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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]

Remote magnetic navigation (RMN) presents a promising approach for catheter ablation in complex arrhythmias. This study aims to offer additional insights into the feasibility, safety, and efficacy of RMN for catheter ablation of epicardial atrial and ventricular arrhythmias in patients without structural heart disease. We present a case series of three patients (39-year-old female, 28-year-old female, and 17-year-old male) referred to our institute for epicardial ablation following unsuccessful endocardial procedures. The first patient exhibited approximately 40,000 monomorphic premature ventricular complexes (PVCs) in a 24-hour Holter recording, while the second patient experienced incessant left ventricular tachycardia (VT). In both cases, the QRS morphology indicated an epicardial origin of the arrhythmia. The third patient suffered from incessant atrial tachycardia (AT) originating from the distal portion of the vein of Marshall (VOM). Epicardial 3D electroanatomic mapping and ablation with RMN were performed with ease and minimal fluoroscopy usage. Coronary angiogram visualization on the RMN screen provided real-time information on the catheter tip's position relative to the coronary arteries. In all cases, the earliest signals were recorded epicardially, and unipolar recordings displayed sharp negative deflections at the sites of successful ablation. In the first patient, pace mapping was superior in the epicardium compared to the endocardium, and PVCs were eradicated by epicardial ablation. In the second patient, epicardial ablation immediately terminated the VT. In the third patient, epicardial ablation at the site exhibiting a distinct VOM potential promptly terminated the AT. No perioperative complications were observed, and all patients remained asymptomatic and free of arrhythmias during long-term follow-up. Our findings suggest that RMN is a feasible, effective, and safe approach for epicardial ablation of left ventricular outflow tract PVCs and VT, as well as atrial tachycardia originating from the VOM. [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: Despite rapid improvement in 3-demensional (3D) mapping technology, fluoroscopy-guided radiofrequency ablation remains the standard of practice in ventricular tachycardia (VT) and premature ventricular contraction (PVC) ablations. This study aimed to demonstrate the safety and efficacy of fluoroless VT/PVC ablation compared with conventional fluoroscopy-guided ablation in a real-world clinical setting. Methods: This was a nonrandomized, single-arm, retrospective study. The primary outcome was the termination of VT/PVC, as determined by noninducible VT/PVC postablation on and off isoproterenol. Safety outcomes included early onset adverse events. Results: Procedural data for 37 fluoroless cases and 39 fluoroscopy-guided cases were included in the analysis. Mean procedure time was significantly lower in the fluoroless group (P = 0.029). Fluoroscopy time was significantly lower in the fluoroless group (P <0.001). Acute success rate and recurrence were not significantly different between both groups (P = 0.675 and P = 0.453, respectively). Complication rates were low and similar between both groups (P = 0.999). Conclusions: Fluoroless VT/PVC ablation with CARTO 3D mapping system guidance showed acceptable procedure time, success in ablation, and adverse event rates. Fluoroscopy and procedure times were better than conventional fluoroscopy-guided VT/PVC ablation. [ABSTRACT FROM AUTHOR]

Bifascicular block entails conduction delay or "block" below the atrioventricular node in two of three fascicles: the right bundle branch, and the left anterior and posterior fascicles of the left bundle branch. Typically, right bundle branch block (RBBB) coexists with either left anterior fascicular block (LAFB) or left posterior fascicular block (LPFB), with potential progression to complete heart block. [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]

Peripartum cardiomyopathy is an idiopathic cardiomyopathy that most commonly affects women in the third trimester of pregnancy or in the first five months of the postpartum period. It has been associated with a myriad of different findings on electrocardiograms and arrhythmias. This review discusses these electrocardiogram changes and arrhythmias in regards to prevalence, genetic landscape, screening and prognostication implications, and management. [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: Robotic systems have been used in a diverse spectrum of cardiac interventions, mainly in the field of invasive cardiology, namely interventional cardiology and electrophysiology (EP). The state-of-the-art robotic systems allow mapping and ablation of various arrhythmias without the need for manual conventional catheter steering. The aim of robotic procedures is to achieve the same effectiveness and safety as conventional procedures, whilst reducing the radiation exposure for patients and operators, and to be able to reach targets within the heart that are otherwise unreachable conventionally with greater precision and catheter stability. Purpose: We aimed to demonstrate the feasibility of 3D electroanatomical mapping (EAM) using the remote magnetic navigation (RMN) system (Niobe ES, Stereotaxis Inc) by comparing the mapping performance of 2 operators (one located in the electrophysiology catheter lab control room and the second ~1200 km away via remote online connection). Methods: Two operators were tasked to perform 3D fast anatomical maps (FAM, CARTO 3 RMT, Biosense Webster) of the right and left atrial and ventricular chambers, as well as the aorta of a 3D phantom representing normal cardiac anatomy. All procedures were recorded on the Odyssey Cinema system for further analysis. Parameters compared were duration of FAM, total volume acquired and average distance of surface match to a contrast enhanced computed tomography (CT) of the same phantom. A composite endpoint of map completeness, mapping time and surface match accuracy was calculated to demonstrate if quality of the maps between operators were comparable. Results: A total of 60 maps were created (6 maps for each right atrium (RA), left atrium (LA), right ventricle (RV), left ventricle (LV) and aorta (Ao) per operator) in an alternating fashion. Average mapping time was 16:08±3:36 min for all chambers with shorter mapping times for right atrial chamber 14:28±3:47 min. Total volumes did not significantly differ between operators. Match statistics also revealed no difference between map completeness. Comparing the composite endpoint, both operators achieved the same accuracy. Conclusion: A distant operator located more than 1200 km away from the RMN laboratory connected online to perform 3D electroanatomical maps of all cardiac chambers of a phantom with equal accuracy and procedure parameters as compared to an operator located in the control room. These results support the feasibility of truly remote-controlled procedures which would allow an expert operator to actively support a local team in EP interventions. [ABSTRACT FROM AUTHOR]

Remote Magnetic Navigation (RMN) is an evolving technology, allowing operators to reduce radiation exposure in addition to providing precise catheter positioning. While many studies are available to characterize the utility of RMN in different arrhythmia subtypes, there is a paucity of literature evaluating RMN in SVT ablations. In this review, we summarize available literature, caveats and benefits of RMN in SVT ablation. [ABSTRACT FROM AUTHOR]

Premature ventricular complexes (PVCs) are widely common in the general population. In patients with recurrent symptoms and structural heart diseases, catheter ablation is highly effective in treating PVCs. Robotic magnetic navigation (RMN) was developed and applied in PVC ablation in the past two decades. RMN has exhibited inherent advantages over manual ablation since its creation, namely drastically decreased fluoroscopy time, improved catheter maneuverability and stability, and better safety profile. Despite earlier reports of lower efficacy and longer procedure times, technological advances and accumulated user experience have significantly decreased procedure time and improved ablation efficacy while retaining its merits. This review provides a summary of the current evidence in the applications, procedural characteristics, efficacy and safety of RMN in PVC ablations. [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]

Myocarditis is a complex inflammatory disease with both acute and chronic stages that have varying presentations of ventricular arrhythmias both upon presentation, as well as during the disease course. The continued expansion of knowledge regarding the arrhythmogenesis of myocarditis has allowed us to understand that ventricular arrhythmias can often occur in spite of resolution of myocardial inflammation, as well as be one of the most severe predictors of worse clinical outcomes. [ABSTRACT FROM AUTHOR]

Ablation of atrial tachycardias arising from the superior portion of Crista Terminalis may be risky because of the possibility to injure the right phrenic nerve. Although few techniques for phrenic nerve displacement have been reported, their execution can be difficult, timeconsuming and expose the patient to further complications related to epicardial puncture. In our case, radiofrequency catheter ablation from the right superior pulmonary vein allowed us to successfully treat the arrhythmia without hampering the phrenic nerve integrity. [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: The utility of ultra-high definition mapping (UHDM) for ablation of premature ventricular contractions (PVC) remains undetermined. The aim of this study was to investigate UHDM for PVC ablation, and additionally to compare to conventional technique. Methods: Twenty patients investigated using UHDM were prospectively included and analyzed. Electrophysiological caracteristics and results were compared to 40 patients ablated using fluoroscopy only. Results: 2541±2033 EGMs and 331±240 PVC beats were recorded for each patient. Surfaces of isochronal activations were 2.3±1.7 and 6.9±6.1 cm2 (first 10 and 20 ms). Local scar was present in 40% and local block in 65%. Areas of pace-mapping > 95, 90 and 85% concordance were 1.5±3.4, 2.1±3.9 and 3.3±5 cm2. Mean distance between the ablation site and the site of best pace-mapping or of earliest activation was 8±8 mm and 5±7 mm. Pre-potential was noted in 17% vs 26% controls (ns). QS pattern was present in 83% vs 83% controls (ns), and earliest activation was - 31±50 vs - 25±14 ms in controls (ns). Procedure (100±36 vs 190±51 min, p< 0.0001) and fluoroscopy duration (15±9 vs 24±9 min, p=0.005) were shorter in controls. Acute success was achieved in 65% patients with UHDM and in 72% controls (p=ns) with lower residual PVC burden in the control group. Over a follow-up of 19±12 months, long-term success was similar between groups (65 vs 68%). Conclusion: UHDM may reveal poorly recognized activation features and PVC mechanism. In this series, conventional mapping was quicker and did clinically as well as UHDM. [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]

Premature ventricular complexes (PVCs) are common in the general population, usually a symptomatic, and deemed to be benign in structurally normal hearts. The spectrum of "benign" outflow tract PVCs ranges from single PVCs to recurrent non-sustained ventricular tachycardia (NSVT). Short-coupled right ventricular outflow tract (RVOT) PVCs may trigger polymorphic ventricular tachycardia (VT) in some patients and can be high risk. In many patients, PVCs can be more frequent and cause symptoms of palpitations, shortness of breath, dizziness, and heart failure. In the presence of underlying heart disease, they may indicate an increase drisk of adverse cardiovascular outcomes. A high PVC burden may lead to ventricular dysfunction and worsen underlying cardiomyopathy.PVCs may also be a marker of underlying pathophysiologic processes such as myocarditis and other acquired and inherited infiltrative cardiomyopathies. In this unique case report, we describe the use of a novel non-contact mapping array for mapping RVOT PVCs. [ABSTRACT FROM AUTHOR]

Cardiac electrophysiology study (EPS) and catheter ablation procedure are established diagnostic and therapeutic procedures for cardiac arrhythmias. Pulmonary embolism (PE) is a relatively rare but potentially fatal complication of cardiac electrophysiology study (EPS). The paradoxical embolism (PDE) occurs due to an intracardiac defect with a right to left shunt with patent foramen ovale (PFO) being the most common cause. The simultaneous occurrence of PE and PDE is rare. Here we present a case of PE and PDE after EPS and radiofrequency catheter ablation (RFCA) of the slow pathway in a patient with recurrent supraventricular tachycardia (SVT) due to atrioventricular nodal reentry tachycardia (AVNRT). To our knowledge, such a case of PE and PDE has not been reported after SVT ablation. [ABSTRACT FROM AUTHOR]

Background: The long-term results of endocardial and percutaneous epicardial catheter ablation of ventricular tachycardia (VT) in patients with structural heart disease are disappointing. Arrhythmia recurrence after ablation, and VTs with an epicardial substrate remain a clinical challenge. The purpose of this manuscript is to elaborate on feasibility and potential advantages of a surgical hybrid ablation (i.e., combined endocardial and surgical epicardial ablation) based on our initial experience consisting of five cases. Methods: Endocardial electro-anatomical voltage and activation maps were created (Carto, Biosense Webster, California, USA), and endocardial radiofrequency applications were applied at exit sites, low voltage areas and isthmi. Next, after surgical access, epicardial voltage and activation maps were produced in combination with visual assessment of the epicardial substrate. Epicardial low voltage areas, isthmi and exit sites were identified and ablated using radiofrequency energy. Results: After the procedure, VT was non-inducible in 80% of the cases (4/5, in one case no induction was performed). No peri-procedural complications occurred. After a mean follow-up of 18 months, one patient remained in sinus rhythm without, and 2 with use of antiarrhythmic drugs. One patient needed a redo procedure after 21 months, and in one patient the amiodarone dose was raised because of 2 sustained VTs. After this additional treatment, both kept sinus rhythm. Conclusions: Hybrid VT ablation is a safe and effective patient tailored procedure that comprises the major advantage of combining direct anatomical visualization and enhanced catheter stability with high-density 3D mapping. As a consequence, this procedure should be considered as a valid treatment option in complex VT management. [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]