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Introduction: There are several prognostic scores for the assessment of risk of atrial fibrillation (AF) recurrence post ablation procedure. However, the use of these complex scores is difficult and the validation on different populations brought divergent results. Our goal was to compare the performance of these risk scores as the basis for the development of a new, simplified score based only on few universally predictive variables. Methods: All cryoballoon‐based AF ablations performed in a single‐center over a 10‐year period were prospectively analyzed with regard to AF recurrence. This served to analyze the performance of APPLE, CAAP‐AF, SCALE‐CryoAF, MB‐LATER, CHADS2, and CHA2DS2‐VASc risk scores. Results: A total of 597 patients, mostly (78.1%) with paroxysmal AF were studied. Analyzed risk scores performed poorer than in the original publications because some risk factors were not predictive of AF recurrence. A simplified score named 0‐1‐2 PL, composed of just two universally predictive variables, AF type (1 point for Persistent AF) and LA dimension (1 point for LA size >45 mm) was developed. The 0‐1‐2 PL score stratified patients into low risk (0 points), intermediate risk (1 point), and high risk categories (2 points) which were related to a 2‐year risk of AF recurrence of 21%, 37%, and 55%, respectively. This score had C‐statistics (0.620) higher/comparable to other investigated much more complex scores. Conclusion: The assessment of risk of AF recurrence at the pre‐ablation stage can be simplified without compromising accuracy. This could help to popularize risk assessment and standardization of AF management. [ABSTRACT FROM AUTHOR]

Background: One of the challenges of left bundle branch (LBB) pacing is placing the pacing lead deep enough in the septum to reach the LBB area, yet not too deep to avoid perforation.Objective: The purpose of this study was to investigate whether the occurrence of the ectopic beats with qR/rsR' morphology in lead V1 (fixation beats) during lead fixation would predict whether the desired intraseptal lead depth had been reached, whereas the lack of fixation beats would indicate a too-shallow position and the need for more lead rotations.Methods: Consecutive patients during LBB pacing device implantation were analyzed retrospectively and then prospectively with respect to the occurrence of fixation beats during each episode of lead rotation. We compared the presence of fixation beats during the lead rotation event directly before the LBB area depth was reached vs during the events before intermediate/unsuccessful positions.Results: A total of 339 patients and 1278 lead rotation events were analyzed. In the retrospective phase, fixation beats were observed in 327 of 339 final lead positions and in 9 of 939 intermediate lead positions (P <.001). Sensitivity, specificity, and positive and negative predictive values of the fixation beats as a marker for reaching the LBB area were 96.4%, 97.3%, 97.3%, and 96.5%, respectively. In the prospective, fixation beats-guided implantation phase, fixation beats were observed in all patients and only at the LBB capture depth.Conclusion: Monitoring fixation beats during deep septal lead deployment can facilitate the procedure and possibly increase the safety of lead implantation. [ABSTRACT FROM AUTHOR]

We investigated prognostic value of four recently proposed ECG markers in patients with cardiac resynchronization therapy (CRT): 1./ pathological preimplantation QRS axis, 2./ increase in QRS amplitude in V3 during biventricular pacing, 3./ negative QRS in V1/V2 during left ventricular (LV)-only pacing, 4./ longer QRS duration during LV-only pacing. A longitudinal cohort study was performed (n = 552).Results: During the 9-year observation period the primary endpoint (death from any cause or urgent heart transplantation) was met in 232 patients. The secondary endpoint of survival free of heart failure hospitalization was met in 292 patients. Long LV-paced QRS and pathological axis predicted unfavorable prognosis in Kaplan-Meier analysis. In multivariable Cox model (functional class, LV ejection fraction, LV end-diastolic dimension, permanent atrial fibrillation, age, gender, heart failure etiology, creatinine level, diabetes mellitus), LV-paced QRS duration remained a significant determinant of both endpoints. The other studied ECG markers lacked independent prognostic value. [ABSTRACT FROM AUTHOR]