J Interv Card Electrophysiol. 2021 Dec;62(3):461-467. doi: 10.1007/s10840-021-00996-y. Epub 2021 Apr 19.

Highlights and comments on EHRA/HRS/APHRS/LAHRS expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome.

Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing

Márcio Jansen de Oliveira Figueiredo, Gerardo Rodriguez Diez, Santiago Nava-Townsend, Alberto Alfie, Carina Hardy, Dario Di Toro, Manlio F Márquez

PMID: 33876382 PMCID: PMC8055211 DOI: 10.1007/s10840-021-00996-y

Abstract

Patients with heart disease, or at high risk of developing a cardiac condition, usually undergo risk assessment by primary care physicians, internal medicine doctors, or cardiologists. There are several methods that can be used for this risk assessment, and their applicability differs with respect to availability, complexity, and usefulness in different geographic populations. This document focuses on some of the many relevant clinical topics recently presented in the "Expert Consensus on Risk Assessment in Cardiac Arrhythmias: Use the Right Tool for the Right Outcome," which include statements based on the best available evidence. In this review, we want to highlight and make some pertinent comments on some of the most relevant points of this Consensus.

© 2021. Springer Science+Business Media, LLC, part of Springer Nature.

Keywords: Atrial fibrillation; Cardiac arrhythmias; Cardiac electrophysiology; Electrocardiography; Invasive electrophysiological study; Ventricular tachycardia

References

1. Nielsen JC, Lin Y-J, de Oliveira Figueiredo MJ, Sepehri Shamloo A, Alfie A, Boveda S, et al. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome. Heart Rhythm. 2020;17(9):e269–316. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32553607 . - PubMed
2. Nielsen JC, Lin Y-J, de Oliveira Figueiredo MJ, Sepehri Shamloo A, Alfie A, Boveda S, et al. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the rigth population. Europace. 2020; Available from: http://www.ncbi.nlm.nih.gov/pubmed/32538434 . - PubMed
3. Nielsen JC, Lin Y-J, de Oliveira Figueiredo MJ, Sepehri Shamloo A, Alfie A, Boveda S, et al. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome. J Arrhythmia. 2020;36(4):553–607. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32782627 . - PubMed
4. Apostolakis S, Lane DA, Buller H, Lip GYH. Comparison of the CHADS2, CHA2DS2-VASc and HAS-BLED scores for the prediction of clinically relevant bleeding in anticoagulated patients with atrial fibrillation: the AMADEUS trial. Thromb haemost. 2013;110(5):1074–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24048467 . - PubMed
5. Rubio Campal JM, Benezet-Mazuecos J, Iglesias Bravo JA, Sánchez Borque P, Miracle Blanco Á, de la Vieja Alarcón JJ, et al. P-wave and interatrial block: new predictor for atrial high rate episodes in patients with cardiac implantable electronic devices. Pacing Clin Electrophysiol. 2018;41(3):223–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29327362 . - PubMed
6. Nielsen JB, Kühl JT, Pietersen A, Graff C, Lind B, Struijk JJ, et al. P-wave duration and the risk of atrial fibrillation: results from the Copenhagen ECG Study. Heart Rhythm. 2015;12(9):1887–95. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25916567 . - PubMed
7. de Bacquer D, Willekens J, de Backer G. Long-term prognostic value of p-wave characteristics for the development of atrial fibrillation in subjects aged 55 to 74 years at baseline. Am J Cardiol. 2007;100(5):850–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17719332 . - PubMed
8. Alfraidi H, Seifer CM, Hiebert BM, Torbiak L, Zieroth S, McIntyre WF. Relation of increasing QRS duration over time and cardiovascular events in outpatients with heart failure. Am J Cardiol. 2019;124(12):1907–11. Available from: http://www.ncbi.nlm.nih.gov/pubmed/31668343 . - PubMed
9. Márquez MF. New observations on the “early repolarization syndrome.” Heart Rhythm. 2012;9(1):84–5. https://doi.org/10.1016/j.hrthm.2011.08.028 . - PubMed
10. Sessa F, Anna V, Messina G, Cibelli G, Monda V, Marsala G, et al. Heart rate variability as predictive factor for sudden cardiac death. Aging. 2018;10(2):166–77. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29476045 . - PubMed
11. Stecker EC, Vickers C, Waltz J, Socoteanu C, John BT, Mariani R, et al. Population-based analysis of sudden cardiac death with and without left ventricular systolic dysfunction: two-year findings from the Oregon Sudden Unexpected Death Study. J Am Coll Cardiol. 2006;47(6):1161–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16545646 . - PubMed
12. Gorgels APM, Gijsbers C, de Vreede-Swagemakers J, Lousberg A, Wellens HJJ. Out-of-hospital cardiac arrest--the relevance of heart failure. The Maastricht Circulatory Arrest Registry. Eur Heart J. 2003;24(13):1204–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12831814 . - PubMed
13. Piers SRD, Tao Q, van Huls van Taxis CFB, Schalij MJ, van der Geest RJ, Zeppenfeld K. Contrast-enhanced MRI-derived scar patterns and associated ventricular tachycardias in nonischemic cardiomyopathy: implications for the ablation strategy. Circ Arrhythm Electrophysiol. 2013;6(5):875–83. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24036134 . - PubMed
14. White JA, Fine NM, Gula L, Yee R, Skanes A, Klein G, et al. Utility of cardiovascular magnetic resonance in identifying substrate for malignant ventricular arrhythmias. Circ Cardiovasc Imaging. 2012;5(1):12–20. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22038987 . - PubMed
15. Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. J Am Coll Cardiol. 2018;72(14):e91–220. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29097296 . - PubMed
16. Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH. atrial fibrillation: epidemiology, pathophysiology, and clinical outcomes. Circ Res. 2017;120(9):1501–17. - PubMed
17. Márquez MF, Baños-González MA, Guevara-Valdivia ME, Vázquez-Acosta J, de Los Ríos Ibarra MO, Aguilar-Linares JA, Jiménez-Cruz M, Matadamas-Hernández N, Camacho-Casillas R, Magaña-Magaña R, Rojel-Martínez U, Alcocer-Gamba MA, Lara-Vaca S, Rodríguez-Reyes H, Islava-Gálvez MA, Betancourt-Hernández LE, Reyes-Reyes N, Beltrán-Gámez ME, Cantú-Brito C, Baños-Velasco AZ, Del Rivero Morfin PJ, González-Hermosillo JA. Anticoagulation therapy by age and embolic risk for nonvalvular atrial fibrillation in Mexico, an upper-middle-income country: the CARMEN-AF registry. Glob Heart. 2020;15(1):32. https://doi.org/10.5334/gh.767 . - PubMed
18. Dagres N, Chao T-F, Fenelon G, Aguinaga L, Benhayon D, Benjamin EJ, et al. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: what is the best practice? Europace. 2018;20(9):1399–421. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29562326 . - PubMed
19. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020; Available from: https://academic.oup.com/eurheartj/advance-article/doi/ https://doi.org/10.1093/eurheartj/ehaa612/5899003 - PubMed
20. González-Hermosillo J, Baños-González MA, Guevara-Valdivia ME, Vázquez-Acosta JA, de Los Ríos Ibarra MO, Aguilar-Linares KA, Cantú-Brito C, Leiva-Pons JL, Pozas-Garza G, Favela-Pérez EA, Márquez MF; CARMEN-AF Committees and Investigators. Gender differences and management of stroke risk of nonvalvular atrial fibrillation in an upper middle-income country: insights from the CARMEN-AF registry. Int J Cardiol Heart Vasc. 2019;22:117–122. https://doi.org/10.1016/j.ijcha.2018.12.017 . - PubMed
21. Allan V, Honarbakhsh S, Casas J-P, Wallace J, Hunter R, Schilling R, et al. Are cardiovascular risk factors also associated with the incidence of atrial fibrillation? A systematic review and field synopsis of 23 factors in 32 population-based cohorts of 20 million participants. Thromb Haemost. 2017;117(5):837–50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28229164 . - PubMed
22. Wang TJ, Massaro JM, Levy D, Vasan RS, Wolf PA, D’Agostino RB, et al. A risk score for predicting stroke or death in individuals with new-onset atrial fibrillation in the community: the Framingham Heart Study. JAMA. 2003;290(8):1049–56. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12941677 . - PubMed
23. Healey JS, Oldgren J, Ezekowitz M, Zhu J, Pais P, Wang J, et al. Occurrence of death and stroke in patients in 47 countries 1 year after presenting with atrial fibrillation: a cohort study. Lancet (London, England). 2016;388(10050):1161–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27515684 . - PubMed
24. Dagres N, Chao TF, Fenelon G, Aguinaga L, Benhayon D, Benjamin EJ, Bunch TJ, Chen LY, Chen SA, Darrieux F, de Paola A, Fauchier L, Goette A, Kalman J, Kalra L, Kim YH, Lane DA, Lip GYH, Lubitz SA, Márquez MF, Potpara T, Pozzer DL, Ruskin JN, Savelieva I, Teo WS, Tse HF, Verma A, Zhang S, Chung MK; ESC Scientific Document Group. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: what is the best practice? Europace. 2018;20(9):1399–1421. https://doi.org/10.1093/europace/euy046 . - PubMed
25. Fauchier L, Samson A, Chaize G, Gaudin A-F, Vainchtock A, Bailly C, et al. Cause of death in patients with atrial fibrillation admitted to French hospitals in 2012: a nationwide database study. Open Heart. 2015;2(1):e000290. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26688739 . - PubMed
26. Fauchier L, Clementy N, Bisson A, Ivanes F, Angoulvant D, Babuty D, et al. Should atrial fibrillation patients with only 1 nongender-related CHA2DS2-VASc risk factor be anticoagulated? Stroke. 2016;47(7):1831–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27231269 . - PubMed
27. Reddy VY, Doshi SK, Kar S, Gibson DN, Price MJ, Huber K, et al. 5-year outcomes after left atrial appendage closure: from the PREVAIL and PROTECT AF trials. J Am Coll Cardiol. 2017;70(24):2964–75. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29103847 . - PubMed
28. Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 2003;107(23):2920–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12771006 . - PubMed
29. Deedwania PC, Lardizabal JA. Atrial fibrillation in heart failure: a comprehensive review. Am J Med. 2010;123(3):198–204. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20193823 . - PubMed
30. Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, et al. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med. 2018;378(5):417–27. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29385358 . - PubMed
31. Packer DL, Mark DB, Robb RA, Monahan KH, Bahnson TD, Poole JE, et al. 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(13):1261–74. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30874766 . - PubMed
32. Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002 Dec 5 [cited 2014 Jan 4];347(23):1825–33. Available from: http://ukpmc.ac.uk/abstract/MED/12466506 . - PubMed
33. Kirchhof P, Camm AJ, Goette A, Brandes A, Eckardt L, Elvan A, et al. Early rhythm-control therapy in patients with atrial fibrillation. N Engl J Med. 2020; Available from: http://www.ncbi.nlm.nih.gov/pubmed/32865375 . - PubMed
34. Andrade JG, Wells GA, Deyell MW, Bennett M, Essebag V, Champagne J, Roux JF, Yung D, Skanes A, Khaykin Y, Morillo C, Jolly U, Novak P, Lockwood E, Amit G, Angaran P, Sapp J, Wardell S, Lauck S, Macle L, Verma A; EARLY-AF Investigators. Cryoablation or drug therapy for initial treatment of atrial fibrillation. N Engl J Med. 2021;384(4):305–15. doi: https://doi.org/10.1056/NEJMoa2029980 . - PubMed
35. Rodríguez-Reyes H, Muñoz Gutiérrez M, Márquez MF, Pozas Garza G, Asensio Lafuente E, Ortíz Galván F, Lara Vaca S, Mariona Montero VA. Muerte súbita cardiaca. Estratificación de riesgo, prevención y tratamiento [Sudden cardiac death. Risk stratification, prevention and treatment]. Arch Cardiol Mex. 2015;85(4):329–36. Spanish. https://doi.org/10.1016/j.acmx.2015.06.002 . - PubMed
36. Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med. 1996;335(26):1933–40. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8960472 . - PubMed
37. Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the task force for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the Europe. Eur Heart J. 2015;36(41):2793–867. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26320108 . - PubMed
38. Kuruvilla S, Adenaw N, Katwal AB, Lipinski MJ, Kramer CM, Salerno M. Late gadolinium enhancement on cardiac magnetic resonance predicts adverse cardiovascular outcomes in nonischemic cardiomyopathy: a systematic review and meta-analysis. Circ Cardiovasc Imaging. 2014;7(2):250–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24363358 . - PubMed
39. di Marco A, Anguera I, Schmitt M, Klem I, Neilan TG, White JA, et al. Late gadolinium enhancement and the risk for ventricular arrhythmias or sudden death in dilated cardiomyopathy: systematic review and meta-analysis. JACC Heart failure. 2017;5(1):28–38. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28017348 . - PubMed
40. Tung R, Bauer B, Schelbert H, Lynch JP, Auerbach M, Gupta P, et al. Incidence of abnormal positron emission tomography in patients with unexplained cardiomyopathy and ventricular arrhythmias: The potential role of occult inflammation in arrhythmogenesis. Heart Rhythm. 2015;12(12):2488–98. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26272522 . - PubMed
41. Smedema J-P, Snoep G, van Kroonenburgh MPG, van Geuns R-J, Dassen WRM, Gorgels APM, et al. Evaluation of the accuracy of gadolinium-enhanced cardiovascular magnetic resonance in the diagnosis of cardiac sarcoidosis. J Am Coll Cardiol. 2005;45(10):1683–90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15893188 . - PubMed
42. Hernández-Madrid A, Paul T, Abrams D, Aziz PF, Blom NA, Chen J, et al. Arrhythmias in congenital heart disease: a position paper of the European Heart Rhythm Association (EHRA), Association for European Paediatric and Congenital Cardiology (AEPC), and the European Society of Cardiology (ESC) Working Group on Grown-up Congeni. Europace. 2018;20(11):1719–53. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29579186 . - PubMed
43. van Hare GF, Javitz H, Carmelli D, Saul JP, Tanel RE, Fischbach PS, et al. Prospective assessment after pediatric cardiac ablation: demographics, medical profiles, and initial outcomes. J Cardiovasc Electrophysiol. 2004;15(7):759–70. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15250858 . - PubMed
44. Brugada J, Blom N, Sarquella-Brugada G, Blomstrom-Lundqvist C, Deanfield J, Janousek J, et al. Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement. Europace. 2013;15(9):1337–82. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23851511 . - PubMed
45. Harrison DA, Harris L, Siu SC, MacLoghlin CJ, Connelly MS, Webb GD, et al. Sustained ventricular tachycardia in adult patients late after repair of tetralogy of Fallot. J Am Coll Cardiol. 1997;30(5):1368–73. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9350941 . - PubMed
46. Gandjbakhch E, Redheuil A, Pousset F, Charron P, Frank R. Clinical diagnosis, imaging, and genetics of arrhythmogenic right ventricular cardiomyopathy/dysplasia: JACC state-of-the-art review. J Am CollCardiol. 2018;72(7):784–804. https://doi.org/10.1016/j.jacc.2018.05.065 . - PubMed
47. Deac M, Alpendurada F, Fanaie F, Vimal R, Carpenter J-P, Dawson A, et al. Prognostic value of cardiovascular magnetic resonance in patients with suspected arrhythmogenic right ventricular cardiomyopathy. Int J Cardiol. 2013;168(4):3514–21. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23701935 . - PubMed
48. Rassi A, Rassi A. Rassi score: another external validation with high performance in patients with chagas cardiomyopathy. J Am Coll Cardiol. 2019;73(13):1734–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30947930 . - PubMed
49. Martinelli Filho M, Sosa E, Nishioka S, Scanavacca M, Bellotti G, Pileggi F. Clinical and electrophysiologic features of syncope in chronic chagasic heart disease. J Cardiovasc Electrophysiol. 1994;5(7):563–70. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7987526 . - PubMed

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