no acute underlying medical cause.
        Ann Emerg Med. 2012; 60: 755-765.e2
        • Bunch T.J.
        • Steinberg B.A.
        Revisiting rate versus rhythm control in atrial fibrillation — timing matters.
        N Engl J Med. 2020; 383: 1383-1384
        • January C.T.
        • Wann L.S.
        • Alpert J.S.
        • Calkins H.
        • Cigarroa J.E.
        • Cleveland Jr., J.C.
        • et al.
        • ACC/AHA Task Force Members
        2014 AHA/ACC/HRS guideline 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 Heart Rhythm Society.
        Circulation. 2014; 130: 199-267
        • Wyse D.G.
        • Waldo A.L.
        • DiMarco J.P.
        • Domanski M.J.
        • Rosenberg Y.
        • Schron E.B.
        • et al.
        • 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
        • de Denus S.
        • Sanoski C.A.
        • Carlsson J.
        • Opolski G.
        • Spinler S.A.
        Rate vs rhythm control in patients with atrial fibrillation: a meta-analysis.
        Arch Intern Med. 2005; 165: 258-262
        • Packer D.L.
        • Mark D.B.
        • Robb R.A.
        Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA Randomized Clinical Trial.
        JAMA. 2019; 321: 1261-1274
        • Marrouche N.F.
        • Brachmann J.
        • Andresen D.
        • Siebels J.
        • Boersma L.
        • Jordaens L.
        • et al.
        • CASTLE-AF Investigators
        Catheter ablation for atrial fibrillation with heart failure.
        N Engl J Med. 2018; 378: 417-427
        • Kirchhof P.
        • Camm A.J.
        • Goette A.
        • Brandes A.
        • Eckardt L.
        • Elvan A.
        • et al.
        • EAST-AFNET 4 Trial Investigators
        Early rhythm-control therapy in patients with atrial fibrillation.
        N Engl J Med. 2020; 383: 1305-1316
        • Bunch T.J.
        • May H.T.
        • Bair T.L.
        • Johnson D.L.
        • Weiss J.P.
        • Crandall B.G.
        • et al.
        Increasing time between first diagnosis of atrial fibrillation and catheter ablation adversely affects long-term outcomes.
        Heart Rhythm. 2013; 10: 1257-1262
        • Wazni O.M.
        • Dandamudi G.
        • Sood N.
        • Hoyt R.
        • Tyler J.
        • Durrani S.
        • et al.
        • STOP AF First Trial Investigators
        Cryoballoon ablation as initial therapy for atrial fibrillation.
        N Engl J Med. 2021; 384: 316-324
        • Andrade J.G.
        • Wells G.A.
        • Deyell M.W.
        • Bennett M.
        • Essebag V.
        • Champagne J.
        • et al.
        • EARLY-AF Investigators
        Cryoablation or drug therapy for initial treatment of atrial fibrillation.
        N Engl J Med. 2021; 384: 305-315
        • Marine J.E.
        Early ablation for paroxysmal atrial fibrillation — safety First.
        N Engl J Med. 2021; 384: 374-375
        • Stewart S.
        • Ball J.
        • Horowitz J.D.
        • Marwick T.H.
        • Mahadevan G.
        • Wong C.
        • et al.
        Standard versus atrial fibrillation-specific management strategy (SAFETY) to reduce recurrent admission and prolong survival: pragmatic, multicentre, randomised controlled trial.
        Lancet. 2015; 385: 775-784
        • Haberman Z.C.
        • Jahn R.T.
        • Bose R.
        • Tun H.
        • Shinbane J.S.
        • Doshi R.N.
        • et al.
        Wireless smartphone ECG enables large-scale screening in diverse populations: twelve-lead ECG as a cardiovascular screening tool.
        J Cardiovasc Electrophysiol. 2015; 26: 520-526
        • Barbic D.
        • DeWitt C.
        • Harris D.
        • Stenstrom R.
        • Grafstein E.
        • Wu C.
        • et al.
        Implementation of an emergency department atrial fibrillation and flutter pathway improves rates of appropriate anticoagulation, reduces length of stay and thirty-day revisit rates for congestive heart failure.
        CJEM. 2018; 20: 392-400
        • Bajorek B.
        • Magin P.
        • Hilmer S.
        • Krass I.
        A cluster-randomized controlled trial of a computerized antithrombotic risk assessment tool to optimize stroke prevention in general practice: a study protocol.
        BMC Health Serv Res. 2014; 14: 55

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