scholarly journals Durable pulmonary vein (PV) isolation at repeat atrial fibrillation (AF) ablation procedure: a comparison between 4 ablation technologies

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Morales ◽  
E Boghossian ◽  
A Rajendra ◽  
J Osorio
Keyword(s):  
Catheter Ablation ◽  
Contact Force ◽  
Force Sensor ◽  
Funding Source ◽  
Ablation Procedure ◽  
Af Ablation ◽  
Repeat Procedure ◽  
Sf 36 ◽  
The Mean ◽  
Catheter Technology

Abstract Background Durable PV isolation is the sought-after endpoint to obtain long term success after AF catheter ablation. Evolution in technology improves efficiency, safety and effectiveness in AF catheter ablation. Purpose To investigate the effectiveness of different catheter technologies in obtaining durable PV isolation in a real-world practice. Methods Retrospective analysis of prospectively collected data of patients undergoing repeat procedures for recurrence of AF or atrial flutter at our institution was performed. Incidence of all PVs being isolated at repeat procedure was recorded and patients 4 groups created based on catheter technology used during index AF ablation procedure (SF: multipored, irrigated catheter; ST: contact force sensor catheter; Cryo: 2nd generation cryobaloon; and STSF: multipored, irrigated, contact force sensing catheter). Results We identified 269 subjects undergoing repeat ablation from May 2014 to September 2019. Mean age was 67±9.7 years, 54.6% were males, 74.4% non-paroxysmal AF at the index procedure. The mean CHA2DS2Vasc score was 2.5±0.26, LA size 4.2±0.6 cm, EF 55.3±10%. The mean time from index to redo procedure was 374±331 days. At repeat procedure all veins were isolated in 24% (6/25) who were initially ablated using SF; 36% (8/22) with Cryo; 44% (47/108) with ST; and 74% (84/114) with STSF catheter. (Figure) Conclusion Patients undergoing index ablation with STSF catheter technology were significantly more likely to have all 4 PVs isolated at repeat procedure compared to previous generation technology. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Biosense Webster

scholarly journals The role of intracardiac echocardiography in reducing radiation exposure during atrial fibrillation ablation

2021 ◽  
Author(s):  
Ioan-Alexandru Minciuna ◽  
Mihai Puiu ◽  
Gabriel Cismaru ◽  
Radu Roșu ◽  
Raluca Tomoaia ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Learning Curve ◽  
Radiation Exposure ◽  
Intracardiac Echocardiography ◽  
Procedure Time ◽  
Af Ablation ◽  
Total Procedure Time ◽  
The Mean

Aims: Intracardiac echocardiography (ICE) is a relatively young technique used during complex electrophysiology proce-dures, such as atrial fibrillation (AF) ablation. The aim of this study was to assess whether the use of ICE modifies the radia-tion exposure at the beginning of the learning curve in AF ablation. Materials and methods: In this retrospective study, 52 patients, in which catheter ablation for paroxysmal or persistent AF was performed, were included. For 26 patients we used ICE guidance together with fluoroscopy, whereas for the remaining 26 patients we used fluoroscopy alone, all supported by electroanatomical mapping. We compared total procedure time and radiation exposure, including fluoroscopy dose and time between the two groups and along the learning curve. Results: Most of the patients included were suffering from paroxysmal AF (40, 76%), pulmonary vein isolation being performed in all patients, without secondary ablation sites. The use of ICE was associated with a lower fluoroscopy dose (11839.60±6100.6 vs. 16260.43±8264.5 mGy, p=0.041) and time (28.00±12.5 vs. 42.93±12.7 minutes, p=0.001), whereas the mean procedure time was similar between the two groups (181.54±50.3 vs 197.31±49.8 minutes, p=0.348). Radiation exposure was lower in the last 9 months compared to the first 9 months of the study (p<0.01), decreasing gradually along the learning curve. Conclusions: The use of ICE lowers radiation exposure in AF catheter ablation from the beginning of the learning curve, without any difference in terms of acute safety or efficacy. Aware-ness towards closest to zero radiation exposure during electrophysiology procedures should increase in order to achieve better protection for both patient and medical staff.

scholarly journals Short coupling with high burden of atrial ectopy in twenty-four hour holter recording predicts recurrence of atrial arrhythmia after atrial fibrillation ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Okajima ◽  
H Imai ◽  
Y Murase ◽  
N Kano ◽  
Y Ogawa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Atrial Arrhythmia ◽  
Controlled Study ◽  
Ablation Procedure ◽  
High Burden ◽  
Af Ablation ◽  
Atrial Ectopy ◽  
Holter Recordings

Abstract Background Atrial arrhythmia recurrence is experienced in up to 20% of patients after initially receiving a catheter ablation for atrial fibrillation (AF). Therefore, it is important to define predictors of atrial arrhythmia recurrence. Atrial ectopy (AE) with short coupling interval (S-AE) has been reported to be a trigger of AF. On the other hand, high burden of AE has been reported to be a useful predictor of atrial arrhythmia recurrences after AF ablation. Thus, the combination of the incidence of S-AE and AE burden during a 24-hour Holter recording could be a useful predictor of atrial arrhythmia recurrence after AF ablation. Purpose To investigate this hypothesis, we performed a retrospective case-controlled study. Methods We enrolled 180 patients who underwent their first catheter ablation procedure for AF and performed a 24-hour Holter recording between 90 to 365 days after their ablation procedure. Patients who performed an additional ablation procedure before the Holter recording were excluded. Finally, we analyzed 173 patients (age: 65±10 years, female: 28.3%, non-paroxysmal: 27.7%). The Holter recordings were analyzed by the same experienced technicians. We defined AE as a narrow QRS complex occurring &gt;25% than prior R-R interval, and S-AE as AE occurring &gt;55% earlier than expected. The relationship between the characteristics of AE during the Holter recording and atrial arrhythmia recurrences was investigated. Results The Holter recordings were performed at a median of 103 (IQR: 98–138) days after ablation. The median number of AE were 144 (IQR: 54–699) beats per day, and S-AE was recorded in 49 patients (28.3%). Forty-two patients (24.3%) had a recurrence of atrial arrhythmia during a median 488-day follow up period. Patients with S-AE had a recurrence of atrial arrhythmia more frequently than those without S-AE (44.9% vs 16.1%, p&lt;0.001). We found the cut-off point of AE burden as 241 beats per day by the receiver operating characteristic curve with 74% sensitivity and 70% specificity to predict atrial arrhythmia recurrence. We divided the patients into four groups according to the presence or absence of S-AE and high AE burden. In the Kaplan-Meier analysis, patients with S-AE and high AE burden had the highest atrial arrhythmia recurrence rate (Log-rank test: p&lt;0.001). In the Cox multivariate analysis, S-AE with high AE burden was an independent predictor of atrial arrhythmia recurrence (HR: 4.27, 95% CI: 2.32–7.85, p&lt;0.001). Conclusion For AF patients who underwent their first catheter ablation, S-AE (&gt;55% earlier than expected) with high AE burden (&gt;241 beats per day) during the 24-hour Holter recording predicted recurrences of atrial arrhythmia. These results can help to develop follow-up strategies after AF ablation. Funding Acknowledgement Type of funding source: None

scholarly journals Protection of the Esophagus During Catheter Ablation of Atrial Fibrillation

2020 ◽  
Author(s):  
Mahmoud Houmsse ◽  
Emile Daoud
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Potential Risk ◽  
High Frequency ◽  
Esophageal Injury ◽  
Ablation Procedure ◽  
High Occurrence ◽  
Af Ablation ◽  
Important Concern

Esophageal injury still occurs with high frequency during ablation of atrial fibrillation (AF). The purpose of this study is to provide a review of methods to protect the esophagus from injury during AF ablation. Despite advances in imaging and ablation, the potential risk of esophageal injury during AF ablation remains an important concern with a high occurrence of esophageal injury (≈15%). There have been numerous studies evaluating varied techniques for esophageal protection including active cooling and displacement of the esophagus. These techniques are reviewed in this manuscript as well as the role of esophageal protection in managing patients undergoing AF ablation procedure.

scholarly journals Perioperative coronary artery spasms in patients undergoing catheter ablation of atrial fibrillation

2021 ◽  
Author(s):  
Masato Hachisuka ◽  
Yuhi Fujimoto ◽  
Eiichiro Oka ◽  
Hiroshi Hayashi ◽  
Teppei Yamamoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Catheter Ablation ◽  
Case Reports ◽  
Rare Complication ◽  
Smoking Habit ◽  
Ablation Procedure ◽  
Af Ablation ◽  
Number Of Patients ◽  
Life Threatening

Abstract Purpose Catheter ablation (CA) is an established treatment for atrial fibrillation (AF). Although coronary artery spasms (CAS) during or after ablation procedures have been described as a rare complication in some case reports, the incidence and characteristics of this complication have not been fully elucidated. The present observational study aimed to clarify the CAS in a large number of patients experiencing AF ablation. Methods A total of 2913 consecutive patients (male: 78%, mean 66 ± 10 years) who underwent catheter ablation of AF were enrolled. Results Nine patients (0.31%, mean 66 ± 10 years, 7 males) had transient ST-T elevation (STE). Eight out of the 9 patients had STE in the inferior leads. STE occurred after the transseptal puncture in 7 patients, after the sheath was pulled out of the left atrium in 1, and 2 h after the ablation procedure in 1. Six patients had definite angiographic CAS without any sign of an air embolization on the emergent coronary angiography. In the3 other patients, the STE improved either directly after an infusion of nitroglycerin or spontaneously before the CAG. The patients with CAS had a higher frequency of a smoking habit (89% vs. 53%; P = .04), smaller left atrial diameter (36 ± 6 vs. 40 ± 7; P = .07), and lower CHADS2 score (0.6 ± 0.5 vs. 1.3 ± 1.1; P = .004) than those without. Conclusions Although the incidence was rare (0.31%), CAS should be kept in mind as a potentially life-threatening complication throughout an AF ablation procedure especially performed under conscious sedation.

scholarly journals Healthcare utilization and outcomes in atrial fibrillation ablation patients with and without insertable cardiac monitoring

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.C Mansour ◽  
E.M Gillen ◽  
A Garman ◽  
S Rosemas ◽  
P.D Ziegler ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Healthcare Utilization ◽  
Cardiac Monitoring ◽  
Funding Source ◽  
Detection Rates ◽  
Af Ablation ◽  
Af Recurrence ◽  
Clinic Visits

Abstract Background Atrial fibrillation (AF) is associated with increased risk of stroke and progression to heart failure, and as a result, increased mortality. Catheter ablation can reduce AF burden, potentially allowing discontinuation from anticoagulant medication in some patients. Post ablation, guidelines recommend ECG monitoring in patients discontinuing anticoagulation to monitor potential AF recurrence. Short-term ECG monitors have lower detection rates for AF recurrence, while long-term insertable cardiac monitors (ICM) increase detection rates and the opportunity to manage and treat AF, when it recurs. Whether more intensive monitoring via ICMs translates to improvements in health outcomes or reduced costs is not well understood. Purpose We examined healthcare utilization/costs and anticoagulant discontinuation following AF ablation, in patients with vs. without ICM. Methods Patients with a catheter ablation for AF between January 1, 2011 - March 31, 2018 were identified in a large U.S. administrative claims database. Patients with ICM implant within 1 year pre- or post-ablation were propensity score matched to patients without ICM, based on: demographics, comorbidities, CHAD2S2-VASc score, medication use and healthcare costs in baseline. Results A total of 691 ICM patients were identified and matched 1:3 with 2,073 non-ICM patients. Mean age was 65 years, 38% were female, and mean (SD) CHAD2S2-VASc was 2.29 (1.53). During an average follow-up from ablation discharge of 37 (19) months, ICM patients incurred fewer AF- and HF-related hospitalizations: mean 0.51 (0.91) vs. 0.62 (1.56) AF-related, p=0.018, and 0.14 (0.48) vs. 0.24 (1.30) HF-related hospitalizations per patient, p=0.00. Correspondingly, average per-patient costs for AF- and HF-related hospitalizations were lower in the ICM cohort: $13,041 ($30,831) vs. $17,140 ($55,576), p=0.016 and $3,921 ($17,865) vs. $6,746 ($33,148), p=0.005. The ICM cohort had a greater number of AF-related clinic visits during follow-up: 14.2 (13.0) vs. 10.2 (11.7) visits per patient, p&lt;0.0001. The proportion of patients undergoing a repeat AF ablation during follow-up was higher in the ICM cohort (22.3% vs. 18.3%, P&lt;0.0001), while the proportion with cardioversions was lower (21.0% vs. 25.1%, p=0.031). In patients indicated for anticoagulation (CHAD2S2-VASc≥2), the rate of anticoagulant discontinuation (defined as gap in coverage ≥90 days) was high in both cohorts: 89.5% and 84.6% of patients in ICM and non-ICM groups, respectively. Conclusions AF ablation patients with ICM experienced fewer AF- and HF-related hospitalizations/costs and fewer cardioversions during follow-up. The greater number of AF-related clinic visits and repeat AF ablations observed in ICM patients indicate closer management. Of note, anticoagulant discontinuation was similarly high in the non-ICM cohort despite guidelines recommending rigorous cardiac monitoring for AF recurrence in the context of discontinuation. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Medtronic

scholarly journals Impact of catheter ablation on HFpEF in people with comorbid atrial fibrillation and HFpEF using invasive haemodynamic testing

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Sugumar ◽  
S Nanayakkara ◽  
D Vizi ◽  
D Chieng ◽  
A Leet ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Output ◽  
Catheter Ablation ◽  
Peak Exercise ◽  
Funding Source ◽  
Af Ablation ◽  
Right Heart Catheterisation ◽  
Haemodynamic Changes ◽  
The Impact

Abstract Background The impact of catheter ablation (CA) for atrial fibrillation (AF) in patients with heart failure with preserved ejection fraction (HFpEF) is unknown. Objectives To determine whether CA for AF reverses adverse haemodynamic changes associated with HFpEF. Methods Consecutive consenting patients with EF ≥50% scheduled for index CA underwent baseline exercise right heart catheterisation (exRHC), cardiac output (CO) measurement, cardiac MRI, echocardiogram, QOL questionnaires and BNP testing. HFpEF was defined by resting pulmonary capillary wedge pressure (PCWP) ≥15mmHg or peak exercise PCWP ≥25 mmHg during exRHC. Patients with HFpEF were offered follow-up exRHC ≥6 months post-CA. Results Of 252 patients scheduled for CA between April 2017 and Sept 2019, 131 (51.9%) qualified for inclusion, 65 (49.6%) consented to exRHC and 11 (16.9%) were excluded due to a subsequent decrease in EF (10) and uncontrolled hypertension (1). Fifty-four underwent exRHC, with 35 (65%) meeting criteria for HFpEF. Of them 26 (74.3%) who underwent CA, 20 (77%) had a follow up exRHC at 12±6 months follow-up, showing an overall decrease in peak exercise PCWP from 30.3±4.2 to 26.8±4.7 mmHg (p&lt;0.05). Patients without arrhythmia recurrence showed significant improvements in peak exercise PCWP (29.2±3.7 to 22.9±2.0 mmHg (p&lt;0.01). Their cardiac output increased from 10.3±3.0 to 12.1±4.0 mmHg p=0.1), and BNP decreased from (94.6±101.6 to 38.0±34.0 mmHg (p=0.06),whereas those with arrhythmia recurrence did not. Overall, 9 patients (45.0%) no longer met criteria for HFpEF. Conclusion There is a high prevalence of HFpEF in people referred for AF ablation. Successful CA for AF reverses the adverse haemodynamic changes associated with HFpEF Changes in PCWP following AF ablation Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): NHMRC, NHF, RACP

Abstract 5663: Intracardiac Echocardiography From Within the Left Atrium Improves the Accuracy of Image Integration During Catheter Ablation of Atrial Fibrillation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Sheldon M Singh ◽  
E. Kevin Heist ◽  
David M Donaldson ◽  
Theofanie Mela ◽  
Jeremy N Ruskin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Intracardiac Echocardiography ◽  
Surface Registration ◽  
List Type ◽  
Image Integration ◽  
Ablation Procedure ◽  
Af Ablation ◽  
Integration Error

Background: Intracardiac echocardiography (ICE) can be integrated with pre-procedural CT or MR imaging to direct catheter ablation of atrial fibrillation (AF). Prior work has described ICE imaging of the left atrium (LA) with the ICE probe in the RA, but it is feasible to image the LA from an ICE probe placed directly into the LA via a trans-septal puncture performed for the mapping/ablation procedure. The purpose of this study was to determine whether direct LA imaging with ICE results in improved image integration during AF ablation compared with LA imaging indirectly from the RA. Methods: Twenty-five consecutive patients undergoing an AF ablation procedure with the CARTO-Sound system were studied. A 10 French phased array catheter with an embedded CARTO navigation sensor was employed to provide 2D echocardiogram images of the LA - 13 patients underwent imaging from the RA alone and 12 patients from the LA. The accuracy of the image integration was assessed by the average integration error after surface registration and the requirement to take supplementary electroanatomic mapping points to obtain acceptable image integration. Results: Twenty-five patients (56% paroxysmal AF, average LA size = 42±8 mm, average EF = 63±10 %) were examined. There was no difference in the time or number of ultrasound contours required to create a LA anatomic map with ICE imaging from the RA versus the LA (24±17min vs. 24±25min, P=1.0, 24±16 contours vs. 29±18 contours, P=0.5). The average integration error for all patients was 2.19±0.59mm. Direct LA imaging was associated with improved integration error compared to indirect LA imaging from the RA (1.85±0.33mm versus 2.51±0.62mm, P=0.004). Image integration using RA acquired LA images had a tendency to be less accurate resulting in the primary operator acquiring additional registration points to supplement the registration process (patients requiring additional registration points for registration: 3/12 for LA imaging versus 9/13 for RA imaging of the LA, P=0.05). Conclusion: Direct ICE imaging from within the LA is feasible and associated with improved accuracy of image integration during AF ablation.

scholarly journals Treatment of segmental tibial defects by bone transport with circular external fixation and a locking plate

2020 ◽  
Vol 48 (4) ◽  
pp. 030006052092040
Author(s):  
Yao Lu ◽  
Teng Ma ◽  
Cheng Ren ◽  
Zhong Li ◽  
Liang Sun ◽  
...  
Keyword(s):  
External Fixation ◽  
Locking Plate ◽  
Short Form ◽  
Clinical Results ◽  
Bone Transport ◽  
Fixation Index ◽  
Fixation Time ◽  
Sf 36 ◽  
Health Related ◽  
The Mean

Objective To evaluate the effectiveness of bone transport involving circular external fixation and locking plate application for the treatment of segmental tibial defects. Methods A retrospective review of 12 patients with segmental tibial defects who underwent bone transport with circular external fixation and locking plate application. We evaluated external fixation time, external fixation index, time to achieve union, and complications. Clinical results were assessed using the Association for the Study and Application of the Methods of Ilizarov (ASAMI) score. Generic health-related outcome was assessed using the 36-Item Short-Form Health Survey questionnaire (SF-36). Results The mean follow-up was 25.8 months, and the mean defect size was 6.7 cm. All of the patients achieved union at the distraction callus and docking site. The average external fixation time was 299.5 days. The mean external fixation index was 16.5 days/cm, and the mean healing index was 44.9 days/cm. The functional outcomes were excellent in eight cases and good in four. The average SF-36 score was 92. Conclusion Bone transport with external fixation and locking plate application may be a promising method for the treatment of segmental tibial defects.

Posterior circulation stroke: an easily overlooked complication of catheter ablation of atrial fibrillation

2020 ◽  
Vol 13 (8) ◽  
pp. e234661
Author(s):  
Tahir Nazir ◽  
Mohiuddin Sharief ◽  
James Farthing ◽  
Irfan M Ahmed
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Treatment Options ◽  
Posterior Circulation ◽  
Diagnosis And Treatment ◽  
Neurological Deficits ◽  
Cerebellar Infarction ◽  
Af Ablation ◽  
Posterior Circulation Stroke ◽  
Ventricular Response

Catheter ablation of atrial fibrillation (AF) has established itself as a safe and proven rhythm control strategy for selected patients with AF over the past decade. Thromboembolic complications of catheter ablation are becoming rare in anticoagulated patients with a risk of stroke reported as 0.3%. A particular challenge is posed by clinical presentation due to ischaemic stroke involving the posterior circulation following catheter ablation because of its substantial differences from the carotid territory stroke, making the timely diagnosis and treatment very difficult. It is crucial to keep an index of clinical suspicion in patients presenting with neurological deficits related to vertebrobasilar circulation following ablation. We describe the case of a man who presented with dizziness and palpitations after radiofrequency catheter ablation of AF. He was found to be in AF with a rapid ventricular response. His dizziness was initially attributed to the cardiac dysrhythmia. As his symptoms continued despite heart rate control, he underwent further investigations and was eventually diagnosed with a posterior circulation stroke resulting in left cerebellar infarction. He was treated with antiplatelet therapy and improved significantly over the following few days. We review and present an up-to-date brief literature review on the complications of catheter ablation of AF and describe pathophysiology, clinical features, diagnosis and treatment options for posterior circulation stroke after AF ablation. This case aims to raise awareness among clinicians about posterior circulation stroke after AF ablation.

scholarly journals Fatigue in patients with systemic lupus erythematosus and neuropsychiatric symptoms is associated with anxiety and depression rather than inflammatory disease activity

Lupus ◽  
2021 ◽  
pp. 096120332110050
Author(s):  
Rory C Monahan ◽  
Liesbeth JJ Beaart-van de Voorde ◽  
Jeroen Eikenboom ◽  
Rolf Fronczek ◽  
Margreet Kloppenburg ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Neuropsychiatric Symptoms ◽  
Anxiety And Depression ◽  
Systemic Lupus ◽  
Sf 36 ◽  
Neuropsychiatric Sle ◽  
Inflammatory Phenotype ◽  
The Mean

Introduction We aimed to investigate risk factors for fatigue in patients with systemic lupus erythematosus (SLE) and neuropsychiatric symptoms in order to identify potential interventional strategies. Methods Patients visiting the neuropsychiatric SLE (NPSLE) clinic of the Leiden University Medical Center between 2007–2019 were included. In a multidisciplinary consensus meeting, SLE patients were classified as having neuropsychiatric symptoms of inflammatory origin (inflammatory phenotype) or other origin (non-inflammatory phenotype). Fatigue was assessed with the SF-36 vitality domain (VT) since 2007 and the multidimensional fatigue inventory (MFI) and visual analogue scale (VAS) since 2011. Patients with a score on the SF-36 VT ≥1 standard deviation (SD) away from the mean of age-related controls of the general population were classified as fatigued; patients ≥2 SD away were classified as extremely fatigued. Disease activity was measured using the SLE disease activity index-2000. The influence of the presence of an inflammatory phenotype, disease activity and symptoms of depression and anxiety as measured by the hospital anxiety and depression scale (HADS) was analyzed using multiple regression analyses corrected for age, sex and education. Results 348 out of 371 eligible patients filled in questionnaires and were included in this study . The majority was female (87%) and the mean age was 43 ± 14 years. 72 patients (21%) had neuropsychiatric symptoms of an inflammatory origin. Fatigue was present in 78% of all patients and extreme fatigue was present in 50% of patients with an inflammatory phenotype vs 46% in the non-inflammatory phenotype. Fatigue was similar in patients with an inflammatory phenotype compared to patients with a non-inflammatory phenotype on the SF-36 VT (β: 0.8 (95% CI −4.8; 6.1) and there was less fatigue in patients with an inflammatory phenotype on the MFI and VAS (β: −3.7 (95% CI: −6.9; −0.5) and β: −1.0 (95% CI −1.6; −0.3)). There was no association between disease activity and fatigue, but symptoms of anxiety and depression (HADS) associated strongly with all fatigue measurements. Conclusion This study suggests that intervention strategies to target fatigue in (NP)SLE patients may need to focus on symptoms of anxiety and depression rather than immunosuppressive treatment.

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