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Mapping strategies that enhance understanding and therapy for atrial fibrillation (AF) remain essential. The paced electrogram feature analysis (PEFA) technique has previously identified slow conduction zones within the ventricle critical for ventricular fibrillation (VF) or ventricular tachycardia. This prospective, exploratory cohort study aimed to determine if PEFA identifies similar slow conduction zones in the left atrium (LA) of patients with AF compared to controls.The study compared patients with paroxysmal AF undergoing catheter ablation with a control group of non-AF patients undergoing left-side electrophysiological procedures. Four electrogram (EGM) characteristics were assessed in the LA at various locations: EGM duration (ms), last deflection (ms), voltage (mV), and latency (ms). Normal values were established from the control cohort and used to calculate the percentage of abnormal EGM features in AF patients. The study included 24 AF patients and 8 controls. AF patients exhibited a higher proportion of abnormal EGM values compared to controls: last deflection 17.2%, latency 16.4%, voltage 8.5%, and EGM duration 9.8%. Normal values determined from the analysis were: 201.5 ms for last deflection, 84.3 ms for EGM duration, 77.7 ms for latency, and 0.26 mV for voltage. This study employed PEFA in the LA to identify previously undescribed metrics of atrial myopathy associated with AF. PEFA represents a potential method for characterizing the AF substrate by targeting abnormal atrial responses to closely coupled stimulation. [ABSTRACT FROM AUTHOR]

We investigated whether posterior left atrial (LA) box isolation (BOXI) improved the rhythm outcome of catheter ablation in persistent atrial fibrillation (AF) when compared with complex fractionated atrial electrograms (CFAE) ablation. A total of 183 patients with persistent AF who underwent catheter ablation were recruited from the AF ablation registry database at Mie University Hospital; 68 patients underwent CFAE ablation, and 115 patients underwent BOXI. All patients underwent clinical review and 24-hour ambulatory ECG monitoring to detect asymptomatic arrhythmias at 1, 3, 6, and 12 months post-initial ablation. Patients in the BOXI group had a significantly higher freedom from AF rate than those in the CFAE group (81.5% vs 63.9%, p=0.014), with a similar trend in propensity score-matched patients (p=0.003). The BOXI procedure emerged as the only independent prognostic factor for freedom from AF recurrence. BOXI led to greater reduction in left atrial diameter from baseline to 3-6 months post-catheter ablation compared to CFAE ablation. Thus, BOXI may offer superiority over CFAE ablation in maintaining sinus rhythm in patients with persistent AF, in addition to pulmonary vein isolation. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is a widely prevalent arrhythmia that increases the risk of cardiovascular mortality. However, optimal treatment of AF remains unclear. Our study aims to understand how AF therapy is affected by comorbid heart disease. Utilizing the AFFIRM trial database, we performed a post hoc analysis to delineate differences in risk factors and treatment outcomes in AF patients with congestive heart failure (CHF) or coronary artery disease (CAD). The primary outcome was defined as death from any cause and further delineated as cardiovascular vs non-cardiovascular death. Multivariable regression was used to define risk factors associated with the primary outcome. Of the 4060 patients enrolled in the study, 939 patients had CHF, and 1551 patients had CAD. While more non-CHF patients and CAD patients on rhythm-control agents died, these differences were accounted for by death from non-cardiovascular causes (CHF: HR, 1.43 [1.09-1.86]; P = 0.009; CAD: HR, 1.23 [1.01-1.52]; P = 0.041). Multivariable regression revealed that comorbid heart disease was a significant risk factor for death in all groups and diminished the association of treatment strategy to the risk of non-CVD death. This analysis suggests that treatment of underlying heart disease may be more influential than treatment strategy in affecting AF outcomes. [ABSTRACT FROM AUTHOR]

Left atrial posterior wall (LAPW) isolation is associated with favorable outcomes for catheter ablation of persistent atrial fibrillation (PEAF); however, the optimal technique remains unclear. We hypothesized that LAPW isolations, which included higher internal ablation lesion densities with larger proportions of left atrium (LA) surface area electrical isolation, would result in increased rates of freedom from arrhythmia recurrence two years following the initial procedure. LAPW lesion density and surface area relative to total LA surface area were calculated using electroanatomic maps of 110 consecutive patients not on antiarrhythmic medications undergoing LAPW isolation for PEAF (CARTO 3, Biosense Webster, Inc.). LAPW isolation was performed at the discretion of 5 experienced operators after voltage mapping. LAPW pulmonary vein entrance and exit block were confirmed. Freedom from arrhythmia recurrence at two years was compared by Kaplan-Meier analysis. LAPW lesion density ranged from 0% to 99%. The proportion of LA surface area isolated ranged from 35% to 75%. There was no significant difference in arrhythmia-free survival stratified by median LAPW ablation density (31% vs 27%, P=0.8) or median proportion of electrically isolated LA surface area (31% vs 27%, P=0.8). Voltage map-guided LAPW isolation did not significantly increase freedom from arrhythmia recurrence (29% vs 28%, P=1). Neither the density of ablation within nor the dimensions of the LAPW isolated region predicted arrhythmia-free survival for catheter ablation of PEAF. Voltage map-guided LAPW isolation resulted in similar ablation efficacy regardless of LA scar burden. [ABSTRACT FROM AUTHOR]

Catheter ablation, a widely used treatment option for patients with AF who are symptomatic despite medical therapy, carries inherent risks and may lead to adverse events. This systematic review aims to evaluate the current evidence on the use of prophylactic colchicine after catheter ablation for AF in reducing the risk of AF recurrence and inflammatory biomarkers. Digital databases were searched systematically to identify studies reporting the outcomes of prophylactic use of colchicine after AF ablation. A total of four studies, recruiting 503 patients, were included in the final analysis. Overall, AF recurrence was higher in the placebo group compared to the colchicine group. However, side effects of colchicine were more frequently observed after colchicine treatment. Colchicine dosing ranged from 0.5 mg to 1.2 mg daily, and the duration of treatment ranged from 14 to 90 days. Gastrointestinal side effects were predominantly reported in the studies investigating initiation of colchicine. In conclusion, the use of prophylactic colchicine after catheter ablation for atrial fibrillation may be a promising strategy for reducing the risk of AF recurrence. [ABSTRACT FROM AUTHOR]

Background: Patients with both atrial fibrillation (AF) and heart failure (HF) with reduced left ventricular ejection fraction (LVEF<55%) have a significantly higher risk of stroke and mortality. Improvement of LVEF has been reported in patients with AF and HF after endocardial ablation, but endocardial ablation in patients with persistent (PersAF) and longstanding persistent AF (LSPAF) has had low success in long-term freedom from atrial arrhythmias without repeat procedures. In this population, we sought to determine if a hybrid approach combining endocardial catheter ablation and epicardial surgical ablation would improve LVEF. Objective: To determine the effect of Hybrid Convergent ablation on LVEF in patients with AF. Methods: A multicenter, retrospective analysis of LVEF pre- and post- Hybrid Convergent was performed in consecutive patients with AF. LVEF was measured through 2D echocardiography. Mean baseline and post-procedure LVEF were compared by one sample t-test or Wilcoxon signed rank test. Results: Data from 158 patients, of whom 98% had PersAF/LSPAF, were included. At baseline, patients were a mean 65.7 ± 8.6 years of age, 74% male, BMI of 33 ± 5.7 kg/m2, and had a mean 6.4 ± 6.5 years history of continuous AF and approximately 27% had failed previous endocardial ablation. Patients with reduced baseline LVEF (<55%) experienced a significant improvement in LVEF versus baseline (+6.84% improved; p < 0.0001) at a mean follow up of 7.8 ± 8.7 months. The observed improvement was greatest in patients with severely reduced LVEF (<40% at baseline, +10.9% improved with mean follow-up of 9.3 ± 10.9 months, p = 0.0002). No change in LVEF was observed in patients with a normal baseline LVEF (p = 0.776). Conclusion: A significant improvement in LVEF was observed in patients with non-paroxysmal AF and reduced EF at baseline, particularly in those with severely reduced LVEF, after Hybrid Convergent ablation. [ABSTRACT FROM AUTHOR]

Sleep-disordered breathing (SDB) is highly prevalent in atrial fibrillation patients, and it reduces the success rate of rhythm control interventions. Current patient assessment implies an accurate clinical evaluation, the use of sleep questionnaires and an adequate sleep study to confirm SDB diagnosis. However, the best way to screen SDB in patients with atrial fibrillation has not yet been established. The authors summarize the most recent and relevant scientific findings in this field and propose a SDB screening organized as an integrated care pathway provided by an interdisciplinary team in an arrhythmia unit. [ABSTRACT FROM AUTHOR]

Cor triatriatum is a rare yet important anomaly. We want to highlight the importance of ICE for realtime assessment of the cardiac anatomy during interventional electrophysiology procedures especially when ancillary imaging modalities have failed to detect abnormalities. In these cases, ICE with color flow Doppler imaging guidance was essential for prompt diagnosis of cor triatriatum including definition of the membrane structure with fenestrations or identifying modest atrial obstruction, and guiding proper and uneventful catheter manipulation around the membrane, especially when manipulating near the pulmonary vein orifices. The development of symptoms in patients with cor triatriatum may be insidious and may be delayed even until late adult life. In our patients the cor triatriatum was an incidental ICE finding without significant hemodynamic consequences, because of the sizable defect in the membrane allowing communication. The incidence of cor triatriatum in our adult patients population is 0.09% (4 of 4269) using ICE during radio frequency ablation procedures for tachyarrhythmias. [ABSTRACT FROM AUTHOR]

Multispline catheters were recently introduced and have led to significant improvements in electrogram acquisition and analysis. Omnipolar mapping is now able to be performed with these multispline catheters. Omnipolar mapping has the advantages of mapping a focal segment without needing the entire chamber of interest to be mapped, does not need a stable reference and is cycle length independent. This article will review the mechanism of omnipolar mapping and show how this technology can be used for multiple arrythmias. [ABSTRACT FROM AUTHOR]

Background: Atrial Fibrillation (AF) is the most common arrhythmia globally in adults and is associated with an increased risk of stroke, morbidity and mortality. There is growing evidence that AF is associated with mild cognitive impairment (MCI). The incidence of both conditions increase with age and both conditions share important risk factors. Objectives: This study aimed to examine the relationship between MCI and AF. The aims of this scoping review is 1) To describe the prevalence of MCI in patients with AF without prior stroke 2) To investigate the pathogenetic mechanisms linking MCI and AF and 3) To examine current screening tools employed to identify MCI. Methods: This scoping review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR). Results: The scoping review included 40 studies. Across the included articles, the mean prevalence of MCI in patients with AF was 36.74%. The main proposed pathologic mechanisms linking MCI and AF were white matter lesions, cardiovascular risk factors, silent cerebral infarction and cerebral hypoperfusion. The most common tools used in these studies to identify MCI were a battery of cognitive tests and the MoCA test. [ABSTRACT FROM AUTHOR]

Background: Atrial Fibrillation (AF) is the most common type of arrhythmia worldwide and is associated with increased mortality and other thromboembolic events. Worldwide, the incidence and prevalence of AF are growing. Physical activity or individualized exercise programs can reduce the risk of death from all causes, CVD, stroke, and congestive heart disease. Besides the positive effects of physical activity and exercise, the relationship between AF and physical activity/exercise remains unclear. Purpose of Study: The purpose of this systematic review is to investigate relevant randomized controlled trials (RCTs) to better delineate the effects of exercise on quality of life and exercise capacity in patients with AF. Method: We searched the following electronic databases; Pubmed, Web of Science, Science Direct and Scopus. We included RCTs that investigated effectiveness of physical activity/exercise on exercise capacity and quality of life. The inclusion criteria were: participant age 18-75 years old; both sexes; any type of AF, including individuals who have received exercise-based AF treatment (including physical activity), prospective cohort studies (≥8-week treatment regimen. Results: We included seven RCTs with a total of 538 patients with various types of atrial fibrillation. All trials were conducted between 2006 and 2022. The mean methodological quality of the included studies was 6.28 according to PEDro scoring. Treatments used in the reviewed studies included aerobic exercise, interval aerobic exercises, and resistance strengthening exercises. The mean follow-up duration of trials was 16 weeks (eight weeks to six months). Conclusion: This systematic review concluded that physical exercise training increased the exercise capacity and quality of life in individuals with AF; however, other studies find discrepant results. Such discrepancies are thought to be related to differences in study methodology, comorbidities of sample groups, individual adaptations, and varying levels of quality of studies. [ABSTRACT FROM AUTHOR]

Background: The study focused to identify markers of success in patients submitted to high-power short-duration (HPSD) atrial fibrillation (AF) ablation with contact force (CF) catheter. Methods: Prospective, observational study with 227 patients with first AF ablation in sinus rhythm using 50W of power and divided in two groups; success and failure according to absence or presence of AF related arrhythmias, respectively. Results: Success observed in 188 and failure in 39 patients, respectively. Median follow-up was 31±21.1 months. Left atrial time was shorter in success than in recurrence group (69.6±23.1 vs 83.2±21.2 min, p=0.008) as in total procedure time (80.1±30.2 vs 98.5±23.3min, (p=0.01). Radiofrequency time was 1,478±321.2 vs 1,888.4±584.1sec (p=0.001) in success and failure groups, respectively. Esophageal warming observed in 58 (30.9%) success and 14 (53.8%) recurrence patients (p=0.01). Higher rate of first-pass isolation observed in success than recurrence, 118 (77.6%) and 15 (50%) (p=0.039), respectively. After ablation heart rate increased from 53.8±9.7 to 66.8±11.6bpm in success and 57±7.7 to 64.4±10.4bpm in recurrence groups (p= 0.001), respectively. Conclusion: HPSD ablation identified that shorter left atrial time, lower luminal esophageal temperature heating, shorter radiofrequency time, higher heart rate increase and first-pass isolation effect were associated with better arrhythmia free-survival rates during follow-up. [ABSTRACT FROM AUTHOR]

Background: Ablation in patients with persistent atrial fibrillation is associated with an increased risk of recurrence. One of the reasons for this is extended left atrial scarring, which can be identified as low-voltage areas (LVA) during left atrial mapping. To increase the success of ablation, these areas should be adequately identified to estimate the success of ablation based on a cut-off value. Therefore, this study aimed to show the relationship between left atrial voltage and the risk of recurrence for patients after ablation of persistent atrial fibrillation. Methods: In this prospective study, 70 patients with persistent AF underwent ablation using a modified stepwise approach. We compared two groups according to the Utah fibrosis criteria: the mild group, with left atrial LVA smaller than 20%, and the severe group, with left atrial LVA of 20% or larger. Both groups were compared based on freedom from any atrial arrhythmia recurrence (>30 secondswith repeated 7-day Holterelectrocardiogram) at 12 months and the use of antiarrhythmic drugs. Results: All patients with atrial fibrillation converted to sinus rhythm by ablation (n=7) had a scar area smaller than 20%. All patients with LVA of 20% or larger were externally cardioverted to to sinus rhythm at the end of the procedure. LVA of 20% or larger tended to show increased recurrence rates after ablation (p= 0.058), significantly shorter periods before recurrence (p=0.041), and a trend toward even shorter periods before recurrence after repeat ablation (p=0.059). Conclusion: The extent of left atrial LVA influences the acute and long-term outcomes of persistent atrial fibrillation ablation. Patients with LVA smaller than 20% could benefit from a stepwise approach. [ABSTRACT FROM AUTHOR]

Background: Hybrid / Convergent (HA) ablation using surgical epicardial and catheter endocardial RF ablation improves freedom from AF in patients with persistent AF. Triggers in the left atrial appendage may contribute to recurrence of AF following catheter ablation. Objective: Assess the impact on AF recurrence following HA with LAA closure (LAAC) with the AtriClip device. Methods: Consecutive patients from 2014-2019 with persistent AF without prior ablation were treated with HA. In 2016 LAAC was added to further reduce both arrhythmia substrate and stroke risk. We assessed one-year outcomes. Recurrence was defined as clinical episode of atrial arrhythmia (AA) after a 90-day blanking period. Results: 139 patients with persistent AF without prior ablation underwent HA. 59 (48%) had HA alone, and 64 (52%) had HA with LAAC. Baseline characteristics were similar in both groups with longer AF chronicity in patients with HA plus LAAC (6.4 vs 4.6 years p=0.15). Complete LAAC was noted in 61 (95%) patients treated with LAAC. There was a trend to improved freedom from any AA in the HA with LAAC group (88% vs 76%; p=0.15). Freedom from any AA off antiarrhythmic drug was significantly improved with HA and LAAC compared to HA alone (77% vs 58%; p=0.04). LAAC patients required fewer repeat catheter ablations at 1 year (p<0.05). No strokes, or deaths were noted in either group. Conclusion: Patients with persistent AF treated with HA and LAAC using the AtriClip device had a significant reduction in AF recurrence off antiarrhythmic drug at one year. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is the most common form of cardiac arrhythmias and often results in complications associated with high morbidity and mortality. While genetic factors undoubtedly play an important role in AF prevalence and pathophysiology, recent studies have begun to uncover equally important contributions from non-genetic factors such as lifestyle habits, age, and gender. Despite advances in AF research, many questions remain unanswered. Objective: Our main objective is to examine whether non-genetic factors have a causative role or exacerbate pre-existing AF. Our secondary objective is to identify opportunities for lifestyle changes that could help in mitigating risks associated with AF. Methods: To prepare this narrative review paper, Medline PubMed was used to search for relevant literature published between 2000 and 2021 using key terms including atrial fibrillation and age, gender, hypertension, type II diabetes, obesity, dyslipidemia, exercise, smoking, and alcohol and coffee consumption. Conclusion: The latest literature provides more evidence that various lifestyle parameters seem to contribute to the development and exacerbation of AF. The pathophysiology in most cases is related to an increase in inflammatory mediators that perturb atrial tissue and adversely affect electric signaling in atrial substrates. It is reasonable to suggest that in some instances lifestyle modifications, such as weight loss, can reduce the incidence of AF. We believe that applying lifestyle modifications may have beneficial effects for patients with AF. The exciting field of AF research continues to rapidly evolve and holds great promise in the way of future therapeutic as well as preventative measures. [ABSTRACT FROM AUTHOR]

Introduction: The limited success rate of conventional ablation approach including isolation of pulmonary veins (PVI) in non-paroxysmal AF has led to the search for alternative ablation strategies. In this study, we evaluated the outcome of three different ablation approaches for non-paroxysmal AF. Methods: Patients were randomly assigned to Group 1: PVI+ isolation of LA posterior wall (PWI), Group 2: PVI+ scar homogenization and Group 3: PVI+PWI+ ablation of sustained non-PV triggers. LA scar (<0.5 mV) was identified by 3-D voltage mapping in sinus rhythm. Freedom from arrhythmia recurrence at 1 year and acute procedure-success, defined as AF termination (organization to AT or conversion to sinus rhythm), were compared across the groups Results: A total of 62 patients were randomized to group 1: 22, group 2: 19 and group 3: 21. Eight (36.3%) in group 1 and 9 (47.3%) in group 2 failed to achieve acute procedural success and underwent PVI+PWI+NPV trigger ablation. Acute success was achieved in all (100%) group 3 patients. Acute procedure failure or recurrence of arrhythmia at 1 year was reported in 54.5% (12/22) in group 1, 68.4% (13/19) group 2 and 28.6% (6/21) in group 3. Compared to group 3, the combined failure rate was significantly higher in group 2 (Chi-Square p= 0.011, Odds ratio 5.42 (95% CI 1.40 to 20.97), p=0.014). Conclusion: In patients with non-paroxysmal AF, PVI+ scar homogenization was associated with significantly lower success rate compared to the ablation strategy targeting PV+ posterior wall +non-PV triggers. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia for which catheter ablation (CA) is considered a first-choice treatment option. Because of the expanding AF pandemic, there is need for highly efficient and effective CA strategies. Pulmonary vein isolation (PVI) is a pivotal part of any AF ablative strategy. Currently, multiple ablation techniques are being utilized to realize PVI, including Remote Magnetic Navigation (RMN) guided radiofrequency (RF) ablation. This study aimed to systematically describe and evaluate a novel, minimally-invasive RMN-guided PVI strategy. Methods: This study retrospectively included a series of consecutive patients diagnosed with AF who were treated with a novel minimallyinvasive RMN-guided PVI strategy between September 2020 and March 2021. Primary outcomes were both procedural efficiency (i.e. LA access time, mapping time, procedure time) and efficacy (first-pass isolation (FPI) and acute success rates). Results: This case series included 14 patients. Efficiency outcomes: The mean total procedure time was 63.1 ± 13.5 minutes. LA access time was 6.5±1.9 minutes. Mapping was completed in 7.1±1.4 minutes. Efficacy outcomes: We observed a 100% FPI rate in right-sided and a 57% FPI rate in left-sided PVs. In all cases there was successful PV isolation at the end of procedure. There were no adverse events. Conclusion: In conclusion, a novel, minimally-invasive RMN guided PVI strategy yields high efficiency, with short procedure and fluoroscopy times, in addition to efficacious PVI. [ABSTRACT FROM AUTHOR]

Cardiac involvement in the rare monogenic autosomal recessive Alström syndrome (ALMS) may manifest as infantile, juvenile or adult dilated or restrictive cardiomyopathy. Case reports have described ventricular arrhythmias and conduction system disease, though little is known about atrial arrhythmia burden and management in these patients. This case presents a possible underreported atrial phenotype of the ALMS with exceptionally advanced structural remodelling with atrial scar encompassing nearly the entire left atrium in a young patient. It highlights the difficulties in managing these patient with medical rate and rhythm control due to frequent multi-organ involvement and concomitant conduction system disease, as well as the challenges faced during invasive activation mapping in an exceptionally disease atrial myocardium with ubiquitous complex low amplitude EGMs undermining the value of high density mapping with automated annotation algorithms. [ABSTRACT FROM AUTHOR]

Background: Radiofrequency ablation (RFA)is an important treatment option for patients with atrial fibrillation (AF). During RFA, a significant amount of energy is delivered into the left atrium (LA), resulting in considerable LA-injury. The impact of this damage on mechanical and endocrine LA-function, however, is often disregarded. We therefore aimed to evaluate the endocrine- and mechanical function of the heart 4-months after RFA of AF. Methods: In total 189 patients eligible for RFA of AF were studied. The levels of the N-terminal pro-B-natriuretic peptide (NT-proBNP) and the mid-regional fragment of the N-terminal pro-atrial natriuretic peptide (MR-proANP) were measured. The maximum LAvolume (LAVmax),the LA ejection fraction (LAEF) and the LA peak longitudinal strain (PALS), were measured using transthoracic echocardiography. The measurements were performed before and 4-months after the intervention. Results: 87 patients had a recurrence during a mean follow-up of 143±36 days. NT-proBNP and MR-proANP decreased significantly at follow-up. This reduction was greater in patients who did not suffer any recurrence after RFA. The LAVmax decreased significantly, whereas the PALS only improved in patients who did not suffer from any recurrence. On the other hand, LAEF did not change significantly after RFA of AF. Conclusions: Despite extensive ablation during RFA of AF, the endocrine function of the heart improved 4-months after the index procedure. Patients with no arrhythmia recurrence showed a more pronounced improvement in their endocrinal function. Mechanically, the LAVmax was reduced, and the LA strain improved significantly. [ABSTRACT FROM AUTHOR]

Background: Radio frequency ablation (RFA)is an important treatment option for patients with atrial fibrillation (AF). During RFA, a significant amount of energy is delivered into the left atrium (LA), resulting in considerable LA-injury. The impact of this damage on mechanical and endocrine LA-function, however, is often disregarded. We therefore aimed to evaluate the endocrine- and mechanical function of the heart 4-months after RFA of AF. Methods: In total, 189 patients eligible for RFA of AF were studied. The levels of the N-terminal pro-B-natriuretic peptide (NT-proBNP) and the mid-regional fragment of the N-terminal pro-atrial natriuretic peptide (MR-proANP) were measured. The maximum LAvolume (LAVmax), the LAejection fraction (LAEF) and the LA peak longitudinal strain (PALS), were measured using transthoracic echocardiography. The measurements were performed before and 4-months after the intervention. Results:87 patients had a recurrence during a mean follow-up of 143±36 days. NT-proBNP and MR-proANP decreased significantly at follow-up. This reduction was greater in patients who did not suffer any recurrence after RFA. The LAVmax decreased significantly, where as the PALS only improved in patients who did not suffer from any recurrence. On the other hand, LAEF did not change significantly after RFA of AF. Conclusions: Despite extensive ablation during RFA of AF, the endocrine function of the heart improved 4-months after the index procedure. Patients with no arrhythmia recurrence showed a more pronounced improvement in their endocrinal function. Mechanically, the LAV max was reduced, and the LA strain improved significantly. [ABSTRACT FROM AUTHOR]

Background: A novel QDOT MICRO (Biosense Webster, Inc., Irvine, CA) catheter with optimized temperature control and microelectrodes was designed to incorporate real-time temperature sensing with contact force detection and microelectrodes to streamline ablation workflow. The QDOT-MICRO feasibility study evaluated the workflow, performance, and safety of temperature-controlled catheter ablation in patients with symptomatic paroxysmal atrial fibrillation with conventional ablation setting. Methods: This was a non-randomized, single-arm, first-in-human study. The primary outcome was pulmonary vein isolation (PVI), confirmed by entrance block after adenosine and/or isoproterenol challenge. Safety outcomes included incidences of early-onset primary adverse events (AEs) and serious adverse device effects (SADEs). Device performance was evaluated via physician survey. Results: All evaluated patients (n = 42) displayed 100% PVI. Two primary AEs (4.8%) were reported: 1 pericarditis and 1 vascular pseudoaneurysm. An additional SADE of localized infection was reported in 1 patient. No stroke, patient deaths, or other unanticipated AEs were reported. Average power delivered was 32.1±4.1 W, with a mean temperature of 40.8°C±1.6°C. Mean procedure (including 20-minute wait), fluoroscopy, and radiofrequency application times were 129.8, 6.7, and 34.0 minutes, respectively. On device performance, physicians reported overall satisfactory performance with the new catheter, with highest scores for satisfaction and usefulness of the temperature indicator. Conclusions: Initial clinical experience with the novel catheter showed 100% acute PVI success and acceptable safety and device performance in temperature-controlled ablation mode. There were no deaths, stroke, or unanticipated AEs. Fluoroscopy and procedural times were short and similar or better than reported for prior generation catheters. [ABSTRACT FROM AUTHOR]

Background: Atrial Fibrillation (AF) is the most common tachyarrhythmia and is associated with increased risk of stroke, morbidity and mortality. AF is responsible for up to a quarter of all strokes and is often asymptomatic until a stroke occurs. Screening for AF is a valuable approach to reduce the burden of stroke in the population. Objectives:The motivation for this review was to synthesise and appraise the evidence for screening for AF in the community. The aims of this scoping review are 1). To describe the prevalence of newly diagnosed AF in screening programmes 2). Identify which techniques/ tools are employed for AF screening 3). To describe the setting and personnel involved in screening for AF. Eligibility Criteria: All forms of AF screening in adults (=18 years) in primary and community care settings. Methods: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR). Results:Fifty-nine papers were included; most were cross-sectional studies (n=41) and RCTs (n=7). Prevalence of AF ranged from 0-34.5%. Screening tools and techniques included the 12-lead ECG (n=33), the 1-lead ECG smartphone based Alivecor® (n=14) and pulse palpation (n=12). Studies were undertaken in community settings (n=30) or in urban/rural primary care (n=28). Personnel collecting research data were in the main members of the research team (n=31), GPs (n=16), practice nurses (n=10), participants (n=8) and pharmacists (n=4). Conclusion: Prevalence of AF increased with advancing age. AF screening should target individuals at greatest risk of the condition including older adults =65 years of age. Emerging novel technologies may increase the accessibility of AF screening in community and home settings. There is a need for high quality research to investigate AF prevalence and establish accuracy and validity for traditional versus novel screening tools used to screen for AF. [ABSTRACT FROM AUTHOR]

Background: Cancer treatment induced arrhythmia (CTIA) is a well-recognized form of cardiotoxicity associated with chemotherapy. Immune checkpoint inhibitors (ICI) have been associated with important forms of cardiotoxicity, including myocarditis. However, the incidence of CTIA associated with ICI has not been well characterized. Methods: We reviewed all patients treated with ICIs at our institution from Jan. 2010 to Oct. 2015. CTIA was defined as a new diagnosis of clinically relevant arrhythmia within 6 months after ICI initiation. Results: During the study period, 268 patients were treated with immune checkpoint inhibitors, of whom 190 received monotherapy with ipilimumab (n=114), nivolumab (n=52) or pembrolizumab (n=24) and 78 received combination therapy: ipilimumab & nivolumab (n=37), ipilimumab & pembrolizumab (n=39) and nivolumab & pembrolizumab (n=2). Four patients (1.5%) developed CTIA. Of these, 3 patients developed a new diagnosis of atrial fibrillation (AF), one of whom required cardioversion. In 2 cases of new-onset AF, significant provoking factors were present in addition to ICI therapy including thyrotoxicosis in one and metabolic disarray in another. Six patients (2.2%) with a pre-existing diagnosis of paroxysmal AF experienced episodes within 6 months of initiating ICI therapy. None of the arrhythmic events were associated with known or suspected myocarditis. Conclusion: The incidence of arrhythmic complications associated with immune checkpoint inhibitors appears to be very low (~1.5%). Patients with a pre-existing diagnosis of AF may be at-risk of recurrence during ICI treatment and should be monitored accordingly. These data suggest that from an arrhythmia perspective, ICIs appear to be very safe and well-tolerated. [ABSTRACT FROM AUTHOR]

Objective It remains unclear whether atrial fibrillation (AF) alone determines systemic changes in hemocoagulation. Our aim was to examine the prothrombin fragment F1+2 and fibrinopeptide A (FPA) as early markers of coagulation activity still in the first twenty-four hours of paroxysmal AF (PAF) and to correlate them with the arrhythmia onset. Methods 51 non-anticoagulated patients (26 men, 25 women, aged 59.84±1.6 years) and 52 controls (26 men, 26 women, aged 59.50±1.46 years) were sequentially selected. F1+2 and FPA plasma levels were measured by enzyme-linked immunoassays. Results F1+2 was significantly higher in patients (292.61pmol/L±14.03pmol/L vs 183.40pmol/L±8.38pmol/L; p<0.001). FPA was also substantially higher (4.47ng/mL±0.25 ng/mL vs 3.09ng/mL±0.15ng/mL, p<0.001). Among the potential predictors for these deviations: age, gender, BMI, PAF duration and CHA2DS2-VASc score, it was established that higher F1+2 and FPA plasma levels were independently associated only with PAF duration (p<0.05). Moreover, longer episodes were associated with higher values of F1+2 (Adjusted R² = 0.68) and FPA (Adjusted R² = 0.70). Conclusion Increased coagulation activity was present still in the first twenty-four hours of PAF clinical presentation. The disease itself was associated with increasing hypercoagulability over time, suggesting its importance as an independent risk factor for thromboembolic events. [ABSTRACT FROM AUTHOR]

With the expanding integration of complementary and alternative medicine (CAM) practices in conjunction with modern medicine, yoga has quickly risen to being one of the most common CAM practices across the world. Despite widespread use of yoga, limited studies are available, particularly in the setting of dysrhythmia. Preliminary studies demonstrate promising results from integration of yoga as an adjunct to medical therapy for management of dysrhythmias. In this review, we discuss the role of autonomic nervous system in cardiac arrhythmia,interaction of yoga with autonomic tone and its subsequent impact on these disease states. The role of yoga in specific disease states, and potential future direction for studies assessing the role of yoga in dysrhythmia. [ABSTRACT FROM AUTHOR]

Imbalance of the sympathetic and parasympathetic nervous systems is probably the most prevalent autonomic mechanism underlying many arrhythmias. Recently, vagus nerve stimulation (VNS) has emerged as a novel therapeutic modality to treat arrhythmias through its anti-adrenergic and anti-inflammatory actions. Clinical trials applying VNS to the cervical vagus nerve in heart failure patients yielded conflicting results, possibly due to limited understanding of the optimal stimulation parameters for the targeted cardiovascular diseases. Transcutaneous VNS by stimulating the auricular branch of the vagus nerve, has attracted great attention due to its noninvasiveness. In this review, we summarize current knowledge about the complex relationship between VNS and cardiac arrhythmias and discuss recent advances in using VNS, particularly transcutaneous VNS, to treat arrhythmias. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is common in acute myocardial infarction complicated by cardiogenic shock (AMI-CS) requiring percutaneous ventricular assist device (pVAD-Impella®) support during percutaneous coronary interventions (PCI). We evaluated the effects of a coexistent diagnosis of AF on clinical outcomes in patients with AMI-CS undergoing PCI with pVAD support. Methods: The National Inpatient Sample (2008-2014) was queried to identify patients with AMICS requiring PCI with pVAD support and had a concomitant diagnosis of AF. Propensity-matched cohorts (AF+ vs AF-) were compared for in-hospital outcomes. Results: A total of 840 patients with AMICS requiring PCI with pVAD support (420 AF+ vs 420 AF-) were identified in the matched cohort. Patients with AF were older (mean 69.7±12.0 vs 67.9±11.3 yrs, p=0.030). All-cause in-hospital mortality rates between the two groups were similar (40.5% vs 36.7%, p=0.245); however, higher postprocedural respiratory complications (9.5% vs 4.8%, p=0.007) were seen in AF+ group. In-hospital cardiac arrests were more frequent in the AF- group (32.0% vs 19.2%, p<0.001). We examined the length of stay (LOS), transfer to other facilities, and hospital charges as metrics of health care resource consumption and found that the AF+ cohort experienced fewer routine discharges (13.1% vs 30.2%), more frequent transfers to other facilities including skilled nursing facilities or intermediate care facilities (27.3% vs 17.8%; p<0.001), more frequently required the use of home health care (14.3% vs 7.1%; p<0.001). The mean LOS (11.9±10.1 vs 9.11±6.8, p<0.001) and hospital charges ($308,478 vs $277,982, p=0.008) were higher in the AF+ group. Conclusion: In patients suffering AMICS requiring PCI and pVAD support, a coexistent diagnosis of AF was not associated with an increase in all-cause in-hospital mortality as compared to patients without AF. However, healthcare resource consumption as assessed by various metrics was consistently greater in the AF+ group. [ABSTRACT FROM AUTHOR]

Coronary artery spasm during catheter ablation for arrhythmias is a rare but previously reported complication. Timing of presentation, manifestations of vasospasm, and purported mechanisms vary somewhat in the prior literature. We present a case of chest pain, inferior lead ST elevation, and complete AV block with angiographically confirmed right coronary artery (RCA) vasospasm that occurred immediately after catheter ablation for atrial fibrillation. [ABSTRACT FROM AUTHOR]

There is extensive knowledge in the ablation of ventricular arrhythmias in patients with Chagas' cardiomyopathy, as well as specific characteristics of the arrhythmogenic substrate, and the need for an epicardial approach to achieve success. On the contrary, no publications currently address the ablation of atrial fibrillation in these patients or the characteristics of the arrhythmia such as the successful ablation sites. Our two case reports highlight the association of Chagas' disease with atrial arrhythmias, the tailored approach that was needed to give an appropriate treatment and a discussion of our current knowledge of Chagas' cardiomyopathy as a substrate for atrial arrhythmias. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation is the most commonly encountered sustained arrhythmia and is associated with significant morbidity and mortality. Several trials have demonstrated that no mortality benefit exists when choosing a rhythm-control strategy over a rate-control strategy, with some trials suggesting an increase in mortality. Using the AFFIRM trial database we sought to determine the effect of rhythm control strategy in patients with normal or mild atrial enlargement. Methods: AFFIRM Trial database was used to evaluate the effect of rhythm-control strategy compared to rate-control strategy in a subgroup of patients with normal to mild left atrial (LA) enlargement. The primary outcome measures of this study were all-cause mortality, cardiovascular mortality, non-cardiovascular mortality, and hospitalization/ED visit. Results: We identified a subgroup of subjects from the AFFIRM trial with normal or mild LA enlargement (n=2022 of 4060 total subjects). Subjects in the rhythm-control group(n= 1022) had an increased risk of all-cause mortality by 34% (RR 1.34, 95% CI 1.08-1.67; P=0.007) and hospitalization/ED visits by 10% (RR 1.10, 95% CI 1.05-2.16; P=<0.001) compared to rate control group(n= 1000). Conclusion: This study demonstrated that rhythm-control strategy increases the risk of mortality and hospitalization in a subgroup of patients with normal to mild atrial enlargement compared to rate-control strategy. Amiodarone use in this subgroup of patients likely drove these findings. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most commonly encountered arrhythmia in clinical practice. It constitutes a major public health problem, with total related annual expenses estimated at $6.65 billion. The American Heart Association developed Life's Simple 7 (LS7) to define and monitor ideal cardiovascular health (CVH). In this review, we examine the role of individual components of LS7 to provide further insight regarding potential influence of achieving AHA's strategic goal on AF prevention. While significant advances have been made in the secondary prevention of AF, little progress has been made to prevent the first occurrence of this arrhythmia in at-risk patients. Improvement of overall cardiovascular health as defined by LS7 may substantially reduce AF risk. [ABSTRACT FROM AUTHOR]

Background:The class III antiarrhythmic sotalol is renally eliminated with a dose-related propensity to cause adverse drug reactions (ADR) potentially leading to life-threatening arrhythmias. Although product labeling recommends once daily dosing in patients with renal impairment, twice daily dosing is commonly utilized. This study evaluates the safety of this practice. Methods:This retrospective, observational study examined renally impaired patients with atrial fibrillation or atrial flutter admitted for sotalol initiation from July 1, 2012 - December 31, 2014, then for up to 20 months after initiation. Primary endpoints included rates of ADR and therapy changes due to ADR. Secondary endpoints included therapy changes due to arrhythmia recurrence, admissions due to arrhythmia recurrence, and therapy changes for any cause. Results: Analysis included 134 patients with an average creatinine clearance of 51 ml/min, followed over a median of 170 days. Length of stay averaged 3 days with ADR occurring in 53.7% of patients, most commonly QT prolongation or bradycardia. Therapy change due to ADR occurred in 45.5% of patients (n=61). Therapy change due to arrhythmia recurrence occurred in 23.1% (n=31), admission due to arrhythmia recurrence occurred in 24.6% (n=33), and therapy change for any cause occurred in 74.6%(n=100). Conclusion:Initiating sotalol twice daily in renally impaired patients results in ADR and therapy change rates consistent with rates seen in clinical practice for non-renally impaired patients, with minimal length of stay. This practice may be reasonable when initiated in the acute care setting with subsequent outpatient monitoring, however further study is needed. [ABSTRACT FROM AUTHOR]

Atrial fibrillation is the most common cardiac rhythm disorder observed in clinical practice. It carries high morbidity and mortality rates, primarily related to heart failure, stroke and death. Validation of noninvasive markers in the diagnosis of heart failure with preserved ejection fraction and risk stratification is relevant in this clinical setting. The spectral tissue Dopplerderived E/e' ratio is a simple and reproducible index, which has been validated in noninvasive assessment of left ventricular diastolic pressures, regardless of rhythm. Septal E/e' >11 is a good predictor of invasively determined left ventricular diastolic pressure >15 mmHg in patients with atrial fibrillation. Several studies have validated the clinical relevance of abnormal values for E/e' at rest and during exercise in the diagnosis and risk stratification of heart failure with preserved ejection fraction in patients with atrial fibrillation. Increased E/e' value is associated with adverse outcome (death, left atrial appendage thrombus, stroke and heart failure) in patients with atrial fibrillation and predicts arrhythmia recurrence after cardioversion and catheter ablation. In conclusion, E/e' by spectral tissue Doppler is clinically relevant in the clinical management of any patients with atrial fibrillation referred for transthoracic Doppler echocardiography. [ABSTRACT FROM AUTHOR]

Background: Catheter ablation of long-standing persistent AF (LSAF) remains challenging. Since AF-Nest (AFN) description, we have observed that a stable, protected, fast source firing, namely "Background Tachycardia"(BT), could be hidden beneath the chaotic AF. Following pulmonary vein isolation (PVI)+AFN ablation one or more BT may arise or be induced in 30-40% of patients, which could be the culprit forAF maintenance and ablation recurrences. Methods and Results: We studied 114 patients, from 322 sequential LSAF regular ablations, having spontaneous or induced residual BT after EGM-guided PVI+AFN ablation of LSAF; 55.6±11y/o, 97males (85.1%), EF=65.5±8%, LA=42.8±6.7mm. Macroreentrant tachycardias were excluded. Pre-ablationAF 12-leads ECG Digital processing(DP) and spectral analysis(SA) was performed searching for BT before AF ablation and its correlation with BT during ablation. After PVI, 38.1±9 AFN sites/patient and 135 sustained BTs (1-3, 1.2±0.5/patient) were ablated. BT cycle length(CL) was 246.3±37.3ms. In 79 patients presenting suitable DP for SA, the BT-CL was 241.6±34.3ms with intra procedure BT-CL correlation r=0.83/p<0.01. Following BT ablation, AF could not be induced. During FU of 13→60 months(22.8±12m), AF freedom for BT RF(+) vs. BT RF(-) groups were 77.9% vs. 56.4% (p=0.009), respectively. There was no significant complication. Conclusions: BT ablation following PVI and AFN ablation improved long-term outcomes ofLSAF ablation. BT is likely due to sustained microreentry, protected during AF by entry block. BT can be suspected by spectral analysis of the pre-ablation ECG and is likely one important AF perpetuator by causing electrical resonance of the AFN. This ablation strategy warrants randomized, multicenter investigation. [ABSTRACT FROM AUTHOR]

Background : Atrial fibrillation (AF) is the most prevalent arrhythmia leading to hospital admissions. The majority of patients with AF report symptoms that are believed to be associated with the arrhythmia. The symptoms related to AF traditionally are collected during a clinic visit that is influenced by biases associated with recalling the experience over a limited period of time. Purpose: We designed this pilot study to assess the usability and feasibility of a mobile application to assess symptoms in patients with AF. Methods : We designed a mobile application (miAfib) to assess symptoms (chest pain, palpitation, shortness of breath, fatigue, dizziness/lightheadedness), positive affect (happy, excited, content) and negative affect (worried, angry, sad) on multiple occasions throughout the day based on iOS platform. We performed a four-week feasibility trial to examine user adherence, acceptance and experiences with the mobile application. We administered questionnaires to assess factors affecting usage and self-reported acceptance of the application based on a five-point Likert scale with zero representing strongly disagree and 5 representing strongly disagree with. Results : We included ten patients with paroxysmal and persistent AF. The mean number of completed assessments each day was 2.81 ± 1.59 with 94.7% of days with at least one assessment. The users found the application easy to use (4.75±0.46), intended to use it in the future (4.37±1.06) and found it easy to integrate into daily routine (4.5±1.07). Conclusions : In this pilot study, we found participants in this four-week trial reliably used the application and were able to use the app to report their daily symptoms and affect regularly. Participants reported that they found the application easy to use and would consider using the application in the future. [ABSTRACT FROM AUTHOR]

Introduction: Atrial fibrillation is the most common cardiac arrhythmia in the United States. It has been associated with a reduction in patient quality of life and more serious complications such as stroke and heart failure. The aim of this study was to compare the efficacy of commonly performed invasive procedures in keeping patients in normal sinus rhythm. Methods and Results: A retrospective chart review was performed on all patients who underwent primary radiofrequency catheter ablation, the complete Cox-maze, or the hybrid maze at OSF Saint Anthony Medical Center between January 2010 and December 2013 (n=140). Immediately post-procedure, arrhythmia recurrence rates did not differ between the groups (p = 0.28). At all follow-up points thereafter, however, differences in procedural efficacy between surgical and catheter therapy remained highly significant (p < 0.001). At 2 years, 20.3% of the catheter ablation patients were in normal sinus rhythm, when compared to 57.9% of hybrid maze and 72.7% the complete Cox-maze groups. A difference in major complication rates was noted (p = 0.04), with the complete Cox-maze having a 17.4%, the hybrid having 22.7%, and the catheter ablation group having 5.6%. Conclusions: This study was unable to detect differences in the efficacy rates of the surgical procedures, however they were both superior to catheter ablation. Although the hybrid approach is considered minimally invasive, complication rates were similar to those of the complete Cox-maze. Catheter ablation was the safest procedure, and since evidence of reduced mortality after the use of aggressive.rhythm therapy is currently lacking, the results suggest that hybrid surgery for atrial fibrillation should be used after the failure of more conservative measures. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most common arrhythmia in the population. Still there is no unity in understanding of mechanisms and their influence on catheter ablation results. In our study we tried to evaluate accurate initial quantitative indicators of electromechanical remodeling that can border patients from expected good to expected poor results of catheter ablation. We performed electroanatomical mapping and ablation procedures in 94 patient (45 female) in 2012 with 3-year follow-up period. The target points were left atria surface area, complex fragmentation atrial electrograms (CFAE) duration and surface area. We investigated primary procedure efficacy and initial preoperative patterns of patients in sinus rhythm after 3-year follow-up. Patients with paroxysmal AF had about 3-4 such areas with the median duration of fragmentation 84,5 msec and area 10,4 cm2. In persistent AF were 5-6 zones, duration of 149 msec and area 22,95 cm2. In long standing (LS) persistent AF 6-9 zones with duration up to 200 msec and area close to 30 cm2. General efficacy of radiofrequency ablation (RFA) in paroxysmal group was 58,8%, in persistent 33,3% and in LS persistent 12,9% according to Kaplan-Meyer curve with p=0,001. Retrospectively we found that every index in AF recurrence group was 1,5-2 times higher than its equivalent in sinus group. LA surface area was 131,8 cm2 vs 103,7 cm2 respectively. Median CFAE duration in AF patients was 157 msec and 87,5 msec in sinus patients. The principal index of CFAE square area was 2,5 times bigger (24,6 cm2 vs 10,3 cm2 relatively). We concluded that parameters of mechanical (LA volume and surface area) and electrical (CFAE duration and surface area) remodeling have to be defining in tactics and prognosis of catheter ablation in different types of AF. In order to achieve higher efficacy we advise to use stepwise tactic. [ABSTRACT FROM AUTHOR]

Moderate to heavy alcohol use has been shown to be associated with increased atrial fibrillation (AF) incidence. However, the relationship between alcohol use and AF recurrence after pulmonary vein isolation (PVI) is not well known. We sought to study the impact of different alcohol consumption levels on outcomes after AF ablation.A retrospective analysis was performed of 226 consecutive patients undergoing first time PVI for AF. Clinical data were collected including alcohol intake classified into 3 groups: none-rare (< 1 drink/week), moderate (1-7 drinks/week), and heavy (> 7 drinks/week). Patients were followed for recurrences within the first 3 months (blanking period; early recurrence) and after 3 months up to 1 year (late recurrence) after the ablation. Paroxysmal and persistent AF had early recurrence rates of 29.1% and 32.2%, and late recurrence rates of 30.2% and 44.1%, respectively. The none-rare alcohol group had a higher frequency of diabetes mellitus (p=0.007). Neither moderate or heavy alcohol consumption, in reference to the none-rare group, was significantly predictive of early or late AF recurrence on adjusted multivariate logistic regression analysis (p>0.05).Despite known associations between alcohol and incidence of AF, alcohol consumption is not associated with early or late AF recurrence after PVI in this cohort. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most challenging rhythm disturbance worldwide. Arrhythmia and its behavior represent complex pathogenesis highly opposing to contemporary curative modalities. Increasing age of patients carries a certain level of risk for AF. Some underlying diseases in concordance with aging actually accelerate the occurrence of AF. Underestimated superimposed risk factors - aging plus any known risk factor or condition (hypertension, diabetes etc.) - elicit great interest and concern. In light of these concerns we offer an elaborated universal hypothesis in attempt to elucidate the genuine origin of AF substrate. Putative chronic toxicity - toxins and/or involution related pseudotoxins potentially generate micro- and macro-structural changes in atrial myocardium thus inciting both intracellular damage (degeneration of myocites, apoptosis) and extracellular fibrotic proliferation (interstitial fibrosis, formation of matrices, degeneration of cells with fibrotic replacement). The co-products of related underlying diseases in cooperation with cellular senescence, endogenous overproduction of specific lipids/lipoproteins and other pro-atherosclerotic and/or inflammatory components generate a total atrial response - vascular/microvascular damage, intracellular and extracellular injuries. These organizational arrangements covering the entire atrial myocardium and perhaps ganglionated plexi/autonomic branches of the nervous system eventually cause clinical havoc - atrial overstretch, atrial adaptation/maladaptation, electromechanical dysfunction, arrhythmias, heart failure, etc. In essence, valvular heart disease potentially evokes similar changes "violating" thin atrial walls to obey the same scenario. Depicted atriomyodegenerative processes most likely represent the true nature of AF substrate development. Available clinical and morphological evidence potentially designates the atriomyodegenerative or plausible neuro-atriomyodegenerative origin of AF. Deductively fusion of reasons rather than purely heterogeneity is responsible for AF induction. Thus, the uniform approach and synoptic vision of clinical and pathohistological entity may offer an alternative or refreshed viewpoint in AF substrate formation. [ABSTRACT FROM AUTHOR]

Introduction: Symptoms like syncope or palpitations frequently present a diagnostic challenge. An implantable loop recorder (ILR) is an important aid in the management of these patients. Methods: A retrospective study of patients that underwent ILR implantation from November 2007 to 2014. For each patient the indication for implantation, baseline characteristics, previous study, complications, recorded tracing and interventions were evaluated. Results: A total of 62 patients were included, 50% men, with a mean age of 62.5±18.8 years old. Previously to ILR implantation 88.7% of patients had performed Holter, 17.7% external events recorder, 33.9% Tilt test and 29% an electrophysiological study. The implantation indications were recurrent syncope in 90.3%, palpitations 8.1% and ischemic stroke in one patient. Mean follow-up time was 17.1±16.3 months. Symptoms were reported in 66.1% of the patients, 46.8% of those yielding a diagnostic finding. In all cases of palpitation complaints with diagnosis we found atrial fibrillation (AF). In patients with syncope atrioventricular conduction disturbance was demonstrated in 19.6%, sinus node dysfunction in 16.1%, paroxysmal supra-ventricular tachycardia 7.1% and AF in 1.8%. These finding resulted in 19 pacemaker and one CRT-D implantation, introduction of anticoagulation in five patients and one ablation of accessory pathway. There were no major complications. Conclusion: ILR proved to be safe and efficient. It has enabled the identification or exclusion of serious rhythm disturbances in more than half of patients and provided a targeted therapeutic intervention. [ABSTRACT FROM AUTHOR]

Atrial fibrillation is the most prevalent cardiac arrhythmia with a high risk of ischemic stroke. Thromboprophylaxis plays a key role in prevention of cardioembolic and non-cardioembolic events. Oral antithrombotic drugs are most often used to reduce hypercoagulable state. Patients may suffer from both under- and overtreatment compromising the outcomes. Medication peculiarities at large are well-known and widely debated. Non-adherence to antithrombotic drug regimen poses a significant risk of stroke. There is a pressing need for more detailed delineation of risk factors, namely by incorporation of the letter "N" (meaning "Non-adherence to drug therapy") into the well-known risk score alphanumeric display: CHA2DS2N-VASc. Better delineation of risk factors related to antithrombotic treatment as well as those related to treatment for congestive heart failure, hypertension, diabetes are desirable. Similarly, the bleeding risk score formula HAS-BLED might be improved by an additional risk factor, marked as the symbol "E", meaning "Excessive antithrombotic dosing" i.e. HAS-BLEDE. Improved formulas would help raise the predictive scores value and awareness for clinicians facing the problem of non-adherence to treatment regimen. If patients properly followed the prescribed drug therapy regimen it would potentially reveal that we already have ideal or near ideal antithrombotic drug(s). These drugs, herein non-specified, are widely used, but due to non-adherence they are not categorized as the best ones. That is why considerable efforts are focused on continued research and new developments. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is a complex arrhythmia, that has been studied non-invasively assessing atrial refractory period, atrioventricular node (AV) node refractory period, and ventricular response. The AV node plays a fundamental role as it filters many of the numerous irregular atrial impulses bombarding the node. Despite its importance, the electrophysiological (EP) characteristics of the AV node are not routinely evaluated since conventional EP techniques for assessment of refractory period or conduction velocity of the AV node are not applicable in AF. Since rate-control drugs control ventricular response through their effect on the AV node, noninvasive assessment of AV node electrophysiology may be useful. The RR series, though being highly irregular, contains information that can be used for risk stratification and prediction of outcome. In particular, RR irregularity measures during AF have been shown to be related to clinical outcome. This paper reviews the attempts done to noninvasively characterize the AV node and the ventricular response, highlighting clinical applications and limitations of the noninvasive techniques. [ABSTRACT FROM AUTHOR]

Introduction: PVI is an effective, guideline-based treatment for drug refractory symptomatic AF. Balloon cryoablation has been shown to be a safe and effective method for PVI. In the STOP-AF trial, data was produced from practitioners performing PVI with significant experience at high volume centers. This study evaluates the effectiveness and safety of treating symptomatic, drug refractory AF with PVI via cryoablation after implementation in a regional medical center. Method: This represents a retrospective analysis of outcomes after cryoablation treatment for AF in 71 patients over 354.7 +/- 164.4 days. Reported and recorded episodes of AF were categorized into a representative percent of AF "burden" for each 90 day period. Primary effectiveness and safety end points paralleled those of the STOP-AF trial. Results: Patients undergoing cryoablation had a 91% reduction of AF burden at 6 months following the procedure with an event-free survival rate of 45.5 % at a mean follow up of 12 months. The mean burden reduction was 3.21% per quarter. Anti-arrhythmic and anticoagulant medication use was reduced by 14.3% and 26.8% respectively. Significant complications included one report of pulmonary vein stenosis, one report of pseudoaneurysm and 5.5% of patients had transient pericarditis or pericardial effusion following the procedure. Conclusion: The results of this study were comparable to those of the high volume multi-center STOP-AF trial. PVI via cryoablation is a safe and effective alternative treatment of drug refractory symptomatic AF in the setting of a regional medical center. [ABSTRACT FROM AUTHOR]

Hypertrophic cardiomyopathy (HCM) is a genetic cardiovascular disease that predisposes individuals to the development of arrhythmias. The most common sustained arrhythmia is atrial fibrillation (AF). Compared with the general population, patients with HCM are more prone to the development of AF. To avoid embolic complications and the clinical deterioration caused by the development of AF in HCM, identifying patients with a tendency toward AF might affect the management of HCM. In this review, we evaluated the predictors of AF development in patients with HCM. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most common arrhythmia and is a major cardiovascular challenge due to its close association with increased morbidity and mortality. Although the incidence and prevalence of AF is slightly lower in developing countries than in developed countries, the AF-associated risk of stroke is similar. Treatment of AF is far from satisfactory in developing countries, which may be due to limited health-care resources and social and racial characteristics that differ from Western populations. Chronic rate control is still the main treatment strategy of persistent AF because anti-arrhythmic drugs have only a modest long-term effect on maintenance of sinus rhythm, and no superior impact in terms of cardiovascular outcomes. With the development of ablation techniques and strategies, more AF patients received catheter ablation, although the benefit, complications, and high recurrence rate associated with AF ablation remain under investigation. Improvement in antithrombotic therapy of AF has been observed, although still fewer patients receive oral anticoagulants in developing countries than in Western countries. Novel treatment for the prevention of thromboembolism, such as new oral anticoagulants with different mechanisms of action or the percutaneous transcatheter closure of the left atrial appendage, has recently been introduced in developing countries as an alternative option for the prevention of AF-associated strokes. More data are needed regarding upstream therapy. [ABSTRACT FROM AUTHOR]

Psychological Distress and Suicidal Ideation in Patients With Atrial Fibrillation: Prevalence and Response to Management Strategy. Given the complexity of his medical management and increased risk of bleeding due to underlying CLL with thrombocytopenia, AF management was challenging and led to significant stress and anxiety of the patient. Key W ords Smartwatch, Arrhythmia, Surveillance, Atrial Fibrillation Introduction Consumers are now able to purchase mobile devices with built in arrhythmias alerts and other activities. [Extracted from the article]

Aims: MyDiagnostick (MDK) is a novel portable ECG recorder. We conducted this study to evaluate its role in screening for atrial fibrillation (AF). Methods: The device is a cylindrical rod with metallic electrodes at both ends recording electrocardiogram (ECG) when both electrodes are held. Individuals were requested to hold the device for approximately 15 s, the device was then connected to a laptop (with proprietary software downloaded) and analysed. Anonymised ECGs were stored for further analysis. A total of 855 ECGs were recorded and analysed offline by two arrhythmia specialists assessing ECG quality, in particular the level of noise. A noise score (NS) was devised regarding ECG quality. Results: Seven individuals were found with unknown AF (0,8%). In general ECG quality was good and rhythm diagnosis was certain with total interobserver agreement. Conclusion: The MDK provided a rapid and accurate rhythm analysis and has potential implications in preventing ischaemic cardioembolic stroke. [ABSTRACT FROM AUTHOR]

This case report highlights the variety of wide complex tachycardias, and the need for their prompt management, in the growing population of patients with circulatory support devices. We present a case that demonstrates how a wide complex supraventricular tachycardia in a patient with a biventricular assist device can be safely and effectively targeted for treatment using percutaneous radiofrequency catheter ablation, allowing for clinical improvement, weaning of RVAD treatment, and discharge home with LVAD alone. [ABSTRACT FROM AUTHOR]