A Clinical Perspective on Atrial Fibrillation

Chapter
Part of the Series in BioEngineering book series (SERBIOENG)

Abstract

Atrial fibrillation is the most common arrhythmia encountered in clinical practice which requires therapeutic interventions. It severely affects the quality of life and is also one of the most common risk factors of ischemic stroke, which may lead to irreversible handicap and death. This chapter provides an overview of the current understanding of mechanism underlying the arrhythmia, its clinical manifestations, and principles of risk stratification and management. The chapter specifically addresses electrocardiographic manifestations of atrial fibrillation and outlines the challenges when using computer-based arrhythmia characteristics as biomarkers in decision-making regarding the selection of therapy or assessment prognosis.

References

  1. 1.
    J.G. Smith, P.G. Platonov, B. Hedblad, G. Engström, O. Melander, Atrial fibrillation in the Malmö Diet and Cancer study: a study of occurrence, risk factors and diagnostic validity. Eur. J. Epidemiol. 25, 95–102 (2010)CrossRefGoogle Scholar
  2. 2.
    P. Doliwa Sobocinski, E. Anggårdh Rooth, V. Frykman Kull, M. von Arbin, H. Wallén, M. Rosenqvist, Improved screening for silent atrial fibrillation after ischaemic stroke. Europace 14, 1112–1116 (2012)CrossRefGoogle Scholar
  3. 3.
    P.A. Wolf, E.J. Benjamin, A.J. Belanger, W.B. Kannel, D. Levy, R.B. D’Agostino, Secular trends in the prevalence of atrial fibrillation: the Framingham study. Am. Heart J. 131, 790–795 (1996)CrossRefGoogle Scholar
  4. 4.
    D.D. McManus, M. Rienstra, E.J. Benjamin, An update on the prognosis of patients with atrial fibrillation. Circulation 126, e143–146 (2012)CrossRefGoogle Scholar
  5. 5.
    D.M. Lloyd-Jones, T.J. Wang, E.P. Leip, M.G. Larson, D. Levy, R.S. Vasan, R.B. D’Agostino, J.M. Massaro, A. Beiser, P.A. Wolf, E.J. Benjamin, Lifetime risk for development of atrial fibrillation: the Framingham Heart study. Circulation 110, 1042–1046 (2004)CrossRefGoogle Scholar
  6. 6.
    P. Kirchhof, G. Breithardt, E. Aliot, S. Al Khatib, S. Apostolakis, A. Auricchio, C. Bailleul, J. Bax, G. Benninger, C. Blomström-Lundqvist, L. Boersma, G. Boriani, A. Brandes, H. Brown, M. Brueckmann, H. Calkins, B. Casadei, A. Clemens, H. Crijns, R. Derwand, D. Dobrev, M. Ezekowitz, T. Fetsch, A. Gerth, A. Gillis, M. Gulizia, G. Hack, L. Haegeli, S. Hatem, K.G. Häusler, H. Heidbüchel, J. Hernandez-Brichis, P. Jais, L. Kappenberger, J. Kautzner, S. Kim, K.-H. Kuck, D. Lane, A. Leute, T. Lewalter, R. Meyer, L. Mont, G. Moses, M. Mueller, F. Münzel, M. Näbauer, J.C. Nielsen, M. Oeff, A. Oto, B. Pieske, R. Pisters, T. Potpara, L. Rasmussen, U. Ravens, J. Reiffel, I. Richard-Lordereau, H. Schäfer, U. Schotten, W. Stegink, K. Stein, G. Steinbeck, L. Szumowski, L. Tavazzi, S. Themistoclakis, K. Thomitzek, I.C. Van Gelder, B. von Stritzky, A. Vincent, D. Werring, S. Willems, G.Y.H. Lip, A.J. Camm, Personalized management of atrial fibrillation: proceedings from the fourth Atrial Fibrillation competence NETwork/European Heart Rhythm Association consensus conference. Europace 15, 1540–1556 (2013)CrossRefGoogle Scholar
  7. 7.
    M. Haïssaguerre, P. Jaïs, D.C. Shah, L. Gencel, V. Pradeau, S. Garrigues, S. Chouairi, M. Hocini, P. Le Métayer, R. Roudaut, J.C.J., Right and left atrial radiofrequency catheter therapy of paroxysmal atrial fibrillation. J. Cardiovasc. Electrophysiol. 7, 1132–1144 (1996)CrossRefGoogle Scholar
  8. 8.
    M. Hocini, S.Y. Ho, T. Kawara, A.C. Linnenbank, M. Potse, D. Shah, P. Jaïs, M.J. Janse, M. Haïssaguerre, J.M.T. De Bakker, Electrical conduction in canine pulmonary veins: electrophysiological and anatomic correlation. Circulation 105, 2442–2448 (2002)CrossRefGoogle Scholar
  9. 9.
    L. Staerk, J.A. Sherer, D. Ko, E.J. Benjamin, R.H. Helm, Atrial fibrillation: epidemiology, pathophysiology, and clinical outcomes. Circ. Res. 120, 1501–1517 (2017)CrossRefGoogle Scholar
  10. 10.
    H. Kottkamp, Fibrotic atrial cardiomyopathy: a specific disease/syndrome supplying substrates for atrial fibrillation, atrial tachycardia, sinus node disease, AV node disease, and thromboembolic complications. J. Cardiovasc. Electrophysiol. 23, 797–799 (2012)CrossRefGoogle Scholar
  11. 11.
    A. Frustaci, M. Caldarulo, A. Buffon, F. Bellocci, R. Fenici, D. Melina, Cardiac biopsy in patients with ‘primary’ atrial fibrillation. Histologic evidence of occult myocardial diseases. Chest 100, 303–306 (1991)CrossRefGoogle Scholar
  12. 12.
    J.G. Smith, C. Newton-Cheh, P. Almgren, J. Struck, N.G. Morgenthaler, A. Bergmann, P.G. Platonov, B. Hedblad, G. Engström, T.J. Wang, O. Melander, Assessment of conventional cardiovascular risk factors and multiple biomarkers for the prediction of incident heart failure and atrial fibrillation. J. Amer. Coll. Card. 56, 1712–1719 (2010)CrossRefGoogle Scholar
  13. 13.
    F. Gramley, J. Lorenzen, C. Knackstedt, O.R. Rana, E. Saygili, D. Frechen, S. Stanzel, F. Pezzella, E. Koellensperger, C. Weiss, T. Münzel, P. Schauerte, Age-related atrial fibrosis. Age (Dordrecht, Netherlands) 31, 27–38 (2009)CrossRefGoogle Scholar
  14. 14.
    A. Frustaci, C. Chimenti, F. Bellocci, E. Morgante, M.A. Russo, A. Maseri, Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation 96, 1180–1184 (1997)CrossRefGoogle Scholar
  15. 15.
    P.G. Platonov, L.B. Mitrofanova, V. Orshanskaya, S.Y. Ho, Structural abnormalities in atrial walls are associated with presence and persistency of atrial fibrillation but not with age. J. Am. Coll. Cardiol. 58, 2225–2232 (2011)CrossRefGoogle Scholar
  16. 16.
    D. Corradi, S. Callegari, L. Manotti, D. Ferrara, M. Goldoni, R. Alinovi, S. Pinelli, P. Mozzoni, R. Andreoli, A. Asimaki, A. Pozzoli, G. Becchi, A. Mutti, S. Benussi, J.E. Saffitz, O. Alfieri, Persistent lone atrial fibrillation: clinicopathologic study of 19 cases. Heart Rhythm 11, 1250–1258 (2014)CrossRefGoogle Scholar
  17. 17.
    C. Mahnkopf, T.J. Badger, N.S. Burgon, M. Daccarett, T.S. Haslam, C.T. Badger, C.J. McGann, N. Akoum, E. Kholmovski, R.S. Macleod, N.F. Marrouche, Evaluation of the left atrial substrate in patients with lone atrial fibrillation using delayed-enhanced MRI: implications for disease progression and response to catheter ablation. Heart Rhythm 7, 1475–1481 (2010)CrossRefGoogle Scholar
  18. 18.
    L.B. Mitrofanova, V. Orshanskaya, S.Y. Ho, P.G. Platonov, Histological evidence of inflammatory reaction associated with fibrosis in the atrial and ventricular walls in a case-control study of patients with history of atrial fibrillation. Europace 18, iv156–iv162 (2016)Google Scholar
  19. 19.
    A. Boldt, U. Wetzel, J. Lauschke, J. Weigl, J. Gummert, G. Hindricks, H. Kottkamp, S. Dhein, Fibrosis in left atrial tissue of patients with atrial fibrillation with and without underlying mitral valve disease. Heart (British Cardiac Society) 90, 400–405 (2004)CrossRefGoogle Scholar
  20. 20.
    P. Kirchhof, S. Benussi, D. Kotecha, A. Ahlsson, D. Atar, B. Casadei, M. Castella, H.C. Diener, H. Heidbuchel, J. Hendriks, G. Hindricks, A.S. Manolis, J. Oldgren, B.A. Popescu, U. Schotten, B. Van Putte, P. Vardas, S. Agewall, J. Camm, G. Baron Esquivias, W. Budts, S. Carerj, F. Casselman, A. Coca, R. De Caterina, S. Deftereos, D. Dobrev, J.M. Ferro, G. Filippatos, D. Fitzsimons, B. Gorenek, M. Guenoun, S.H. Hohnloser, P. Kolh, G.Y. Lip, A. Manolis, J. McMurray, P. Ponikowski, R. Rosenhek, F. Ruschitzka, I. Savelieva, S. Sharma, P. Suwalski, J.L. Tamargo, C.J. Taylor, I.C. Van Gelder, A.A. Voors, S. Windecker, J.L. Zamorano, K. Zeppenfeld, 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur. Heart J. 37, 2893–2962 (2016)CrossRefGoogle Scholar
  21. 21.
    C. Marini, F. De Santis, S. Sacco, T. Russo, L. Olivieri, R. Totaro, A. Carolei, Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study. Stroke 36, 1115–1119 (2005)CrossRefGoogle Scholar
  22. 22.
    G.Y. Lip, R. Nieuwlaat, R. Pisters, D.A. Lane, H.J. Crijns, Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach. The Euro Heart Survey on atrial fibrillation. Chest 137, 263–272 (2010)CrossRefGoogle Scholar
  23. 23.
    D.A. Lane, G.Y.H. Lip, Use of the CHA\(_2\)DS\(_2\)-VASc and HAS-BLED scores to aid decision making for thromboprophylaxis in nonvalvular atrial fibrillation. Circulation 126, 860–865 (2012)CrossRefGoogle Scholar
  24. 24.
    I. Savelieva, A.J. Camm, Clinical relevance of silent atrial fibrillation: prevalence, prognosis, quality of life, and management. J. Interv. Card. Electrophysiol. 4, 369–382 (2000)CrossRefGoogle Scholar
  25. 25.
    G.Y. Lip, C. Laroche, P.M. Ioachim, L.H. Rasmussen, L. Vitali-Serdoz, L. Petrescu, D. Darabantiu, H.J. Crijns, P. Kirchhof, P. Vardas, L. Tavazzi, A.P. Maggioni, G. Boriani, Prognosis and treatment of atrial fibrillation patients by European cardiologists: one year follow-up of the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot registry). Eur. Heart J. 35, 3365–3376 (2014)CrossRefGoogle Scholar
  26. 26.
    J.S. Healey, S.J. Connolly, M.R. Gold, C.W. Israel, I.C. Van Gelder, A. Capucci, C.P. Lau, E. Fain, S. Yang, C. Bailleul, C.A. Morillo, M. Carlson, E. Themeles, E.S. Kaufman, S.H. Hohnloser, ASSERT Investigators, Subclinical atrial fibrillation and the risk of stroke. N. Engl. J. Med. 366, 120–129 (2012)CrossRefGoogle Scholar
  27. 27.
    D. Bengtsson, L. Brudin, P. Wanby, M. Carlsson, Previously unknown thyroid dysfunction in patients with acute ischemic stroke. Acta Neurol. Scand. 126, 98–102 (2012)CrossRefGoogle Scholar
  28. 28.
    L. Suissa, S. Lachaud, M.H. Mahagne, Optimal timing and duration of continuous electrocardiographic monitoring for detecting atrial fibrillation in stroke patients. J. Stroke Cerebrovasc. Dis. 22, 991–995 (2013)CrossRefGoogle Scholar
  29. 29.
    H. Kamel, K.R. Lees, P.D. Lyden, P.A. Teal, A. Shuaib, M. Ali, S.C. Johnston, Virtual International Stroke Trials Archive Investigators, Delayed detection of atrial fibrillation after ischemic stroke. J. Stroke Cerebrovasc. Dis. 18, 453–457 (2009)CrossRefGoogle Scholar
  30. 30.
    D. Jabaudon, J. Sztajzel, K. Sievert, T. Landis, R. Sztajzel, Usefulness of ambulatory 7-day ECG monitoring for the detection of atrial fibrillation and flutter after acute stroke and transient ischemic attack. Stroke 35, 1647–1651 (2004)CrossRefGoogle Scholar
  31. 31.
    R. Stahrenberg, M. Weber-Krüger, J. Seegers, F. Edelmann, R. Lahno, B. Haase, M. Mende, J. Wohlfahrt, P. Kermer, D. Vollmann, G. Hasenfuss, K. Gröschel, R. Wachter, Enhanced detection of paroxysmal atrial fibrillation by early and prolonged continuous holter monitoring in patients with cerebral ischemia presenting in sinus rhythm. Stroke 41, 2884–2888 (2010)CrossRefGoogle Scholar
  32. 32.
    A.C. Flint, N.M. Banki, X. Ren, V.A. Rao, A.S. Go, Detection of paroxysmal atrial fibrillation by 30-day event monitoring in cryptogenic ischemic stroke: the stroke and monitoring for PAF in real time (SMART) registry. Stroke 43, 2788–2790 (2012)CrossRefGoogle Scholar
  33. 33.
    D.J. Miller, M.A. Khan, R. Schultz, J.R. Simpson, A.M. Katramados, A.N. Russman, Outpatient cardiac telemetry detects a high rate of atrial fibrillation in cryptogenic stroke. J. Neurol. Sci. 324, 57–61 (2013)CrossRefGoogle Scholar
  34. 34.
    L. Elijovich, S.A. Josephson, G.L. Fung, W.S. Smith, Intermittent atrial fibrillation may account for a large proportion of otherwise cryptogenic stroke: a study of 30-day cardiac event monitors. J. Stroke Cerebrovasc. Dis. 18, 185–189 (2009)CrossRefGoogle Scholar
  35. 35.
    J. Brachmann, C.A. Morillo, T. Sanna, V. Di Lazzaro, H.C. Diener, R.A. Bernstein, M. Rymer, P.D. Ziegler, S. Liu, R.S. Passman, Uncovering atrial fibrillation beyond short-term monitoring in cryptogenic stroke patients: three-year results from the cryptogenic stroke and underlying atrial fibrillation trial. Circ. Arrhythm. Electrophysiol. 9, e003333 (2016)CrossRefGoogle Scholar
  36. 36.
    J. Reiffel, A. Verma, J.L. Halperin, B. Gersh, S. Tombul, J. Carrithers, L. Sherfesee, P. Kowey, Rationale and design of REVEAL AF: a prospective study of previously undiagnosed atrial fibrillation as documented by an insertable cardiac monitor in high-risk patients. Am. Heart J. 167, 22–27 (2014)CrossRefGoogle Scholar
  37. 37.
    D.J. Gladstone, M. Spring, P. Dorian, V. Panzov, K.E. Thorpe, J. Hall, H. Vaid, M. O’Donnell, A. Laupacis, R. Côté, M. Sharma, J.A. Blakely, A. Shuaib, V. Hachinski, S.B. Coutts, D.J. Sahlas, P. Teal, S. Yip, J.D. Spence, B. Buck, S. Verreault, L.K. Casaubon, A. Penn, D. Selchen, A. Jin, D. Howse, M. Mehdiratta, K. Boyle, R. Aviv, M.K. Kapral, M. Mamdani, Atrial fibrillation in patients with cryptogenic stroke. N. Engl. J. Med. 370, 2467–2477 (2014)CrossRefGoogle Scholar
  38. 38.
    T. Sanna, H.-C. Diener, R.S. Passman, V. Di Lazzaro, R.A. Bernstein, C.A. Morillo, M.M. Rymer, V. Thijs, T. Rogers, F. Beckers, K. Lindborg, J. Brachmann, Cryptogenic stroke and underlying atrial fibrillation. N. Engl. J. Med. 370, 2478–2486 (2014)CrossRefGoogle Scholar
  39. 39.
    J. Benezet-Mazuecos, J.M. Rubio, J. Farré, Atrial high rate episodes in patients with dual-chamber cardiac implantable electronic devices: unmasking silent atrial fibrillation. Pacing Clin. Electrophysiol. 37, 1080–1086 (2014)CrossRefGoogle Scholar
  40. 40.
    T.V. Glotzer, A.S. Hellkamp, J. Zimmerman, M.O. Sweeney, R. Yee, R. Marinchak, J. Cook, A. Paraschos, J. Love, G. Radoslovich, K.L. Lee, G.A. Lamas, M.O.S.T. Investigators, Atrial high rate episodes detected by pacemaker diagnostics predict death and stroke: report of the Atrial Diagnostics Ancillary Study of the MOde Selection Trial (MOST). Circulation 107, 1614–1619 (2003)CrossRefGoogle Scholar
  41. 41.
    T.V. Glotzer, E.G. Daoud, D.G. Wyse, D.E. Singer, M.D. Ezekowitz, C. Hilker, C. Miller, D. Qi, P.D. Ziegler, The relationship between daily atrial tachyarrhythmia burden from implantable device diagnostics and stroke risk: the TRENDS study. Circulation. Arrhythm. Electrophysiol. 2, 474–480 (2009)CrossRefGoogle Scholar
  42. 42.
    S.H. Hohnloser, A. Capucci, E. Fain, M.R. Gold, I.C. van Gelder, J. Healey, C.W. Israel, C.P. Lau, C. Morillo, S.J. Connolly, A.S.S.E.R.T. Investigators, Committees, ASymptomatic atrial fibrillation and Stroke Evaluation in pacemaker patients and the atrial fibrillation Reduction atrial pacing Trial (ASSERT). Am. Heart J. 152, 442–447 (2006)Google Scholar
  43. 43.
    D.T. Martin, M.M. Bersohn, A.L. Waldo, M.S. Wathen, W.K. Choucair, G.Y.H. Lip, J. Ip, R. Holcomb, J.G. Akar, J.L. Halperin, IMPACT Investigators, Randomized trial of atrial arrhythmia monitoring to guide anticoagulation in patients with implanted defibrillator and cardiac resynchronization devices. Eur. Heart J. 36, 1660–1668 (2015)CrossRefGoogle Scholar
  44. 44.
    B.J. Hirsh, R.S. Copeland-Halperin, J.L. Halperin, Fibrotic atrial cardiomyopathy, atrial fibrillation, and thromboembolism: mechanistic links and clinical inferences. J. Am. Coll. Cardiol. 65, 2239–2251 (2015)CrossRefGoogle Scholar
  45. 45.
    K.M. Henriksson, B. Farahmand, S. Asberg, A. Terént, N. Edvardsson, First-ever atrial fibrillation documented after hemorrhagic or ischemic stroke: the role of the CHADS\(_2\) score at the time of stroke. Clin. Cardiol. 34, 309–316 (2011)CrossRefGoogle Scholar
  46. 46.
    M.A. Baturova, A. Lindgren, J. Carlson, Y.V. Shubik, S.B. Olsson, P.G. Platonov, Predictors of new onset atrial fibrillation during 10-year follow-up after first-ever ischemic stroke. Int. J. Cardiol. 199, 248–252 (2015)CrossRefGoogle Scholar
  47. 47.
    M.-L. Zuo, S. Liu, K.-H. Chan, K.-K. Lau, B.-H. Chong, K.-F. Lam, Y.-H. Chan, Y.-F. Lau, G.Y.H. Lip, C.-P. Lau, H.-F. Tse, C.-W. Siu, The CHADS\(_2\) and CHA\(_2\)DS\(_2\)-VASc scores predict new occurrence of atrial fibrillation and ischemic stroke. J. Interv. Card. Electrophysiol. 37, 47–54 (2013)CrossRefGoogle Scholar
  48. 48.
    S. Suzuki, K. Sagara, T. Otsuka, H. Kano, S. Matsuno, H. Takai, T. Uejima, Y. Oikawa, A. Koike, K. Nagashima, H. Kirigaya, J. Yajima, H. Tanabe, H. Sawada, T. Aizawa, T. Yamashita, Usefulness of frequent supraventricular extrasystoles and a high CHADS\(_2\) score to predict first-time appearance of atrial fibrillation. Am. J. Cardiol. 111, 1602–1607 (2013)CrossRefGoogle Scholar
  49. 49.
    I.C. Van Gelder, H.F. Groenveld, H.J.G.M. Crijns, Y.S. Tuininga, J.G.P. Tijssen, A.M. Alings, H.L. Hillege, J.A. Bergsma-Kadijk, J.H. Cornel, O. Kamp, R. Tukkie, H.A. Bosker, D.J. Van Veldhuisen, M.P. Van den Berg, R.A.C.E.I.I. Investigators, Lenient versus strict rate control in patients with atrial fibrillation. N. Engl. J. Med. 362, 1363–1373 (2010)CrossRefGoogle Scholar
  50. 50.
    M. Haïssaguerre, P. Jaïs, D.C. Shah, A. Takahashi, M. Hocini, G. Quiniou, S. Garrigue, A. Le Mouroux, P. Le Métayer, J. Clémenty, Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N. Engl. J. Med. 339, 659–666 (1998)CrossRefGoogle Scholar
  51. 51.
    J.C. Nielsen, A. Johannessen, P. Raatikainen, G. Hindricks, H. Walfridsson, S.M. Pehrson, A. Englund, J. Hartikainen, L.S. Mortensen, P.S. Hansen, MANTRA-PAF Investigators, Long-term efficacy of catheter ablation as first-line therapy for paroxysmal atrial fibrillation: 5-year outcome in a randomised clinical trial. Heart 103, 368–376 (2017)CrossRefGoogle Scholar
  52. 52.
    P.G. Platonov, V.D.A. Corino, M. Seifert, F. Holmqvist, L. Sörnmo, Atrial fibrillatory rate in the clinical context: natural course and prediction of intervention outcome. Europace 16, iv110–iv119 (2014)CrossRefGoogle Scholar
  53. 53.
    T. Lankveld, C.B. de Vos, I. Limantoro, S. Zeemering, E. Dudink, H.J. Crijns, U. Schotten, Systematic analysis of ECG predictors of sinus rhythm maintenance after electrical cardioversion for persistent atrial fibrillation. Heart Rhythm 13, 1020–1027 (2016)CrossRefGoogle Scholar
  54. 54.
    D.D. McManus, J. Lee, O. Maitas, N. Esa, R. Pidikiti, A. Carlucci, J. Harrington, E. Mick, K.H. Chon, A novel application for the detection of an irregular pulse using an iPhone 4S in patients with atrial fibrillation. Heart Rhythm 10, 315–319 (2013)CrossRefGoogle Scholar
  55. 55.
    A.-S. Olsson, J. Engdahl, Detection of atrial fibrillation with intermittent handheld electrocardiogram in patients with ischemic stroke and transient ischemic attack and transient ischemic attack. J. Stroke Cerebrovasc. Dis. 25, 2648–2652 (2016)CrossRefGoogle Scholar
  56. 56.
    J.K. Lau, N. Lowres, L. Neubeck, D.B. Brieger, R.W. Sy, C.D. Galloway, D.E. Albert, S.B. Freedman, iPhone ECG application for community screening to detect silent atrial fibrillation: a novel technology to prevent stroke. Int. J. Cardiol. 165, 193–194 (2013)CrossRefGoogle Scholar
  57. 57.
    J.P.J. Halcox, K. Wareham, A. Cardew, M. Gilmore, J.P. Barry, C. Phillips, M.B. Gravenor, Assessment of remote heart rhythm sampling using the Alivecor heart monitor to screen for atrial fibrillation: the REHEARSE-AF study. Circulation 136, 1784–1794 (2017)CrossRefGoogle Scholar
  58. 58.
    G.C. Flaker, K. Belew, K. Beckman, H. Vidaillet, J. Kron, R. Safford, M. Mickel, P. Barrell, AFFIRM Investigators, Asymptomatic atrial fibrillation: demographic features and prognostic information from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Am. Heart J. 149, 657–663 (2005)CrossRefGoogle Scholar
  59. 59.
    European Society of Cardiology, (ESC), European Heart Rhythm Association (EHRA), M. Brignole, A. Auricchio, G. Baron-Esquivias, P. Bordachar, G. Boriani, O.-A. Breithardt, J. Cleland, J.-C. Deharo, V. Delgado, P.M. Elliott, B. Gorenek, C.W. Israel, C. Leclercq, C. Linde, L. Mont, L. Padeletti, R. Sutton, P.E. Vardas, 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association. Europace 15, 1070–1118 (2013)Google Scholar
  60. 60.
    A. Bollmann, A. Tveit, D. Husser, M. Stridh, L. Sörnmo, P. Smith, S.B. Olsson, Fibrillatory rate response to candesartan in persistent atrial fibrillation. Europace 10, 1138–1144 (2008)CrossRefGoogle Scholar
  61. 61.
    F. Holmqvist, M. Stridh, J.E. Waktare, L. Sörnmo, S.B. Olsson, C.J. Meurling, Atrial fibrillatory rate and sinus rhythm maintenance in patients undergoing cardioversion of persistent atrial fibrillation. Eur. Heart J. 27, 2201–2207 (2006)CrossRefGoogle Scholar
  62. 62.
    M.B. Choudhary, F. Holmqvist, J. Carlson, H.-J. Nilsson, A. Roijer, P.G. Platonov, Low atrial fibrillatory rate is associated with spontaneous conversion of recent-onset atrial fibrillation. Europace 15, 1445–1452 (2013)CrossRefGoogle Scholar
  63. 63.
    C.J. Meurling, J.E. Waktare, F. Holmqvist, A. Hedman, A.J. Camm, S.B. Olsson, M. Malik, Diurnal variations of the dominant cycle length of chronic atrial fibrillation. Am. J. Physiol. 280, H401–H406 (2001)Google Scholar
  64. 64.
    F. Sandberg, A. Bollmann, D. Husser, M. Stridh, L. Sörnmo, Circadian variation in dominant atrial fibrillation frequency in persistent atrial fibrillation. Physiol. Meas. 31, 531–542 (2010)CrossRefGoogle Scholar
  65. 65.
    S. Petrutiu, A.V. Sahakian, S. Swiryn, Short-term dynamics in fibrillatory wave characteristics at the onset of paroxysmal atrial fibrillation in humans. J. Electrocardiol. 40, 155–160 (2007)CrossRefGoogle Scholar
  66. 66.
    P.G. Platonov, M. Stridh, M. de Melis, L. Urban, J. Carlson, G. Corbucci, F. Holmqvist, Analysis of atrial fibrillatory rate during spontaneous episodes of atrial fibrillation in humans using implantable loop recorder electrocardiogram. J. Electrocardiol. 45, 723–726 (2012)CrossRefGoogle Scholar
  67. 67.
    European Medicines Agency, Biomarkers (2017), http://www.ema.europa.eu/ema/. Accessed 17 Oct 2017
  68. 68.
    Food and Drug Administration (FDA), Biomarker qualification program (2017), http://www.fda.gov/. Accessed 17 Oct 2017
  69. 69.
    A.L. Goldberger, L.A. Amaral, L. Glass, J.M. Hausdorff, P.C. Ivanov, R.G. Mark, J.E. Mietus, G.B. Moody, C.K. Peng, H.E. Stanley, PhysioBank, PhysioToolkit, and PhysioNet: components of a new research resource for complex physiologic signals. Circulation 101, E215–220 (2000)CrossRefGoogle Scholar
  70. 70.
    J.-P. Couderc, The Telemetric and Holter ECG Warehouse Initiative (THEW): a data repository for the design, implementation and validation of ECG-related technologies, in Proceedings of IEEE Conference on Engineering in Medicine and Biology (EMBS) 32, 6252–6255 (2010)Google Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Cardiology, Clinical Sciences and Center for Integrative ElectrocardiologyLund UniversityLundSweden
  2. 2.Department of Electronics, Information and BioengineeringPolitecnico di MilanoMilanItaly

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