Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology

BACKGROUND AND AIMS: Data on the hybrid atrial fibrillation (AF) treatment are lacking in patients with structural heart disease undergoing concomitant CryoMaze procedures. The aim was to assess whether the timely pre-emptive catheter ablation would achieve higher freedom from AF or atrial tachycardia (AT) and be associated with better clinical outcomes than surgical ablation alone. METHODS: The trial investigated patients with non-paroxysmal AF undergoing coronary artery bypass grafting and/or valve repair/replacement with mandatory concomitant CryoMaze procedure who were randomly assigned to undergo either radiofrequency catheter ablation (Hybrid Group) or no further treatment (Surgery Group)...

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AIMS: Data about whether empirical superior vena cava isolation (SVCI) improves the success rate of paroxysmal atrial fibrillation (PAF) is conflicting. This study sought to firstly investigate the characteristics of SVC-triggered AF, and secondly investigate the impact of electroanatomical mapping guided SVCI in addition to circumferential pulmonary vein isolation (CPVI) on the outcome of PAF ablation in the absence of provoked SVC triggers. METHODS: A total of 130 patients undergoing PAF ablation underwent electrophysiological studies before ablation...

BACKGROUND: When it occurs, pulmonary vein (PV) stenosis after atrial fibrillation (AF) ablation is associated with significant morbidity. Even mild-to-moderate PV narrowing may have long-term implications. Unlike thermal ablation energies such as radiofrequency (RF) or cryothermy, pulsed field ablation (PFA) is a non-thermal modality associated with less fibrotic proliferation. Herein, we compared the effects of PFA vs thermal ablation on PV narrowing after AF ablation. METHODS: ADVENT was a multicenter, randomized, single-blind study comparing PFA (pentaspline catheter) with thermal ablation - force-sensing RF or cryoballoon (CB) - to treat drug-refractory paroxysmal AF...

BACKGROUND: Simulators training have been recently introduced in EP programs in order to improve catheter manipulation skills without complication risks. AIM: To survey the current use of EP simulators and the perceived need of these tools in clinical training and practice. METHODS: A 20-item online questionnaire developed by the Scientific Initiatives Committee of the European Heart Rhythm Association (EHRA) in collaboration with EHRA Digital Committee was disseminated through the EHRA Scientific Research Network members, national EP groups, and social media platforms...

A significant proportion of patients who suffer from atrial fibrillation and are in need of thromboembolic protection are not treated with oral anticoagulation or discontinue this treatment shortly after its initiation. This undertreatment has not improved sufficiently despite the availability of direct oral anticoagulants which are associated with less major bleeding than vitamin K antagonists. Multiple reasons account for this, including bleeding events or ischaemic strokes whilst on anticoagulation, a serious risk of bleeding events, poor treatment compliance despite best educational attempts or aversion to drug therapy...

BACKGROUND AND AIMS: To predict worsening heart failure hospitalizations (WHFH) in patients with implantable defibrillators and remote monitoring (RM), the HeartInsight algorithm (Biotronik, Berlin, Germany) calculates a heart failure (HF) score combining seven physiologic parameters: 24-hour heart rate (HR), nocturnal HR, HR variability, atrial tachyarrhythmia, ventricular extrasystoles, patient activity, and thoracic impedance. We compared temporal trends of the HF score and its components 12 weeks before a WHFH with 12-week trends in patients without WHFH, to assess whether trends indicate deteriorating HF regardless of alert status...

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BACKGROUND AND OBJECTIVES: Data on the optimal use of antithrombotic drugs and associated clinical outcomes in patients with atrial fibrillation (AF) and acute ischemic stroke (IS) are limited. We investigated the prescription patterns of antithrombotics in community practice and long-term clinical prognosis according to early poststroke antithrombotic therapy in patients with AF and acute IS. METHODS: Patients with AF who were admitted for acute IS at a single tertiary hospital in 2010-2020 were retrospectively reviewed...

Cardiac electrophysiology is an evolving field that relies heavily on costly device- and catheter-based technologies. An increasing number of patients with heart rhythm disorders are becoming eligible for cardiac interventions, not least due to the rising prevalence of atrial fibrillation and increased longevity in the population. Meanwhile, the expansive costs of healthcare face finite societal resources, and a cost-conscious approach to new technologies is critical. Cost-effectiveness analyses support rational decision-making in healthcare by evaluating the ratio of healthcare costs to health benefits for competing therapies...

BACKGROUND: Sudden cardiac death (SCD) may occur in apparently healthy individuals, including athletes. We report the diagnostic role of post-mortem genetic testing, molecular autopsy (MA), in elucidating the cause of SCD in athletes. METHODS: We reviewed a database of 6860 consecutive cases of SCD referred to our specialist cardiac pathology centre. All cases underwent detailed cardiac autopsy and 748 were deemed to be athletes. Of these, 42 (6%) were investigated with MA (28 using a targeted sequencing, 14 exome sequencing)...

Right bundle branch block (RBBB) and resulting RV electromechanical discoordination are thought to play a role in the disease process of subpulmonary right ventricular (RV) dysfunction that frequently occur post-repair tetralogy of Fallot. We sought to describe this disease entity, the role of pulmonary re-valvulation and the potential added value of RV cardiac resynchronization therapy (RV-CRT). Two patients with repaired tetralogy of Fallot, complete right bundle branch block, pulmonary regurgitation and significantly decreased RV function underwent echocardiography, cardiac magnetic resonance, and an invasive study to evaluate the potential for RV-CRT as part of the management strategy...

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BACKGROUND: Different disease processes can combine to cause to atrial fibrillation (AF). Their contribution to recurrent AF after ablation in patients is not known. OBJECTIVE: Cardiovascular processes associated with recurrent AF after AF ablation were determined by quantifying biomolecules related to inflammation, metabolism, proliferation, fibrosis, shear-stress, atrial pressure, and others in the AXAFA biomolecule study. METHODS: Twelve circulating cardiovascular biomolecules (ANGPT2, BMP10, CA125, hsCRP, ESM1, FABP3, FGF23, GDF15, IGFBP7, IL6, NT-proBNP, hsTnT) were quantified in plasma samples obtained prior to a first AF ablation using high-throughput, high-precision assays...

AIMS: Chronic Obstructive Pulmonary Disease (COPD) may influence management and prognosis of Atrial Fibrillation (AF), but this relationship has been scarcely explored in contemporary global cohorts. We aimed to investigate the association between AF and COPD, in relation to treatment patterns and major outcomes. METHODS: From the prospective, global GLORIA-AF Registry, we analysed factors associated with COPD diagnosis, as well as treatment patterns and risk of major outcomes in relation to COPD...

BACKGROUND: Noninvasive myocardial scar characterization with cardiac magnetic resonance (CMR) has been shown to accurately identify conduction channels and can be an important aid for ventricular tachycardia (VT) ablation. A new mapping method based on targeting deceleration zones (DZs) has become one of the most commonly used strategies for VT ablation procedures. AIMS: To analyze the capability of CMR to identify DZs and to find predictors of arrhythmogenicity in CMR channels...

BACKGROUND AND AIMS: Systolic blood pressure (SBP) drops recorded by 24-hour ambulatory blood pressure (BP) monitoring (ABPM) identify patients with susceptibility to reflex syncope and orthostatic intolerance. We tested the hypothesis that treatments aimed to increase BP (reassurance, education & life-style measures plus pharmacological strategies) can reduce SBP drops. METHODS: Multicentre, observational proof-of-concept study performed in patients with reflex syncope and/or orthostatic intolerance and with SBP drops on a screening ABPM...

BACKGROUND AND AIMS: Depression, the most prevalent psychiatric disorder, is associated with the occurrence and development of atrial fibrillation (AF). P2X7 receptor (P2X7R) activation participates in the development of depression, but little attention has been given to its role in AF. This study was to investigate the effects of P2X7R on AF in depression models. METHODS: Lipopolysaccharide (LPS) and chronic unpredictable stress (CUS) were carried out to induce depression in rodents...

No abstract text is available yet for this article.

No abstract text is available yet for this article.