Abstract 4372844: Genomic Insights into Tachycardia-Mediated Cardiomyopathy: The Impact of TTN Truncating Variants

POSTER PRESENTATIONS

This document is a compilation of the current American College of Cardiology Foundation/American Heart Association (ACCF/AHA) practice guideline recommendations for atrial fibrillation (AF) from the “ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation),”* the “2011 ACCF/AHA/HRS Focused Update on the Management of Patients With Atrial Fibrillation (Updating the 2006 Guideline)”† and the “2011 ACCF/AHA/HRS Focused Update on the Management of Patients With Atrial Fibrillation (Update on Dabigatran).”‡ Updated and new recommendations from 2011 are noted and outdated recommendations have been removed. No new evidence was reviewed, and no recommendations included herein are original to this document. The ACCF/AHA Task Force on Practice Guidelines chooses to republish the recommendations in this format to provide the complete set of practice guideline recommendations in a single resource. ### 1.1. Pharmacological and Nonpharmacological Therapeutic Options #### 1.1.1. Rate Control During AF Class I 1. Measurement of the heart rate at rest and control of the rate using …

ObjectivesTo discuss the relation between TLR2, HIF-1α, MMP-9 as immunological and inflammatory factor in the occurrence and maintenance of atrial fibrillation.Methods57 cases of atrial fibrillation were chosen, 20 cases were...

ORAL PRESENTATION

Pattern of Atrial Fibrillation and Cognitive Function in Young Patients With Atrial Fibrillation and Low CHADS2 Score: Insights From the BRAIN-AF Trial.

The usefulness of global left atrial strain for predicting atrial fibrillation recurrence after catheter ablation in patients with persistent and paroxysmal atrial fibrillation

Prevalence of Silent Cerebral Ischemia in Paroxysmal and Persistent Atrial Fibrillation and Correlation With Cognitive Function

Complex fractionated atrial electrograms (CFAEs) may play a role in the genesis of atrial fibrillation (AF). One type of CFAE is continuous electrical activity (CEA). The prevalence and characteristics of CEA in patients with paroxysmal and persistent AF are unclear. In 44 patients (age = 59 +/- 8 years) with paroxysmal (25) or persistent (19) AF, bipolar electrograms were systematically recorded for > or =5 seconds at 24 left atrial (LA) sites, including 8 antral sites, and 2 sites within the coronary sinus (CS). CEA was defined as continuous depolarization for >1 second with no isoelectric interval. CEA was recorded at the LA septum (79%), antrum (66%), posterior (68%) and anterior walls (67%), roof (66%), base of the LA appendage (61%), inferior wall (61%), posterior mitral annulus (48%), CS (41%), and in the LA appendage (14%). Antral CEA was equally prevalent in patients with paroxysmal (63%) and persistent AF (70%, P = 0.12). In patients with paroxysmal AF, the prevalence of CEA was similar among antral and nonantral LA sites, except for the LA appendage. However, in patients with persistent AF, CEA was more prevalent at the nonantral (80%) than antral sites (70%, P = 0.03). CEA at nonantral sites except the CS was more prevalent in persistent than in paroxysmal AF (80% vs 57%, P < 0.001). The mean duration of intermittent episodes of CEA was longer in persistent than in paroxysmal AF (P < 0.001). The higher prevalence and duration of CEA at nonantral sites in persistent than in paroxysmal AF is consistent with a greater contribution of LA reentrant mechanisms in persistent AF. However, the high prevalence of CEA at nonantral sites in paroxysmal atrial fibrillation (PAF) suggests that CEA alone is a nonspecific marker of appropriate target sites for ablation of AF. The characteristics of CEA that most accurately identify drivers of AF remain to be determined.

▪ Abstract Atrial fibrillation is frequently disabling and resistant to antiarrhythmic drugs. Curative treatment by catheter-based ablation has been shown to be feasible either by achieving long linear lesions, mainly in the left atrium, or by targeting the initiating focus, most frequently in the pulmonary veins. This paper reviews the different ablation approaches, their results, potential complications, and relative merits.

Persistent atrial fibrillation (AF) patients undergoing a catheter ablation are at risk for adverse outcomes, due to comorbidities and a more advanced arrhythmia substrate. There may be barriers to catheter ablation in patients with persistent AF, compared to those with paroxysmal AF. We compared long-term outcomes after ablation in patients with paroxysmal and persistent AF. Patients undergoing de novo AF catheter ablation from April 2012 to March 2022 in Ontario, Canada, were included. The primary outcome was a composite of all-cause mortality and all-cause hospitalization. Inverse probability of treatment weighting created balanced cohorts of paroxysmal and persistent AF patients. Cox proportional hazards models estimated the effect on persistent vs. paroxysmal AF. There were 10 788 patients who underwent an ablation. Persistent AF patients accounted for 25% of the population. In our weighted cohort, patients had similar age (standardized difference 0.027), female sex [standardized difference (SD) 0.018], and medical comorbidities (Charlson comorbidity score; 0.5% in both, SD 0.018). In the weighted cohort, the primary composite outcome occurred in 5.5% in paroxysmal AF and 6.3% in persistent AF at 30 days (HR 1.15, 95% CI 0.94-1.40, P = 0.168), 19.8% vs. 19.7% at 1 year (HR 1.00, 95% CI 0.90-1.11, P = 0.971), and 34.1% vs. 35.4% at 3 years (HR 1.05, 95% CI 0.97-1.13, P = 0.269). There was no increased risk of the individual components at 30 days, 1 year, or 3 years. The risk of all-cause mortality and hospitalization outcomes in persistent and paroxysmal AF patients undergoing ablation was similar at 30 days, 1 year, and 3 years post-ablation. The impact of persistent AF on long-term outcomes (i.e. all-cause mortality) is primarily attributable to comorbid conditions.

A new era of atrial fibrillation (AF) treatment began in 1997–1998 with the discovery that triggers within the pulmonary veins initiate AF and reports that elimination of these triggers is successful in treating AF in its paroxysmal form.1–3 However, in patients with persistent AF, the success rate of exclusive pulmonary vein isolation is substantially lower.4,5 To improve the outcome of persistent AF ablation, different ablation strategies have been explored, but to date the optimal strategy has not been defined. Although some groups argue that limited ablation, including pulmonary vein isolation and, if present, ablation of nonpulmonary vein triggers, is sufficient for persistent AF ablation, other groups, including ours, favor more extensive, substrate-based ablation in addition to pulmonary vein isolation. In this review, we will discuss the rationale for a substrate-based ablation strategy to treat persistent AF and show why elimination of triggers is not sufficient in most patients with persistent AF. Response by Roten et al on p 1232 In a simple model, an electric impulse in AF can form because of abnormalities in impulse generation (triggers) or can result from abnormal impulse propagation (reentry). By a strict definition, a trigger is a focal source of new impulse generation. The mechanism by which a new impulse can form is either abnormal automaticity or triggered activity. Trigger-ablation protocols target these sources of new impulse generation. Abnormal impulse propagation, on the other hand, depends on altered substrate properties causing nonuniform or slowed conduction. This in turn causes multiple forms of wave reentry thought to be responsible for AF perpetuation: random reentry (multiple wavelets), macro- and microreentry, or functional reentry (rotors). Substrate-based ablation strategies aim to abate abnormal impulse propagation and interrupt any form of atrial reentry. Triggers of paroxysmal AF are mainly located in the pulmonary …

We hypothesized that the 'residual' thromboembolic risk in therapeutically anticoagulated patients undergoing cardioversion could potentially be related to abnormal haemorheology and platelet activation. To test this hypothesis, we firstly investigated the role of haemorheology and platelet activation in patients with paroxysmal and persistent atrial fibrillation (AF), who were compared with healthy controls and patients with permanent AF. Second, we compared these indices in patients with persistent AF, before and after successful cardioversion. We measured indices of haemorheology (haematocrit, plasma viscosity, and fibrinogen), fibrin D-dimer (an index of thrombogenesis and fibrin turnover) and platelet activation (as assessed by platelet aggregation and plasma levels of beta-thromboglobulin, and soluble P-selectin) in 29 patients with paroxysmal AF, 87 patients with permanent AF and 29 healthy controls in sinus rhythm. The effects of cardioversion were studied in 20 patients with persistent AF, who maintained sinus rhythm at 2 months follow-up. Plasma levels of beta-thromboglobulin (P = 0.03) and fibrin D-dimer (P = 0.001) were higher in patients with AF, when compared with controls; the highest levels were seen in those with permanent AF (Tukey's test, < 0.05). Plasma viscosity was significantly higher in the patients with paroxysmal AF compared with healthy controls (P = 0.02). Plasma soluble P-selectin levels and platelet aggregation responses to all four platelet agonists (adenosine diphosphate, collagen, epinephrine and thrombin) in patients with paroxysmal AF and permanent AF were similar to controls. Plasma fibrinogen, viscosity and other markers of platelet activation (including platelet aggregation) were not significantly different in patients with paroxysmal AF, during episodes of AF and sinus rhythm (P = not significant), although mean haematocrit was significantly higher during the episodes of AF compared with episodes of sinus rhythm (P = 0.03). Among the patients with persistent AF who remained in sinus rhythm at 2 months following successful cardioversion, there was a significant decrease in the plasma levels of soluble P-selectin at 2 weeks and 2 months, when compared with baseline (pre-cardioversion) levels (P < 0.001). Haemorheology and platelet aggregation response to agonists did not change significantly, except for a transient increase in platelet aggregation response to collagen at 2 weeks (P = 0.045). In conclusion. abnormal haemostatic and platelet activation in patients with permanent AF are not consistently observed in patients with paroxysmal and persistent AF. Abnormal haemorheology appears to play an important role in patients with paroxysmal AF, especially during the paroxysms of AF. Cardioversion of persistent AF to sinus rhythm appears to decrease the platelet activation, but whether this translates into a beneficial reduction in thromboembolic risk requires further study.

Knowledge of the impact of paroxysmal and persistent atrial fibrillation (AF) after catheter ablation on in-hospital outcomes and 30-day readmission remains limited. This study aimed to evaluate the procedural outcomes and 30-day readmission rates among patients with paroxysmal or persistent AF who were hospitalized for AF ablation. Using the Nationwide Readmissions Database, our study included patients aged ≥18 years with AF who were hospitalized and underwent catheter ablation during 2017-2020. Then, we compared the in-hospital procedural outcomes and 30-day readmission rates between patients with paroxysmal and persistent AF, respectively. Our study included 7310 index admissions for paroxysmal AF ablation and 9179 index admissions for persistent AF ablation. According to our analysis, there was no significant difference in procedural complications-namely, cerebrovascular accident, vascular complications, major bleeding requiring blood transfusion, phrenic nerve palsy, pericardial complications, and systemic embolization-between the persistent and paroxysmal AF groups. There was also no significant difference in early mortality between these groups (0.5% vs. 0.7%; P = .22). Persistent AF patients had significantly higher rates of prolonged index hospitalization (9.9% vs. 7.2%; P < .01) and non-home discharge (4.8% vs. 3.1%; P < .01). The 30-day readmission rates were comparable in both groups (10.0% vs. 9.5%; P = .34), with recurrent AF and heart failure being two of the most common causes of cardiac-related readmissions. Catheter ablation among hospitalized patients with paroxysmal or persistent AF resulted in no significant difference in procedural complications, early mortality, or 30-day readmission. This suggests that catheter ablation of AF can be performed with a relatively similar safety profile for both paroxysmal and persistent AF.

Aim&nbsp;- to determine the features of intracardiac hemodynamics according to echocardiography in patients with arterial hypertension (AH) and frequent recurrences of atrial fibrillation (AF). Materials and Methods.&nbsp;There were examined 146 patients aged from 37 to 86 years with AH stage II complicated by frequent recurrences of AF. As a comparison group, there were examined 26 patients aged 39 to 74 years with AH II stage without AF. The duration of the arrhythmic anamnesis ranged from 1 to 30 years and averaged 5.7±0.5 years. Paroxysmal form of AF was observed in 56 (38.4%) patients and persistent form of AF observed in 90 (61,6%) patients. The anamnesis of AH ranged from 1 to 40 and averaged 11.6 ± 0.6 years. The vagal variant of AF was determined in 31 (21.2%) patients, the adrenal variant of AF in 70 (47.9%), and mixed variant of AF in 45 (30.9%) patients. All patients underwent echocardiography according to the standard protocol. Results and Discussion.&nbsp;In the groups of AF (paroxysmal and persistent), compared to group with AH, absolute and relative sizes and volume of left atrium were higher (p&lt;0.0001); IVRT was decreased (p&lt;0.05); the ratio E/A was decreased (p&lt;0.03); and the prevalence of mitral (p&lt;0.03) and tricuspid (p=0.02) valve regurgitation was found. In the group of AH and persistent AF, compared to group with AH, the average ratio E/e' was statistically higher (p=0.03), and the 1 degree of mitral regurgitation prevailed (p=0.02). The group of AH and paroxysmal AF was characterized by higher incidence of 2 degree of tricuspid valve regurgitation (p=0.05) and lower maximum transaortic speed compared to group with AH (p=0.04). In the group of AH and mixed variant of AF, compared to group with AH and vagal variant of AF the 2nd degree of mitral regurgitation prevailed (p=0.05). In the group of AH and adrenal variant of AF the tricuspid valve regurgitation and 1 degree of tricuspid valve regurgitation were prevalent compared compared to group with AH and vagal variant of AF (p=0.02). In the group with AH and vagal variant of AF aortic valve regurgitation (p=0.05) and 1 degree of aortic valve regurgitation (p=0.02) were prevalent compared to group with AH and adrenal variant of AF. Conclusion.&nbsp;In the groups of AH and AF (paroxysmal and persistent) in contrast to group with AH absolute and relative sizes and volume of left atrium were higer, IVRT was decreased, the ratio E/A was decreased, the prevalence of mitral and tricuspid valve regurgitation. In the group of AH and persistent AF in contrast to group with AH were higher ratio E/e 'average and the prevalence of 1 degree of mitral regurgitation. &nbsp;The group of AH and paroxysmal AF was characterized by higher incidence of 2 degree of tricuspid valve regurgitation &nbsp;and lower maximum transaortic speed in contrast to group with AH. In the group of AH and mixed variant of AF in contrast to group with AH and vagal variant of AF the 2nd degree of mitral regurgitation was prevailed. In the group of AH and adrenal variant of AF the tricuspid valve regurgitation and 1 degree of tricuspid valve regurgitation were prevalent in contrast to group with AH and vagal variant of AF. In the group with AH and vagal variant of AF, aortic valve regurgitation and 1 degree of aortic valve regurgitation were prevalent in contrast to group with AH and adrenal variant of AF.

Increased left atrial pressure (LAP) contributes to dyspnea and heart failure with preserved ejection fraction in patients with atrial fibrillation (AF). The purpose of this study was to investigate the differences in baseline LAP and LAP response to rapid pacing between paroxysmal and persistent AF. This observational study prospectively enrolled 1369 participants who underwent AF catheter ablation, excluding those with reduced left ventricular ejection fraction. H2FPEF score was calculated by echocardiography and baseline characteristics. Patients underwent LAP measurements during AF, sinus rhythm, and heart rates of 90, 100, 110, and 120 beats per minute (bpm), induced by right atrial pacing and isoproterenol. The baseline LAP-peak in the persistent AF group consistently exceeded that in the paroxysmal AF (PAF) group across each H2FPEF score subgroup (all P<0.05). LAP-peak increased with pacing (19.5 to 22.5 mm Hg) but decreased with isoproterenol (20.4 to 18.4 mm Hg). Under pacing, patients with PAF exhibited a significantly lower LAP-peak (90 bpm) than those with persistent AF (17.7±8.2 versus 21.1±9.3 mm Hg, P<0.001). However, there was no difference in LAP-peak (120 bpm) between the 2 groups (22.1±8.1 versus 22.9±8.4 mm Hg, P=0.056) because the LAP-peak significantly increased with heart rate in the group with PAF. Patients with PAF exhibited lower baseline LAP with greater increases during rapid pacing compared with individuals with persistent AF, indicating a need to revise the H2FPEF score for distinguishing PAF from persistent AF and emphasizing the importance of rate and rhythm control in PAF for symptom control. URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02138695.