vestarВестник аритмологииJournal of Arrhythmology1561-86412658-7327НАО «Инкарт»10.35336/VA-1160vestar-1245Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESЭффективность торакоскопического лечения непароксизмальных форм фибрилляции предсердийThe effectiveness of thoracoscopic treatment of non-paroxysmal atrial fibrillationhttps://orcid.org/0000-0003-1791-9163РевишвилиА. Ш.RevishviliA. Sh.

Москва, Большая Серпуховская ул., д. 27

Moscow, 27 Bolshaya Serpukhovskaya str.

https://orcid.org/0000-0001-5837-7255СтребковаЕ. Д.StrebkovaE. D.

Москва, Большая Серпуховская ул., д. 27

Moscow, 27 Bolshaya Serpukhovskaya str.

elizabeth.strebkova@yandex.ruhttps://orcid.org/0000-0001-7065-0250АртюхинаЕ. А.ArtyukhinaЕ. А.

Москва, Большая Серпуховская ул., д. 27

Moscow, 27 Bolshaya Serpukhovskaya str.

https://orcid.org/0000-0002-1572-3178МалышенкоЕ. С.MalishenkoE. S.

Москва, Большая Серпуховская ул., д. 27

Moscow, 27 Bolshaya Serpukhovskaya str.

https://orcid.org/0000-0001-9160-6531НовиковМ. А.NovikovM. A.

Москва, Большая Серпуховская ул., д. 27

Moscow, 27 Bolshaya Serpukhovskaya str.

https://orcid.org/0000-0001-8231-6866КадыроваМ.KadirovaM.

Москва, Большая Серпуховская ул., д. 27

Moscow, 27 Bolshaya Serpukhovskaya str.

ФГБУ "Национальный медицинский исследовательский центр хирургии имени А.В.Вишневского" Минздрава РоссииРоссияFederal State Budgetary Educational Institution “A.V. Vishnevskiy National Medical Research Center of Surgery” of the Ministry of Healthcare of the Russian FederationRussian Federation2023200720233032331Copyright © Ревишвили А.Ш., Стребкова Е.Д., Артюхина Е.А., Малышенко Е.С., Новиков М.А., Кадырова М., 20232023Ревишвили А.Ш., Стребкова Е.Д., Артюхина Е.А., Малышенко Е.С., Новиков М.А., Кадырова М.Revishvili A.S., Strebkova E.D., Artyukhina Е.А., Malishenko E.S., Novikov M.A., Kadirova M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestar.elpub.ru/jour/article/view/1245Цель

Цель. Оценить эффективность торакоскопической аблации (ТА) персистирующих и длительно-персистирующих формы фибрилляции предсердий (ФП) в отдаленном периоде наблюдения.

Материал и методы исследования. ТА ФП с одномоментной ампутацией ушка левого предсердия была выполнена 50 пациентам с персистирующей (I группа) и 50 пациентам с длительно-персистирующей ФП (II группа). Эффективность процедуры определялась как отсутствие любой предсердной тахиаритмии (ФП, трепетания предсердий или наджелудочковой тахикардии) продолжительностью более 30 секунд, зарегистрированной на холтеровском мониторировании в контрольные точки исследования.

Результаты

Результаты. Эффективность ТА в I группе составила 78%, во II группе - 63% в течение трехлетнего периода наблюдения (p=0,037). Катетерные аблации через 3 месяца после ТА потребовались в I группе - 8 (16%) пациентам и во II группе - 9 (18%) (p>0,05), из которых у двоих пациентов на ЭКГ регистрировалось типичное трепетание предсердий, потребовавшее выполнение радиочастотной аблации кавотрикуспидального истмуса. Эффективность этапного лечения ФП через 3 месяца после дополнительной катетерной аблации составила 100%, через 6 месяцев - 88,2%.

Выводы

Выводы. Видеоассистированную ТА фибрилляции предсердий следует считать перспективным методом устранения непароксизмальных форм фибрилляции предсердий.

Aim

Aim. To evaluate the efficacy of thoracoscopic ablation (TSA) of persistent and long-standing atrial fibrillation (AF) in the long-term follow-up period.

Methods

Methods. TSA of AF with unilateral left atrial appendage exclusion was performed in 50 patients with persistent (group I) and 50 patients with long-onset AF (group II). Efficacy was defined as the absence of any atrial tachyarrhythmia (atrial fibrillation, atrial flutter, or supraventricular tachycardia) lasting more than 30 seconds recorded on Holter ECG monitoring at study controls.

Results

Results. TSA was 78% effective in group I and 63% effective in group II over the three-year follow-up period (p=0,037). Catheter ablations 3 months after TSA were required in 8 (16%) patients in group I and 9 (18%) in group II (p>0,05), of which two patients had typical atrial flutter on ECG, which required radiofrequency ablation of the cavotricuspid isthmus. The efficacy of staged treatment of AF at 3 months after additional catheter ablation was 100% and 88,2% after 6 months.

Conclusion

Conclusion. Video-assisted thoracoscopic ablation of atrial fibrillation should be considered a promising approach for the management of persistent and long-standing atrial fibrillation.

фибрилляция предсердийторакоскопическая аблацияперсистирующая формадлительно-персистирующая форма фибрилляции предсердийatrial fibrillationtoracoscopic ablationpersistent formlong-standing atrial fibrillationReferencesHindricks G, Potpara T, Dagres N, 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. 2021;42: 373-498. https://doi.org/10.1093/eurheartj/ehaa945.Hindricks G, Potpara T, Dagres N, 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. 2021;42: 373-498. https://doi.org/10.1093/eurheartj/ehaa945.Lippi G, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: An increasing epidemic and public health challenge. Int J Stroke. 2021;16(2): 217-221. https://doi.org/10.1177/1747493019897870.Lippi G, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: An increasing epidemic and public health challenge. Int J Stroke. 2021;16(2): 217-221. https://doi.org/10.1177/1747493019897870.Пиданов ОЮ, Богачев-Прокофьев АВ, Елесин ДА и др. Торакоскопическая аблация для лечения пациентов с изолированной формой фибрилляции предсердий в России. Патология кровообращения и кардиохирургия. 2018;22(2): 14-21. http://dx.doi.org/10.21688/1681-3472-2018-2-14-21.Pidanov OYu, Bogachev-Prokophiev AV, Elesin DA, et al. Thoracoscopic ablation for treatment of patients with lone atrial fibrillation in Russia. Circulation Pathology and Cardiac Surgery. 2018;22(2): 14-21. (In Russ.) http://dx.doi.org/10.21688/1681-3472-2018-2-14-21.Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke Statistics-2019 update: A report from the American Heart Association. Circulation. 2019;139: 56-528. https://doi.org/10.1161/CIR.0000000000000659.Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke Statistics-2019 update: A report from the American Heart Association. Circulation. 2019;139: 56-528. https://doi.org/10.1161/CIR.0000000000000659.Ревишвили АШ, Кадырова М, Попов ВА, и др. Влияние индексируемого объема левого предсердия на эффективность торакоскопического лечения фибрилляции предсердий. Медицинская визуализация. 2022;26(3): 22-33. https://doi.org/10.24835/1607-0763-1162.Revishvili ASh, Kadirova M, Popov VA, et al. Influence of Left Atrium Volume Index on effectiveness of Thoracoscopic Ablation in the Treatment of Atrial Fibrillation. Medical Visualization. 2022;26(3): 22-33. [(In Russ.) https://doi.org/10.24835/1607-0763-1162.Berger WR, Meulendijks ER, Limpens J, et al. Persistent atrial fibrillation: a systematic review and meta-analysis of invasive strategies. Int J Cardiol. 2019;278: 137-43. https://doi.org/10.1016/j.ijcard.2018.11.127.Berger WR, Meulendijks ER, Limpens J, et al. Persistent atrial fibrillation: a systematic review and meta-analysis of invasive strategies. Int J Cardiol. 2019;278: 137-43. https://doi.org/10.1016/j.ijcard.2018.11.127.Prasad SM, Maniar HS, Camillo CJ, et al. The Cox maze III procedure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant procedures. J. Thorac. Cardiovasc Surg. 2003;126: 1822-1828. https://doi.org/10.1016/s0022-5223(03)01287-x.Prasad SM, Maniar HS, Camillo CJ, et al. The Cox maze III procedure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant procedures. J. Thorac. Cardiovasc Surg. 2003;126: 1822-1828. https://doi.org/10.1016/s0022-5223(03)01287-x.Cox JL. The longstanding, persistent confusion surrounding surgery for atrial fibrillation. J Thorac Cardiovasc Surg. 2010;139: 1374-86. https://doi.org/10.1016/j.jtcvs.2010.02.027.Cox JL. The longstanding, persistent confusion surrounding surgery for atrial fibrillation. J Thorac Cardiovasc Surg. 2010;139: 1374-86. https://doi.org/10.1016/j.jtcvs.2010.02.027.Je HG, Shuman DJ, Ad N. A systematic review of minimally invasive surgical treatment for atrial fibrillation: a comparison of the Cox-Maze procedure, beating-heart epicardial ablation, and the hybrid procedure on safety and efficacy. Eur J Cardiothorac Surg. 2015;48(4): 531-40. https://doi.org/10.1093/ejcts/ezu536.Je HG, Shuman DJ, Ad N. A systematic review of minimally invasive surgical treatment for atrial fibrillation: a comparison of the Cox-Maze procedure, beating-heart epicardial ablation, and the hybrid procedure on safety and efficacy. Eur J Cardiothorac Surg. 2015;48(4): 531-40. https://doi.org/10.1093/ejcts/ezu536.Haïssaguerre M, Jaȉs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339: 659-666. https://doi.org/10.1056/NEJM199809033391003.Haïssaguerre M, Jaȉs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339: 659-666. https://doi.org/10.1056/NEJM199809033391003.Wesselink R, Neefs J, van den Berg NWE, et al. Does left atrial epicardial conduction time reflect atrial fibrosis and the risk of atrial fibrillation recurrence after thoracoscopic ablation? Post hoc analysis of the AFACT trial. BMJ Open. 2022;12(3): 056829. https://doi.org/10.1136/bmjopen-2021-056829.Wesselink R, Neefs J, van den Berg NWE, et al. Does left atrial epicardial conduction time reflect atrial fibrosis and the risk of atrial fibrillation recurrence after thoracoscopic ablation? Post hoc analysis of the AFACT trial. BMJ Open. 2022;12(3): 056829. https://doi.org/10.1136/bmjopen-2021-056829.Артюхина ЕА, Дедух ЕВ, Яшков МВ. Этапный хирургический и катетерный подход к лечению длительно-персистирующей фибрилляции предсердий. Российский кардиологический журнал. 2019;(7): 96-98. https://doi.org/10.15829/1560-4071-2019-7-96-98.Artyukhina EA, Dedukh EV, Yashkov MV. Stage surgical and catheter approach to the treatment of long-persistent atrial fibrillation. Russian Journal of Cardiology. 2019;(7):96-98. (In Russ.) https://doi.org/10.15829/1560-4071-2019-7-96-98.Nuhrich JM, Geisler AC, Steven D, et al. Active atrial function and atrial scar burden after multiple catheter ablations of persistent atrial fibrillation. Pacing Clin Electrophysiol. 2017;40: 175-82. https://doi.org/10.1111/pace.13004.Nuhrich JM, Geisler AC, Steven D, et al. Active atrial function and atrial scar burden after multiple catheter ablations of persistent atrial fibrillation. Pacing Clin Electrophysiol. 2017;40: 175-82. https://doi.org/10.1111/pace.13004.Wolf RK, Schneeberger EW, Osterday R, et al. Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg. 2005;130: 797-802. https://doi.org/10.1016/j.jtcvs.2005.03.041.Wolf RK, Schneeberger EW, Osterday R, et al. Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg. 2005;130: 797-802. https://doi.org/10.1016/j.jtcvs.2005.03.041.Badhwar V, Rankin JS, Damiano RJ, et al. The Society of Thoracic Surgeons 2017 clinical practice guidelines for the surgical treatment of atrial fibrillation. Ann Thorac Surg. 2017;103: 329-41. https://doi.org/10.1016/j.athoracsur.2016.10.076.Badhwar V, Rankin JS, Damiano RJ, et al. The Society of Thoracic Surgeons 2017 clinical practice guidelines for the surgical treatment of atrial fibrillation. Ann Thorac Surg. 2017;103: 329-41. https://doi.org/10.1016/j.athoracsur.2016.10.076.Guo H, Qing H, Zhang Y, et al. Stand-alone surgical ablation for atrial fibrillation: a novel bilateral double-port approach. J Thorac Dis. 2019;11: 1989-95. https://doi.org/10.21037/jtd.2019.04.98.Guo H, Qing H, Zhang Y, et al. Stand-alone surgical ablation for atrial fibrillation: a novel bilateral double-port approach. J Thorac Dis. 2019;11: 1989-95. https://doi.org/10.21037/jtd.2019.04.98.Yu C, Li H, Zhang H, et al. Midterm results of standalone thoracoscopic epicardial ablation with box lesion for atrial fibrillation. Interact Cardiovasc Thorac Surg. 2021;33(3): 354-361. https://doi.org/10.1093/icvts/ivab148.Yu C, Li H, Zhang H, et al. Midterm results of standalone thoracoscopic epicardial ablation with box lesion for atrial fibrillation. Interact Cardiovasc Thorac Surg. 2021;33(3): 354-361. https://doi.org/10.1093/icvts/ivab148.Guo QZ, Zhu D, Bai ZX, et al. A novel “box lesion” minimally invasive totally thoracoscopic surgical ablation for atrial fibrillation. Ann Acad Med Singap. 2015;44(1): 6-12.Guo QZ, Zhu D, Bai ZX, et al. A novel “box lesion” minimally invasive totally thoracoscopic surgical ablation for atrial fibrillation. Ann Acad Med Singap. 2015;44(1): 6-12.Boersma LV, Castella M, van Boven W, et al. Atrial fibrillation catheter ablation versus surgical ablation treatment (FAST): a 2-center randomized clinical trial. Circulation. 2012;125: 23-30. https://doi.org/10.1161/CIRCULATIONAHA.111.074047.Boersma LV, Castella M, van Boven W, et al. Atrial fibrillation catheter ablation versus surgical ablation treatment (FAST): a 2-center randomized clinical trial. Circulation. 2012;125: 23-30. https://doi.org/10.1161/CIRCULATIONAHA.111.074047.Sindby JE, Vadmann H, Lundbye-Christensen S, et al. Percutaneous versus thoracoscopic ablation of symptomatic paroxysmal atrial fibrillation: a randomised controlled trial-the FAST II study. J Cardiothorac Surg. 2018;13(1): 101. https://doi.org/10.1186/s13019-018-0792-8.Sindby JE, Vadmann H, Lundbye-Christensen S, et al. Percutaneous versus thoracoscopic ablation of symptomatic paroxysmal atrial fibrillation: a randomised controlled trial-the FAST II study. J Cardiothorac Surg. 2018;13(1): 101. https://doi.org/10.1186/s13019-018-0792-8.Ревишвили АШ, Таймасова ИА, Артюхина ЕА, и др. Среднесрочные результаты торакоскопического и гибридного лечения фибрилляции предсердий. Вестник аритмологии. 2021;28(3): 5-12. https://doi.org/10.35336/VA-2021-3-5-12.Revishvili ASh, Taimasova IA, Artyukhina EA, et al. Mid-term outcomes of thoracoscopic and hybrid therapy of atrial fibrillation. Journal of Arrhythmology. 2021;28(3): 5-12. (In Russ.) https://doi.org/10.35336/VA-2021-3-5-12.Pison L, La Meir M, van Opstal J, et al. Hybrid thoracoscopic surgical and transvenous catheter ablation of atrial fibrillation. J Am Coll Cardiol. 2012;60: 54-61. https://doi.org/10.1016/j.jacc.2011.12.055.Pison L, La Meir M, van Opstal J, et al. Hybrid thoracoscopic surgical and transvenous catheter ablation of atrial fibrillation. J Am Coll Cardiol. 2012;60: 54-61. https://doi.org/10.1016/j.jacc.2011.12.055.Beyer E, Lee R, Lam BK. Point: Minimally invasive bipolar radiofrequency ablation of lone atrial fibrillation: early multicenter results. J Thorac Cardiovasc Surg. 2009;137(3): 521-526. https://doi.org/10.1016/j.jtcvs.2008.11.031.Beyer E, Lee R, Lam BK. Point: Minimally invasive bipolar radiofrequency ablation of lone atrial fibrillation: early multicenter results. J Thorac Cardiovasc Surg. 2009;137(3): 521-526. https://doi.org/10.1016/j.jtcvs.2008.11.031.van Laar C, Kelder J, van Putte BP. The totally thoracoscopic maze procedure for the treatment of atrial fibrillation. Interact Cardiovasc Thorac Surg. 2017;24: 102-111. https://doi.org/10.1093/icvts/ivw311.van Laar C, Kelder J, van Putte BP. The totally thoracoscopic maze procedure for the treatment of atrial fibrillation. Interact Cardiovasc Thorac Surg. 2017;24: 102-111. https://doi.org/10.1093/icvts/ivw311.Vos LM, Bentala M, Geuzebroek GS, et al. Long-term outcome after totally thoracoscopic ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2020;31(1): 40-45. https://doi.org/10.1111/jce.14267.Vos LM, Bentala M, Geuzebroek GS, et al. Long-term outcome after totally thoracoscopic ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2020;31(1): 40-45. https://doi.org/10.1111/jce.14267.Choi MS, On YK, Jeong DS, et al. Usefulness of Postprocedural Electrophysiological Confirmation Upon Totally Thoracoscopic Ablation in Persistent Atrial Fibrillation. Am J Cardiol. 2020;125(7): 1054-1062. https://doi.org/10.1016/j.amjcard.2019.12.046.Choi MS, On YK, Jeong DS, et al. Usefulness of Postprocedural Electrophysiological Confirmation Upon Totally Thoracoscopic Ablation in Persistent Atrial Fibrillation. Am J Cardiol. 2020;125(7): 1054-1062. https://doi.org/10.1016/j.amjcard.2019.12.046.van der Heijden CAJ, Weberndörfer V, Luermans JGLM, et al. Hybrid ablation of atrial fibrillation: A unilateral left-sided thoracoscopic approach. J Card Surg. 2022;10.1111/jocs.17144. https://doi.org/10.1111/jocs.17144.van der Heijden CAJ, Weberndörfer V, Luermans JGLM, et al. Hybrid ablation of atrial fibrillation: A unilateral left-sided thoracoscopic approach. J Card Surg. 2022;10.1111/jocs.17144. https://doi.org/10.1111/jocs.17144.Hong KN, Russo MJ, Liberman EA, et al. Effect of epicardial fat on ablation performance: a three-energy source comparison. J Card Surg. 2007;22: 521-524. https://doi.org/10.1111/j.1540-8191.2007.00454.x.Hong KN, Russo MJ, Liberman EA, et al. Effect of epicardial fat on ablation performance: a three-energy source comparison. J Card Surg. 2007;22: 521-524. https://doi.org/10.1111/j.1540-8191.2007.00454.x.Osmancik P, Budera P, Zdarska J, et al. Electrophysiological findings after surgical thoracoscopic atrial fibrillation ablation. Heart Rhythm. 2016;13: 1246-1252. https://doi.org/10.1016/j.hrthm.2016.02.007.Osmancik P, Budera P, Zdarska J, et al. Electrophysiological findings after surgical thoracoscopic atrial fibrillation ablation. Heart Rhythm. 2016;13: 1246-1252. https://doi.org/10.1016/j.hrthm.2016.02.007.Khoynezhad A, Warrier N, Worthington T, et al. A narrative review of hybrid ablation for persistent and long-standing persistent atrial fibrillation. Ann Transl Med. 2021;9(11): 947. https://doi.org/10.21037/atm-21-196.Khoynezhad A, Warrier N, Worthington T, et al. A narrative review of hybrid ablation for persistent and long-standing persistent atrial fibrillation. Ann Transl Med. 2021;9(11): 947. https://doi.org/10.21037/atm-21-196.Vos LM, Kotecha D, Geuzebroek GSC, et al. Totally thoracoscopic ablation for atrial fibrillation: a systematic safety analysis. Europace. 2018;20(11): 1790-1797. https://doi.org/10.1093/europace/eux385.Vos LM, Kotecha D, Geuzebroek GSC, et al. Totally thoracoscopic ablation for atrial fibrillation: a systematic safety analysis. Europace. 2018;20(11): 1790-1797. https://doi.org/10.1093/europace/eux385.Prosper A, Shinbane J, Maliglig A, et al. Left Atrial Appendage Mechanical Exclusion: Procedural Planning Using Cardiovascular Computed Tomographic Angiography. J Thorac Imaging. 2020; 35(4): 107-118. https://doi.org/10.1097/RTI.0000000000000504.Prosper A, Shinbane J, Maliglig A, et al. Left Atrial Appendage Mechanical Exclusion: Procedural Planning Using Cardiovascular Computed Tomographic Angiography. J Thorac Imaging. 2020; 35(4): 107-118. https://doi.org/10.1097/RTI.0000000000000504.Yan T, Zhu S, Zhu M, et al. Clinical Performance of a Powered Surgical Stapler for Left Atrial Appendage Resection in a Video-Assisted Thoracoscopic Ablation for Patients with Nonvalvular Atrial Fibrillation. Int Heart J. 2021;62(4): 764-770. https://doi.org/10.1536/ihj.20-765.Yan T, Zhu S, Zhu M, et al. Clinical Performance of a Powered Surgical Stapler for Left Atrial Appendage Resection in a Video-Assisted Thoracoscopic Ablation for Patients with Nonvalvular Atrial Fibrillation. Int Heart J. 2021;62(4): 764-770. https://doi.org/10.1536/ihj.20-765.Di Biase L, Burkhardt JD, Mohanty P, et al. Left atrial appendage isolation in patients with longstanding persistent AF undergoing catheter ablation: BELIEF trial. J Am Coll Cardiol. 2016;68:1929-40. https://doi.org/10.1016/j.jacc.2016.07.770.Di Biase L, Burkhardt JD, Mohanty P, et al. Left atrial appendage isolation in patients with longstanding persistent AF undergoing catheter ablation: BELIEF trial. J Am Coll Cardiol. 2016;68:1929-40. https://doi.org/10.1016/j.jacc.2016.07.770.Probst J, Jideus L, Blomstrom P, et al. Thoracoscopic epicardial left atrial ablation in symptomatic patients with atrial fibrillation. Europace. 2016;18: 1538-1544. https://doi.org/10.1093/europace/euv438.Probst J, Jideus L, Blomstrom P, et al. Thoracoscopic epicardial left atrial ablation in symptomatic patients with atrial fibrillation. Europace. 2016;18: 1538-1544. https://doi.org/10.1093/europace/euv438.van Laar C, Bentala M, Weimar T, et al. Thoracoscopic ablation for the treatment of atrial fibrillation: a systematic outcome analysis of a multicentre cohort. Europace. 2019;21(6): 893-899. https://doi.org/10.1093/europace/euy323.van Laar C, Bentala M, Weimar T, et al. Thoracoscopic ablation for the treatment of atrial fibrillation: a systematic outcome analysis of a multicentre cohort. Europace. 2019;21(6): 893-899. https://doi.org/10.1093/europace/euy323.

The authors declare that there are no conflicts of interest present.