- Author
-
J. Neefs
- Title
- Neurohumoral arrhythmogenic mechanisms and the treatment of atrial fibrillation
- Supervisors
-
J.R. de Groot
- Co-supervisors
-
S.M. Boekholdt
- Award date
- 12 June 2020
- Number of pages
- 267
- ISBN
- 9789402820508
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
Atrial fibrillation (AF) is the most common cardiac arrhythmia in humans. For AF to occur a trigger and substrate are necessary to start and perpetuate the arrhythmia. AF is induced by a complex interplay of clinical and biological risk factors. Despite of state-of-the-art therapeutic interventions AF remains a progressive, symptomatic disease.
The first part of the thesis focusses on predicting patients who are at risk to develop AF. We found that body composition, especially a greater abdominal fat distribution, was association with new-onset AF. In the PREDICT-AF study we will investigate blood and atrial tissue markers of pathophysiological changes in new-onset AF in 150 patients, aiming to predict post-operative and new-onset AF and identify new targets of therapies.
In the second part, we found that mineralocorticoid receptor antagonists significantly lowered the risk of new-onset or recurrent AF risk compared to control. This effect was more pronounced in patients with heart failure, but neutral in heart failure with a preserved ejection fraction.
In the last part, we found that freedom of AF after thoracoscopic AF ablation plus ganglion plexus ablation was similar to control, but was associated with more major complications. Sinus node dysfunction (SND) occurred in 7.1% of patients after thoracoscopic AF ablation, but the majority of SND was of temporary nature and resolved within days postoperatively. In patients with an extremely enlarged left atrium the efficacy of standalone thoracoscopic AF ablation was considerable. The thromboembolic risk per risk factor of the CHA2DS2-VASc score was the highest in age group 65-74 years, while comorbid cardiovascular conditions were associated with lower, but still considerably increased risks. After a standardised evaluation visit with a dedicated AF nurse practitioner, a quarter of the patient remained under nurse-led care and almost half of patients could be referred back to a general practitioner. - Persistent Identifier
- https://hdl.handle.net/11245.1/ed33f9bd-78fe-43b1-aa56-15b2564eb84e
- Downloads
-
Thesis (complete)
Front matter
Chapter 1: General introduction and thesis outline
Chapter 2: Body fat distribution as risk factor of new-onset atrial fibrillation. Substudy of the European Prospective Investigation Into Cancer and Nutrition in Norfolk (EPIC-Norfolk) study
Chapter 3: PREventive left atrial appenDage resection for the predICtion of fuTure Atrial Fibrillation: PREDICT-AF
Chapter 4: Aldosterone pathway blockade to prevent atrial fibrillation: A systematic review and meta-analysis
Chapter 5: Response to “comment on “Aldosterone pathway blockade to prevent atrial fibrillation: A systematic review and meta-analysis” by Neefs et al.”
Chapter 6: Effect of spironolactone on atrial fibrillation in patients with heart failure with preserved ejection fraction: Post hoc analysis of the randomized, placebo controlled TOPCAT trial
Chapter 7: Should every patient with atrial fibrillation and CHA2DS2-VASc score of 1 be anticoagulated? A systematic review of 37,030 Patients
Chapter 8: Additional ganglion plexus ablation during thoracoscopic surgical ablation of advanced atrial fibrillation. Intermediate follow-up of the AFACT study
Chapter 9: Clinical course of sinus node dysfunction after thoracoscopic ablation for atrial fibrillation – Analysis of the ganglion plexus ablation in patients with advanced atrial fibrillation (AFACT) trial
Chapter 10: Care and referral patterns in a large, dedicated nurse-led atrial fibrillation outpatient clinic
Chapter 11: Thoracoscopic surgical atrial fibrillation ablation in patients with an extremely enlarged left atrium
Chapter 12: Summary and future perspectives
Chapter 13: Samenvatting en toekomstperspectieven
List of publications; Contributing authors; PhD portfolio; Dankwoord; About the author; Nawoord
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