Summary and general discussion 165 CHAPTER 10 SUMMARY AND GENERAL DISCUSSION Introduction Cardiac electrophysiology, a subspecialty of cardiology, concentrates on the management of cardiac arrhythmias and the prevention of sudden cardiac death. Within the Erasmus MC a specialised team comprising cardiac electrophysiologists, fellows, nurse practitioners, nursing staff, technicians, and research personnel is committed to the treatment and care of individuals suffering from heart rhythm disorders. The treatment of heart rhythm disorders has evolved over the last decades to a broad spectrum of invasive and non-invasive therapies. The invasive treatment arsenal includes pacemakers, implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy (CRT), and catheter ablation of cardiac arrhythmias (1). Both cardiac implantable electronic device (CIED) therapy, and catheter ablation have further progressed in recent years, with associated improvement in effectiveness. Furthermore, patient centred care with an emphasis on shared decision making has entered the clinical arena. Presently, there is an enhanced accent on risk factor management, which may optimise therapy outcomes and as such was the underlying principle of this thesis. Part I – Evaluation of complications in atrial fibrillation management Summary Atrial fibrillation (AF) is a supraventricular tachyarrhythmia with uncoordinated atrial electrical activation (2). It is the most common cardiac arrhythmia in adults and constitutes a significant burden to patients, communal health, and health economy. The lifetime risk of AF in Europe is as high as 40% (2). In 2021 approximately 123,400 newly diagnosed AF cases were documented in the Netherlands (3). Currently, the first aim is to improve lifestyle management and initiate a more aggressive risk factor management. Secondly, patients with AF are at increased risk of stroke and the use of oral anticoagulation will reduce this risk, but in turn introduces a bleeding risk. Finally, a choice will be made between rate or rhythm control depending on patient preferences, symptoms, comorbidity, and anticipated 10
RkJQdWJsaXNoZXIy MTk4NDMw