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Background/Objectives: The present study introduces our targeted approach for concomitant surgical ablation (CSA) using non-invasive phase mapping (NIPM) and describes its effectiveness regarding freedom from atrial fibrillation (AF). Methods: This retrospective study included cardiac surgical patients undergoing preoperative NIPM for CSA guidance. The primary outcome was freedom from AF six months after surgery. Key secondary outcomes were freedom from AF at hospital discharge and three months, frequency of biatrial ablation, feasibility and safety, the rate of CSA, complications, and levels of biomarkers. The control group consisted of patients undergoing CSA without NIPM. Results: Forty-four patients (Control: n = 31/NIPM: n = 13) were included. The NIPM group was younger (64 vs. 71 years [p = 0.044]), had a lower EuroSCORE II (2.6 vs. 3.4 [p = 0.041]), and a smaller left atrial size (46 mm vs. 54 mm [p = 0.025]). Surgery duration was longer in the NIPM group (285 vs. 230 min [p = 0.037]) with similar aortic cross-clamp times. Preoperative NIPM resulted in an effective frequency of CSA of 93%. CSA was more extensive in the NIPM group, with biatrial ablation performed in 54% vs. 26% of patients (p = 0.09). Conclusions: Routine preoperative NIPM in patients with non-paroxysmal atrial fibrillation might aid in increasing the number of patients receiving concomitant surgical ablation and developing a personalized CSA approach for every patient. [ABSTRACT FROM AUTHOR]

New-onset atrial fibrillation after cardiac surgery (NOAF) is a frequent complication and is associated with postoperative stroke, increased mortality, prolonged hospital length of stay, and higher treatment costs. The structures maintaining NOAF are mainly unknown. Thus, the present study aims to describe electrophysiological patterns of NOAF that might be future therapeutic targets. We present preliminary data from an ongoing prospective single-center cohort study of patients developing NOAF. We have included consecutive patients undergoing cardiac surgery and monitored them for the first seven postoperative days for the development of NOAF. Patients presenting with NOAF underwent non-invasive electrophysiological mapping using a 252-electrocardiogram vest to identify focal and rotational potential drivers (PDs) of NOAF. After mapping, a computed tomography scan of the chest was performed to generate a 3-dimensional model of the atria, where the PDs were projected, thus allowing a visual identification of NOAF maintaining structures. The primary outcome was the electrophysiological description of PDs of NOAF and NOAF-maintaining structures within the atria. Of 205 enrolled patients, 62 (30%) developed NOAF. Electrophysiological mapping was performed in 23 NOAF patients (37%). A median of 29 (21-48[IQR]) rotational PDs and a median of 26 (20-35[IQR]) focal PDs were identified per patient. The most frequent localizations of rotational drivers were the upper half of the right atrium (23 patients, 100%), the inferior/posterior left atrium (22 patients, 96%), and the left pulmonary veins (22 patients, 96%). The most frequent localizations of focal drivers were the upper half of the right atrium (22 patients, 96%), the left (22 patients, 96%), and right pulmonary veins (20 patients, 87%). Based on these preliminary results, structures such as the upper right atrium might play a role in maintaining NOAF and thus be targets for future preventive or therapeutic strategies. As the study is ongoing with the opening of a second study center in 2024, more precise results allowing identification of risk factors for specific PD locations and associations with outcomes are expected. [ABSTRACT FROM AUTHOR]

Aims: New‐onset atrial fibrillation (NOAF) is the most common complication after cardiac surgery, occurring in 25–50% of patients. It is associated with post‐operative stroke, increased mortality, prolonged hospital length of stay, and higher treatment costs. Previous small observational studies have identified the left atrium as a source of the electrical rotors and foci maintaining NOAF, but confirmation by a large prospective clinical study is still missing. The aim of the proposed study is to investigate whether the source of NOAF lies in the left atrium. The correct identification of NOAF‐maintaining structures in cardiac surgical patients might offer potential therapeutic targets for prophylactic perioperative ablation strategies. Methods and results: This is a prospective single‐centre observational study of patients developing NOAF after cardiac surgery. The primary outcome is the description of NOAF‐maintaining structures within the atria. Key secondary outcomes include overall mortality, intensive care unit length of stay, hospital–ventilator‐free days, and proportion of persistent NOAF. In NOAF patients, the non‐invasive electrophysiological mapping will be conducted using a 252‐electrode electrocardiogram vest. After mapping, a low‐dose computed tomography scan of the chest will be performed to integrate the electrophysiological mapping results into a 3D picture of the heart. The study will include approximately 570 patients, of whom 30% (n = 170) are expected to develop NOAF. Sample size calculation revealed that 157 NOAF patients are necessary to assess the primary outcome. Patients will be tracked for a total of 5 years. Conclusions: This is the largest prospective study to date describing the electrophysiological mechanisms of NOAF using non‐invasive mapping. [ABSTRACT FROM AUTHOR]

We report on an impressive case of a previously healthy 47-year-old female Caucasian SARS-CoV-2 positive patient who died within 48 h after initial cardiac symptoms. Autopsy revealed necrotizing myocarditis and extensive microthrombosis as the cause of death. The interesting feature of this case is the combination of both myocarditis and extensive localized microthrombosis of cardiac capillaries. Microthrombosis was not present in other organs, and the patient did not show typical features of diffuse alveolar damage in the lungs. Taken together, our morphologic findings illustrate the angiocentric, microangiopathic, thromboinflammatory disease with significant thrombotic diathesis prevalent in COVID-19, which has been previously described in the literature, likely warranting thromboprophylaxis even in oligosymptomatic circumstances. This case also delineates several potential etiologies for microthrombosis, i.e., inflammatory reactions and primary hypercoagulative states. Further systematic analyses on risk stratification for receipt of prophylactic anticoagulation in COVID-19 are urgently required., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Menter, Cueni, Gebhard and Tzankov.)