Cases Of Paroxysmal Atrial Fibrillation Research Articles

Holter Monitoring Analysis of Women Infected with the Human Immunodeficiency Virus.

The aim of the study was to assess the clinical features of women infected with the human immunodeficiency virus (HIV) using Holter monitoring. Thirty-five female patients infected with HIV using a Holter monitor at the Ditan Hospital were retrospectively analyzed. In terms of basic rhythms, there were 30 cases of sinus rhythm, 27 cases of ventricular premature beat, 26 cases of supraventricular premature beat, 12 cases of mild reduction of HRV, 9 cases of normal heart rate variability (HRV), 8 cases of supraventricular tachycardia, 5 cases of abnormal ST-segment changes and 2 cases of sinus bradycardia 2 cases of paroxysmal atrial fibrillation 2 cases of junctional escape rhythm. There was only one case in each of the following ECG changes: persistent atrial fibrillation, sinus tachycardia, couplet supraventricular premature beats, accelerated idioventricular rhythm, sinoatrial block, second-degree Mobitz type I atrioventricular block, second-degree Mobitz type II atrioventricular block, complete right bundle branch block, T-wave abnormality, and significant reduction of HRV. The Holter monitor can show more changes in the electrocardiogram (ECG) of HIV-- positive patients, particularly significant ECG abnormalities, such as paroxysmal atrial fibrillation, and can direct early clinical treatment to serious adverse results.

Significance of the APPLE score and the monocyte–HDL cholesterol ratio in predicting late recurrence of atrial fibrillation following catheter ablation based on a retrospective study

ObjectiveCollect the characteristics of patients’ baseline data, and explore the predictive factors of late recurrence of atrial fibrillation (AF) after catheter ablation according to whether late recurrence or not. The...

Comparison of zero fluoroscopy versus fluoroscopy guided ablation for atrial fibrillation: A single center experience

Abstract Funding Acknowledgements Type of funding sources: None. Background With advances in mapping equipment and increased use of intracardiac echocardiography (ICE), atrial fibrillation (AF) ablations can be safely performed without fluoroscopy. Benefits include no radiation exposure to patient and staff and reduced long-term orthopedic complications related to use of lead aprons for staff. Published data comparing zero fluoroscopy ablation (ZFA) and conventional fluoroscopy guided ablation (CFA) for AF is limited to small case series and meta-analysis. Aim To evaluate the safety and procedural outcomes of a simplified ZFA approach, comparing it to standard of care (CFA). Methods Consecutive AF cases from 03/2021 to 09/2022 at our institution were included. 120 cases underwent ZFA (RF ablation, ICE and 3D mapping guided) and 155 cases underwent CFA (Cryo or RF ablation, fluoroscopy, ICE and 3D map guided). For the ZFA group, a simplified ICE based map of relevant anatomical structures was created, in order to guide trans-septal (TS) access and left -sided ablation (See figure) and no pre-procedural imaging was obtained. All CFA cases had pre-procedural cardiac CT or MRI to evaluate left atrial anatomy. Redo ablation cases represented 17% of the ZFA and 23% of the CFA patients. All cases were performed by operators with >12 years of experience, and all cases underwent general anesthesia. Only two ZFA cases required a brief period of fluoroscopy (under 2 min each) to achieve safe trans-septal access (including one case with a prior ASD closure device). Results Mean age was 67 for ZFA and 69 for CFA groups respectively (p=NS). 69% of ZFA and 71% of CFA cases were men. Persistent AF cases more frequently underwent posterior wall isolation in the ZFA group (98% vs 68%, P<0.01), but despite this, procedural times were similar for both groups (168±55 min ZFA vs 172±51 min CFA, P=NS). Procedural success (pulmonary vein isolation ± posterior wall isolation) was achieved in all ZFA and 99% of CFA cases. At a mean follow up 12 months, Freedom for AF was 81% for paroxysmal AF and 74% for persistent AF cases in the ZFA group, and 79% for paroxysmal AF cases and 71% for persistent AF cases in the CFA group (p=NS). Procedural complications included one TIA in the ZFA group and 2 pericardial effusions in the CFA group (p=NS). Use of antiarrhythmic drugs post ablation did not differ between the ZFA and the CFA groups (23% vs 27%, p=NS). Conclusion Our ZFA approach for AF was safe, effective and produced similar outcomes compared to a traditional CFA approach. ZFA has considerable health benefits for personnel and patients without compromising procedural outcomes. The cost of ICE catheters may be offset by eliminating the need for pre-procedural imaging (CT or MRI) commonly used prior to AF ablations. Our study adds to the growing literature supporting the safety of catheter ablation in a non-fluoroscopy environment.

Paroxysmal Atrial Fibrillation with Rapid Ventricular Response Following COVID-19 Nasopharyngeal Swab: A Case Report

Nasopharyngeal (NP) swab sampling is a simple procedure that has become extremely popular in the coronavirus disease 2019 (COVID-19) era, with hundreds of million specimens collected every day. However, rare but serious complications have been reported following NP swab acquisition. Here we present a case of paroxysmal atrial fibrillation associated with NP specimen collection in a healthy healthcare provider undergoing COVID-19 testing during departmental screening. This response may have been caused by an exaggerated vagal tone triggered by the trigeminocardiac reflex. Less invasive collection methods, such as saliva testing, may be warranted in predisposed individuals.

Prevalence and Characteristics of Inspiration-Induced Negative Left Atrial Pressure during Pulmonary Vein Isolation.

Atrial fibrillation (AF) ablation is performed under deep sedation, which may cause inspiration-induced negative left atrial pressure (INLAP) associated with deep inspiration. INLAP could be the cause of periprocedural complications. We retrospectively enrolled 381 patients with AF (mean age, 63.9 ± 10.8 years; 76 women; 216 cases of paroxysmal AF) who underwent CA under deep sedation using an adaptive servo ventilator (ASV). Patients whose LAP was not obtained were excluded. INLAP was defined as <0 mmHg of mean LAP during inspiration immediately after the transseptal puncture. The primary and secondary endpoints were the presence of INLAP and the incidence of periprocedural complications. Among 381 patients, INLAP was observed in 133 (34.9%). Patients with INLAP had higher CHA2DS2-Vasc scores (2.3 ± 1.5 vs. 2.1 ± 1.6) and 3% oxygen desaturation indexes (median 18.6 (interquartile range 11.2-31.1) vs. 15.7 (8.1-25.3)), and higher prevalence of diabetes mellitus (23.3 vs. 13.3%) than patients without INLAP. Air embolism occurred in four patients with INLAP (3.0 vs. 0.0%). INLAP is not rare in patients undergoing CA for AF under deep sedation with ASV. Much attention should be paid to the possibility of air embolism in patients with INLAP.

Prevalence of Cardio-Embolic Brain Complications in Permanent and Paroxysmal Atrial Fibrillation Patients.

Background: Atrial fibrillation (AF) is the most frequent of all cardiac arrhythmias, with an increasing prevalence in the last 20 years. Cardio-embolic brain complications (CEBC) related to AF often occur or recur, even following appropriate treatment. Method: We conducted a retrospective study and analyzed the presence of stroke, dementia, and Parkinson’s disease (PD) in both paroxysmal and permanent AF patients. The records of 1111 consecutive admitted patients with primary diagnosis of AF at the Municipal Emergency University Hospital, Timisoara, between 2015 and 2016 were examined. Statistical analysis was performed on the patients included in the study based on the inclusion and exclusion criteria. Results: A significant statistical difference was noted among the permanent AF group for stroke (48.75% vs. 26.74%, p < 0.001) and dementia (10.25% vs. 3.86%, p < 0.001) compared to paroxysmal AF patients. Permanent AF patients presented a higher risk of developing stroke, dementia, and PD compared to patients with paroxysmal AF. Meanwhile, male gender and an increase in age showed an increase in the odds of having cardio-embolic brain complications in patients with paroxysmal AF. Conclusion: Based on the results obtained, it can be concluded that the risk of cardio-cerebral embolic complications is greater in permanent AF patients compared to paroxysmal AF cases. Ischemic stroke and dementia are more frequent in the permanent AF group, but analyzing the data regarding the age of onset paroxysmal AF is critical due to the fact that it involves a younger population. Prompt diagnosis and treatment can help significantly in saving stroke patients.

Heart rate during sinus rhythm predicts paroxysmal atrial fibrillation on 30-day mobile cardiac telemetry monitoring

Abstract Background Low mean heart rate at ambulatory ECG monitoring and low resting heart rate are both predictors of later incident atrial fibrillation (AF). The aim of this study is to determine whether mean heart rate at ambulatory ECG is a predictor of paroxysmal AF that can be detected with extended ambulatory ECG registration. Methods We included all patients who recorded 2–30 full days of ambulatory ECG using a full disclosure mobile cardiac telemetry device in USA 2019–2020, and without AF on the first full day of registration (n=18,220, mean age 64.4 years, 57.2% women). The association between mean heart rate on the first day and the occurrence of paroxysmal AF (≥30 seconds duration) during subsequent up to 30 day ECG recording was analysed using logistic regression models adjusted for age, sex and duration of ECG recording, according to tertiles of mean heart rate (39–66, 67–76 and &amp;gt;77 beats per minute) as well as modelled using restricted cubic splines. Results During a median registration duration of 16 days there were 1,290 cases of paroxysmal AF (7.1%). More paroxysmal AF occurred in the lower tertiles of mean heart rate (11.2% in tertile 1, 6.2% in tertile 2, and 4.4% in tertile 3). After adjustment, low mean heart rate was associated with a higher risk of AF (OR 1.69, 95% CI 1.47–1.93 p&amp;lt;0.001 for tertile 1 vs tertile 2, and OR 1.84, 95% CI 1.58–2.15, p&amp;lt;0.001 for tertile 1 vs tertile 3). Cubic spline curves indicated that lowest risks of AF were seen among subjects with a mean heart rate ≈80 beats per minute. Conclusion Low mean heart rate at 24hECG predicts detection of paroxysmal AF during extended ≤30 day ambulatory ECG monitoring. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Swedish Heart Lung foundationSwedish Society for Medical Research

Prevalence and distribution of non-pulmonary vein atrial fibrillation triggers in real-world clinical settings

Abstract Background Epidemiology of non-pulmonary vein (PV) triggers of atrial fibrillation (AF) is not fully known. Purpose This study aimed to clarify the prevalence and distribution of non-PV triggers in real-world clinical settings of AF catheter ablation. Methods One-thousand and twenty patients undergoing AF ablations were retrospectively analyzed (mean age 65 years old, 702 males (69%), 506 paroxysmal and 514 non-paroxysmal). Induction and observation of AF triggers were attempted using intravenous isoproterenol/adenosine triphosphate and repeated direct current cardioversion during AF in each session. Documentable non-PV AF triggers were characterized in the studied population. Premature atrial contractions that did not initiate AF were excluded. Results A hundred and twenty-six non-PV triggers were documented in 108 patients (10.6%). Non-PV trigger was documented in 6.3% of 1st session cases, whereas 30.9% of recurrent cases undergoing multiple sessions (p&amp;lt;0.0001). Left atrial (LA) posterior wall was the most prevalent site (N=34), followed by 30 intra-atrial septum (IAS), 29 superior vena cava (SVC), 13 crista terminalis, 7 right atrial (RA) free wall, 6 LA anterior wall, 3 coronary sinus (CS), 3 left atrial appendage, and 1 persistent left superior vena cava (LSVC). We classified those non-PV triggers into 4 groups; 43 LA, 33 thoracic veins (SVC, CS and LSVC), 30 IAS and 20 RA. Thoracic vein/RA origins were more prevalently detected in paroxysmal AF cases (57%) compared to non-paroxysmal AF (28%) (p&amp;lt;0.01). Conversely, LA origin was more prevalently detected in non-paroxysmal AF cases (48%) compared to paroxysmal AF (20%) (p&amp;lt;0.01). Conclusions Prevalence of non-PV trigger in cases undergoing multiple sessions is extremely high, suggesting a particular importance of non-PV trigger targeting in patients with recurrent AF undergoing 2nd or 3rd ablation sessions. Progressive nature of AF with newly generated AF triggers should be under consideration. Distributions of non-PV triggers are largely different between paroxysmal and non-paroxysmal AF. These findings may help ablation strategy regarding non-PV trigger targeting in practice. Funding Acknowledgement Type of funding sources: None.

Higher serum sST2 is associated with increased left atrial low-voltage areas and atrial fibrillation recurrence in patients undergoing radiofrequency ablation.

To conduct a comprehensive analysis of prospectively measuring the concentration of soluble suppression of tumorigenicity 2 (sST2) to predict left atrial (LA) low-voltage areas (LVAs) and atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFA). This was a prospective cohort study. A total of 84 patients, including 54 paroxysmal AF cases and 30 persistent AF cases who underwent RFA, were recruited. Electroanatomical voltage mapping determined the extent of LVAs. The serum level of sST2 was measured by enzyme-linked immunosorbent assay. All patients were followed for 12months after the RFA procedure to verify AF recurrence. The concentration of sST2 measured in the sample was 17.90-198.77pg/mL, and the range of LA LVAs was 0-85.6%. The sST2 level positively correlated with LVAs (r = 0.40; P = 0.005). When comparing the top and bottom quartile, sST2 is significantly associated with LA LVAs (OR = 1.833, 95% CI: 1.582-2.011, P = 0.004). When compared with the 1st quartile group, the multivariable adjusted hazard ratios for AF recurrence after RFA were 1.57 (95% CI: 1.182-1.795) for the 4th quartile group, 1.44 (95% CI: 1.085-1.598) for the 3rd quartile group, and 1.27 (95% CI: 0.954-1.318) for the 2nd quartile group. The AF-free survival rates of patients with 1st quartile and 4th quartile sST2 levels after ablation were 95% and 59.6%, respectively (Log Rank test, P = 0.027). Elevated sST2 levels of AF patients were associated with higher LA LVAs and a significantly increased risk of recurrence. The circulating sST2 concentration might be a pre-diagnostic marker of AF recurrence after RFA.

New right bundle branch block after selective HIS bundle pacing, Two methods for correction

HIS Bundle Pacing (HBP) is considered the most physiologic pacing technique as it generates a physiological activation of both ventricles through synchronous ventricular depolarization of His bundle– Purkinje conduction system. Permanent HBP and Atrioventricular Node (AVN) ablation in patients with heart failure and atrial fibrillation were found to have an improvement in cardiac function and reduction of left ventricular dimensions [1]. We present case of paroxysmal atrial fibrillation and atypical atrial flutter that underwent HBP and AVN ablation. The patient developed a Right Bundle Branch Block (RBBB) following his AVN ablation with widening of QRS duration to 148 msec. We managed to correct this and restore a narrow QRS by two different mechanisms: 1. Programming the Interventricular (VV) delay to 20 msec (His pacing first followed by septal RV pacing through a back-up lead, 2. Unipolar pacing of the HIS lead with different configuration. By both methods, QRS duration was reduced to 108-110 msec with restoration of physiologic biventricular pacing. To the best of our knowledge, this has not been reported before. Keywords: atrial fibrillation; his bundle pacing; ablate; pace.

Left atrial appendage orifice area and morphology is closely associated with flow velocity in patients with nonvalvular atrial fibrillation

BackgroundThromboembolic events are the most serious complication of atrial fibrillation (AF), and the left atrial appendage (LAA) is the most important site of thrombosis in patients with AF. During the period of COVID-19, a non-invasive left atrial appendage detection method is particularly important in order to reduce the exposure of the virus. This study used CT three-dimensional reconstruction methods to explore the relationship between LAA morphology, LAA orifice area and its mechanical function in patients with non-valvular atrial fibrillation (NVAF).MethodsA total of 81 consecutive patients with NVAF (36 cases of paroxysmal atrial fibrillation and 45 cases of persistent atrial fibrillation) who were planned to undergo catheter radiofrequency ablation were enrolled. All patients were examined by transthoracic echocardiography (TTE), TEE, and computed tomography angiography (CTA) before surgery. The LAA orifice area was obtained according to the images of CTA. According to the left atrial appendage morphology, it was divided into chicken wing type and non-chicken wing type. At the same time, TEE was performed to determine left atrial appendage flow velocity (LAAFV), and the relationship between the left atrial appendage orifice area and LAAFV was analyzed.ResultsThe LAAFV in Non-chicken wing group was lower than that in Chicken wing group (36.2 ± 15.0 cm/s vs. 49.1 ± 22.0 cm/s, p-value < 0.05). In the subgroup analysis, the LAAFV in Non-chicken wing group was lower than that in Chicken wing group in the paroxysmal AF (44.0 ± 14.3 cm/s vs. 60.2 ± 22.8 cm/s, p-value < 0.05). In the persistent AF, similar results were observed (29.7 ± 12.4 cm/s vs. 40.8 ± 17.7 cm/s, p-value < 0.05). The LAAFV in persistent AF group was lower than that in paroxysmal AF group (34.6 ± 15.8 cm/s vs. 49.9 ± 20.0 cm/s, p-value < 0.001). The LAAFV was negatively correlated with left atrial dimension (R = − 0.451, p-value < 0.001), LAA orifice area (R= − 0.438, p-value < 0.001) and left ventricular mass index (LVMI) (R= − 0.624, p-value < 0.001), while it was positively correlated with LVEF (R = 0.271, p-value = 0.014). Multiple linear regression analysis showed that LAA morphology (β = − 0.335, p-value < 0.001), LAA orifice area (β = − 0.185, p-value = 0.033), AF type (β = − 0.167, p-value = 0.043) and LVMI (β = − 0.465, p-value < 0.001) were independent factors of LAAFV.ConclusionsThe LAA orifice area is closely related to the mechanical function of the LAA in patients with NVAF. The larger LAA orifice area and LVMI, Non-chicken wing LAA and persistent AF are independent predictors of decreased mechanical function of LAA, and these parameters might be helpful for better management of LA thrombosis.

Decrease in red cell distribution width as a useful predictor of success after catheter ablation for atrial fibrillation: a retrospective multi-center study.

Red cell distribution width (RDW) is reportedly associated with cardiovascular events, including atrial fibrillation (AF). We investigated whether the RDW values were associated with the outcomes of catheter ablation for AF. This retrospective multicenter study included 501 patients with AF (239 paroxysmal AF cases, 196 persistent AF cases, and 66 long-standing persistent AF cases) who underwent initial AF ablation between March 2017 and May 2018. The RDW values were evaluated before and at 1-3months after the procedure. The patients were stratified based on the recurrence of AF within 1year after the index procedure with a blanking period of 3months into recurrence group (107 patients, 21.4%) and no-recurrence group (394 patients, 78.6%). There were no significant differences in preoperative RDW values between the groups (p = 0.37). The RDW value did not change significantly after the ablation in the recurrence group (13.55-13.60%, p = 0.37), although it decreased significantly in the no-recurrence group (13.64-13.37%, p < 0.001). Multivariate Cox proportional hazards regression analyses revealed that a postoperative change in RDW (ΔRDW) was independently associated with AF recurrence (hazard ratio 2.00, 95% confidence interval 1.42-2.76, p < 0.001). Receiver operating characteristic curve analysis revealed that a ΔRDW cut-off value of - 0.1% provided a c-statistic of 0.65 for predicting AF recurrence. Decrease in RDW during the blanking period after ablation independently predicted the 1-year success of AF ablation.

Impact of creatinine clearance on clinical outcomes in elderly atrial fibrillation patients receiving apixaban: J-ELD AF Registry sub-analysis

Abstract Background Randomized clinical trials demonstrated the efficacy and safety of apixaban in preventing stroke in patients with atrial fibrillation (AF). However, data on patients with low creatinine clearance (CCr), especially CCr 15–29 mL/min, are limited. Methods The J-ELD AF Registry is a large-scale, multicenter prospective observational study of Japanese non-valvular AF patients aged ≥75 years taking on-label dose (standard dose of 5 mg bid or reduced dose of 2.5 mg bid) of apixaban. The enrollment period was from September 2015 to August 2016, and the observation period for each patient was 1 year. The entire cohort (3,015 patients from 110 institutions) was divided into three CCr subgroups: CCr ≥50 mL/min (n=1,165, 38.6%), CCr 30–49 mL/min (n=1,395, 46.3%), and CCr 15–29 mL/min (n=455, 15.1%). Results Most patients (74.3%) in the CCr ≥50 group received the standard apixaban dose, and most (97.4%) in the CCr 15–29 group received the reduced apixaban dose. The average age was 79.2 years for the CCr ≥50 group, 82.5 years for the CCr 30–49 group, and 85.6 years for the CCr 15–29 group. The lower CCr value group included more female patients, had lower body weight, and less cases of paroxysmal AF, as well as more cases of heart failure, peripheral artery disease, and myocardial infarction as comorbidities. The CHA2DS2-VASc and HAS-BLED scores were 4.2±1.2 and 2.4±0.8 for the CCr ≥50 group, 4.5±1.2 and 2.4±0.8 for the CCr 30–49 group, and 4.9±1.2 and 2.4±0.7 for the CCr 15–29 group, respectively. Kaplan Meier curves for cumulative incidence of events are shown in Figure. The event incidence rates (/100 person-years) were 1.76, 1.39, and 1.67 for stroke or systemic embolism (log rank p=0.762), 1.39, 1.93, and 3.13 for bleeding requiring hospitalization (log rank p=0.159), 1.75, 2.76, and 7.87 for total deaths (log rank p&amp;lt;0.001), and 0.46, 0.84, and 2.62 for cardiovascular deaths (log rank p&amp;lt;0.001), in the CCr ≥50 group, CCr 30–49 group, and CCr 15–29 group, respectively. After adjusting for confounders by Cox regression analysis, CCr 15–29 was an independent risk for total death [hazard ratio (HR) 3.22, 95% confidence interval (CI) 1.68–6.17, with reference to the CCr ≥50 group] and cardiovascular death [HR 3.18, 95% CI 1.06–9.56], but not for stroke or systemic embolism [HR 0.94, 95% CI 0.40–2.24], or bleeding requiring hospitalization [HR 2.00, 95% CI 0.93–4.28]. Conclusions The incidence of events in each CCr value group was comparable for stroke or systemic embolism and bleeding requiring hospitalization, and significantly higher for total deaths and cardiovascular deaths only in the CCr 15–29 group, in Japanese non-valvular AF patients aged ≥75 years. Cumulative incidence rates of events Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Bristol-Myers Squibb

Paroxysmal Atrial Fibrillation Induced by Ciprofloxacin: A Rare Adverse Effect

Despite their adverse effects, fluoroquinolones continue to be commonly prescribed antibiotics. Ciprofloxacin remains the safest with remarkably few adverse effects of all fluoroquinolones. Here, we present a rare case of paroxysmal atrial fibrillation induced by ciprofloxacin intake in a 72-year-old woman. She was treated with ciprofloxacin and ceftriaxone for urinary tract infection caused by Klebsiella pneumonia and complicated with liver abscess. On the fifth day of ciprofloxacin intake, she suddenly complained of heart palpitations and epigastric pain. An electrocardiogram revealed supraventricular tachycardia type atrial fibrillation at 130 beats per minute. No QT interval prolongation was noted. Ciprofloxacin was stopped as it was the most incriminated to induce arrhythmia. A control electrocardiogram showed normal sinus rhythm. We continued ceftriaxone use solely for 3 weeks until the resolution of the liver abscess. Although rare, early detection of atrial fibrillation induced by ciprofloxacin may decrease the severity of complications and prevent death.

Detection rate and treatment gap for atrial fibrillation identified through screening in community health centers in China (AF-CATCH): A prospective multicenter study.

Atrial fibrillation (AF) is underdiagnosed and especially undertreated in China. We aimed to investigate the prevalence of unknown and untreated AF in community residents (≥65 years old) and to determine whether an education intervention could improve oral anticoagulant (OAC) prescription. We performed a single-time point screening for AF with a handheld single-lead electrocardiography (ECG) in Chinese residents (≥65 years old) in 5 community health centers in Shanghai from April to September 2017. Disease education and advice on referral to specialist clinics for OAC treatment were provided to all patients with actionable AF (newly detected or undertreated known AF) at the time of screening, and education was reinforced at 1 month. Follow-up occurred at 12 months. In total, 4,531 participants were screened (response rate 94.7%, mean age 71.6 ± 6.3 years, 44% male). Overall AF prevalence was 4.0% (known AF 3.5% [n = 161], new AF 0.5% [n = 22]). The 183 patients with AF were older (p < 0.001), taller (p = 0.02), and more likely to be male (p = 0.01), and they had a higher prevalence of cardiovascular disease than those without AF (p < 0.001). In total, 85% (155/183) of patients were recommended for OAC treatment by the established guidelines (CHA2DS2-VASc ≥ 2 for men; ≥ 3 for women). OAC prescription rate for known AF was 20% (28/138), and actionable AF constituted 2.8% of all those screened. At the 12-month follow-up in 103 patients (81% complete), despite disease education and advice on specialist referral, only 17 attended specialist clinics, and 4 were prescribed OAC. Of those not attending specialist clinics, 71 chose instead to attend community health centers or secondary hospital clinics, with none prescribed OAC, and 15 had no review. Of the 17 patients with new AF and a class 1 recommendation for OAC, only 3 attended a specialist clinic, and none were prescribed OAC. Of the 28 AF patients taking OAC at baseline, OAC was no longer taken in 4. Ischemic stroke (n = 2) or death (n = 3) occurred in 5/126 (4%), with none receiving OAC. As screening was performed at a single time point, some paroxysmal AF cases may have been missed; thus, the rate of new AF may be underestimated. We demonstrated a noticeable gap in AF detection and treatment in community-based elderly Chinese: actionable AF constituted a high proportion of those screened. Disease education and advice on specialist referral are insufficient to close the gap. Before more frequent or intensive screening for unknown AF could be recommended in China, greater efforts must be made to increase appropriate OAC therapy in known AF to prevent AF-related stroke.

Feasibility and safety of uninterrupted apixaban in patients undergoing radiofrequency ablation for atrial fibrillation.

An optimal periprocedural anticoagulation strategy is essential for minimizing bleeding and thromboembolic complications during atrial fibrillation (AF) ablation. Limited data are available on the uninterrupted use of apixaban in patients with AF undergoing catheter ablation. This study aimed to evaluate the safety and efficacy of uninterrupted apixaban in patients undergoing radiofrequency ablation for AF. In particular, we evaluated silent cerebral infarction (CI) during radiofrequency catheter ablation of AF. This was a prospective and nonrandomized cohort study. A total of 259 consecutive patients who underwent AF ablation were evaluated; 157 patients received apixaban (Api group), and 102 patients received dose-adjusted (PT-INR 2.0-3.0) warfarin (Wf group). All oral anticoagulants were continued throughout the periprocedural period, including the morning of the procedure. Intravenous heparin was administered during the procedure and neutralized by protamine at the end of the procedure. Sixty-one patients underwent magnetic resonance imaging (MRI) after the procedure to evaluate for silent CI. Mean age was 66 ± 11years; there were 91 men (73.7%) and 148 cases of paroxysmal AF (57.1%). No symptomatic CI was observed. Silent CI occurred in 6/61 patients (9.8%). No significant difference was observed between the Api group (4/30 patients, 13.3%) and the Wf group (2/31 patients, 6.5%). There was no significant difference regarding major bleeding events between the Api group (1/157 patients, 0.6%) and the Wf group (2/102 patients, 2.0%). The safety and efficacy of uninterrupted apixaban for patients undergoing AF ablation were equivalent to warfarin for preventing bleeding and thromboembolic complications.

073_16804-H5 Relation Between Heart Rate Change and Recurrence After Pulmonary Vein Isolation in Patients With Paroxysmal Atrial Fibrillation

We examined the relation between heart rate (HR) change and recurrence of atrial fibrillation (AF) after pulmonary vein isolation (PVI). We retrospectively examined 49 consecutive cases of paroxysmal AF who performed first PVI procedure from April to September 2015. HR of electrocardiograms were

Safety and efficacy of Cardi-O-fix occluder for percutaneous closure of a patent foramen ovale

Background:Amplatzer occluder and Cardio-O-fix occluder are currently used in percutaneous closure of patent foramen ovale. However, there is still a lack of relevant reports comparison the differences between them. The aim of this study was to evaluate the short-term and mid-term safety and efficacy of the Cardi-O-fix occluder in preventing recurrent cerebrovascular events in patients with a patent foramen ovale (PFO).Methods:We enrolled 246 patients (105 men) with a PFO from May 30, 2013 to March 30, 2015 in this single-center prospective study. All patients were treated by PFO interventional closure, with the Cardi-O-fix PFO occluder being used in 180 patients and the Amplatzer PFO occluder being utilized in the remaining 66 patients. After the procedure, we verified the safety and efficacy of different devices using contrast transthoracic echocardiography.Results:Neither recurrent stroke nor death was encountered during the follow-up of 12 months. Transient ischemic attack (TIA) was noted in 2 patients (1.1%) in the Cardi-O-fix PFO occluder group, and 1 patient suffered from TIA (1.5%) in the Amplatzer PFO occluder group. Among them, only 1 patient exhibited a small right to left shunt (RLS). There was no statistical difference in recurrent cerebral ischemic events. Three cases of paroxysmal atrial fibrillation were observed in the Cardi-O-fix PFO occluder group. One reverted spontaneously to sinus rhythm and the other 2 cases had pharmacologic conversion to sinus rhythm. One case of paroxysmal atrial fibrillation occurred in the Amplatzer group, which underwent pharmacologic conversion to sinus rhythm. There was no significant difference between the 2 groups regarding incidence of arrhythmia. No occluder translocation, erosion, pericardial effusion, and puncture site bleeding were observed in the 2 groups within 12 months of follow-up. The complete closure rates of the Cardi-O-fix and Amplatzer PFO occluder devices at the 12 months after the procedure were 73.9% and 63.6%, respectively, and the effective closure rates were 90.6% and 86.4%, respectively. There was no statistically significant difference in the complete closure rate and effective occlusion rate (P > 0.05) between the devices.Conclusions:There was no significant difference in the short- and mid-term efficacy and safety between the Cardi-O-fix PFO occluder and Amplatzer PFO occluder. The efficacy and safety of the Cardi-O-fix occluder were comparable to those of the Amplatzer PFO occluder.

A case of paroxysmal atrial fibrillation with electrical connection via the ligament of Marshall between the left superior pulmonary vein and left atrium

A case of paroxysmal atrial fibrillation with electrical connection via the ligament of Marshall between the left superior pulmonary vein and left atrium

Proarrhythmic Effects Of Antiarrhythmic Drugs: Case Study Of Flecainide Induced Ventricular Arrhythmias During Treatment Of Atrial Fibrillation.

Flecainide is a class 1C antiarrhythmic drug especially used for the management of supraventricular arrhythmia. Flecainide also has a recognized proarrhythmic effect in patients treated for ventricular tachycardia. It is used to treat a variety of cardiac arrhythmias including paroxysmal atrial fibrillation, paroxysmal supraventricular tachycardia and ventricular tachycardia. Flecainide has local anesthetic effects and belongs to the class 1C AADs that block sodium channels, thereby slowing conduction through the heart. It selectively increases anterograde and retrograde accessory pathway refractoriness. The action of flecainide in the heart prolongs the PR interval and widens the QRS complex. The proarrhythmic effects however noted are not widely reported. We report a case of paroxysmal atrial fibrillation with structurally normal heart who was treated with oral Flecainide. There were no adverse events and no QTc prolongation was noted on ECG. Despite subjective improvement a repeat Holter detected him to have multiple short non sustained ventricular arrhythmias. Development of ventricular arrhythmias, salvos and non-sustained ventricular tachycardia after a month of initiation of oral flecainide detected by 24 hours ECG Holter lead to discontinuation of flecainide and subsequent early electrophysiological studies and successful ablation. Initiation of oral Flecainide in a case of atrial fibrillation with subjective improvement and regular ECG monitoring, no QTc prolongation can still lead to development of dangerous ventricular arrhythmias. A cautious approach and thorough investigations and follow up are recommended.