Non-valvular Paroxysmal Atrial Fibrillation Research Articles

Association of iron deficiency anemia with the development of paroxysms of atrial fibrillation within a year after pharmacological cardioversion with amiodarone

BACKGROUND: Anemia is a common problem with atrial fibrillation. There is a limited number of studies examining the role of iron deficiency anemia in the course of atrial fibrillation. AIM: To evaluate the association of iron deficiency anemia with the development of recurrent atrial fibrillation within 12 months in patients after pharmacological cardioversion with amiodarone. MATERIAL AND METHODS: The study included 198 patients over 18 years of age [120 (60.6%) men and 78 (39.4%) women, median age 71 (63.2; 77) years] with paroxysmal non-valvular atrial fibrillation and duration of paroxysm 48 h, after successful pharmacological cardioversion with amiodarone. The group with anemia included 99 patients (all had iron deficiency anemia), the group without anemia included 99 people. Patients with anemia were older; the groups were comparable in other main indicators. The development of recurrent atrial fibrillation over 1 year of follow-up was assessed by the Kaplan–Meier method and the Cox proportional hazards model. Differences were considered statistically significant at a p value 0.05. RESULTS: In the iron deficiency anemia group, symptomatic relapses of atrial fibrillation developed in 40.4% of patients during 1 year of observation; in the group without anemia — in 25.3% of patients (p=0.003). Kaplan–Meier analysis showed that iron deficiency anemia is associated with an increased risk of developing recurrent atrial fibrillation within 1 year after pharmacological cardioversion with amiodarone, relative risk 1.87 (p=0.014). Comparison of the risks associated with iron deficiency anemia and iron deficiency (regardless of the presence of anemia) showed a greater risk of recurrent atrial fibrillation associated with iron deficiency than with anemia (for interaction p=0.014). CONCLUSION: A comparison of the risks of developing recurrent atrial fibrillation in patients with iron deficiency itself and in patients with iron deficiency anemia showed a greater influence on the prognosis of recurrent atrial fibrillation by the presence of iron deficiency.

Nomogram to predict recurrence risk factors in patients with non-valvular paroxysmal atrial fibrillation after catheter radiofrequency ablation.

Radiofrequency catheter ablation (RFCA) is an effective method for controlling the heart rate of paroxysmal atrial fibrillation (PAF). However, recurrence is trouble under the RFCA. To gain a deeper understanding of the risk factors for recurrence in patients, we created a nomogram model to provide clinicians with treatment recommendations. A total of two hundred thirty-three patients with PAF treated with RFCA at Guizhou Medical University Hospital between January 2021 and December 2022 were consecutively included in this study, and after 1 year of follow-up coverage, 166 patients met the nadir inclusion criteria. Patients with AF were divided into an AF recurrence group and a non-recurrence group. The nomogram was constructed using univariate and multivariate logistic regression analyses. By calculating the area under the curve, we analyzed the predictive ability of the risk scores (AUC). In addition, the performance of the nomogram in terms of calibration, discrimination, and clinical utility was evaluated. At the 12-month follow-up, 48 patients (28.92%) experienced a recurrence of AF after RFCA, while 118 patients (71.08%) maintained a sinus rhythm. In addition to age, sex, and TRV, LAD, and TTPG were independent predictors of recurrence of RFCA. The c-index of the nomogram predicted AF recurrence with an accuracy of.723, showing good decision curves and a calibrated nomogram, as determined by internal validation using a bootstrap sample size of 1000. We created a nomogram based on multifactorial logistic regression analysis to estimate the probability of recurrence in patients with atrial fibrillation 1 year after catheter ablation. This plot can be utilized by clinicians to predict the likelihood of recurrence.

Efficacy and safety of antazoline vs propafenone for conversion of paroxysmal atrial fibrillation to sinus rhythm: a randomized, double-blind study (AnProAF).

Antazoline is a frequently used antiarrhythmic drug (AAD); however, to date, no randomized controlled trial has evaluated its efficacy and safety for cardioversion of recent‑onset atrial fibrillation (AF) in comparison with other approved AADs. This study aimed to compare clinical efficacy and safety of antazoline and propafenone for a rapid conversion of nonvalvular paroxysmal AF to sinus rhythm in patients without heart failure. This was a single‑center, randomized, double‑blind study. It included patients with AF (lasting <48 hours) who were in a stable cardiopulmonary condition and eligible for cardioversion. The individuals who fulfilled the inclusion criteria were randomly assigned to receive either antazoline (up to 300 mg) or propafenone (up to 140 mg) intravenously. The primary end point was conversion of AF to sinus rhythm confirmed on electrocardiography. Overall, 94 participants (46 [48.9%] in the antazoline group and 48 [51.1%] in the propafenone group) were included. The mean (SD) age was 67.5 (14) years, and 40 participants (42.5%) were men. Successful AF conversion was observed in 29 patients (63%) from the antazoline group and 25 individuals (52.1%) from the propafenone group (P = 0.39). The median time to conversion was 10 minutes in the antazoline group and 30 minutes in the propafenone group (P = 0.03). Severe adverse events were observed in 5 patients (10.8%) treated with antazoline and 5 individuals (10.4%) who received propafenone. Intravenous antazoline demonstrated efficacy and safety comparable to those of intravenous propafenone for acute conversion of nonvalvular paroxysmal AF to sinus rhythm in patients without heart failure.

The value of serial echocardiography in risk assessment of patients with paroxysmal atrial fibrillation.

Progression from paroxysmal to persistent atrial fibrillation (AF) is associated with increased morbidity and mortality. We examined the association of left atrial (LA) remodeling by serial echocardiography, and AF progression over an extended follow-up period. Two-hundred ninety patients (mean age 61 ± 11years, 73% male) who underwent transthoracic echocardiography performed at first presentation for non-valvular paroxysmal AF (PAF) and repeat echocardiogram 1-year later, were followed for progression to persistent AF. LA and left ventricular (LV) dimensions, volumes, LA reservoir, conduit and booster pump strains, LV global longitudinal systolic strain (GLS) assessedby 2D speckle tracking, and PA-TDI (time delay between electrical and mechanical LA activation- reflecting the extent of LA fibrosis) were compared on serial echocardiography. Sixty-nine (24%) patients developed persistent AF over a mean follow-up period of 6.3years. At baseline, patients with subsequent persistent AF had larger LA dimensions (46mm vs. 42mm, p < 0.001), indexed LA volumes (41ml/m2 vs. 34ml/m2, p < 0.001), lower LA reservoir and conduit strain (17.6% vs. 27.6%, p < 0.001; 10.5% vs. 16.3%, p < 0.001; respectively) and longer PA-TDI (155ms vs. 132ms, p < 0.001) compared to the PAF group. Patients with subsequent persistent AF showed over time significant enlargement in LA volumes (from 37.7ml/m2 to 42.4ml/m2, p < 0.001), lengthening of PA-TDI (from 142.2ms to 162.2ms, p = 0.002), and decline in LA reservoir function (from 21.9% to 18.1%, p = 0.024) after adjusting for age, gender, diabetes and LV GLS. There were no changes in LA diameter, LA conduit or booster pump function. Conversely, the PAF group showed no decline in LA function. Patients who developed persistent AF had larger LAsize and impaired LA function and atrial conduction times at baseline, compared to patients who remained PAF. Over the 1-year time course of serial echocardiographic evaluation, there was progression of LA remodeling in patients who subsequently developed persistent AF, but not in patients who remained inPAF.

Abstract 12590: Association of Iron Deficiency With the Recurrence of Atrial Fibrillation After Pharmacological Cardioversion

Introduction: Anemia and iron deficiency (ID) are common conditions in patients with atrial fibrillation (AF). The presence of anemia may be associated with worse outcome in patients with AF. The potential role of ID in the development of AF has been discussed recently, however the issue is considered only in the context of anemia. Thus, information on the direct impact of ID on AF development and on the sinus rhythm maintenance remains limited. Methods: The purpose of this article is to study the effects of ID on the frequency of recurrence of AF within 12 months in patients with paroxysmal AF after pharmacological cardioversion with amiodarone.198 patients (120 men) with nonvalvular paroxysmal AF with successful pharmacological cardioversion were included in the study between 2019-2021 years. The Me of the patients age is 71 (63,2–77) year. ID is assumed to be present when serum ferritin &lt;100 ng/mL or 100 ng/mL ≤ serum ferritin ≤299 ng/mL with transferrin saturation (TSAT) &lt;20%. The primary outcome was AF recurrence within 12 months after pharmacological cardioversion. AF recurrence is statistically tested by the Kaplan-Meier test. Results: The patients were divided into 2 groups: group 1 - 116 patients with ID, group 2 - 82 patients without ID. The groups did not differ in the main clinical parameters, comorbidities and medications. After cardioversion, all patients received treatment according to the current guidelines. The significant difference in AF recurrence was observed between groups. Within 12 months of observation, AF recurrence was developed in 49 (42.2%) patients in group 1 and in 16 (19.5%) patients in group 2 (p=0.0008). The RR of the recurrence of AF in patients with ID is 2.64 [95% CI: 1.5-4.65] (p=0.0003). Conclusion: ID is associated with the higher chances of AF recurrence within 12 months after pharmacological cardioversion. ID increases the risk of AF recurrence by 2,64 times within 12 months after pharmacological cardioversion.

Acute Effect of Atrial Fibrillation on Circulating Natriuretic Peptides: The Influence of Heart Rate, Rhythm Irregularity, and Left Atrial Pressure Overload

Plasma natriuretic peptides (NPs) are increased in patients with atrial fibrillation (AF) compared with the patients with sinus rhythm. This study investigated whether this phenomenon is intrinsic to heart rhythm irregularity and independent of the heart rate and left atrial pressure (LAP) overload. We investigated 46 patients (age: 59 ± 10years, male gender: 77%) with non-valvular paroxysmal AF who were scheduled for catheter ablation and had documented stable sinus rhythm for at least 18hours before the procedure. All patients underwent direct measurement of right atrial pressure and LAP, simultaneously with assessment of plasma B-type NP, N-terminal pro-brain NP, and mid-regional pro-atrial NP. The baseline measurement was followed by induction of AF by rapid atrial pacing in the first 24 patients and by regular pacing from the coronary sinus at 100/min (corresponding to the mean heart rate during induced AF) in the latter 22 patients. Hemodynamic assessment and blood sampling were repeated after 20min of the ongoing AF or fast regular paging. The baseline characteristics and hemodynamic measurements were comparable between study groups; however, patients in the regular atrial pacing group had a higher body mass index and a larger left atrial diameter compared with the induced AF group. Plasma levels of all 3 NPs increased significantly during induced AF but not during fast regular pacing, and the increase of NPs was independent of right atrial pressure and LAP. Baseline concentrations of NPs and heart rhythm irregularity were the only independent predictors of increased NPs.

Inflammatory Markers as Predictors of Atrial Fibrillation Recurrence: Exploring the C-Reactive Protein to Albumin Ratio in Cryoablation Patients.

Atrial fibrillation (AF) is a common cardiac rhythm disorder associated with hemodynamic disruptions and thromboembolic events. While antiarrhythmic drugs are often recommended as the initial treatment, catheter ablation has emerged as a viable alternative. However, the recurrence of AF following ablation remains a challenge, and there is growing interest in exploring inflammatory markers as predictors of recurrence. This retrospective, cross-sectional analysis included 249 patients who underwent cryoablation for paroxysmal AF. The relationship between the 'C-reactive protein (CRP) to albumin ratio (CAR)' and AF recurrence was examined. Two hundred and forty-nine patients with paroxysmal non-valvular atrial fibrillation were included. They were divided into two groups: those without recurrence (Group 1) and those with recurrence (Group 2). Significant differences were observed in age (57.2 ± 9.9 vs. 62.5 ± 8.4, p = 0.001) and left atrial size (4.0 ± 0.5 vs. 4.2 ± 0.7, p = 0.001) between the two groups. In blood parameters, significant differences were found in CRP (5.2 ± 1.3 vs. 9.4 ± 2.8, p < 0.001) and neutrophil counts (5.1 ± 2.2 vs. 6.7 ± 3.6, p = 0.001). In univariate regression analysis, age (OR: 1.058, CI: 1.024-1.093, p = 0.001), WBC count (OR: 1.201, CI: 1.092-1.322, p < 0.001), neutrophil count (OR: 1.239, CI: 1.114-1.378, p = 0.001), CAR (OR: 1.409, CI: 1.183-1.678, p < 0.001), and left atrial diameter (OR: 0.968, CI: 0.948-0.989, p = 0.002) showed significant associations with AF recurrence. Inflammation plays a crucial role in the initiation and progression of AF. This study demonstrated that along with age, the CAR can serve as an independent predictor of AF recurrence following cryoablation.

Use of left atrial automated functional myocardial imaging to identify patients with paroxysmal atrial fibrillation at high risk of stroke.

Left atrial automated functional myocardial imaging (AFILA) is a new software program for analyzing the structure and function of the left atrium (LA). The present study sought to analyze the correlation between the LA function parameters as measured by AFILA echocardiography and the risk of cerebral ischemic stroke (CIS) in patients with non-valvular paroxysmal atrial fibrillation (NVPAF) to explore the diagnostic value of LA strain in patients with congestive heart failure, hypertension, age of ≥75 years (doubled), diabetes mellitus, stroke or transient ischemic attack (TIA) (doubled), age of 65-74 years, and sex category (female) (CHA2DS2-VASc) scores of <2. A total of 205 patients with NVPAF were included in the study and divided into the no-CIS group (154 patients) and the CIS group (51 patients). The baseline clinical data for the 2 groups were analyzed, and routine echocardiography examinations were performed. AFILA was used to evaluate the LA function of all the patients. Compared to the no-CIS group, the LA emptying fraction and the LA reservoir strain were decreased, the LA contractile strain (S_CT) was increased, and the S_CT value changed from negative to positive in the CIS group, and the difference between the 2 groups were statistically significant (P<0.001). However, there were no significant differences in the volume at the onset of LA contraction, LA evacuation volume, LA minimum volume, LA maximum volume, and LA conduit strain between the 2 groups. The multifactorial regression analysis showed that age, hypertension, and the S_CT were independently associated risk factors for patients with CIS. After correcting for the clinical factors included in the CHA2DS2-VASc score, the S_CT was shown to predict to NVPAF with stroke [odds ratio (OR): 1.234, 95% confidence interval (CI): 1.101-1.383, P=0.000]. In addition, we included the CHA2DS2-VASc score (instead of age, diabetes, coronary artery disease, and hypertension) in a multiple regression analysis, and found that the S_CT was still significant (OR: 1.252, 95% CI: 1.118-1.402, P=0.000). The difference between the 2 groups in the CHA2DS2-VASc score for the S_CT was statistically significant, especially when the CHA2DS2-VASc score was <2. The S_CT equaled -4.5% was the cut-off value for the presence or absence of CIS in the NVPAF patients, with an area under the curve (AUC) of 0.866, sensitivity of 0.80, and specificity of 0.75 (P<0.0001). Comparison with LA volume parameter, measuring LA strain by AFILA provides a better index for the dynamic assessment of impaired LA function in patients with NVPAF combined with CIS, especially in those with a CHA2DS2-VASc score of <2. In addition, a LA S_CT of >-4.5% is a valuable cut-off for patients with NVPAF. The results of the current study may form the basis for a large prospective multicenter interventional study in which patients with impaired LA S_CT are randomized to receive oral anti-coagulant (OAC) therapy or no OAC therapy for the primary prevention of stroke.

Association of iron deficiency with atrial fibrillation recurrence after pharmacological cardioversion

Aim. This study aims to assess the association between iron deficiency (ID) and recurrences of atrial fibrillation (AF) in patients after pharmacological cardioversion with amiodarone within 12 months.Material and methods. The open-label, prospective, single-center study included 198 patients with non-valvular paroxysmal AF after successful pharmacological cardioversion with amiodarone. Group I included 116 patients with ID, and group II — 82 patients with normal iron status. The primary end-point of the study was the development of symptomatic AF recurrences within 12 months after the cardioversion which was estimated by the Kaplan-Meier method. The differences were considered statistically significant if p-value was &lt;0,05.Results. Absolute ID was found in patients of group I; anemia was revealed in 85,3% of the patients. The groups did not differ in basic clinical and demographical parameters, concomitant diseases and drug therapy. Along with that, the I group patients were older (the median was 73 (64,8-79) years old and 69 (63-75) years old, respectively, р=0,008), and their left ventricular mass was larger (the median was 145 (115-176) g and 132,5 (118,2-145) g, respectively, р=0,004). The sinus rhythm restoration in group I required less dose of amiodarone (the median was 450 (300-600) mg and 1000 (600-1200) mg, respectively, р&lt;0,001) and less time from the start of the drug administration to the rhythm restoration (the median was 7 (3-10) and 12 (9-18) hours, respectively, р&lt;0,001). During the 12-month follow-up period, 49 (42,2%) patients in group I and 16 (19,5%) patients in group II developed AF recurrences (р=0,0008), hazard ratio 2,64 (95% confidence interval: 1,5-4,65) (р=0,0003).Conclusion. ID is associated with the increase of the number of symptomatic AF recurrences in patients after pharmacological cardioversion with amiodarone within 12 months.

Effect of radiofrequency catheter ablation on left atrial structure and function in patients with different types of atrial fibrillation

Radiofrequency catheter ablation (RFCA) is widely used to treat atrial fibrillation (AF), but its effect on left atrial (LA) remodeling in patients with AF is not completely clarified. Few studies have reported the changes in structure and function of the left atrium in patients with different types of AF after RFCA. To analyze the effect of RFCA on the LA structure and function in patients with nonvalvular paroxysmal AF, persistent AF and long-standing persistent AF (LSPAF). RFCA was performed in 180 patients with paroxysmal AF, persistent AF and LSPAF. The changes of LA structure and function in echocardiogram and speckle-tracking echocardiography findings were compared before the procedure, and at 1, 2, 3, 4 weeks, and 2, 3, 6, and 9–12 months after the procedure. There were 60 patients in the paroxysmal AF group, 60 in the persistent AF group and 60 patients in LSPAF group. The pre-procedure LA diameter and volume were smaller in the paroxysmal AF group than persistent AF and LSPAF group. There was no significant change of in the LA structure and function in the paroxysmal AF group within 1 year. In the persistent AF and LSPAF groups, LA structure (anteroposterior diameter, LA volume) significantly decreased, but remained larger than that in paroxysmal AF group. In persistent and LSPAF, function (LA ejection fraction, strain, strain rate) increased significantly within 1 week, then gradually increased. RFCA improved the LA structure and function and resulted in heart reverse remodeling, especially for persistent AF and LSPAF.

Efficacy and Safety of Nepcell STM in Achieving Hemostasis After Removal of a 15-Fr Femoral Venous Sheath in Patients Undergoing Cryoballoon Ablation for Atrial Fibrillation.

Background: Hemostasis at the femoral venous access site after cryoballoon ablation (CA) for atrial fibrillation (AF) is often prolonged because of aggressive anticoagulation and the use of 15-Fr-caliber sheaths. The Nepcell STM (NC) is a newly developed hemostatic pad made of fibrosed calcium alginate extracted from natural seaweed. The calcium ions from the NC accelerate the clotting cascade. This single-center randomized clinical trial assessed the efficacy and safety of the NC in patients undergoing CA for AF. Methods and Results: In all, 62 patients undergoing CA for non-valvular paroxysmal AF were randomly assigned to either the NC or control group. The primary endpoints of this study were time to hemostasis, internal hemorrhage, and rebleeding. Secondary endpoints were the length of hospital stay (LOS) and vascular complications at 1 month. The time to hemostasis was significantly shorter in NC than control group (mean [±SD] 377±216 vs. 505±241 s; P=0.031). The frequency of internal hemorrhaging (6% vs. 37%; P=0.003) and rebleeding (0% vs. 13%; P=0.033) was lower in the NC than control group, contributing to a decreased LOS in the NC group (3.56±0.67 vs. 4.23±0.73 days; P<0.001). There were no NC-related vascular complications at the 1-month echographic examination. Conclusions: The use of NC was associated with a shorter hemostasis time and fewer bleeding complications in patients undergoing CA for AF, leading to a shorter LOS.

Left Ventricular Flow Distribution as a Novel Flow Biomarker in Atrial Fibrillation.

Introduction: Four-dimensional (4-D) flow cardiac magnetic resonance imaging can be used to elegantly describe the hemodynamic efficiency of left ventricular (LV) flow throughout the cardiac cycle. Patients with nonvalvular paroxysmal atrial fibrillation (PAF) may have occult LV disease. Flow distribution analysis, based on 4-D flow, may unmask the presence of LV disease by assessing flow components: direct flow, retained flow, delayed ejection, and residual volume. This study aimed to identify LV hemodynamic inefficiencies in patients with PAF and normal systolic function. We hypothesized that the fraction of direct flow to the total end-diastolic volume would be reduced in patients with PAF compared with controls. Methods: We used 4-D LV flow component analysis to compare hemodynamics in 30 healthy controls and 50 PAF patients in sinus rhythm. Results: PAF subjects and healthy controls had similar LV mass, volume, and ejection fraction. Direct flow was lower in the PAF group than in the controls (44.5 ± 11.2% vs. 50.0 ± 12.2%, p = 0.042) while delayed ejection was higher in the PAF group (21.6 ± 5.6% vs. 18.6 ± 5.7%, p = 0.022). Conclusion: PAF patients demonstrated a relative reduction in direct flow and elevation in delayed ejection.

The onset of paroxysmal non-valvular atrial fibrillation in men with hypertension is associated with an increase in blood levels of transforming growth factor beta 1

Abstract Funding Acknowledgements Type of funding sources: None. Background. Patients with essential hypertension (H), primarily men, are characterized by early formation of left ventricular hypertrophy (LVH) followed by left atrial (LA) enlargement, which significantly increases the risk of development non-valvular atrial fibrillation (nAF). The most important pathogenic factor in the development of nAF is fibrosis of the LA myocardium. One of the key profibrogenic factors is transforming growth factor beta 1(TGF-beta1). Purpose. To evaluate the blood levels of TGF-beta1 in hypertensive men with paroxysmal nAF and without AF. Methods.The study included 57 men with H grade 2–3 and with LVH (age 48 ± 4 years), of those 26 with paroxysmal nAF and 31 without AF. Controls were 26 practically healthy men. All patients with paroxysmal nAF had an at least one episode of paroxysmal AF attack with spontaneous return to normal sinus rhythm and were in sinus rhythm at the time of the assessment. Patients with valvular heart disease, heart failure, ischemic heart disease, cardiomyopathy, cardiac surgery, thyroid disease, diabetes mellitus, obesity, anemia, infectious or pulmonary diseases were not included. The examination of patients include standard methods as well as echocardiography. Levels of TGF-beta1 in blood serum were measured by immune enzyme assay. All patients included in the study received standard antihypertensive therapy. Results. It was found that the blood levels of TGF-beta1 in whole group of men with H were significantly higher (13,2 [5,3;22,5] ng/mL, р=0,034 ) than in practically healthy men (7,3 [2,3;16,5] ng/mL ). The highest blood levels of TGF-beta1 were found in hypertensive men with paroxysmal nAF (18,4 [9,2;31,8] ng/mL ) and significantly exceeded (р=0,018) those in hypertensive men without AF ( 11,6 [ 4,5;19,7] ng/mL ). The following positive correlations were found in whole group of men with H between TGF-beta1 blood levels and a number of echocardiographic parameters: LA size (LA volume/height2 ) (r = 0,510, р=0,012), LV mass index ( LV mass/BSA (g/m2) ( r = 0,411, р=0,027) and E/e′ (averaged) ratio (r = 0,357, р=0,036). Conclusion. The data obtained indicate that TGF-beta1 can play an important role, both in the pathogenesis of pathological remodeling of the LV and LA in men with H, and in the development of AF in these patients.

Thoracoscopic ablation delays progression from paroxysmal to persistent atrial fibrillation

ObjectiveThe study objective was to determine whether mini-invasive transthoracoscopic atrial fibrillation ablation can delay the progression of atrial fibrillation from paroxysmal to persistent. MethodsPatients aged 18 to 80 years with paroxysmal nonvalvular atrial fibrillation and a history of stroke or systemic thromboembolism were consecutively enrolled from September 2014 to June 2019. In the treatment group, patients underwent transthoracoscopic atrial fibrillation ablation plus left atrial appendage excision (atrial fibrillation ablation plus left atrial appendage excision group). Patients unwilling to receive surgical intervention were treated with antiarrhythmic drugs and oral anticoagulants and recruited as a control group (atrial fibrillation plus antiarrhythmic drugs group). The primary end point was the progression of atrial fibrillation from paroxysmal to persistent. ResultsThis study included 49 patients in the atrial fibrillation plus antiarrhythmic drugs group (29 men) and 77 patients in the atrial fibrillation ablation plus left atrial appendage excision group (48 men). In the atrial fibrillation ablation plus left atrial appendage excision group, after a median follow-up of 951 days (interquartile range, 529-1366 days), 8 patients (10.4%) progressed to persistent atrial fibrillation. In the atrial fibrillation plus antiarrhythmic drugs group, after a median follow-up of 835 days (interquartile range, 548-1214 days), 14 patients (28.6%) progressed to persistent atrial fibrillation. The atrial fibrillation ablation plus left atrial appendage excision group had a significantly lower incidence of atrial fibrillation progression than the atrial fibrillation plus antiarrhythmic drugs group during follow-up (3.9 vs 12.3 per 100 person-years, log-rank 8.6, P = .003). ConclusionsPatients with paroxysmal nonvalvular atrial fibrillation who chose to undergo transthoracoscopic atrial fibrillation ablation had a lower incidence of progression to persistent atrial fibrillation than patients who chose conservative therapy. This strategy might be especially suitable for patients with paroxysmal nonvalvular atrial fibrillation at high risk of stroke and high risk of bleeding.

Difference in risk factors of silent brain infarction between paroxysmal and persistent atrial fibrillation.

Although silent brain infarction is an independent risk factor for subsequent symptomatic stroke and dementia in patients with nonvalvular atrial fibrillation, little is known regarding differences in risk factors for silent brain infarction between patients with paroxysmal and persistent nonvalvular atrial fibrillation. This study population consisted of 190 neurologically asymptomatic patients (mean age, 64±11years) with nonvalvular atrial fibrillation (119 paroxysmal, 71 persistent) who were scheduled for catheter ablation. All patients underwent brain magnetic resonance imaging to screen for silent brain infarction prior to ablation. Transthoracic and transesophageal echocardiography was performed to screen for left atrial abnormalities (left atrial enlargement, spontaneous echo contrast, or left atrial appendage emptying velocity) and complex plaques in the aortic arch. Silent brain infarction was detected in 50 patients (26%) [26 patients (22%) in paroxysmal vs. 24 patients (34%) in persistent, p=0.09]. Multiple logistic regression analysis indicated that age and diabetes mellitus or chronic kidney disease (estimated glomerular filtration rate<60mL/min/1.73m2) were associated with silent brain infarction in patients with paroxysmal nonvalvular atrial fibrillation (p<0.05), whereas no modifiable risk factors of silent brain infarction were observed in patients with persistent nonvalvular atrial fibrillation. These findings suggest that intensive intervention for diabetes mellitus and renal impairment from the paroxysmal stage or ablation therapy at the time of paroxysmal stage to prevent progression to persistent nonvalvular atrial fibrillation may prevent silent brain infarction and consequently reduce the risk of future symptomatic stroke.

Predictors of Phrenic Nerve Injury During Pulmonary Vein Isolation for Curing Atrial Fibrillation With Balloon-Based Visually Guided Laser Ablation.

Pulmonary vein (PV) isolation (PVI) with balloon-based visually guided laser ablation (VGLA) is useful for treating atrial fibrillation (AF), but phrenic nerve injury (PNI) is an important complication. We investigated the predictors of developing PNI during VGLA.Methods and Results:We included 130 consecutive patients who underwent an initial VGLA of non-valvular paroxysmal AF. Twenty patients developed PNI during the PVI. The patients with PNI had a significantly larger right superior PV ostial area (RSPVOA) than the other patients (mean [±SD] 284.7±47.0 vs. 233.1±46.4 mm2, respectively; P<0.01). Receiver operating characteristic analyses revealed that the area under the RSPVOA curve was 0.79 (95% confidence interval [CI] 0.69-0.90) with an optimal cut-off point of 238.0 mm2(sensitivity, 0.58; specificity, 0.95). In multivariate analyses, a large RSPVOA (HR 1.02, 95% CI 1.01-1.03, P<0.01) and small balloon size (HR 0.70, 95% CI 0.50-0.99, P=0.04) were independent risk factors for PNI during VGLA. PNI remained in 13 patients after the procedure, but 12 of these patients recovered from the PNI during the follow-up period. The incidence of PNI during VGLA was relatively high, but PNI improved in most cases. A large RSPVOA and small balloon size were predictors of PNI during VGLA.

Рівні катехоламінів у пацієнтів промислового міста з пароксизмальною фібриляцією передсердь неклапанного ґенезу

Atrial fibrillation is one of the most complex health problems in the world, as the incidence of embolic complications is 2.1 % per year among patients with paroxysmal atrial fibrillation. Currently, atrial fibrillation is considered a potentially fatal arrhythmia, given the wide range of its negative consequences associated not only with a significant deterioration in the quality of life, but also with a significant increase in the frequency of serious complications. One of the most important roles in the genesis of cardiac arrhythmias is played by the sympathoadrenal system. Elevated catecholamines levels have arrhythmogenic properties and may contribute to recurrent arrhythmias. To evaluate catecholamine levels among industrial city patients with non-valvular paroxysmal atrial fibrillation. The daily excretion of norepinephrine in the 1 group was 25.95 [23.10; 32.50] mcg/day, and in the 2 group 27.90 [23.40; 32.80] mcg/day and was significantly higher in the groups of patients by 12.6 and 18.0 %, respectively, compared with the 3 group of healthy individuals, where the level of this indicator was 24.20 [22.60; 26.70] mcg/day (p &lt; 0.05). The level of norepinephrine had the largest area under the curve (AUC = 0.64, 95% CI 0.53-0.74) among the analyzed catecholamines in the urine for the development of recurrent arrhythmia, with a cutoff point &gt; 24.8 mcg/day sensitivity of 75.00% and specificity of 54.41 %. For norepinephrine levels &gt; 24.8 mcg/day, the relative risk of arrhythmia recurrence was 2.63.95 % CI 1.15-6.03. The results obtained in our work indicate the involvement of the sympathoadrenal system in the course of paroxysmal atrial fibrillation. The level of norepinephrine had the highest quality model for the development of arrhythmia recurrence among the analyzed catecholamines, with its level exceeding 24.8 mcg/day increasing the relative risk of arrhythmia recurrence.

The T786C polymorphism of NOS3 gene effect on the level of nitric oxide metabolites among patients with non-valvular paroxysmal atrial fibrillation

The objective of the research - to determine the the T786C polymorphism of nos3 gene effect on the level of nitric oxide metabolites among patients with non-valvular paroxysmal atrial fibrillation.Material and methods. To achieve this goal, a prospective study was conducted on the basis of the communal uncommercial company “City Hospital № 10” of Zaporizhzhia City Council. The sample of patients was conducted in the period from 2014 to 2019. The results of the study are based on data from a comprehensive examination and dynamic monitoring of 176 patients with paroxysmal atrial fibrillation on the background of coronary heart disease combined with hypertension, of which 98 were from the city of Zaporizhzhia and 78 were from rural areas. Almost healthy 31 volunteers were examined on an outpatient basis.Results. Plasma NO2 levels in both groups area urban and rural patients - 7.02 [5.74 ; 8.14] mmol/L and 6.77 [5.47 ; 7.98] mmol/l, respectively, were significantly lower compared to 8.46 [7.45 ; 9.45] mmol/L in the healthy group (p&lt;0.05). Significantly, the lowest level of NO3 was in the group of patients from the city of 10.36 [8.14 ; 13.32] mmol/L, in vs. to the value of 11.69 [10.36; 15.33] mmol/L in the group of patients from rural areas and against 13.36 [11.85 ; 15.35] mmol/L in the group of healthy individuals, (p&lt;0.05). The highest value of NO2+NO3 was in the group of healthy people - 21.56 [20.38 ; 24.53] mmol/L, against the level of 18.02 [15.83 ; 21.78] mmol/L in the group of patients from rural areas and - 17.60 [14.80 ; 20.35] mmol/L in the group from urban area (p &lt; 0.05). The median NO2 level in the subgroup of homozygotes for the T allele was 7.86 [6.66; 8.88] mmol/L and was significantly higher than in the subgroup of heterozygotes TC - 6.66 [5.18; 7.98] mmol/L – and the subgroup of homozygotes for the C - 5.81 [5.07; 6.72] mmol/l (p&lt;0.05). The highest value of NO2+NO3 was in the homozygote subgroup for the T - 20.35 [17.07 ; 25.16] mmol/l, both against the level of 17.52 [15.37 ; 20.72] mmol/L of the TC heterozygote subgroup, and against 16.41 [14.48; 17.93] mmol/L of the homozygote subgroup for the C allele (p&lt;0.05). However, there was no significant difference between the heterozygote and homozygote subgroups for the C allele (p&gt;0.05). Conclusions. Decreased nitric oxide metabolites occur among patients with non-valvular paroxysmal atrial fibrillation compared with the healthy group. The level of nitrate-ions in the group of patients from the city was significantly lower than in the group of patients from the rural areas. The level of nitrite-ions was lower among patients with the C allele of the T786C polymorphism of the 3 type of nitric oxide synthase gene, whereas the value of nitrate-ions did not depend on this polymorphism.

A new risk model for the evaluation of the thromboembolic milieu in patients with atrial fibrillation: the PALSE score.

The evaluation of thromboembolic risk is the cornerstone of atrial fibrillation (AF) management. Thromboembolic risk is associated with the presence of left atrial (LA) thrombus and spontaneous echo contrast (SEC), namely the thromboembolic milieu. We aimed to assess the predictors of the thromboembolic milieu in terms of LA thrombus and/ or SEC in patients with paroxysmal AF undergoing electrical cardioversion or catheter ablation, and to develop an effective risk model for detecting the thromboembolic milieu. We included a total of 434 patients with nonvalvular paroxysmal AF who underwent transesophageal echocardiography prior to cardioversion or catheter ablation. In patients with the thromboembolic milieu, total protein and C‑reactive protein levels, LA diameter, and systolic pulmonary artery pressure (SPAP) were higher, while left ventricular ejection fraction (LVEF) was lower than in patients without the thromboembolic milieu. In a multivariate logistic regression analysis, age, total protein levels, LVEF, LA diameter, and SPAP were independent predictors of LA thrombus and/or SEC. In a receiver operating characteristic curve analysis, the optimal cutoff values for the discrimination of patients with the thromboembolic milieu were as follows: 60 years for age; 7.3 mg/dl for total protein; 40% for LVEF; 40 mm for LA diameter; and 35 mm Hg for SPAP. Based on these cutoff values, we developed a novel risk model, namely, the PALSE score. The area under the curve for the PALSE score was 0.833. Patients with a PALSE score lower than 1 did not show thrombus or spontaneous echo contrast. The PALSE score, which includes total protein levels, age, LA diameter, SPAP, and LVEF, seemed to accurately predict the presence of the thromboembolic milieu in patients with paroxysmal AF.

Role of 2D speckle-tracking echocardiography in the assessment of left atrial function and its relation to the presence of left atrial appendage thrombus in patients with non-valvular paroxysmal atrial fibrillation

Introduction The study aimed to evaluate the role of speckle-tracking echocardiography (STE) in the assessment of left atrial (LA) function and its relation to the presence of left atrial appendage thrombus (LAAT) compared with the gold standard transesophageal echocardiography (TEE) among patients with nonvalvular paroxysmal atrial fibrillation (AF). Patients and methods Forty five patients with nonvalvular paroxysmal AF were included in the study. All patients underwent transthoracic echocardiography (TTE) immediately prior to or following clinically indicated TEE. LA deformation parameters such as left atrial global longitudinal strain-reservoir (LAGLS-RES), left atrial global longitudinal strain pump (LAGLS-pump), left atrial strain rate systolic (LA SR S), left atrial strain rate emptying (LA SR E), and left atrial strain rate atrial (LA SR A) were measured using 2D-STE. Through TEE, we assessed the presence of LAAT, left atrial appendage ejection fraction (LAA EF), left atrial appendage emptying (LAA E), and left atrial appendage filling (LAA F) velocities. Patients were divided into two groups according to the presence of LAAT. Results LAAT was detected in 14 (31%) patients of our study population. STE-derived LAGLS-RES, LAGLS-pump, and LA SR A values were found to be significantly lower in patients with LAAT. There was positive correlation between LAA E velocity and LAGLS-RES, LAGLS-pump, LA SR S, and LA SR A (r=0.358, P Conclusion 2-D STE can be used for the assessment of LA mechanical function and discriminate patients with LAAT from those without LAAT compared with the gold standard TEE among patients with non-valvular paroxysmal AF.