Publications by authors named "Andi Eie Albertsen"

11 Publications

  • Page 1 of 1

Anterior-Lateral Versus Anterior-Posterior Electrode Position for Cardioverting Atrial Fibrillation.

Circulation 2021 Nov 24. Epub 2021 Nov 24.

Department of Cardiology, Viborg Regional Hospital, Denmark.

Smaller randomized studies have reported conflicting results regarding the optimal electrode position for cardioverting atrial fibrillation. However, anterior-posterior electrode position is widely used as a standard and believed to be superior to anterior-lateral electrode position. Therefore, we aimed to compare anterior-lateral and anterior-posterior electrode position for cardioverting atrial fibrillation in a multicenter randomized trial. In this multicenter, investigator-initiated, open-label trial, we randomly assigned patients with atrial fibrillation scheduled for elective cardioversion to anterior-lateral or anterior-posterior electrode position. The primary outcome was the proportion of patients in sinus rhythm after the first shock. The secondary outcome was the proportion of patients in sinus rhythm after up to four shocks escalating to maximum energy. Safety outcomes were any cases of arrhythmia during or after cardioversion, skin redness, and patient-reported peri-procedural pain. We randomized 468 patients. The primary outcome occurred in 126 patients (54%) assigned to anterior-lateral electrode position and in 77 patients (33%) assigned to anterior-posterior electrode position, a risk difference of 22 percentage-points, 95%-confidence interval: 13-30, P<0.001. The number of patients in sinus rhythm after the final cardioversion shock was 216 patients (93%) assigned to anterior-lateral electrode position and 200 patients (85%) assigned to anterior-posterior electrode position, a risk difference of 7 percentage-points, 95%-confidence interval: 2-12. There were no significant differences between groups in any safety outcomes. Anterior-lateral electrode position was more effective than anterior-posterior electrode position for biphasic cardioversion of atrial fibrillation. There were no significant differences in any safety outcome.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.121.056301DOI Listing
November 2021

The Danish Future Patient Telerehabilitation Program for Patients With Atrial Fibrillation: Design and Pilot Study in Collaboration With Patients and Their Spouses.

JMIR Cardio 2021 Jul 19;5(2):e27321. Epub 2021 Jul 19.

Department of Cardiology, Viborg and Skive Regional Hospital, Viborg, Denmark.

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is predicted to more than double in prevalence over the next 20 years. Tailored patient education is recommended as an important aspect of AF care. Current guidelines emphasize that patients become more active participants in the management of their own disease, yet there are no rehabilitation programs for patients with AF in the Danish health care system. Through participatory design, we developed the Future Patient Telerehabilitation (TR) Programs, A and B, for patients with AF. The 2 programs are based on HeartPortal and remote monitoring, together with educational modules.

Objective: The aim of this pilot study is to evaluate and compare the feasibility of the 2 programs of TR for patients with AF.

Methods: This pilot study was conducted between December 2019 and March 2020. The pilot study consisted of testing the 2 TR programs, A and B, in two phases: (1) treatment at the AF clinic and (2) TR at home. The primary outcome of the study was the usability of technologies for self-monitoring and the context of the TR programs as seen from patients' perspectives. Secondary outcomes were the development of patients' knowledge of AF, development of clinical data, and understanding the expectations and experiences of patients and spouses. Data were collected through interviews, questionnaires, and clinical measurements from home monitoring devices. Statistical analyses were performed using the IBM SPSS Statistics version 26. Qualitative data were analyzed using NVivo 12.0.

Results: Through interviews, patients articulated the following themes about participating in a TR program: usefulness of the HeartPortal, feeling more secure living with AF, community of practice living with AF, and measuring heart rhythm makes good sense. Through interviews, the spouses of patients with AF expressed that they had gained increased knowledge about AF and how to support their spouses living with AF in everyday life. Results from the responses to the Jessa AF Knowledge Questionnaire support the qualitative data, as they showed that patients in program B acquired increased knowledge about AF at follow-up compared with baseline. No significant differences were found in the number of electrocardiography recordings between the 2 groups.

Conclusions: Patients with AF and their spouses were positive about the TR program and they found the TR program useful, especially because it created an increased sense of security, knowledge about mastering their symptoms, and a community of practice linking patients with AF and their spouses and health care personnel. To assess all the benefits of the Future Patient-TR Program for patients with AF, it needs to be tested in a comprehensive randomized controlled trial.

Trial Registration: ClinicalTrials.gov NCT04493437; https://clinicaltrials.gov/ct2/show/NCT04493437.
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http://dx.doi.org/10.2196/27321DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8329756PMC
July 2021

Role for machine learning in sex-specific prediction of successful electrical cardioversion in atrial fibrillation?

Open Heart 2020 06;7(1)

Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark.

Objective: Electrical cardioversion is frequently performed to restore sinus rhythm in patients with persistent atrial fibrillation (AF). However, AF recurs in many patients and identifying the patients who benefit from electrical cardioversion is difficult. The objective was to develop sex-specific prediction models for successful electrical cardioversion and assess the potential of machine learning methods in comparison with traditional logistic regression.

Methods: In a retrospective cohort study, we examined several candidate predictors, including comorbidities, biochemistry, echocardiographic data, and medication. The outcome was successful cardioversion, defined as normal sinus rhythm immediately after the electrical cardioversion and no documented recurrence of AF within 3 months after. We used random forest and logistic regression models for sex-specific prediction.

Results: The cohort comprised 332 female and 790 male patients with persistent AF who underwent electrical cardioversion. Cardioversion was successful in 44.9% of the women and 49.9% of the men. The prediction errors of the models were high for both women (41.0% for machine learning and 48.8% for logistic regression) and men (46.0% for machine learning and 44.8% for logistic regression). Discrimination was modest for both machine learning (0.59 for women and 0.56 for men) and logistic regression models (0.60 for women and 0.59 for men), although the models were well calibrated.

Conclusions: Sex-specific machine learning and logistic regression models showed modest predictive performance for successful electrical cardioversion. Identifying patients who will benefit from cardioversion remains challenging in clinical practice. The high recurrence rate calls for thoroughly informed shared decision-making for electrical cardioversion.
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http://dx.doi.org/10.1136/openhrt-2020-001297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7307540PMC
June 2020

Cardioversion of atrial fibrillation in a real-world setting: non-vitamin K antagonist oral anticoagulants ensure a fast and safe strategy compared to warfarin.

Europace 2018 07;20(7):1078-1085

Department of Cardiology, Viborg Regional Hospital, Heibergs Allé 4, Viborg, Denmark.

Aims: Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used as thromboembolic prophylaxis in cardioversion. We examined the waiting time to cardioversion and the outcomes in patients with non-valvular atrial fibrillation (AF) of > 48 h of duration who were treated with either NOACs or warfarin.

Methods And Results: Anticoagulation was handled in a structured, multidisciplinary AF-clinic. The objectives were the waiting time to cardioversion, and thromboembolism and major bleeding events within 60 days. In total, 2150 electrical cardioversions were performed; 684 (31.8%) of patients were on NOACs and 1466 (68.2%) were on warfarin. The waiting time to non-TOE-guided cardioversion was significantly shorter in the NOAC group compared with the warfarin group for all cardioversions (P < 0.001 for log-rank test) and for first-time cardioversions (P < 0.001 for log-rank test). For all non-TOE-guided cardioversions, 80% of procedures on NOACs and 67% of procedures on warfarin were performed within 25 days (P < 0.001). Thromboembolism occurred in one patient (0.15%) receiving NOAC and in two patients (0.14%) receiving warfarin (risk ratio (RR) 1.07; 95% confidence interval (CI) 0.10-11.81). Major bleeding events occurred in four patients (0.58%) in the NOAC group and 11 patients (0.75%) in the warfarin group (RR 0.78; 95% CI 0.25-2.43).

Conclusion: In a real-world clinical setting with anticoagulation handled in a structured multidisciplinary AF clinic, the waiting time to cardioversion was shorter with NOACs compared to warfarin. The rates of thromboembolism and major bleeding events were low, with NOACs shown to be as effective and safe as warfarin.
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http://dx.doi.org/10.1093/europace/eux188DOI Listing
July 2018

[In Process Citation].

Ugeskr Laeger 2015 08;177(34):1652-3

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August 2015

[A structured multidisciplinary approach ensures correct anticoagulation therapy to patients with atrial fibrillation].

Ugeskr Laeger 2015 Jun;177(24)

Hjertemedicinsk Afdeling, Regionshospitalet Viborg, Heibergs Allé 4, 8800 Viborg.

Atrial fibrillation (AF) is associated with an increased risk of stroke and mortality. Anticoagulation therapy reduces the risk of stroke in patients with AF. In a structured multidisciplinary AF-clinic correct anticoagulation treatment according to guidelines was achieved in 99% (170 out of 172 patients) compared to 79% (143 out of 179 patients) in the "usual care" period (p < 0.001). We propose establishment of structured multidisciplinary AF-clinics in Denmark to ensure optimal antithrombotic treatment and adherence to current guidelines.
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June 2015

Adverse effect of right ventricular pacing prevented by biventricular pacing during long-term follow-up: a randomized comparison.

Eur J Echocardiogr 2011 Oct 20;12(10):767-72. Epub 2011 Aug 20.

Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark.

Aims: To investigate whether biventricular (BIV) pacing preserves left ventricular ejection fraction (LVEF) and reduces LV dyssynchrony when compared with standard dual-chamber right ventricular (RV) pacing in consecutive patients with high-grade atrioventricular block during 3 years of pacing.

Methods And Results: Fifty patients were randomized to RV pacing or BIV pacing. LVEF was measured using three-dimensional echocardiography. Tissue Doppler imaging was used to quantify LV dyssynchrony in terms of the standard deviation of the time-to-peak velocity (Ts-SD). LVEF differed significantly between the two groups during 3 years of pacing (ANOVA: P=0.003). LVEF in the RV group decreased from 59±5% at baseline to 53±11% (P=0.01), while LVEF remained unchanged in the BIV group (57±7% at baseline vs. 58±10% (P=0.40). After 3 years of follow-up, we observed no difference in LV dyssynchrony, LV remodelling or measurements of clinical heart failure (N-terminal pro-brain natriuretic peptide, walking test, and New York Heart Association functional class) between the two groups. However, in the RV group, but not in the BIV group, dyssynchrony increased significantly (P=0.005) during follow-up. Furthermore, adverse LV remodelling was observed in the RV group with increased systolic volume and thinning of the LV septum.

Conclusion: BIV pacing preserves LVEF and minimizes LV dyssynchrony during long-term follow-up. Adverse remodelling observed during 3 years of RV pacing was prevented by BIV pacing. However, the adverse impact of RV pacing on LV function was not reflected in measures of clinical heart failure.

Clinical Trial Registration: www.clinicaltrials.gov (identification number: NCT00228241).
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http://dx.doi.org/10.1093/ejechocard/jer136DOI Listing
October 2011

Long-term clinical outcome and left ventricular lead position in cardiac resynchronization therapy.

Europace 2009 Sep 6;11(9):1177-82. Epub 2009 Aug 6.

Department of Cardiology, Aarhus University Hospital, Skejby, Bendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark.

Aims: To identify the predictive value of a presumed optimal left ventricular lead positions (LV-Ps) on the long-term clinical outcome in patients with cardiac resynchronization therapy (CRT).

Methods And Results: Clinical information was collected from patient files in consecutive patients treated with CRT from 1997 to 2007. A presumed optimal LV-Ps were defined as a position between 2 and 5 o'clock in the short-axis circumference and basal or mid-ventricular in the long axis. Symptomatic response was defined as improvement in NYHA class (>or=1) and echocardiographic response as improvement in left ventricular ejection fraction of >or=5% absolute. We included 567 patients [median age 66 years, 453 (80%) male]. The LV-Ps were optimal in 334 (59%) patients. The hazard ratio for all-cause mortality with an optimal LV-Ps was unadjusted 0.79 (0.59-1.06) and adjusted 0.99 (0.71-1.40). The odds ratio (OR) for symptomatic response with an optimal LV-Ps was unadjusted 1.13 (0.79-1.64) and adjusted 1.05 (0.67-1.64), and the OR for echocardiographic response was unadjusted 1.60 (1.02-2.49) and adjusted 1.42 (0.88-2.31).

Conclusion: A presumed optimal LV-Ps between 2 and 5 o'clock in the short-axis circumference and basal or mid-ventricular in the long axis is not associated with a lower mortality or a better clinical response in patients treated with CRT.
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http://dx.doi.org/10.1093/europace/eup202DOI Listing
September 2009

Simple preimplant identification of optimum VV timing before cardiac resynchronization therapy: tissue Doppler imaging versus conventional 2D echocardiography.

Echocardiography 2009 Apr 27;26(4):412-9. Epub 2008 Nov 27.

Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, Aarhus N, Denmark.

Aims: Optimum interventricular (VV) timing may potentially reduce the number of nonresponders to cardiac resynchronization therapy (CRT). We investigated whether optimum VV-timing interval could be determined before CRT implantation by means of tissue Doppler imaging (TDI) analysis and from visual assessment of conventional 2D echocardiography.

Methods And Results: Thirty consecutive patients prospectively underwent 2D, 3D, and TDI echocardiographic evaluation before and 1 month after CRT. By using 3D echocardiography, LVEF was found to be increased from 23.8 +/- 6% to 35.7 +/- 9% 1 month after CRT (P < 0.001). NYHA class improved from 3.0 +/- 0.6 to 1.8 +/- 0.6 (P < 0.001). In 93% (77-99% with 95% confidence limits) of the patients optimum VV timing was correctly predicted based on preimplant TDI identification of the region with delayed myocardial contraction. A similar result could be obtained in 83% (65-94%) of the patients simply by visual assessment of conventional black and white 2D echocardiography (ns).

Conclusion: Preimplant TDI evaluation seems to be convenient for the determination of optimum VV timing. Further postimplant adjustment guided by TDI is hardly necessary unless patients do not experience clinical benefit. TDI may seem superior to visual assessment of dyssynchrony by means of conventional 2D echocardiography. However, this simple technique indicated optimum VV timing in the majority of cases in this study.
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http://dx.doi.org/10.1111/j.1540-8175.2008.00811.xDOI Listing
April 2009

DDD(R)-pacing, but not AAI(R)-pacing induces left ventricular desynchronization in patients with sick sinus syndrome: tissue-Doppler and 3D echocardiographic evaluation in a randomized controlled comparison.

Europace 2008 Feb 12;10(2):127-33. Epub 2008 Jan 12.

Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark.

Aims: Increasing evidence from randomized trials and experimental studies indicates that right ventricular (RV) pacing may induce congestive heart failure. We studied regional left ventricular (LV) dyssynchrony and global LV function in 50 consecutive patients with sick sinus syndrome (SSS) randomized to either atrial pacing [AAI(R)] or dual chamber RV-pacing [DDD(R)].

Methods And Results: Fifty consecutive patients were randomized to AAI(R) or DDD(R)-pacing. Tissue-Doppler imaging was used to quantify LV dyssynchrony in terms of number of segments with delayed longitudinal contraction (DLC). Left ventricular ejection fraction (LVEF) was measured using three-dimensional echocardiography. Dyssynchrony was more pronounced in the DDD(R)-group than in the AAI(R)-group at the 12 months follow-up (P < 0.05). This reflected a significant increase of dyssynchrony in the DDD(R)-group from baseline to the 12 months follow-up (1.3 +/- 1 to 2.1 +/- 1 segments displaying DLC per patient), P < 0.05. No change was observed in the AAI(R)-group (1.6 +/- 2 to 1.3 +/- 2 segments displaying DLC per patient, NS). No difference in LVEF, NYHA or NT-proBNP was observed between AAI(R)- and DDD(R)-mode after 12 months of pacing although LVEF decreased significantly in the DDD(R)-group from baseline (63.1 +/- 8%) to the 12 months follow-up (59.3 +/- 8%, P < 0.05), while LVEF remained unchanged in the AAI(R)-group (61.5 +/- 11% at baseline vs. 62.3 +/- 7% after 12 months, NS.

Conclusion: In patients with SSS, DDD(R)-pacing but not AAI(R)-pacing induces significant LV desynchronization and reduction of LVEF.
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http://dx.doi.org/10.1093/europace/eum279DOI Listing
February 2008

Left ventricular lead performance in cardiac resynchronization therapy: impact of lead localization and complications.

Pacing Clin Electrophysiol 2005 Jun;28(6):483-8

Department of Cardiology, Aarhus University Hospital (Skejby), Brendstrupgaardsvej, DK-8200 Aarhus N, Denmark.

Introduction: Cardiac resynchronization therapy (CRT) using left ventricular (LV) pacing from the coronary sinus tributary is increasingly and frequently used in patients with severe congestive heart failure. The present study investigates LV lead performance in different anatomic locations.

Methods: The LV pacing site was defined by bi-plane fluoroscopy. In the left anterior oblique view, the coronary sinus is encircling the mitral ring with the tributaries radiating out like the hands of a watch. Using this clockwise method, Group A had an LV pacing site before 3 o'clock and Group B at or after 3 o'clock. In right anterior oblique view, the LV was divided into three segments: basal, mid-ventricular, and apical.

Results: LV lead implantation was successful in all of 120 consecutive patients. Mean follow-up was 16.7 months. Implantation time decreased from mean 190 to 80 minutes during the period (P = 0.01). The mean LV lead stimulation threshold increased initially and stabilized afterwards. The threshold measured at last follow-up was higher than at implantation (2.3 vs 2.7 microJ, P = 0.04). Useful venograms were obtained in 94 patients. No significant difference in thresholds was observed between Groups A and B. Phrenic nerve stimulation was most commonly seen in Group B (8/70 vs 1/24, P = 0.001).

Conclusion: Implantation of an LV lead for CRT is possible in patients with congestive heart failure and associated with an acceptable low complication rate. LV lead implantation is associated with a learning curve. At mid-term follow-up, LV lead performance is stable and unrelated to the LV implantation site.
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http://dx.doi.org/10.1111/j.1540-8159.2005.40066.xDOI Listing
June 2005
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