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Aims: There is little known about segmental atrial function in patients with atrial arrhythmias. We evaluated segmental atrial contractility using colour Doppler tissue imaging (CDTI) in patients with chronic atrial fibrillation (CAF) who were successfully restored and maintained in sinus rhythm (SR). [ABSTRACT FROM PUBLISHER]

Aims The relative efficacy and safety of open irrigated tip catheters compared with conventional non-irrigated catheters for pulmonary vein isolation (PVI) is unknown. Methods Forty-eight patients undergoing PVI using an open irrigated tip ablation catheter (Group 1) were compared with a group of 31 historical controls (Group 2). The control group underwent similar procedures using a standard, 4 mm tip, temperature controlled ablation catheter. Electrical mapping with a circular catheter was used to guide segmental radiofrequency ablation at the vein ostia. Results At follow-up (3.5±3.5 months) after a single procedure 35/48 (73%) patients in Group 1 and 14/31 (45%) in Group 2 were in sinus rhythm (p=0.03). Antiarrhythmic drug use was lower among those in Group 1 maintained in sinus rhythm (9/35 (26%) vs 8/14 (57%), p=0.002). Recurrent atrial fibrillation was more common in Group 2 (28/31 (90%) vs 28/48 (58%) p=0.004). Serious complications were uncommon in both groups. Conclusions Compared with an historical control group, pulmonary vein isolation using open irrigated tip catheters was superior to ablation with conventional 4 mm tip catheters. Patients undergoing ablation with an irrigated tip catheter were less likely to experience symptomatic recurrences of atrial fibrillation or require further therapy for post-procedural arrhythmias. [ABSTRACT FROM PUBLISHER]

Background: Cardiac amyloidosis (CA) is an under-recognized cause of heart failure. Left atrial (LA) myopathy contributes to a worse prognosis in heart failure and is a feature of transthyretin (ATTR) and light-chain (AL) CA. LA mechanical dispersion (LA-MD) is a novel marker of intra-atrial dyssynchrony implicated in LA myopathy and the future development of atrial fibrillation (AF)., Aims: This study aimed to determine the characteristics and prognostic value of LA myopathy in ATTR and AL cardiomyopathy through a comprehensive LA echocardiographic evaluation., Methods: ATTR (n = 86) and AL (n = 86) CA patients were compared with hypertensive heart disease (HHT) patients (n = 58). Transthoracic echocardiographic measurements including LA strain and LA-MD were obtained with patient follow-up for mortality., Results: ATTR and AL patients had a median follow-up of 66 months, with 26 mortality events. Left ventricular (LV) mass, diastolic function (average-e' and E/e'), LV global longitudinal strain, and LA volume and function (LA function index and strain) were more impaired in ATTR versus AL; these echocardiographic parameters were more impaired in both amyloid groups compared to HHT patients (P < 0.05). LA-MD was increased in ATTR versus AL [median 72.2 (inter-quartile range 55-88.9) vs. 54 (43.5-64.2), respectively, P < 0.001]. Multivariable logistic regression adjusted for age, presence of AF, LV mass, global and basal strain, and E/e' demonstrated that LA-MD was an independent determinant of ATTR CA (P = 0.014). On multivariable analysis, LA reservoir strain was independently associated with the presence of heart failure in the CA group (P < 0.001). LA minimum volume (cut-off ≥18 mL/m 2 ) was a determinant of mortality in AL CA [Cox proportional hazard ratio (HR) 1.042 (1.003-1.082), P = 0.034 and Kaplan-Meier analysis, P = 0.016]., Conclusion: Characterizing LA myopathy has significant diagnostic and prognostic utility in CA. ATTR patients have increased atrial dyssynchrony, which may have implications for AF development. LA reservoir strain was associated with heart failure in CA, whilst LA minimum volume was a predictor of mortality in AL CA., (© 2024 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Aims: Differentiating phenotypes of cardiac "hypertrophy" characterised by increased wall thickness on echocardiography is essential for management and prognostication. Transthoracic echocardiography is the most commonly used screening test for this purpose. We sought to identify echocardiographic markers that distinguish infiltrative and storage disorders that present with increased left ventricular (LV) wall thickness, namely, cardiac amyloidosis (CA) and Anderson-Fabry disease (AFD), from hypertensive heart disease (HHT)., Methods: Patients were retrospectively recruited from Westmead Hospital, Sydney, and Princess Alexandra Hospital, Brisbane. LV structural, systolic, and diastolic function parameters, as well as global (LVGLS) and segmental longitudinal strains, were assessed. Previously reported echocardiographic parameters including relative apical sparing ratio (RAS), LV ejection fraction-to-strain ratio (EFSR), mass-to-strain ratio (MSR) and amyloidosis index (AMYLI) score (relative wall thickness ×  E / e ') were evaluated., Results: A total of 209 patients {120 CA [58 transthyretin amyloidosis (ATTR) and 62 light-chain (AL) amyloidosis], 31 AFD and 58 HHT patients; mean age 64.1 ± 13.7 years, 75% male} comprised the study cohort. Echocardiographic measurements differed across the three groups, The LV mass index was higher in both CA {median 126.6 [interquartile range (IQR) 106.4-157.9 g/m 2 ]} and AFD [median 134 (IQR 108.8-152.2 g/m 2 )] vs. HHT [median 92.7 (IQR 79.6-102.3 g/m 2 ), p  < 0.05]. LVGLS was lowest in CA [median 12.29 (IQR 10.33-15.56%)] followed by AFD [median 16.92 (IQR 14.14-18.78%)] then HHT [median 18.56 (IQR 17.51-19.97%), p  < 0.05]. Diastolic function measurements including average e ' and E / e ' were most impaired in CA and least impaired in AFD. Indexed left atrial volume was highest in CA. EFSR and MSR differentiated secondary (CA + AFD) from HHT [receiver operating curve-area under the curve (ROC-AUC) of 0.80 and 0.91, respectively]. RAS and AMYLI score differentiated CA from AFD (ROC-AUC of 0.79 and 0.80, respectively). A linear discriminant analysis with stepwise variable selection using linear combinations of LV mass index, average e ', LVGLS and basal strain correctly classified 79% of all cases., Conclusion: Simple echocardiographic parameters differentiate between different "hypertrophic" cardiac phenotypes. These have potential utility as a screening tool to guide further confirmatory testing., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Ferkh, Tjahjadi, Stefani, Geenty, Byth, De Silva, Boyd, Richards, Mollee, Korczyk, Taylor, Kwok, Kizana, Ng and Thomas.)

Aims: Atrial fibrillation (AF) can result in the development of left atrial appendage (LAA) thrombi. We sought to examine demographic and echocardiographic predictors of LAA thrombus in patients with persistent AF., Methods and Results: One hundred and sixty-five patients in persistent AF (36 with LAA thrombus and 129 without thrombus) were studied. Demographic and cardiovascular risk factors were retrospectively examined. Transthoracic (TTE) and transoesophageal echocardiography (TOE) were performed to assess the size and function of the left ventricle (LV), left atrium (LA), LAA, and spontaneous echo contrast (SEC) in the LA and right atrium (RA). Univariate demographic predictors of LA thrombus included systolic blood pressure, ischaemic heart disease and congestive heart failure. Indexed LV mass and septal E' velocity on TTE and mean LAA emptying velocity and the presence of SEC in both the LA and RA on TOE were predictors of thrombus. In a multiple logistic regression analysis the only independent predictor of thrombus was indexed LV mass (P < 0.001). Receiver operator characteristic curve analysis also demonstrated that indexed LV mass had the highest area under the curve (AUC: 0.98)., Conclusion: In the present study, increased LV mass was the strongest predictor of LAA thrombus in persistent AF. LA SEC and RA SEC were univariate predictors of LAA thrombus but did not add predictive value to a multivariate model including LV mass. This study highlights the importance of diagnosing and treating LV hypertrophy associated with persistent AF, which may reduce the risk of LAA thrombus and thrombo-embolic stroke.

Aims: There is little known about segmental atrial function in patients with atrial arrhythmias. We evaluated segmental atrial contractility using colour Doppler tissue imaging (CDTI) in patients with chronic atrial fibrillation (CAF) who were successfully restored and maintained in sinus rhythm (SR)., Methods and Results: We compared the segmental atrial contractility in 39 CAF patients who were successfully cardioverted and maintained in SR for 6 months. Follow up echocardiograms were performed at baseline, 1 week, 1 month and 6 months and compared to a normal age matched cohort (n = 34). Using CDTI, mean peak velocities of atrial contraction were measured from annular, mid and superior segments of lateral and septal walls of the left atrium and right atrium in the apical four-chamber view. Segmental velocities from the posterior and anterior walls of the left atrium were measured from the apical two-chamber view. Segmental left atrial velocities improved over time in the CAF group, with the majority of the recovery occurring in the first month, but failed to normalise even at 6 months. In comparison, the right atrial velocities in the AF group had normalised at 1 month., Conclusion: Patients with CAF have persistent segmental left atrial dysfunction even 6 months after restoration and maintenance of SR, though right atrial velocities appear to normalise. This differential recovery indicates that left atrial function remains subnormal in patients with CAF despite maintenance of SR, suggesting underlying atrial myopathy or fibrosis as a consequence of CAF.

Aims: The relative efficacy and safety of open irrigated tip catheters compared with conventional non-irrigated catheters for pulmonary vein isolation (PVI) is unknown., Methods: Forty-eight patients undergoing PVI using an open irrigated tip ablation catheter (Group 1) were compared with a group of 31 historical controls (Group 2). The control group underwent similar procedures using a standard, 4 mm tip, temperature controlled ablation catheter. Electrical mapping with a circular catheter was used to guide segmental radiofrequency ablation at the vein ostia., Results: At follow-up (3.5+/-3.5 months) after a single procedure 35/48 (73%) patients in Group 1 and 14/31 (45%) in Group 2 were in sinus rhythm (p=0.03). Antiarrhythmic drug use was lower among those in Group 1 maintained in sinus rhythm (9/35 (26%) vs 8/14 (57%), p=0.002). Recurrent atrial fibrillation was more common in Group 2 (28/31 (90%) vs 28/48 (58%) p=0.004). Serious complications were uncommon in both groups., Conclusions: Compared with an historical control group, pulmonary vein isolation using open irrigated tip catheters was superior to ablation with conventional 4 mm tip catheters. Patients undergoing ablation with an irrigated tip catheter were less likely to experience symptomatic recurrences of atrial fibrillation or require further therapy for post-procedural arrhythmias.