Longer and better lives for patients with atrial fibrillation: the 9th AFNET/EHRA consensus conference

Scientific Data

Publisher Correction: High resolution optical mapping of cardiac electrophysiology in pre-clinical models - PMC Back to Top Skip to main content NIH NLM Logo Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation Search PMC Full-Text Archive Search in PMC Advanced Search User Guide Journal List Sci Data v.11; 2024 PMC10796748 Other Formats PDF (618K) Actions Cite Collections Share Permalink Copy RESOURCES Similar articles Cited by other articles Links to NCBI Databases Journal List Sci Data v.11; 2024 PMC10796748 As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice Logo of sdata Sci Data. 2024; 11: 93. Published online 2024 Jan 18. doi: 10.1038/s41597-024-02941-w …

Journal of Cardiovascular Magnetic Resonance

Background: The left atrial volume (LAV) is a crucial cardiac parameter in several clinical settings such as in atrial fibrillation or heart failure for the assessment of diastolic dysfunction and cardiac risk. Currently available LAV reference values were defined by 2d transthoracic echocardiography (2d-TTE). However, LAV measurements are routine part of CMR protocols, though data on the interchangeability of LAV values between CMR and 2d-TTE remain scarce.Methods: We performed CMR (3 T scanner MAGNETOM™ Skyra, Siemens Healthineers, Erlangen, Germany) and 2d-TTE in 2126 participants of the Hamburg City Health Study (HCHS), a population-based cohort study of the middle-aged population in Hamburg. LAV was assessed in TTE from the 4-and 2-chamber view by the method of disk summation. In CMR, LAV was also measured in cine images from the 2-and 4-chamber orientation, employing the …

Biomedicines

Desmoglein-2 mutations are detected in 5–10% of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Endurance training accelerates the development of the ARVC phenotype, leading to earlier arrhythmic events. Homozygous Dsg2 mutant mice develop a severe ARVC-like phenotype. The phenotype of heterozygous mutant (Dsg2mt/wt) or haploinsufficient (Dsg20/wt) mice is still not well understood. To assess the effects of age and endurance swim training, we studied cardiac morphology and function in sedentary one-year-old Dsg2mt/wt and Dsg20/wt mice and in young Dsg2mt/wt mice exposed to endurance swim training. Cardiac structure was only occasionally affected in aged Dsg20/wt and Dsg2mt/wt mice manifesting as small fibrotic foci and displacement of Connexin 43. Endurance swim training increased the right ventricular (RV) diameter and decreased RV function in Dsg2mt/wt mice but not in wild types. Dsg2mt/wt hearts showed increased ventricular activation times and pacing-induced ventricular arrhythmia without obvious fibrosis or inflammation. Preload-reducing therapy during training prevented RV enlargement and alleviated the electrophysiological phenotype. Taken together, endurance swim training induced features of ARVC in young adult Dsg2mt/wt mice. Prolonged ventricular activation times in the hearts of trained Dsg2mt/wt mice are therefore a potential mechanism for increased arrhythmia risk. Preload-reducing therapy prevented training-induced ARVC phenotype pointing to beneficial treatment options in human patients.

European Journal of Pediatrics

Studies on the right ventricular dysfunction (RV) in systemic lupus erythematosus (SLE) patients are limited, particularly in the pediatric age group. The study aimed to identify subclinical RV alterations in childhood-onset SLE (c-SLE) using conventional and three-dimensional echocardiography (3DE). Forty SLE pediatric patients and 40 healthy controls were included. Disease activity and chronicity were evaluated by SLE disease activity index (SLEDAI) score and SLE damage index (SDI). Participants underwent detailed RV echocardiographic examination with conventional and 3DE assessment using 3D auto RV software. Patients included 35/40 (87.5%) females with mean age of 15.6 ± 1.7 years. Using conventional pulmonary artery systolic pressure echocardiography-derived measurement, none of the c-SLE patients had pulmonary hypertension. By 3DE, RV end-systolic and end-diastolic volumes (p = < …

Biomedicines

Desmoglein-2 mutations are detected in 5–10% of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Endurance training accelerates the development of the ARVC phenotype, leading to earlier arrhythmic events. Homozygous Dsg2 mutant mice develop a severe ARVC-like phenotype. The phenotype of heterozygous mutant (Dsg2mt/wt) or haploinsufficient (Dsg20/wt) mice is still not well understood. To assess the effects of age and endurance swim training, we studied cardiac morphology and function in sedentary one-year-old Dsg2mt/wt and Dsg20/wt mice and in young Dsg2mt/wt mice exposed to endurance swim training. Cardiac structure was only occasionally affected in aged Dsg20/wt and Dsg2mt/wt mice manifesting as small fibrotic foci and displacement of Connexin 43. Endurance swim training increased the right ventricular (RV) diameter and decreased RV function in Dsg2mt/wt mice but not in wild types. Dsg2mt/wt hearts showed increased ventricular activation times and pacing-induced ventricular arrhythmia without obvious fibrosis or inflammation. Preload-reducing therapy during training prevented RV enlargement and alleviated the electrophysiological phenotype. Taken together, endurance swim training induced features of ARVC in young adult Dsg2mt/wt mice. Prolonged ventricular activation times in the hearts of trained Dsg2mt/wt mice are therefore a potential mechanism for increased arrhythmia risk. Preload-reducing therapy prevented training-induced ARVC phenotype pointing to beneficial treatment options in human patients.

Heart Rhythm

The outbreak of the COVID-19 pandemic was first reported in China between December 2019 and January 2020; it then spread to Europe, with Italy one of the first countries to have recognized clusters. Within a few weeks, the COVID-19 pandemic had reached all the Western countries with such a dramatic course that it was recognized by the World Health Organization as a public health emergency of international concern. The COVID-19 pandemic turned everyone’s life upside down, and the end of the emergency was declared by the World Health Organization only on May 5, 2023. The mortality associated with the COVID-19 pandemic resulted not only from the severity of SARS-CoV-2 infection but also from a critical, massive disruption of health care systems and of care provision, especially for the elderly and for the most vulnerable patients.

European Heart Journal

Aims There is currently no consensus on whether atrial fibrillation (AF) patients at low risk for stroke (one non-sex-related CHA2DS2-VASc point) should be treated with an oral anticoagulant. Methods and results We conducted a multi-country cohort study in Sweden, Denmark, Norway, and Scotland. In total, 59 076 patients diagnosed with AF at low stroke risk were included. We assessed the rates of stroke or major bleeding during treatment with a non-vitamin K antagonist oral anticoagulant (NOAC), a vitamin K antagonist (VKA), or no treatment, using inverse probability of treatment weighted (IPTW) Cox regression. In untreated patients, the rate for ischaemic stroke was 0.70 per 100 person-years and the rate for a bleed was also 0.70 per 100 person-years. Comparing NOAC with no treatment, the stroke rate was lower [hazard ratio (HR) 0.72; 95% confidence interval (CI) 0.56 …

Atrial fibrillation (AF) is often associated with limiting symptoms, and with significant impairment in quality of life. As such, treatment strategies aimed at symptom control form an important pillar of AF management. Such treatments include a wide variety of drugs and interventions, including, increasingly, catheter ablation. These strategies can be utilised either singly or in combination, to improve and restore quality of life for patients, and this review covers the current evidence base underpinning their use. In this Review, we discuss the pros and cons of rate vs. rhythm control, while offering practical tips to non-specialists on how to utilise various treatments and counsel patients about all relevant treatment options. These include antiarrhythmic and rate control medications, as well as interventions such as cardioversion, catheter ablation, and pace-and-ablate.

Giornale Italiano di Cardiologia (2006)

[Management and treatment of atrial fibrillation in cancer patients: an important decision-making hub in cardio-oncology]. - Abstract - Europe PMC Sign in | Create an account https://orcid.org Europe PMC Menu About Tools Developers Help Contact us Helpdesk Feedback Twitter Blog Tech blog Developer Forum Europe PMC plus Search life-sciences literature (43,947,359 articles, preprints and more) Search Advanced search Feedback This website requires cookies, and the limited processing of your personal data in order to function. By using the site you are agreeing to this as outlined in our privacy notice and cookie policy. Abstract Full text [Management and treatment of atrial fibrillation in cancer patients: an important decision-making hub in cardio-oncology]. Boriani G 1 , Mantovani M 1 , Cherubini B 1 , Tartaglia E 1 , Bonini N 1 Author information Affiliations 1. Cardiologia, Dipartimento di Scienze Biomediche, …

Over the next 25 years the incidence of ischaemic strokes is projected to increase by> 27% in Europe, leading to higher rates of morbidity, mortality, and healthcare costs. 1 Detecting patients at risk for ischaemic strokes and implementing preventive therapeutic strategies are crucial steps towards improving the prognosis of these individuals. In particular, patients with isolated sinus node dysfunction (ISND), even those without a history or current diagnosis of supraventricular tachyarrhythmias, face an elevated risk of cardiovascular events when compared with the general population. 2 Isolated sinus node dysfunction, which comprises a wide spectrum of sinoatrial dysfunctions, is a frequently encountered condition in clinical practice and may be suspected through surface electrocardiogram (ECG), Holter-ECG, and internal loop recorder. Unlike atrial fibrillation (AF), the identification and management of the …

European Heart Journal-Digital Health

Aims European and American clinical guidelines for implantable cardioverter defibrillators are insufficiently accurate for ventricular arrhythmia (VA) risk stratification, leading to significant morbidity and mortality. Artificial intelligence offers a novel risk stratification lens through which VA capability can be determined from the electrocardiogram (ECG) in normal cardiac rhythm. The aim of this study was to develop and test a deep neural network for VA risk stratification using routinely collected ambulatory ECGs. Methods and results A multicentre case–control study was undertaken to assess VA-ResNet-50, our open source ResNet-50-based deep neural network. VA-ResNet-50 was designed to read pyramid samples of three-lead 24 h ambulatory ECGs to decide whether a heart is capable of VA based on the ECG alone. Consecutive adults with VA from East Midlands, UK, who …

Heart Rhythm

BackgroundVoltage mapping could identify the conducting channels potentially responsible for ventricular tachycardia (VT). Standard thresholds (0.5-1.5 mV) were established using bipolar catheters. No thresholds have been analyzed with high density mapping catheters. In addition, channels identified by cardiac magnetic resonance (CMR) has been proven to be related with VT.ObjectivesTo analyze the diagnostic yield of a personalized voltage map using CMR to guide voltage thresholds adjustment.MethodsAll consecutive patients with scar-related VT undergoing ablation after CMR (October 2018-December 2020) were included. First, personalized CMR-guided voltage thresholds were defined systematically according to scar and channels distribution. Second, to validate these new thresholds, a comparison with standard thresholds (0.5-1.5mV) was carried out. Tissue characteristics of areas identified as …

JACC: Clinical Electrophysiology

BackgroundSerum bone morphogenetic protein 10 (BMP10) blood levels are a marker for history of atrial fibrillation (AF) and for major adverse cardiovascular events in patients with AF, including stroke, AF recurrences after catheter ablations, and mortality. The predictive value of BMP10 in patients undergoing cardiac surgery and association with morphologic properties of atrial tissues are unknown.ObjectivesThis study sought to study the correlation between BMP10 levels and preoperative clinical traits, occurrence of early and late postoperative atrial fibrillation (POAF), and atrial fibrosis in patients undergoing cardiac surgery.MethodsPatients with and without preoperative AF history undergoing first cardiac surgery were included (RACE V, n = 147). Preoperative blood biomarkers were analyzed, left (n = 114) and right (n = 125) atrial appendage biopsy specimens were histologically investigated after WGA …

Background and Aims Mineralocorticoid receptor antagonists (MRAs) improve cardiovascular outcomes in a variety of settings. This study aimed to assess whether cardioprotective effects of MRAs are modified by heart failure (HF) and atrial fibrillation (AF) status and to study their impact on AF events. Methods MEDLINE, Embase, and Cochrane Central databases were searched to 24 March 2023 for randomized controlled trials evaluating the efficacy of MRAs as compared with placebo or usual care in reducing cardiovascular outcomes and AF events in patients with or at risk for cardiovascular diseases. Random-effects models and interaction analyses were used to test for effect modification. Results Meta-analysis of seven trials (20 741 participants, mean age: 65.6 years, 32% women) showed that the efficacy of MRAs, as compared with placebo, in …

Journal of Cardiovascular Medicine

BackgroundTraditional scores as CHADS 2 and CHA 2 DS 2-Vasc are suitable for predicting stroke and systemic embolism in patients with atrial fibrillation (AF) and have shown to be also associated with mortality. Other more complex scores have been recommended for survival prediction. The purpose of our analysis was to test the performance of different clinical scores in predicting 1-year mortality in AF patients.

Plos one

Aims Embolic stroke of undetermined source (ESUS) accounts for up to 20% of ischemic strokes annually. Undetected atrial fibrillation (AF) is one important potential underlying cause. For AF, oral anticoagulation has evolved as the most preferable means of secondary stroke prevention. To detect unrecognized paroxysmal AF, long-term ECG monitoring is required, and implantable cardiac monitors (ICM) appear most suitable. Yet, ICMs are particularly costly, implantation is invasive, and remote monitoring places a personnel burden on health care providers. Here, we use data from a large cohort of ESUS patients to systematically analyze the effort of ICM remote monitoring for AF diagnosis and the strain on health care providers. Methods and results From a prospective, single-center, observational ESUS registry, we analyzed all ICM-equipped patients post-ESUS (n = 172) between January 1st, 2018, and December 31st, 2019. Through January 2nd, 2023, 48 patients (27.9%) were diagnosed with AF by ICM remote monitoring. During follow-up, a total of 29,180 remote monitoring episodes were transmitted, of which 17,742 were alarms for AF. A systematic estimation of workload revealed that on average, 20.3 trained physician workhours are required to diagnose one patient with AF. Conclusion ICM remote monitoring is useful to diagnose AF in cohort of post-ESUS patients. However, the number of ICM alarms is high, even in a cohort at known high risk of AF and in whom AF detection is therapeutically consequential. Improved automated event classification, clear recommendations for ICM interrogation after AF diagnosis, and a careful …

Europace

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 and results 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. The primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACEs). A total of 36 263 patients (mean age 70.1 ± 10.5 years, 45.2% females) were included; 2,261 (6.2%) had COPD. The prevalence of COPD was lower in Asia and higher in North America. Age, female sex, smoking, body mass index, and cardiovascular …

Heart Rhythm

Initial findings from feasibility studies on pulsed field ablation (PFA) in the treatment of atrial fibrillation (AF) indicated high rates of efficacy and pulmonary vein (PV) isolation (PVI) durability upon systematic remapping. Nonetheless, there remains a shortage of data regarding effectiveness, lesion durability and safety of the procedure beyond the scope of feasibility studies. This analysis was conducted to assess the efficacy, safety and lesion durability associated with PFA for AF in real-life settings.

JAMA

ImportanceAtrial cardiopathy is associated with stroke in the absence of clinically apparent atrial fibrillation. It is unknown whether anticoagulation, which has proven benefit in atrial fibrillation, prevents stroke in patients with atrial cardiopathy and no atrial fibrillation.ObjectiveTo compare anticoagulation vs antiplatelet therapy for secondary stroke prevention in patients with cryptogenic stroke and evidence of atrial cardiopathy.Design, Setting, and ParticipantsMulticenter, double-blind, phase 3 randomized clinical trial of 1015 participants with cryptogenic stroke and evidence of atrial cardiopathy, defined as P-wave terminal force greater than 5000 μV × ms in electrocardiogram lead V1, serum N-terminal pro-B-type natriuretic peptide level greater than 250 pg/mL, or left atrial diameter index of 3 cm/m2or greater on echocardiogram. Participants had no evidence of atrial fibrillation at the time of randomization …

Europace

The Brugada Syndrome (BrS) is an inherited arrhythmogenic condition that can 4 predispose to fatal ventricular tachyarrhythmias, and has also been associated with 5 ventricular standstill and heart block 1–3. Current guidelines recommend that BrS 6 can be diagnosed in the presence of an unprovoked spontaneous type 1 pattern 7 (spT1) in leads V1 or V2 on the surface ECG positioned at the sternal margins at 8 the fourth intercostal space, or at the third or second intercostal spaces (the “high 9 precordial leads”-HPL). The type 1 pattern is characterised by coved ST segment 10 elevation≥ 2 mV and a negative T wave, and may be concealed and only induced 11 (diT1) after provocative drug testing with intravenous sodium channel blockers 12 (SCB). In this case, a diagnosis of ‘concealed’BrS may be corroborated by 13 previous aborted cardiac arrest (aCA), arrhythmic syncope or nocturnal agonal 14 respiration, and/or a family history of BrS or of juvenile sudden death (SD) with a 15 negative autopsy and circumstance suspicious for BrS 4. Several clinical and ECG 16 parameters have been proposed to identify subjects at risk of experiencing life-17 threatening arrhythmias during follow-up 5–7; a spT1 pattern at presentation has 18 consistently been associated with increased risk, whereas a diT1 confers a better 19

Europace

Aims Recent trial data demonstrate beneficial effects of active rhythm management in patients with atrial fibrillation (AF) and support the concept that a low arrhythmia burden is associated with a low risk of AF-related complications. The aim of this document is to summarize the key outcomes of the 9th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Methods and results Eighty-three international experts met in Münster for 2 days in September 2023. Key findings are as follows: (i) Active rhythm management should be part of the default initial treatment for all suitable patients with AF. (ii) Patients with device-detected AF have a low burden of AF and a low risk of stroke. Anticoagulation prevents some strokes and also increases major but non-lethal bleeding. (iii) More research is needed to …

Europace

Introduction Traditional AF recurrence after catheter ablation is reported as a binary outcome. However, a paradigm shift towards a more granular definition, considering arrhythmic or symptomatic burden, is emerging. Hypothesis We hypothesize that ablation reduces AF burden independently of conventional recurrence status in persistent AF patients, correlating with symptom burden reduction. Methods 98 patients with persistent AF from the DECAAFII trial with pre-ablation follow-up were included. Patients recorded daily single-lead ECG strips, defining AF burden as the proportion of AF days among total submitted ECG days. The primary outcome was atrial arrhythmia recurrence. The Atrial Fibrillation Severity Scale (AFSS) was administered pre-ablation and at 12-months post-ablation. Results At follow-up, 69 patients had atrial …

Europace

Background and Aims There are few data on the feasibility of population screening for paroxysmal AF using hand-held ECG devices outside a specialist setting or in people over the age of 75. We investigated the feasibility of screening when conducted without face-to-face contact (‘remote’) or via in-person appointments in primary care, and explored impact of age on screening outcomes. Methods People aged ≥65 years from 13 general practices in England participated in screening during 2019-20. This involved attending a practice nurse appointment (10 practices) or receiving an ECG device by post (3 practices). Participants were asked to use a handheld ECG for 1-4 weeks. Screening outcomes included: uptake, quality of ECGs, AF detection rates, and uptake of anticoagulation if AF was detected. Results Screening was carried out by 2,141 (87.5%) of …

Europace

Aims Metabolic syndrome (MetS) is associated with arrhythmias and cardiovascular mortality. Arrhythmogenesis in MetS results from atrial structural and electrical remodelling. The small-conductance Ca2+-activated K+ (SK) currents modulate atrial repolarization and may influence atrial arrhythmogenicity. This study investigated the regulation of SK current perturbed by a high-fat diet (HFD) to mimic MetS. Methods and results Thirty mice were divided into two groups that were fed with normal chow (CTL) and HFD for 4 months. Electrocardiography and echocardiography were used to detect cardiac electrical and structure remodelling. Atrial action potential duration (APD) and calcium transient duration (CaTD) were measured by optical mapping of Langendorff-perfused mice hearts. Atrial fibrillation (AF) inducibility and duration were assessed by burst pacing. Whole-cell patch …

Europace

Background and aims Women have been historically underrepresented in implantable cardioverter defibrillator (ICD) trials. No data on sex differences regarding subcutaneous-ICDs (S-ICD) carriers have been described. Aim of our study was to investigate sex-related differences among unselected S-ICD recipients. Methods Consecutive patients enrolled in the multicenter, international i-SUSI registry were analyzed. Comparisons between sexes were performed using a 1:1 propensity matching adjusted analysis for age, body mass index (BMI), left ventricular function and substrate. The primary outcome was the rate of appropriate shocks during follow-up. Inappropriate shocks and other device-related complications were deemed secondary outcomes. Results A total of 1698 patients were extracted from the iSUSI registry; 399 (23.5%) were females. After …

Europace

Structured Abstract Background and Aims Atrial fibrillation (AF) recurs in about one third of patients after catheter ablation (CA), mostly in the first year. Little is known about the electrophysiological findings and the effect of re-ablation in very late AF recurrences after more than one year. The aim of this study was to determine the characteristics and outcomes of the first repeat CA after very late recurrence of AF after index CA. Methods We analysed patients from a prospective Swiss registry that underwent a first repeat ablation procedure. Patients were stratified depending on the time to recurrence after index procedure: early recurrence (ER) for recurrences within the first year and late recurrence (LR) if the recurrence was later. The primary endpoint was freedom from AF in the first year after repeat ablation. Results Out of 1864 patients included in the registry …

Europace

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 and results 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. The primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACEs). A total of 36 263 patients (mean age 70.1 ± 10.5 years, 45.2% females) were included; 2,261 (6.2%) had COPD. The prevalence of COPD was lower in Asia and higher in North America. Age, female sex, smoking, body mass index, and cardiovascular …

Europace

* Corresponding author. Tel:+ 44 191 241 8615; fax:+ 44 191 241 8666. E-mail address: gavin. richardson@ ncl. ac. uk

Europace

Background and Aims High-power-short-duration (HPSD) ablation is an effective treatment for atrial fibrillation but poses risks of thermal injuries to the oesophagus and vagus nerve. This study investigates incidence and predictors of thermal injuries, employing machine learning. Methods A prospective observational study was conducted at Leipzig Heart Centre, Germany, excluding patients with multiple prior ablations. All patients received Ablation Index guided HPSD ablation and subsequent oesophagogastroduodenoscopy. A machine learning algorithm categorized ablation points by atrial location and analysed ablation data, including Ablation Index, focusing on the posterior wall. The study is registered in clinicaltrials.gov (NCT05709756). Results Between February 2021, and August 2023, 238 patients were enrolled, of whom 18 (7.6%; 9 oesophagus …

Europace

Background and Aims There are few data on the feasibility of population screening for paroxysmal AF using hand-held ECG devices outside a specialist setting or in people over the age of 75. We investigated the feasibility of screening when conducted without face-to-face contact (‘remote’) or via in-person appointments in primary care, and explored impact of age on screening outcomes. Methods People aged ≥65 years from 13 general practices in England participated in screening during 2019-20. This involved attending a practice nurse appointment (10 practices) or receiving an ECG device by post (3 practices). Participants were asked to use a handheld ECG for 1-4 weeks. Screening outcomes included: uptake, quality of ECGs, AF detection rates, and uptake of anticoagulation if AF was detected. Results Screening was carried out by 2,141 (87.5%) of …

Europace

Aims Guidelines recommend opportunistic screening for atrial fibrillation (AF), using a 30 s single-lead electrocardiogram (ECG) recorded by a wearable device. Since many patients have paroxysmal AF, identification of patients at high risk presenting with sinus rhythm (SR) may increase the yield of subsequent long-term cardiac monitoring. The aim is to evaluate an AI-algorithm trained on 10 s single-lead ECG with or without risk factors to predict AF. Methods and results This retrospective study used 13 479 ECGs from AF patients in SR around the time of diagnosis and 53 916 age- and sex-matched control ECGs, augmented with 17 risk factors extracted from electronic health records. AI models were trained and compared using 1- or 12-lead ECGs, with or without risk factors. Model bias was evaluated by age- and sex-stratification of results. Random forest models identified …

Europace

Aims Catheter ablation (CA) of ventricular tachycardia (VT) has become an important tool to improve clinical outcomes in patients with appropriate transvenous implantable cardioverter defibrillator (ICD) shocks. The aim of our analysis was to test whether VT ablation (VTA) impacts long-term clinical outcomes even in subcutaneous ICD (S-ICD) carriers. Methods and results International Subcutaneous Implantable Cardioverter Defibrillator (iSUSI) registry patients who experienced either an ICD shock or a hospitalization for monomorphic VT were included in this analysis. Based on an eventual VTA after the index event, patients were divided into VTA+ vs. VTA− cohorts. Primary outcome of the study was the occurrence of a combination of device-related appropriate shocks, monomorphic VTs, and cardiovascular mortality. Secondary outcomes were addressed individually. Among …

Europace

Aims Identifying heart failure (HF) patients who will benefit from cardiac resynchronization therapy (CRT) remains challenging. We evaluated whether virtual pacing in a digital twin (DT) of the patient’s heart could be used to predict the degree of left ventricular (LV) reverse remodelling post-CRT. Methods and results Forty-five HF patients with wide QRS complex (≥130 ms) and reduced LV ejection fraction (≤35%) receiving CRT were retrospectively enrolled. Echocardiography was performed before (baseline) and 6 months after CRT implantation to obtain LV volumes and 18-segment longitudinal strain. A previously developed algorithm was used to generate 45 DTs by personalizing the CircAdapt model to each patient’s baseline measurements. From each DT, baseline septal-to-lateral myocardial work difference (MWLW-S,DT) and maximum rate of LV systolic pressure rise …

Europace

Electrical storm (ES) is a state of electrical instability, manifesting as recurrent ventricular arrhythmias (VAs) over a short period of time (three or more episodes of sustained VA within 24 h, separated by at least 5 min, requiring termination by an intervention). The clinical presentation can vary, but ES is usually a cardiac emergency. Electrical storm mainly affects patients with structural or primary electrical heart disease, often with an implantable cardioverter-defibrillator (ICD). Management of ES requires a multi-faceted approach and the involvement of multi-disciplinary teams, but despite advanced treatment and often invasive procedures, it is associated with high morbidity and mortality. With an ageing population, longer survival of heart failure patients, and an increasing number of patients with ICD, the incidence of ES is expected to increase. This European Heart Rhythm Association clinical consensus …

Europace

Aims Pulmonary vein isolation (PVI) is a well-established strategy for the treatment of paroxysmal atrial fibrillation (PAF). Despite randomized controlled trials and real-world data showing the promise of pulsed-field ablation (PFA) for this treatment, long-term efficacy and safety data demonstrating single-procedure outcomes off antiarrhythmic drugs remain limited. The aim of the FARA-Freedom Study was to evaluate the long-term efficacy and safety of PFA using the pentaspline catheter for PAF. Methods and results FARA-Freedom, a prospective, non-randomized, multicentre study, enrolled patients with PAF undergoing de novo PVI with PFA, who were followed for 12 months with weekly transtelephonic monitoring and a 72-h Holter ECG at 6 and 12 months. The primary safety endpoint was a composite of device- or procedure-related serious adverse events out to 7 days post …

Europace

We read with great interest the article by Xie et al. regarding the results of atrial fibrillation (AF) ablation in patients with heart failure (HF) with preserved ejection fraction (HFpEF). 1 In their study, based on a large cohort of patients with HFpEF, they showed that the ablation strategy significantly reduced the primary composite endpoint of all-cause death or rehospitalization for worsening HF compared with no ablation. Saksena et al. stated that AF is associated with HF progression in early symptomatic HFpEF and pump failure death in advanced HFpEF. Thus, the authors concluded that AF may adversely impact HFpEF due to its association with HF progression and mortality. 2 Previous studies and subgroup analyses have also demonstrated the benefit of the ablation therapy in patients with HFpEF and AF. Yamauchi et al. stated that the ablation therapy is a very suitable method for restoring sinus rhythm and thus …

Europace

Aims Metabolic syndrome (MetS) is associated with arrhythmias and cardiovascular mortality. Arrhythmogenesis in MetS results from atrial structural and electrical remodelling. The small-conductance Ca2+-activated K+ (SK) currents modulate atrial repolarization and may influence atrial arrhythmogenicity. This study investigated the regulation of SK current perturbed by a high-fat diet (HFD) to mimic MetS. Methods and results Thirty mice were divided into two groups that were fed with normal chow (CTL) and HFD for 4 months. Electrocardiography and echocardiography were used to detect cardiac electrical and structure remodelling. Atrial action potential duration (APD) and calcium transient duration (CaTD) were measured by optical mapping of Langendorff-perfused mice hearts. Atrial fibrillation (AF) inducibility and duration were assessed by burst pacing. Whole-cell patch …

Europace

Aims Conduction abnormalities post-transcatheter aortic valve implantation (TAVI) are common. Post-TAVI PR prolongation was mainly studied as an adjunct to new-onset bundle branch block. The net effect of isolated PR prolongation (IPRP) without post-TAVI QRS changes is not well known. The aim of this study was to define the incidence and clinical significance of post-TAVI IPRP. Methods and results A total of 1108 consecutive TAVI patients were reviewed. Patients with IPRP were compared with patients without post-TAVI electrocardiogram (ECG) changes. Clinical outcomes included permanent pacemaker implantation (PPI) and overall mortality. A total of 146 patients with IPRP were compared with 290 patients without post-TAVI ECG changes. At 1 year follow-up, 4 (2.7%) and 7 (2.4%) patients underwent PPI (P = 0.838) and 10 (6.8%) and 25 (8.6%) died (P = 0.521 …

Europace

The DF-4 defibrillator standard has been rapidly adopted due to its convenience at implantation. There are however tradeoffs compared to the traditional DF-1 standard which are underappreciated. This viewpoint outlines the advantages and limitations of current defibrillator lead standards which should be kept in mind, as they impact the options which are available to deal with issues which may arise.