Long-standing Atrial Fibrillation Research Articles

Atrial fibrillation management during septal myectomy for hypertrophic cardiomyopathy: A systematic review.

Atrial fibrillation is common in patients with hypertrophic cardiomyopathy, and significantly impacts mortality and morbidity. In patients with atrial fibrillation undergoing septal myectomy, concomitant surgery for atrial fibrillation may improve outcomes. A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All studies reporting the outcomes of combined septal myectomy and atrial fibrillation surgery were included. A total of 10 observational studies were identified, including 644 patients. Most patients had paroxysmal atrial fibrillation. The proportion with prior unsuccessful ablation ranged from 0 to 19%, and preoperative left atrial diameter ranged from 44 ± 17 to 52 ± 8 mm. Cox-Maze IV (n = 311) was the most common technique used, followed by pulmonary vein isolation (n = 222) and Cox-Maze III (n = 98). Patients with persistent or longstanding atrial fibrillation more frequently received Cox-Maze III/IV. Ranges of early postoperative outcomes included: mortality 0 to 7%, recurrence of atrial tachyarrhythmias 4.4 to 48%, cerebrovascular events 0 to 1.5%, and pacemaker insertion 3 to 21%. Long-term data was limited. Freedom from atrial tachyarrhythmias at 1 year ranged from 74% to 96%, and at 5 years from 52% to 100%. Preoperative predictors of late atrial tachyarrhythmia recurrence included left atrial diameter >45 mm, persistent or longstanding preoperative atrial fibrillation and longer atrial fibrillation duration. In patients with atrial fibrillation undergoing septal myectomy, the addition of ablation surgery adds low overall risk to the procedure, and likely reduces the risk of recurrent atrial fibrillation in the long term. Future randomised studies comparing septal myectomy with or without concomitant AF ablation are needed.

Previous Catheter Ablation Predicts In-Hospital Restoration of Sinus Rhythm in Patients Presenting with Recent-Onset Atrial Fibrillation-The Retrospective HAMBURG-AF Study.

Background and Objectives: Atrial fibrillation (AF) is the most common arrythmia of the human heart. Patients mostly present highly symptomatic with dyspnea and tachycardia and have a disproportionate risk of developing heart failure or stroke events. We aimed to evaluate the determinants of early conversion into sinus rhythm during initial stay at the emergency department of a large tertiary care center. Materials and Methods: A total of 1384 subjects with recent-onset AF were recruited between October 2014 and April 2017. Patients with longstanding AF were excluded, resulting in a total of 935 patients for the present analysis. Results: In multivariate adjusted logistic regression analyses, previous catheter ablation therapy was a strong predictor of conversion in sinus rhythm during the stay in the emergency department, with an odds ratio (OR) of 3.87 (95% CI 2.40, 6.54; p < 0.001). In contrast, existing antiarrhythmic medication showed no association with facilitated conversion [OR 0.89 (95%CI 0.65, 1.20); p = 0.44]. Likewise, conventional cardiovascular risk factors (hypertension, dyslipidemia, diabetes) were also not associated with conversion during hospital stay. Conclusion: This is the first report on the relevance of previous ablation therapy for early restoration of sinus rhythm in recent-onset AF. Although catheter ablation is associated with relevant risk of late recurrence of atrial fibrillation, it seems to have a large benefit for patients with recent-onset AF.

Prone-position computed tomography in the late phase for detecting intracardiac thrombi in the left atrial appendage before catheter ablation for atrial fibrillation.

BackgroundContrast computed tomography (CT) is a useful tool for the detection of intracardiac thrombi. We aimed to assess the accuracy of the late‐phase prone‐position contrast CT (late‐pCT) for thrombus detection in patients with persistent or long‐standing persistent atrial fibrillation (AF).MethodsEarly and late‐phase pCT were performed in 300 patients with persistent or long‐standing AF. If late‐pCT did not show an intracardiac contrast defect (CD), catheter ablation (CA) was performed. Immediately before CA, intracardiac echocardiography (ICE) from the left atrium was performed to confirm thrombus absence and the estimation of the blood velocity of the left atrial appendage (LAA). For patients with CDs on late‐pCT, CA performance was delayed, and late‐pCT was performed again after several months following oral anticoagulant alterations or dosage increases.ResultsOf the 40 patients who exhibited CDs in the early phase of pCT, six showed persistent CDs on late‐pCT. In the remaining 294 patients without CDs on late‐pCT, the absence of a thrombus was confirmed by ICE during CA. In all six patients with CD‐positivity on late‐pCT, the CDs vanished under the same CT conditions after subsequent anticoagulation therapy, and CA was successfully performed. Furthermore, the presence of residual contrast medium in the LAA on late‐pCT suggested a decreased blood velocity in the LAA ( ≤ 15 cm/s) (sensitivity = 0.900 and specificity = 0.621).ConclusionsLate‐pCT is a valuable tool for the assessment of intracardiac thrombi and LAA dysfunction in patients with persistent or long‐standing persistent AF before CA.

The efficacy of synchronized direct current shock in reverting long standing persistent atrial fibrillation in to sinus rhythm. What help to achieve high success rate?

Background: Atrial fibrillation is the most frequent cardiac arrhythmia encountered in general medicine and cardiology practice. Synchronized direct current shock is a known safe and effective procedure to revert long standing persistent atrial fibrillation into sinus rhythm.&#x0D; Patients and Methods: Patients with long-standing atrial fibrillation who were seen at the author’s private clinic and Al-Hassani Heart Center in Sulaimanya from April 2018 to December 2020 were chosen for rhythm control subjected to synchronized direct current cardioversion under heavy sedation applying a modified anterolateral paddles position with 200J and 300J successively according to the reversion dose required.&#x0D; Objectives: The Objective of current study was to assess the efficacy of synchronized direct current shock in reverting long-standing persistent atrial fibrillation into sinus rhythm and recognizing factors that help in achieving high success rate.&#x0D; Results: In this case series study 61 patients were included thirty-one males 30 females The success rate was 89%. Even patients with atrial fibrillation duration more than 2 years showed a success rate of 84%. The recurrence rate of atrial fibrillation was 30% within a follow up period of one month to 2 years. The modified paddles position has helped in achieving high reversion rate where success increased from 62% to 85% and failure rate decreased from 38% to 15%. The shock dose needed for reversion ranged from 200J to 300 J. There was no correlation between the needed dose for reversion and body weight where patients with body weight of 71-80kg, more than 80% reverted with 200J. Pre shock antiarrhythmic drugs did not facilitate the conversion, the reversion rate in patients with or without antiarrhythmic drugs were 85% and 82% successively. No per procedure complications were seen. &#x0D; Conclusion: Electrical cardioversion of atrial fibrillation with modified paddles position is a safe, effective and smooth procedure with significantly high success rate and very low incidence of complications even with very long-standing atrial fibrillation.

Left ventricular ejection fraction reduction due to atrial fibrillation: clinical and echocardiographic predictors

Abstract Funding Acknowledgements Type of funding sources: None. Background The diagnosis of atrial fibrillation (AF) induced cardiomyopathy can be challenging. It relies on ruling out other causes of dilated cardiomyopathy, upon recovery of left ventricular ejection fraction (LVEF) following return to sinus rhythm (SR). Aim The aim of this study was to identify clinical and echocardiographic predictors for developing new dilated cardiomyopathy in patients with AF or atrial flutter (AFL). Methods This is a retrospective study conducted in a large tertiary care center. Patients that suffered deterioration of LVEF under 50% during AF demonstrated by pre-cardioversion trans-esophageal echocardiography (TEE) were compared to those with preserved LV function during AF. All patients had documented preserved LVEF at baseline (EF &amp;gt;50%) while in SR. Patients with a previous history of reduced LVEF during SR were excluded. Results From a total of 482 patients included in the final analysis, 80 (17%) patients had reduced LV function and 402 (83%) had preserved LV function during the pre-cardioversion TEE. Patients with reduced LVEF were more likely to be male and with a more rapid ventricular response during AF/AFL. A history of prosthetic valves was also identified as a risk factor for reduced LVEF. Patients with reduced LVEF also had higher incidence of TR and RV dysfunction. Conclusion In "real world" experience, male patients with rapid ventricular response during AF or AFL are more prone to LVEF reduction. Patients with prosthetic valves are also at risk for LVEF reduction during AF/AFL. Lastly, TR and RV dysfunction may indicate relatively long-standing AF with an associated reduction in LVEF.

Severe Atrial Functional Mitral Regurgitation: Clinical and Echocardiographic Characteristics, Management and Outcomes

ObjectivesThis study was designed to compare the clinical and echocardiographic characteristics, management, and outcomes of severe atrial functional mitral regurgitation (AFMR) to primary mitral regurgitation (PMR). BackgroundAFMR remains poorly defined clinically. MethodsConsecutive patients who underwent transesophageal echocardiography at our institution between 2011 and 2018 for severe mitral regurgitation with preserved left ventricular function were screened. We excluded patients with endocarditis, any form of cardiomyopathy, or prior mitral intervention. The absence of leaflet pathology defined AFMR. Outcomes included death and heart failure hospitalizations. ResultsA total of 283 patients were included (AFMR = 14%, PMR = 86%). Compared to PMR, patients with AFMR had more comorbidities, including hypertension (94.9% vs. 76.2%; p = 0.015), diabetes mellitus (46.2% vs. 18.4%; p < 0.001), long-standing atrial fibrillation (28.2% vs. 13.1%; p = 0.015), prior nonmitral cardiac surgery (25.6% vs. 9.8%; p = 0.004), and pacemaker placement (33.3% vs. 13.5%; p = 0.002). They also had higher average E/e’ (median [interquartile range]:16.04 [13.1 to 22.46] vs. 14.1 [10.89 to 19]; p = 0.036) and worse longitudinal left atrial strain peak positive value (16.86 ± 12.15% vs. 23.67 ± 14.09%; p = 0.002) compared to PMR. During follow-up (median: 22 months), patients with AFMR had worse survival (log-rank p = 0.009) and more heart failure hospitalizations (log-rank p = 0.002). They were also less likely to undergo mitral valve intervention (59.0% vs. 83.6%; p = 0.001), although surgery was associated with improved survival (log-rank p = 0.021). On multivariable regression analysis, AFMR was independently associated with mortality [adjusted odds ratio: 2.61, 95% confidence interval: 1.17 to 5.83; p = 0.02]. ConclusionsAFMR constitutes an under-recognized high-risk group, with significant comorbidities, limited therapeutic options, and poor outcomes.

Disappearing left atrial appendage clot-the need for a more meticulous search.

The online version contains supplementary material available at 10.1007/s12055-021-01154-9.

Incidence, predictors and outcomes of device-related thrombus after left atrial appendage closure with the WATCHMAN device-Insights from the EWOLUTION real world registry.

In this analysis of the EWOLUTION registry, we evaluated the incidence, relevance and predictors of device-related thrombus in a large multi-center real-world cohort undergoing LAAc with the WATCHMAN device. We analyzed the 835 patients who underwent percutaneous LAA closure with the WATCHMAN device in the EWOLUTION registry in whom at least one TEE follow up was performed. Patients were 74 ± 9 y/o and were at high risk for stroke and bleeding (CHA2DS2-VASC-Score 4.3± 1.7; HAS-BLED-Score 2.3± 1.2). Device-related thrombus was detected in 4.1% (34/835) after a median of 54 days (IQR 42-111 days) with 91.2% (31/34) being detected within 3months after the procedure or at the time of first TEE. Hereby DRT occurred irrespective of postprocedural anticoagulation. Patients with DRT more frequently had long-standing, non-paroxysmal atrial fibrillation (82.4 vs. 64.9%, p< .01), evidence of dense spontaneous echo contrast (26.5 vs. 11.9%, p= .03) and larger LAA diameters at the ostium (22.8± 3.5 vs. 21.1± 3.5 mm, p< .01) compared to patients without DRT. Left ventricular ejection fraction, device compression ratio and the incidence of renal dysfunction did not differ between the two groups. In a multivariate analysis, only non-paroxysmal atrial fibrillation identified as an independent predictor of developing DRT. Specific treatment of DRT was initiated in 62% (21/34) of patients whereas resolution was confirmed in 86% (18/21) of cases. Overall, no significant differences in annual rates of stroke/TIA or systemic embolism were observed in patients with or without DRT (DRT 1.7 vs. No-DRT 2.2%/year, p= .8). In real-world patients undergoing LAAc with the WATCHMAN device, DRT is rare. DRT was most frequently detected within the first 3months after LAAc regardless of post-procedural regimen and was not associated with an increased risk of stroke or SE. While long-standing atrial fibrillation was the only independent factor associated with DRT, medical treatment of DRT resulted in a resolution of thrombi in most cases.

Abstract 17261: Maintenance of Sinus Rhythm After His Bundle Pacing and AV Nodal Ablation in Patients With Recurrent Atrial Fibrillation After Catheter Ablation

Background: Catheter ablation (CA) is the most effective means of rhythm control for atrial fibrillation (AF) but is not curative. Irregular and rapid ventricular activation by AF begets AF. Cardiac resynchronization and atrioventricular nodal (AVN) ablation have been associated with favorable atrial remodeling and spontaneous reversion to sinus rhythm in patients with longstanding atrial fibrillation. Hypothesis: We hypothesized that in patients with longstanding persistent AF who had failed CA, AVN ablation and His bundle pacing (HBP) may improve maintenance of sinus rhythm. Methods and Results: A total of 13 patients (5 female, age 69±8.7 years, 8 with HFrEF, BMI 29 ±5 kg/m 2 ,LVEF 38±15%, NYHA 3±0.6) underwent simultaneous AVN ablation and HBP an average of 531 days (Range 1-2158 days) after CA for AF with recurrent AF. Prior to AVN ablation and HBP these patients had a median 9-year history of AF (IQR: 5-15 years) with a median of 2 prior cardioversions (IQR: 1-4) and 2 prior CA. All patients had failed at least 1 antiarrhythmic drug. In 3 patients HBP induced cardiac resynchronization of pre-existing bundle branch block and in 8 patients HBP was fused with ventricular pacing to optimize QRS duration. 12 of 13 patients had an atrial lead. All patients underwent cardioversion at the time of the procedure. In a median of follow up of 21 months (IQR:4-74 months), 7 of the 13 patients (54%) had no device detected or clinical recurrence of AF. In follow up LVEF increased to 46±12.7% and NYHA class to 2 ±0.2. Of patients with recurrence, 3 underwent CA and had no recurrence of AF in subsequent follow up. Conclusion: In patients with advanced longstanding persistent AF, a strategy of AVN ablation and HBP allowed for ventricular rate control with a narrow QRS. This approach resulted in a lower than expected rate of AF recurrence.

Abstract 13060: Calcified Left Atrium: A Therapeutic Challenge for Atrial Fibrillation

Background: Myocardial calcium deposits are common in patients with end stage renal disease (ESRD) but present a challenge in patients with atrial fibrillation (AF) and may limit ablation success with currently available energy sources, while increasing stroke risk during ablation. Obective: We describe a challenging case of symptomatic AF management in a patient with a calcified (coconut) left atrium (LA). Methods: N/A Results: A fifty year old woman with ESRD, seen for longstanding symptomatic paroxysmal AF and AF induced hypotension during hemodialysis (HD). She had cardioverted with calcium channel blockers and amiodarone previously and was maintained on metoprolol and amiodarone. She was admitted for symptomatic atrial flutter and underwent an attempted ablation. Trans-esophogeal echocardiogram (TEE) before ablation demonstrated a dilated and severely calcified/coconut LA (figure). Despite extensive radiofrequency ablation, bi-directional block could not be achieved across the cavo-tricuspid isthmus even with disappearance of the local electrograms and non-induciblity at the end of the case. She continues to have symptomatic AF on amiodarone and hypotension at HD and AF ablation is considered unlikely to be successful with an increased complication rate. Conclusion: Porcelain LA has been reported in literature in patients with AF and ESRD. There is no contemporary data on AF management or ablation in these challenging patients and further clinical investigation is needed to determine the feasibility and safety of ablation. Performing pre-operative TEEs in all patients with ESRD is reasonable to assess for LA calcification prior to trans-septal puncture and LA ablation.

Abstract 14352: Staged Hybrid Atrial Fibrillation Ablation With Addition of Endoscopic Left Atrial Appendage Closure Reduces Arrhythmia Recurrence Between 3 and 12 Months Compared to Non-staged Hybrid Without Closure

Introduction: The hybrid, or convergent procedure, uses a minimally invasive combined epicardial/endocardial ablation approach for patients in persistent AF. In the staged hybrid approach, the electrophysiologist performs the endocardial ablation a minimum of 30 days after the surgeon performs epicardial ablation. Placement of a left atrial appendage (LAA) closure device (AtriCure AtriClip) has been shown to electrically isolate the LAA. Added to the scar formation on the posterior wall via epicardial ablation, it eliminates additional substrate in persistent atrial fibrillation (AF). Hypothesis: Patients with persistent AF who underwent a staged hybrid approach with thoracoscopic placement of the AtriClip may have less likelihood of arrhythmia recurrence between 3 and 12 months compared with those who underwent nonstaged hybrid ablations without use of the AtriClip. Methods: Patients in persistent or long-standing paroxysmal AF underwent ablation using either a staged hybrid approach with AtriClip (n=23) or a nonstaged hybrid approach without AtriClip (n=136). Groups were compared by running a t-test (mean±SD) or Wilcoxon rank sum [median, interquartile range (IQR)]. Categorical data were compared with Pearson’s chi-squared test. Results: Significantly fewer patients who had undergone a staged hybrid with AtriClip recurred with arrhythmia (2, 8.7%) compared to those with a nonstaged, no AtriClip approach (40, 29.4%) (p=0.04) between 3 and 12 months. The staged hybrid approach also had significantly fewer patients requiring cardioversion to restore sinus rhythm during the procedure (p&lt;0.001). Conclusions: A staged hybrid approach with AtriClip placement reduced recurrent arrhythmia between 3 and 12 months compared to a nonstaged hybrid procedure without AtriClip. A benefit was also seen in a steep reduction in the need for cardioversion during the subsequent endocardial ablation to restore sinus rhythm.

Electrophysiological mechanisms of arrhythmias after thoracoscopic Maze procedure

Object of the study : combination of thoracoscopic epicardial ablation with subsequent catheter procedures is a modern and effective approach for the treatment of long-standing atrial fibrillation (LSAF). Given the standard method of epicardial ablation, the design of which depends mainly on the tools and technologies used, subsequent catheter ablation should eliminate all typical weaknesses of the epicardial stage. The aim of this study was to establish the main causes of recurrence of atrial arrhythmias in patients with LSAF after primary epicardial ablation using the Dallas lesion set technique. Methods: thoracoscopic ablation was performed for 330 patients, standard bipolar pulmonary vein (PV) isolation and monopolar linear lesions were performed to isolate the posterior wall of the left atrium (LA) (AtriCure Inc.). 47 of them, because of the recurrence of various atrial arrhythmias, the second endocardial stage of electrophysiological examination and radiofrequency catheter ablation (RFCA) was performed, with the vast majority of repeat procedures in a period of 3-6 months. The protocol for endocardial RFCA, in addition to mapping and eliminating the main cause of recurrence (atrial tachycardia, atrial flutter, or AF), included PV and posterior wall isolation control. Results : the study showed that after Dallas lesion set thoracoscopic ablation in patients with recurrence of atrial arrhythmias: 1) it is often necessary to re-isolate LA posterior wall (a typical area for restoration of the conduction is the roof, however, rare variants of conducting through the posterior connection of the right PV are also possible); 2) after epicardial ablation of the LA roof with a monopolar electrode, a wide non-homogeneous scar forms with numerous zones of slow conduction, low-amplitude, fragmented signals, not reaching the mitral valve, this scar is the main cause of incisional flutter; 3) as a cause of arrhythmia recurrence, additional AF drivers are also possible, that are not covered by the design of epicardial ablation - ectopic/micro-reentrant tachycardias, various arrhythmias from the right atrium. Conclusions: catheter ablation after thoracoscopic MAZE procedure allows to eliminate the existing limitations of the epicardial lines and supplementing them with the effect on the mechanisms of maintaining AF that are unique to a particular patient.

Atrial functional mitral regurgitation: mechanisms and surgical implications.

The term atrial functional mitral regurgitation refers to a newly recognized disease entity in which mitral regurgitation occurs secondary to left atrial disease, without left ventricular dilatation and intrinsic mitral valve disease, typically in the setting of long-standing atrial fibrillation. Recent evidence suggests that atrial functional mitral regurgitation is associated with increased risk of death and heart failure re-hospitalization. The etiology, pathophysiology, and mechanism of atrial functional mitral regurgitation is not completely understood but they should not be regarded as the same as for the conventional type of functional mitral regurgitation secondary to left ventricular dilatation and dysfunction. Mitral annular dilatation, atriogenic leaflet distortion, insufficient leaflet remodeling, and subtle left ventricular dysfunction may play a role in the pathogenesis of atrial functional mitral regurgitation. The therapeutic and surgical considerations of atrial functional mitral regurgitation are different from those of ventricular functional mitral regurgitation. In this review, we assess current evidence regarding this new disease entity and propose a new surgical approach based on up-to-date understanding and experience of this condition.

Spontaneous Conversion of Long-Standing Atrial Fibrillation/Flutter

There have been no recent descriptions of the spontaneous conversion of long-standing atrial fibrillation (AF) or flutter (AFl) to sinus rhythm which, in the past, has been associated with rheumatic mitral valve disease and treatment with digoxin. We present 3 contemporary cases, all of whom progressed from AF to slow AFl and then spontaneously converted to slow sinus or junctional rhythm. None of these patients had rheumatic heart disease or were treated with digoxin. In conclusion, we believe that they provide support for the broader view that this uncommon phenomenon is associated with a severe atrial myopathy due to scar and inflammation.

High-power, short-duration atrial fibrillation ablations using contact force sensing catheters: Outcomes and predictors of success including posterior wall isolation

Little is known about the long-term outcomes and predictors of success of high-power, short-duration (HPSD) contact force (CF) atrial fibrillation (AF) ablations. The purpose of this study was to determine long-term freedom from AF and predictors of freedom from AF for 50-W, 5- to 15-second CF ablation. We examined 4-year outcomes and predictors of freedom from AF after AF ablation for 1250 consecutive patients undergoing HPSD CF ablations. Patient demographics were age 66.6 ± 10.5 years, female 30.9%, left atrial (LA) size 4.26 ± 0.66 cm, paroxysmal AF 35.7%, persistent AF 56.6%, and longstanding AF 7.7%. Initial ablation times were procedure 114.2 ± 45.9 minutes, fluoroscopy 15.5 ± 11.5 minutes, and total radiofrequency 20.6 ± 7.7 minutes. TactiCath was used in 47.7%, SmartTouch in 52.3%, and posterior wall isolation (PWI) was performed in 34%. Four-year freedom from AF after multiple ablations were paroxysmal AF 87.0%, persistent AF 71.9%, and longstanding AF 64.9%. Single procedure success was 74.9% for TactiCath, 64.7% for SmartTouch (P <.001), and 73.0% for no PWI vs 58.9% for PWI (P <.0001). PWI did not change outcomes for paroxysmal AF but had worse outcomes for nonparoxysmal AF. Multivariate analysis showed 6 independent predictors of worse outcome after initial ablation: older age (P = .014), female gender (P <.0001), persistent AF (P = .0001), larger LA size (P <.001), PWI (P = .049), and use of SmartTouch vs TactiCath catheter (P= .007). Redo ablations were performed in 13.8%, and the outcome was better when more veins had reconnected after the initial ablation and when AF was paroxysmal. Analysis revealed 6 independent predictors of outcome for HPSD CF. At redo ablations, the outcome was better if more veins had reconnected and could be re-isolated.

ATRIAL FUNCTIONAL MITRAL REGURGITATION IN A PATIENT WITH LONG-STANDING PERSISTENT ATRIAL FIBRILLATION

Atrial functional mitral regurgitation (MR) secondary to long-standing atrial fibrillation is often misdiagnosed. 59 year old male with a 15 year history of persistent long-standing atrial fibrillation (AF) experienced recurrent hospitalizations for respiratory failure. Transesophageal

Real-world behavior of CRT pacing using the AdaptivCRT algorithm on patient outcomes: Effect on mortality and atrial fibrillation incidence.

BackgroundThe AdaptivCRT (aCRT) algorithm continuously adjusts cardiac resynchronization therapy (CRT) according to intrinsic atrioventricular conduction, providing synchronized left ventricular pacing in patients with normal PR interval and adaptive BiV pacing in patients with prolonged PR interval. Previous analyses demonstrated an association between aCRT and clinical benefit. We evaluated the incidence of patient mortality and atrial fibrillation (AF) with aCRT compared with standard CRT in a real‐world population.Methods and ResultsPatients enrolled in the Medtronic Personalized CRT Registry and implanted with a CRT from 2013‐2018 were divided into aCRT ON or standard CRT groups based upon device‐stored data. A Frailty survival model was used to evaluate the potential survival benefit of aCRT, accounting for patient heterogeneity and center variability. Daily AF burden and first device‐detected AF episodes of various durations were recorded by the device during follow‐up.A total of 1814 CRT patients with no reported long‐standing AF history at implant were included. Mean follow‐up time was 26.1 ± 16.5 months and 1162 patients (64.1%) had aCRT ON. Patient survival probability at 36 months was 88.3% for aCRT ON and 83.7% for standard CRT (covariate‐adjusted hazard ratio [HR] = 0.71, 95% CI: 0.53‐0.96, P = .028). Mean AF burden during follow‐up was consistently lower in aCRT ON patients compared with standard CRT. At 36 months, the probability of AF was lower in patients with aCRT ON, regardless of which AF definition threshold was applied (6 minutes‐30 days, all P < .001).ConclusionUse of the AdaptivCRT algorithm was associated with improved patient survival and lower incidence of AF in a real‐world, prospective, nonrandomized registry.

Сравнительная характеристика биатриальной и левопредесердной аблации в хирургическом лечении длительно персистирующей формы фибрилляции предсердий у пациентов с сочетанной патологией сердца

Сравнительная характеристика биатриальной и левопредесердной аблации в хирургическом лечении длительно персистирующей формы фибрилляции предсердий у пациентов с сочетанной патологией сердца

P1878Long-term effect of atrial fibrillation on the evolution of mitral and tricuspid valve regurgitation

Abstract Background While severe mitral regurgitation is a well-established risk factor for atrial fibrillation (AF), it is less known whether atrial fibrillation induces mitral/tricuspid valve regurgitation (MR/TR). The present study aims to identify the long-term effects of permanent or non-permanent AF on atrial remodelling and on the progression of MR/TR. Methods The severity of MR/TR was assessed at baseline and after a period of 65±10 months in 37 patients with permanent AF, in 80 patients with non-permanent AF (of whom 43 were treated with ablation) and in 53 control patients with persistent sinus rhythm. MR/TR was qualitatively assessed by the multi-integrative approach, and quantitatively by measurement of the colour jet area. Results At baseline, AF patients had larger MR jet areas than control patients. At follow up, progression of MR, expressed as delta MR jet area, was 0.05±1.3 cm2 in the control group, 0.73±2.1 cm2 in the non-permanent AF group and 1.95±3.6 cm2 in the permanent AF group (p=0.001). Severe MR at follow up was observed in 0%, 2.5%, 8%, respectively. After adjustment for baseline clinical and echocardiographic parameters, permanent AF remained independently associated with the progression of MR. There was a significant positive correlation between a progression of MR and an increase in left atrial volume index (r=0.31, p&lt;0.001). Although rhythm control in non-permanent AF patients was better with AF ablation than with medical treatment only, the MR evolution was similar (delta MR jet area: 0.85±2.05 cm2 vs 0.61±2.12 cm2, p=0.6). Comparable findings, albeit less pronounced, were observed for the association between of AF and TR progression. MR jet area Conclusions The presence of longstanding AF is associated with a significant progression of MR/TR mainly due to atrial remodelling. Our data showed a beneficial effect of sustained rhythm control, either medically or by ablation, on MR/TR progression.

Additional cavotricuspid isthmus block ablation may not improve the outcome of atrial fibrillation ablation.

Pulmonary vein isolation (PVI) is an effective procedure for atrial fibrillation (AF). The role of additional cavotricuspid isthmus (CTI) block ablation remains controversial in AF patients without atrial flutter (AFL). Therefore, this study aimed to explore the clinical outcome of additional CTI block ablation in patients without AFL. Between January 2013 and December 2017, a total of 139 patients who did not have documented AFL and who underwent catheter ablation for AF were recruited. Fifty-seven patients were classified in additional CTI block ablation group and 82 patients were classified in without CTI group. The incidence of early-onset and late-onset atrial arrhythmia recurrence was compared between the two groups. The additional CTI group had a higher prevalence of persistent or long-standing AF and larger left atrial volume. The additional CTI group had a higher incidence of late-onset atrial arrhythmia recurrence (38.6%vs 12.2%; P<.001). When compared to without CTI group, additional CTI therapy did not have a better outcome in terms of freedom of atrial arrhythmia in subgroup analysis. The incidence of early-onset and late-onset atrial arrhythmia recurrence did not differ between additional CTI group and without CTI group in paroxysmal AF patients and nonparoxysmal AF patients after propensity scoring matching. CTI block ablation in addition to PVI for AF patients without a history of AFL or inducible AFL during ablation may not improve the clinical outcome of AF ablation in the patients with larger LA volume, nonparoxysmal AF, or post-PVI inducible AF.