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Atrial fibrillation (AF) and chronic kidney disease (CKD) are associated with an increased risk of ischemic stroke. The aim of this study was to compare the clinical characteristics, the incidence of left atrial appendage (LAA) thrombus and its predictors, and spontaneous echo contrast (SEC) in a population of patients with AF depending on estimated glomerular filtration rate (eGFR) values.This study included 1962 patients who underwent transesophageal echocardiographic examination prior to cardioversion or ablation in the years 2014-2018 in three cardiac centers.More than a quarter of AF patients had decreased eGFR (60 mL/min/1.73 m2) and were characterized as a high-risk population, with more comorbidities, higher thromboembolic and bleeding risk compared to those with normal renal function. Oral anticoagulation (OAC) was prescribed in 97% and 93% of patients with decreased and normal eGFR, respectively, with a higher prevalence of prescribed non-vitamin K antagonist oral anticoagulants (NOACs). The incidence of LAA thrombus (24%, 9% and 4%) and SEC (25%, 25% and 19%) increases simultaneously with a decrease in eGFR (30, 30-59 and ≥ 60 mL/min/1.73 m2, respectively). Among patients prescribed reduced doses of NOAC, those with decreased eGFR were more often observed with LAA thrombus (10% vs. 2.5%). Non-paroxysmal AF, heart failure and previous bleeding were predictors of LAA thrombus, irrespective of eGFR value. CKD was the predictor of LAA thrombus in all patients including those with non-paroxysmal AF, males, without diabetes, without hypertension and with CHA2DS2-VASc2.Despite OAC, patients with concomitant AF and CKD remain at high risk for LAA thrombus formation.

Background: The aim of the study was to compare 7 available risk models in the prediction of 30-day mortality following transcatheter aortic valve implantation (TAVI). Heart team decision supported by different risk score calculations is advisable to estimate the individual procedural risk before TAVI. Methods: One hundred and fifty-six consecutive patients (n = 156, 48% female, mean age 80.03 ± 8.18 years) who underwent TAVI between March 2010 and October 2014 were in­cluded in the study. Thirty-day follow-up was performed and available in each patient. Base­line risk was calculated according to EuroSCORE I, EuroSCORE II, STS, ACEF, Ambler’s, OBSERVANT and SURTAVI scores. Results: In receiver operating characteristics analysis, neither of the investigated scales was able to distinguish between patients with or without an endpoint with areas under the curve (AUC) not exceeding 0.6, as follows: EuroSCORE I, AUC 0.55; 95% confidence intervals (CI) 0.47–0.63, p = 0.59; EuroSCORE II, AUC 0.59; 95% CI 0.51–0.67, p = 0.23; STS, AUC 0.55; 95% CI 0.47–0.63, p = 0.52; ACEF, AUC 0.54; 95% CI 0.46–0.62, p = 0.69; Ambler’s, AUC 0.54; 95% CI 0.46–0.62, p = 0.70; OBSERVANT, AUC 0.597; 95% CI 0.52–0.67, p = 0.21; SURTAVI, AUC 0.535; 95% CI 0.45–0.62, p = 0.65. SURTAVI model was calibrated best in high-risk patients showing coherence between expected and observed mortality (10.8% vs. 9.4%, p = 0.982). ACEF demonstrated best classification accuracy (17.5% vs. 6.9%, p = 0.053, observed mortality in high vs. non-high-risk cohort, respectively). Conclusions: None of the investigated risk scales proved to be optimal in predicting 30-day mortality in unselected, real-life population with aortic stenosis referred to TAVI. This data supports primary role of heart team in decision process of selecting patients for TAVI.

Background: The aims of the study are 1) to assess antiarrhythmic prophylaxis efficacy dur­ing the first 2 months after radiofrequency ablation (ARF) due to AF; 2) to define risk factors for early AF recurrence (EAFR) after ARF; 3) to determine the long-term follow-up results and risk factors for late AF recurrence (LAFR). Methods: A total number of 210 consecutive patients who had undergone ARF due to AF were analyzed. Patients were randomized into three groups: Group 1 (G1), without any anti­arrhythmic drug (AAD); Group 2 (G2), with amiodarone or sotalol; Group 3 (G3), with last ineffective AAD. The study was designed to analyze two periods: short-term observation, the first 2 months after ARF; and at least 2 years of long-term follow-up. Results: After 2 months, clinical data were collected from 171 patients (123 males, mean age of 50.3 years; persistent AF in 19.8%; lone AF in 36.6%). Sinus rhythm (SR) was maintained in 84 (49.1%) patients; 35 (20.4%) patients presented with a single episode of AF, 39 (23%) patients experienced a reduction in number of AF episodes, and 13 (7.5%) patients showed no improvement. No predisposing factor for early recurrence was found. After a mean follow-up of 55 months, clinical data were collected in 137 patients, of which 47 (34%) maintained SR. Those more likely to sustain SR were: males (82.9% vs. 62.2%; p = 0.018), younger patients (44.8 ± 12.7 vs. 52.5 ± 9.9; p = 0.0001), patients with smaller left atrium diameter (4.05 ± ± 0.49 cm vs. 4.25 ± 0.51 cm; p = 0.04), and those without any AF recurrence during the first 2 months after ARF (78.7% vs. 35.6%; p < 0.0001). In the multivariable analysis, the inde­pendent risk factors for LAFR were hypertension (p < 0.001) and persistent AF (p = 0.014). Conclusions: Antiarrhythmic prophylaxis does not affect the number of AF recurrences during the first 2 months after ablation. SR maintenance during a blanking period after AF ablation is a positive prognostic factor in long-term follow-up. Persistent AF and hypertension are independent risk factors for late AF recurrence after pulmonary vein isolation.

A prospective, randomized study was conducted to evaluate the efficacy and tolerability of oral propafenone and quinidine for the conversion of paroxysmal atrial fibrillation (AF).Eighty one consecutive patients (female/male 46/35; mean age 64.0 +/- 11.6), admitted to hospital with AF lasting no longer than 48 hours, were randomized in terms of their pharmacological therapy. Forty three patients (55%) were randomly assigned to Group I and received propafenone 600 mg orally as the initial therapy, with an additional dose of 300 mg after eight hours, if the sinus rhythm had not been restored by then. Thirty eight patients (45%) (Group II) received 1 mg digoxin IV followed by an oral loading of quinidine (400 mg followed by 200 mg every two hours).The conversion rate assessed after 24 hours was the same in both groups (Gr. I vs. Gr. II: 90.7 vs. 91.4%), with the same number of mild side effects (Gr. I vs. Gr. II: 37.2% vs. 45.7%). No life-threatening adverse events were reported. Propafenone achieved a higher efficacy rate during the first eight hours (83.3 vs. 54.3%; p = 0.01), with a significantly shorter time required to sinus rhythm recovery throughout the study period, with a median time of 165 min (95% confidence interval 120-278) vs. 360 min (95% confidence interval 298-650; p0.05). There was some indication of greater effectiveness of propafenone than quinidine in early sinus rhythm restoration in patients with: no structural heart disease, in those with an AF duration shorter than 12 hours, and in patients with an ejection fraction55%.Although both drugs revealed the same effectiveness, the conversion to sinus rhythm in the group treated with propafenone was observed more quickly despite the longer paroxysmal AF episode duration.