Persistent Forms Of Atrial Fibrillation Research Articles

The Role of Risk Factor Modification in Atrial Fibrillation: Outcomes in Catheter Ablation.

The management of atrial fibrillation has evolved significantly over the last ten years with advancements in medical and catheter ablation approaches, but these have limited success when used in isolation. Trends in the management of lifestyle modifications have surfaced, as it is now better understood that modifiable risk factors contribute significantly to the development and propagation of atrial fibrillation, as well as failure of treatment. International guidelines have integrated the role of lifestyle modification in the management of atrial fibrillation and specifically in the persistent form of atrial fibrillation; these guidelines must be addressed prior to considering catheter ablation. Effective risk factor modification is critical in increasing the likelihood of an arrhythmia-free survival following catheter ablation.

Case report: the effect of endovascular closure of an open oval window on the course of atrial fibrillation and the processes of reverse remodeling of the heart chambers

The volume of the left atrium is one of the key factors associated with both the development of primary atrial fibrillation and its progression. Open atrial communication is considered as a factor predisposing to dilation and remodeling of the heart cavities. We present a clinical case of endovascular closure of an open oval window in a patient with a persistent form of AF, a moderately reduced left ventricular ejection fraction, who had previously undergone radiofrequency ablation, and persistent manifestations of heart failure. A 58-year-old patient was hospitalized in November 2019 with clinical manifestations of increasing heart failure. History: persistent form of atrial fibrillation with pronounced ventricular tachysystole. In April 2019, the patient underwent radiofrequency ablation, during which signs of open oval window were revealed. The initial left ventricular ejection fraction is 41%, the anterior–posterior left atrium size is 47 mm, the NT-proBNP level is 912 pg/m. In the subsequent period, steady sine waves were recorded.

The role of laboratory markers in predicting the effectiveness of catheter treatment for atrial fibrillation: a literature review

Atrial fibrillation (AF) is the most common cardiac arrhythmia among the adult population. There are many possible causes of AF: structural heart disease, inflammatory and autoimmune diseases, obesity, alcohol abuse, diabetes mellitus, obstructive sleep apnea and old age. The ectopic activity of pulmonary vein couplings lies in the pathogenesis of paroxysmal and persistent forms of AF. The role of AF itself in triggering the inflammatory process in the atrium myocardium has also been proven. Despite the large amount of existing data, the search for the causes of AF continues. Previously, AF was considered the outcome of prolonged hemodynamic stress, arterial hypertension and valvular heart disease. Recently, views on the pathogenesis of AF have changed, since patients with metabolic diseases, without hypertrophy and dilatation of the left ventricle, but with disturbances in the structure and function of the atria, most often the left atrium, are increasingly encountered. There is an active search for laboratory markers to identify groups of patients most susceptible to developing AF. Determining the cause of atrial fibrillation and pathogenesis in each patient is important for selecting therapy and determining treatment tactics. Currently, a search is underway for laboratory markers that may be associated with the manifestation of atrial fibrillation, with atriopathy, and the effectiveness/ineffectiveness of catheter treatment for atrial fibrillation. An analysis of clinical studies was carried out based on articles indexed in the Scopus, VAK, Russian Science Citation Index, PubMed, and Web of Science databases.

Эффективность и безопасность приёма оральных антикоагулянтов у пациентов с фибрилляцией предсердий

The coagulation and platelet parameters of the hemostasis system in patients with paroxysmal and persistent forms of atrial fibrillation against the background of taking direct oral anticoagulants used for the prevention of ischemic stroke and other systemic thromboembolic events in this group of patients were analyzed. Self-cancellation and irregular intake of anticoagulant therapy is the cause of thrombosis risk in the studied patients.

Assessing left atrial intramyocardial fat infiltration from computerized tomography angiography in patients with atrial fibrillation.

Epicardial adipose tissue might promote atrial fibrillation (AF) in several ways, including infiltrating the underlying atrial myocardium. However, the role of this potential mechanism has been poorly investigated. The aim of this study is to evaluate the presence of left atrial (LA) infiltrated adipose tissue (inFAT) by analysing multi-detector computer tomography (MDCT)-derived three-dimensional (3D) fat infiltration maps and to compare the extent of LA inFAT between patients without AF history, with paroxysmal, and with persistent AF. Sixty consecutive patients with AF diagnosis (30 persistent and 30 paroxysmal) were enrolled and compared with 20 age-matched control; MDCT-derived images were post-processed to obtain 3D LA inFAT maps for all patients. Volume (mL) and mean signal intensities [(Hounsfield Units (HU)] of inFAT (HU -194; -5), dense inFAT (HU -194; -50), and fat-myocardial admixture (HU -50; -5) were automatically computed by the software. inFAT volume was significantly different across the three groups (P = 0.009), with post-hoc pairwise comparisons showing a significant increase in inFAT volume in persistent AF compared to controls (P = 0.006). Dense inFAT retained a significant difference also after correcting for body mass index (P = 0.028). In addition, more negative inFAT radiodensity values were found in AF patients. Regional distribution analysis showed a significantly higher regional distribution of LA inFAT at left and right superior pulmonary vein antra in AF patients. Persistent forms of AF are associated with greater degree of LA intramyocardial adipose infiltration, independently of body mass index. Compared to controls, AF patients present higher LA inFAT volume at left and right superior pulmonary vein antra.

Zero x-ray pulmonary vein isolation with heliostar radiofrequency balloon: efficacy and safety

Abstract Introduction Single shot pulmonary vein isolation techniques are currently an attractive and effective alternative to point-by-point ablation. The Heliostar® radiofrequency balloon is capable of producing single shot isolation with reduced procedure times and high efficacy and safety. A particular feature of this new balloon is its ability to be visualized on the Carto 3® navigation system, which makes it possible to reduce or even eliminate the use of X-rays (XR) in this type of procedure. Objectives Our objective was to demonstrate the efficacy and safety of pulmonary vein isolation with Heliostar® radiofrequency balloon without the use of XR. Methods Twenty-five patients with paroxysmal (68%) or persistent (32%) atrial fibrillation were prospectively included in our centre and underwent pulmonary vein isolation with radiofrequency balloon. Ten cases were performed without XR (40%), and the remaining 15 (60%) using fluoroscopy. All cases were performed under general anaesthesia and using the Carto 3® navigation system. Electroanatomical mapping was performed pre and post ablation in all cases. Mapping was performed in sinus rhythm. In cases without XR, intracardiac echocardiography was used to guide the transseptal puncture and the rest of the procedure. Technical and clinical data were collected. Cases with and without XR were compared. Results There were no complications in either group. All veins were successfully isolated, with 56% first pass isolation in the non-XR group versus 68% in the XR group (non-significant difference). The vein with the highest percentage of first pass isolations was the left inferior vein in both groups. Procedure times were similar (median left atrial dwell time of 34 minutes in the non-XR group and 36 minutes in the XR group, non-significant difference). There was also no difference in the median time to isolation from the start of radiofrequency application in each vein (10 seconds in both groups). Left atrial size was normal in most patients, and ventricular function was preserved, with no differences between the two groups. The non-XR group had a higher number of patients with left main trunk, but the XR group had a higher percentage of patients with persistent forms of atrial fibrillation. Conclusion Zero-XR pulmonary vein isolation with Heliostar® balloon is possible and safe, with similar efficacy and first pass isolation rate, similar procedure time and no relevant complications in our series.

Evaluation of efficacy and identification of predictors of recurrence in patients after pulmonary vein cryoballoon ablation

Aim. To evaluate the effectiveness and identify predictors of recurrence after pulmonary veins (PV) cryoballoon isolation patients with atrial fibrillation (AF).Methods. In total, the study included 100 patients who met the selection criteria. Depending on the form and duration of AF paroxysms documented by ECG and Holter monitoring, patients were divided into two groups. The first group included 57 patients with paroxysmal AF (57%), and the second group included 43 patients with persistent AF (43%).Results. As a result of our study, important achievements of the greatest efficiency during cryoballon ablation were identified: isolation of all PV; achievement of the “input-output” block (elimination of spike activity according to the diagnostic electrode in the PV during appplication), which was recorded at a temperature of -30 and more °C; the minimum appplication time is 180 sec after reaching the entry-exit block. An electroanatomical diagram of the left atrium with a high frequency of left atrium and PV activity in patients with paroxysmal and persistent forms of AF was developed. Nine zones with pronounced activity were identified, more pronounced zones with low-amplitude activity in patients with persistent AF. The multivariate Cox analysis showed predictors, an exceptional effect on the risk of AF recurrence after cryoballoon ablation: the presence of diabetes mellitus led to the risk of AF recurrence by 2.39, incomplete isolation of the PV by 3.98 times, the value of left atrial volume index ≥ 61.9 ml/m2 in 2.91 times, peak atrial longitudinal strain value of left atrium ≤29.3.Conclusion. The results of the study allow us to determine the criteria for high efficiency during cryoballoon ablation, as well as a high-risk group for relapse. When selecting patients for cryoballoon control of PV coronavirus, with the achievement of a greater one, possible factors should be considered: indexed volume of left atrium according to multispiral computed tomography, peak atrial longitudinal strain value of left atrium, absence of diabetes mellitus.

Features of the Course of Atrial Fibrillation in Patients with the History of COVID-19: Impact on the Possibility and Tactics of Restoring Sinus Rhythm

Introduction. Atrial fibrillation (AF) is a potentially life-threatening complication of infection. In general, AF has a high prevalence in elderly population with cardiovascular risk factors and comorbidities. Thus, the presence of AF correlates with adverse outcomes in patients with previous coronavirus disease (COVID-19) which deserves increased attention and should be appropriately treated to prevent adverse outcomes.
 The aim. To analyze the prevalence and clinical course of AF in hospitalized patients after COVID-19 to determine approaches to restoring sinus rhythm.
 Materials and methods. The study included 179 patients with various types of heart rhythm and conduction disorders who suffered from COVID-19 and were hospitalized to the Department of Clinical Arrhythmology and Electrophysiology of the National Scientific Center “The M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine of the NAMS of Ukraine” from 09/20/2020 to 12/21/2021. 116 patients were hospitalized with AF who suffered from coronavirus infection between 1 and 12 months ago (5.1 ± 0.2 months on average). Other heart rhythm and conduction disorders were the cause of hospitalization for 63 patients (35.2%). The first group was formed by 36 people (31%) in whom AF occurred after coronavirus infection. The second group included 25 patients in whom the form of AF changed, namely: there was a transition from paroxysmal form of AF to persistent AF, or persistent AF to a permanent form of AF. The third group included 55 patients in whom the form of AF did not change. However, in the third group, two subgroups were formed: 3A consisting of 35 patients, in whom, although the form of AF did not change, the frequency or duration of paroxysms increased, and 3B, which included 20 patients without significant changes in the course of AF. As a control group, 49 patients with AF without a history of coronavirus infection were examined.
 Results. In most patients (65%), the reason for hospitalization was AF. The first recorded paroxysms of this arrhythmia were recorded in 31% of patients 2 months after the coronavirus infection. In this group, more than half of the cases (58.4%) were patients with persistent AF, and 8.3% of those hospitalized failed to restore sinus rhythm. In those who had AF before COVID-19, 75% of its course worsened: the frequency or duration of paroxysms increased. The persistent form of AF was dominant and occurred after a previous infection in 58% of cases. In patients who had AF before COVID-19, its course worsened (in 76% of the examined persons) after the infection. Patients with a history of coronavirus infection had more frequent use of drug therapy, which is probably due to the delayed time of hospitalization to the clinic from the onset of the paroxysm.
 Conclusion. AF is the most common arrhythmia and has a worse course in hospitalized patients after coronavirus infection.

Atrial fibrillation progression after cryoablation vs. radiofrequency ablation: the CIRCA-DOSE trial.

Atrial fibrillation (AF) is a chronic progressive disorder. Persistent forms of AF are associated with increased rates of thromboembolism, heart failure, and death. Catheter ablation modifies the pathogenic mechanism of AF progression. No randomized studies have evaluated the impact of the ablation energy on progression to persistent atrial tachyarrhythmia. Three hundred forty-six patients with drug-refractory paroxysmal AF were enrolled and randomly assigned to contact-force-guided RF ablation (CF-RF ablation, 115), 4 min cryoballoon ablation (CRYO-4, 115), or 2 min cryoballoon ablation (CRYO-2, 116). Implantable cardiac monitors placed at study entry were used for follow-up. The main outcome was the first episode of persistent atrial tachyarrhythmia. Secondary outcomes included atrial tachyarrhythmia recurrence and arrhythmia burden on the implantable monitor. At a median of 944.0 (interquartile range [IQR], 612.5-1104) days, 0 of 115 patients (0.0%) randomly assigned to CF-RF, 8 of 115 patients (7.0%) assigned to CRYO-4, and 5 of 116 patients (4.3%) assigned to CRYO-2 experienced an episode of persistent atrial tachyarrhythmia (P = .03). A documented recurrence of any atrial tachyarrhythmia ≥30 s occurred in 56.5%, 53.9%, and 62.9% of those randomized to CF-RF, CRYO-4, and CRYO-2, respectively; P = .65. Compared with that of the pre-ablation monitoring period, AF burden was reduced by a median of 99.5% (IQR 94.0%, 100.0%) with CF-RF, 99.9% (IQR 93.3%-100.0%) with CRYO-4, and 99.1%% (IQR 87.0%-100.0%) with CRYO-2 (P = .38). Catheter ablation of paroxysmal AF using radiofrequency energy was associated with fewer patients developing persistent AF on follow-up.

Relationship between structural changes in the myocardium of the left atrium and the effectiveness of cryoablation in persistent atrial fibrillation

Introduction. High-resolution contrast-enhanced cardiac magnetic resonance imaging reveals left atrial fibrosis, the severity of which may be related to the effectiveness of catheter ablation.Aim. To study the structural changes of the left atrium myocardium according to magnetic resonance imaging with contrast in patients with persistent atrial fibrillation before balloon cryoablation and compare the results with the effectiveness of the intervention.Materials and methods. The study included 89 patients with persistent form of atrial fibrillation. The patients were randomized into two groups: in the 1st, the pulmonary veins cryoablation was performed (n = 39 (53.4%)); in the 2nd, the pulmonary veins and posterior wall of the left atrium cryoablation was performed (n = 34 (46.6%)). All patients before cryoablation underwent cardiac magnetic resonance imaging with delayed contrast using a high-resolution MR pulse sequence. The clinical efficacy of the intervention was evaluated after 12 months after the cryoablation.Results. The severity of fibrotic myocardial lesion of the left atrium before balloon cryoablation was 0.7% [0; 3,07]. Overall efficiency of the intervention rate was 57.1%. Cryoablation was most effective (59.5%) in patients severity of fibrosis less than 20% and least effective (50%) severity of fibrosis more than 20%. Risk factors for atrial fibrillation recurrence after cryoablation were: early atrial fibrillation recurrence, female sex, the maximum atrial fibrillation duration more than 3 months, stroke/TIA.Conclusion. The severity of left atrial fibrosis more than 20%, early recurrence of atrial fibrillation in the first 3 months after the cryoablation, female sex, the duration of the maximum atrial fibrillation episode more than 3 months, and a history of stroke/transient ischemic attack may be associated with recurrence of AF during the period observation 3–12 months.

Adjunct posterior wall isolation reduces the recurrence of atrial fibrillation in patients undergoing cryoballoon ablation: A systematic review and meta-analysis.

Recurrence rates of atrial fibrillation (AF) remain high even after complete wide area circumferential pulmonary vein isolation (PVI). In recent years adjunct posterior wall isolation (PWI) has been performed in patients with more persistent forms of AF but the benefits remain unclear. The objective of this meta-analysis was to evaluate the efficacy of adjunct posterior wall isolation in reducing recurrence rates of AF using cryoballoon ablation (CBA). We searched PubMed, Google Scholar, Clinicaltrials.gov and Cochrane CENTRAL. We included studies comparing PVI to PVI + PWI in patients with either persistent or paroxysmal AF (PAF) undergoing CBA. After data extraction and quality assessment of the studies, we assessed recurrence rates of atrial tachy-arrhythmias (AF, atrial flutter, and atrial tachycardia) as well as total ablation time and procedural adverse events. Risk ratio (RR), mean difference (MD), and 95% confidence interval (CI) were calculated using Review Manager. Concomitant PWI exhibited a substantial reduction in the risk of AF recurrence (RR: 0.51; 95% CI: 0.42-0.63, p < .00001), as well as all atrial arrhythmias (RR: 0.58; 95% CI: 0.49-0.68, p < .00001). On subgroup analysis, in patients with only PAF, adjunct PWI resulted in significant reduction in recurrence risk of AF (RR: 0.56; 95% CI: 0.41-0.76, p = .0002) as well. There was no significant difference in adverse events between both groups (RR: 0.90; 95% CI: 0.44-1.86; p = .78), whereas total ablation time was significantly increased in PVI + PWI group (MD: 21.75; 95% CI: 11.13-32.37, p < .0001). Adjunct PWI when compared to PVI alone decreases recurrence rates of atrial fibrillation after CBA of patients with persistent as well as paroxysmal atrial fibrillation.

Gender Differences in Atrial Fibrosis and Cardiomyopathy Assessed by Left Atrial Low-Voltage Areas During Catheter Ablation of Atrial Fibrillation

Atrial myocardial degeneration predisposes to atrial fibrillation (AF), ischemic stroke, and heart failure. Studies suggest the presence of gender differences in atrial myocardial degeneration. This study aimed to delineate gender differences in the prevalence, predictors, and prognostic impact of left atrial low-voltage areas (LVAs). This observational study included 1,488 consecutive patients who underwent initial ablation for AF. Voltage mapping was performed after pulmonary vein isolation during sinus rhythm. LVAs were defined as regions where bipolar peak-to-peak voltage was <0.50mV. LVA prevalence was higher in women (38.7%) than in men (16.0%). High age, persistent form of AF, diabetes mellitus, and a large left atrium were shown to be common predictors in both gender categories. Heart failure and history of stroke/thromboembolic events were men-specific predictors of LVA existence. Women experienced more AF recurrence than men (31.1% vs 25.7%, p=0.027). LVA existence was significantly associated with increased AF recurrence in each gender category, with a respective hazard ratio, 95% confidence interval, and pvalue of 2.45, 1.87 to 3.22, and <0.0001 in men and 1.82, 1.33 to 2.49, and <0.0001 in women. In conclusion, LVA was more frequent in women than men, and predicted frequent AF recurrence irrespective of gender category.

Efficacy of different variants of endocardial balloon cryoablation in patients with persistent atrial fibrillation

Aim. To study the effectiveness of “extended” cryoballon ablation in patients with a persistent form of atrial fibrillation (AF) and to determine the risk factors for AF recurrence after cryoablation.Methods. The study included 89 patients (62±10 years, 24 [27%] men) with a persistent form of AF. The patients were randomized into two groups: in the 1st, the pulmonary veins (PV) cryoablation was performed (n=48 [53.9%]); in the 2nd, the PV cryoablation was performed in combination with cryoablation of the posterior wall of the left atrium (n=41 [46.1%]). The number of patients at high risk of thromboembolic events predominated in Group 2 (p=0,03). There is a high frequency of taking antiarrhythmic drugs of class III in this group (p=0.018). The follow-up period was 12 months. Clinical efficacy was assessed during a survey and daily ECG monitoring at face-to-face visits after 3, 6 and 12 months.Results. Antral isolation of PV was achieved in all 89 (100%) patients in both groups. In group 2, the average number of applications in the posterior wall of the PV was 10 [9; 13]. The effectiveness of cryoablation in group 1 by the end of the 12-month follow-up period was 54.2%, in group 2 - 56.1%. The complication rate (6.7%) in both groups did not differ statistically (p=0.683). The risk of arrhythmia recurrence didn’t depend on the strategy of cryoablation in postablation period (p=0.834). When conducting a single-factor analysis, a statistically significant effect on the probability of AF recurrence in the period of 3-12 months in group 1 was caused by AF recurrence in the blind period (95% confidence interval (CI): 1.5-27.7, p=0.013), in group 2 belonging to the female sex (95% CI: 1.2-24.6, p=0.032) and AF relapse in the blind period (95% CI: 1.5-128.5, p=0.020). During multivariate analysis in group 2, a statistically significant influence on the risk of AF recurrence in the period of 3-12 months was exerted by belonging to the female sex (hazard ratio (HR) 7.84; 95% CI 1478-42,23; p=0.016) and the presence of early AF recurrence (HR 20.36; 95% CI 1.99-208.23; p=0.011).Conclusion. Extended cryoablation in terms of efficiency and safety was comparable with the standard cryoablation. Early recurrence of AF (in the first 3 months after the intervention) turned out to be an independent risk factor for AF recurrence in the long-term period up to 12 months after cryoablation in both groups.

SUBPOPULATIONS OF LYMPHOCYTES AND MONOCYTES IN PATIENTS` VENOUS BLOOD WITH ATRIAL FIBRILLATION OR ATRIAL FLUTTER ASSOCIATED WITH HYPERTENSION

Objective: The most common reason of arrhythmia onset nowadays is hypertensive desease. The aim of the study is to compare the subpopulations of lymphocytes (LCTs) and monocytes (MCTs) in blood of patients (pts) with paroxysmal and persistent forms of AF or atrial flutter (AFL) associated with arterial hypertension. Design and method: The study involved 103 patients with atrial fibrillation and flutter that occurred on the backdround of hypertension. Depending on the form of arrhythmia, patients were divided into three main groups: group I – with paroxysmal form of atrial fibrillation, group II – with a persistent form of atrial fibrillation, group III – with a persistent form of atrial flutter. The control groups included patients with hypertension, but without these arrhythmias and healthy individuals who entered groups IV and V, respectively. The lymphocytes and monocytes subpopulation in peripheral blood was assessed by flow cytometry. Results: Analyzing the lymphocyte subpopulations in peripheral blood of patients with atrial fibrillation and flutter (groups I, II and III), it was found that the number of cells with cytotoxic activity (NK and NKT) in both absolute count and percentage values was significantly higher than in healthy individuals. A statistically significant decrease of T-regulatory cells number was found in patients with arrhythmias compared to control groups (p &lt; 0.05). In patients with AF and AFL associated with hypertension, compared to patients with hypertension without these rhythm disturbances or healthy individuals, there is an increased number of classical and intermediate monocytes subpopulations. Conclusions: 1. In patients with atrial fibrillation or atrial flutter associated with hypertension, compared to patients with hypertension without these rhythm disturbances or healthy people, there is an increased number of classical and intermediate monocytes fraction and a decreased content of T-regulatory cells in peripheral blood, an increased number of cells with cytotoxic activity (NK and NKT) compared to healthy individuals. These changes can be one of the factors for the activation of systemic and local inflammatory processes that can lead to fibrosis in the myocardium and the associated electrical and structural remodeling typical for AF and AFL.

Assessment of structural changes in the left atrium myocardium according to cardiac magnetic resonance with contrast before and after balloon cryoablation in patients with persistent atrial fibrillation

Aim. To study the structural changes of the left atrium myocardium according to magnetic resonance imaging with contrast in patients with persistent atrial fibrillation before and after balloon cryoablation and compare the results with the effectiveness of the intervention.Material and methods of research. The study included 28 patients with persistent form of atrial fibrillation. All patients before and after magnetic resonance imaging underwent cardiac magnetic resonance imaging with delayed contrast using a high-resolution MR pulse sequence (voxel size 1,25x1,25x1,25 mm) before and after cryoablation.The severity of atrial fibrous lesion was calculated automatically using a specialized LGE HEART Analyzer program using algorithms based on the myocardial contrast index with a threshold value of 1.38. The clinical efficacy of the intervention was evaluated after 12 months and the relationship was determined structural changes in the myocardium of the left atrium according to contrast magnetic resonance imaging data before and after the cryoablation.Results. The severity of fibrotic myocardial lesion of the left atrium before balloon cryoablation was 1,5 [0,16; 9,3]%. In Utah patients, stage 1 fibrosis was detected in 71,4% (n=20), stage 2 in 14,3% (n=4), stage 3 in 3,6% (n=1), stage 4 in 10,7% (n=3). 3 months after cryoablation, there was an increase in the severity of fibrosis of 2,7 [1,02; 18,8]% (p&lt;0,001). Overall efficiency of the intervention rate was 57,1%. The construction of Kaplan- Meyer curves demonstrated that the intervention was most effective in patients with minimal severity of fibrosis before ablation (Utah I) and least effective in more pronounced fibrotic lesion (stage Utah III and IV)Conclusion. Magnetic resonance imaging of the heart with contrast allows to assess fibrotic lesion of the myocardium of left atrial, which may be one of the factors of the effectiveness of interventional treatment of persistent AF.

Lymphocytes and monocytes subpopulation composition in peripheral blood in patients with atrial fibrillation and futter

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): NSC "Institute of cardiology, clinical and regenerative medicine named by acad. Strazhesko" NAMS of Ukraine The purpose of the trial is to compare the state of intracardiac and systemic hemodynamics in patients with paroxysmal and persistent forms of atrial fibrillation and flutter that appeared on the base of arterial hypertension, depending on the lymphocytes and monocytes subpopulation composition in peripheral blood. Materials and methods The study involved 103 patients with atrial fibrillation and flutter and were divided into three main groups: I – with paroxysmal form of atrial fibrillation, II – with a persistent form of atrial fibrillation, III – with a persistent form of atrial flutter. The subpopulation composition of lymphocytes and monocytes in peripheral blood was assessed by the method of flow cytometry. Hemodynamic parameters were evaluated using echocardiography, office blood pressure measurement, daily blood pressure monitoring, and transesophageal echocardiography. For control, the data of patients with hypertension but without the above-mentioned arrhythmias were used, and practically healthy people who entered groups IV and V, respectively. Results and discussion The number of cells with cytotoxic activity (NK and T-NK) in both absolute and percentage values was significantly higher in groups with arrhythmia than in practically healthy individuals. A mathematically significant decrease of T-regulatory cells number (p ≤0.05) in the second and third groups compared to the control groups was detected, same as increased number of classical and intermediate monocytes fractions. Comparing echocardiogram results indicators between groups I, II, III and I V, a mathematical significant difference (p≤0.05) between the LVID was revealed: LVIDd, LVEDV, LVESV, IVS, PW thickness; LA AP, RVmid diameter at end-diastole, E/A and LVMI. Compared to V the group difference was significant only between LVIDd, LA AP size, IVS thickness, and PW thikness. Office systolic blood pressure was significantly higher in patients with arrhythmias. According to daily blood pressure monitoring, the difference between the indicators of average and maximum diastolic pressure was significant. Conclusions In patients with atrial fibrillation and flutter as a result of hypertension, compared to patients without arrhythmias or healthy people, there is an increased content of pro-inflammatory monocytes subpopulation, T-cytotoxic cells and a decreased amount of T-regulatory cells. According to EchoCG, these patients had more severe structural changes in the myocardium: an increased LA AP and LV hypertrophy, a thickening of IVS and PW, and diastolic dysfunction. The recorded measurement indicators of SBP and DBP differed mathematically significantly, which indicates hemodynamic disorders caused by both rhythm disturbances and manifestations of arterial hypertension.

Efficacy and safety of pulmonary vein isolation with irrigated radiofrequency balloon with a zero-fluoroscopy protocol

Abstract Funding Acknowledgements Type of funding sources: None. Introduction From the beginning, the use of X-ray (XR) has been a critical component in both the guidance and development of arrhythmia ablation procedures. Despite the development of non-fluoroscopic navigators, the single-shot techniques for atrial fibrillation ablation procedures still rely almost exclusively on the use of XR. Recently, the Heliostar® irrigated radiofrequency balloon has been developed, which can be completely visualized on the Carto 3® navigation system. This special feature makes it possible to minimise the use of XR in this type of procedure or even suppress it. We present our first experience after the implementation of a "zero-XR" protocol for this procedure. Objectives The aim of this study was to demonstrate that "zero-XR" ablation of atrial fibrillation with Heliostar® radiofrequency balloon is possible and safe. Methods This is a single-centre study. Consecutively 22 patients with paroxysmal (63.6%) or persistent (36.4%) atrial fibrillation underwent pulmonary vein isolation by irrigated radiofrequency balloon (Heliostar®). Eight of the cases were performed without fluoroscopy, supported by the navigation system and intracardiac ultrasound, and the remaining 14 were performed without limitation of the use of XR. Clinical, echocardiographic and technical data were collected from all 22 patients. All cases were performed under general anaesthesia, with the Carto 3® navigation system. Mapping was performed in sinus rhythm whenever possible. Results 100% isolation of the veins was achieved, with 62.1% first pass isolation in the non-XR group versus 56.4% in the XR group (non-significant difference). The vein with the highest percentage of first pass isolations was the left inferior vein in both groups. There were no complications in either group. Procedure times were similar (left atrial dwell time of 32 minutes in the non-XR group and 40 minutes in the XR group, non-significant difference), although the mapping time was slightly shorter in the non-XR group (9,9±5 non-XR vs 16±6.9, p=0.04). There was also no difference in the mean time to isolation from the start of radiofrequency application in each vein (10.6 seconds in the non-XR group and 11 seconds in the XR group, p=0.75). The non-XR group had a higher number of patients with left main trunk, but the XR group had a higher percentage of patients with persistent forms of atrial fibrillation. Left atrial size was normal in most patients, and ventricular function was preserved, with no differences between the two groups. Conclusion Pulmonary vein isolation with the Heliostar® radiofrequency balloon without XR is possible and safe, with similar efficacy and first pass isolation rate, similar procedure time and no relevant complications in our series.

The connection between systemic inflammation activity and the state of renin-angiotensin system with the course of cardiac arrhythmias

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): NSC "Institute of cardiology, clinical and regenerative medicine named after acad. Strazhesko" NAMS of Ukraine The purpose of the work is to compare the clinical course of paroxysmal and persistent forms of atrial fibrillation and flutter, depending on the systemic­ inflammation­ activity and the renin-angiotensin system state. Materials and methods The study involved 147 patients, including 103 people with rhythm­ disturbances, who werer divided into three main groups (with paroxysmal atrial fibrillation, persistant atrial fibrillation and persistant atrial flutter). Systemic inflammation activity was determined by the level of highlysensitive C-reactive protein in the serum. Renin-angiotensin activity ­ system was characterized by the angiotensin-converting factor level.The activity of ACE in blood plasma was determined by an express method using FAPGG as a substrate ("Sigma", USA), tris(oxymethyl)-aminoman, sodium chloride, EDTA ("Merck", Germany). Results The level of highlysensitive C-reactive protein in patients with Af and AFl was significantly elevated in 6. 7 times and was (8. 31±0. 42) against (1. 25±0. 01) mg/l is normal (p&amp;lt;0. 001). In the group with the persistent form of AF, the content of CRP was higher than in the group with paroxysmal form of AF, by 8. 5%, although the difference between the groups was unreliable. ACE activity in the blood plasma of the pts with arrhythmia was likely elevated, as the rateof ACE was 45. 10±2. 26 μkat/L and exceeded the nominal value by 180 %. 86 patients with rhythm disturbances, which was 83%, there was a significant increase of CRP level . Among patients with paroxysmal FP, it was 31 patients (88%), in the group with a persistent form of FP - 30 patients (78%) and in the presence of TP - 25 patients (83%, respectively). In contrast, in patients without rhythm disturbances who had hypertension and relatively healthy people, the number of patients with elevated levels is highly sensitive th CRP was only 9%, i.e. 4 patients. Comparing the data strong statistical significance was revealed. (p&amp;lt; 0.005). Conclusions An increased level of highlysensitiveC-reactive protein as a marker of systemic inflammation is observed in groups of patients with arrhythmias compared with patients with hypertension without rhythm disturbances, indicating a higher intensity of systemic inflammation. Serum ACE levels in 82 % of patients with arrhythmias were higher than normal compared to 27 % of patients without rhythm disturbances (p&amp;lt;0. 05), which may indicate hyperactivation of RAAS.

Interstitial Edema of the Interatrial Septum in Patients with Atrial Fibrillation and Chronic Heart Failure.

We studied the presence of interstitial edema of the interatrial septum in patients with chronic heart failure (CHF) with atrial fibrillation (n=23) or without rhythm disturbances (n=9). The intensity of the MRI signal of the interatrial septum, interventricular septum, and skeletal muscle by T2-weighted MRI and the enhancement index of interatrial septum (the ratio of the signal intensity of the interatrial septum to the signal intensity of the skeletal muscle) were evaluated. The enhancement index of interatrial septum ⩾2 was regarded as an MRI sign of myocardial edema. The enhancement index of interatrial septum in patients with persistent atrial fibrillation was 2.4 (2.21; 2.69) and was higher than in CHF patients with paroxysmal atrial fibrillation and in CHF patients without arrhythmias and surpassed the control values (p<0.05), which indicates the presence of MRI signs of edema of the myocardium of the interatrial septum. The obtained data confirm the presence of myocardial edema of the interatrial septum in CHF patients and persistent form of atrial fibrillation, which expands the understanding of the pathogenesis of this condition.

Atrial fibrillation recurrences despite durable pulmonary vein isolation: Characteristics, management and outcomes, the PARTY-PVI study

Recurrences of atrial fibrillation (AF) after pulmonary vein (PV) isolation (PVI) are mainly due to PV reconnections. However, a growing number of patients have recurrences despite durable PVI. The optimal ablative strategy for these patients is unknown. We aimed at analyzing the impact of various ablation strategies in such patients in the context of a large multicenter study. Patients scheduled for a redo ablation of AF and presenting durable PVI were included in 39 centers. PV-based, linear-based, electrogram-based and trigger-based ablation strategies were compared. A total of 367 patients underwent a redo AF ablation procedure revealing a durable PVI (43.6% paroxysmal AF, 67.0% men, 63.4 ± 10.2 years, CHA2DS2-VASc of 1.7 ± 1.4) between 2010 and 2020. Regarding strategy combinations, 200 (54.5%) patients underwent a single ablation strategy, while 136 (37.1%) and 24 (6.5%) patients underwent a combination of 2 and 3 strategies, respectively. Following the redo ablation procedure, arrhythmia recurrence was observed in 122 patients (33.2%) at 12 months. The recurrence rate was not significantly different between paroxysmal and persistent AF groups (P = 0.120). In multivariate analysis, none of the ablation strategies employed during the redo procedure improved the 12-month arrhythmia-free survival. The degree of left atrial dilatation (HR: 1.36, 95%CI: 1.13–1.65, P = 0.002) was the only independent factor associated with arrhythmia-free survival at 12 months (Fig. 1). In patients with recurrent AF despite durable PVI, no ablation strategy used during the redo procedure appears to be superior in improving the 12-month atrial arrhythmia free survival. The AF recurrence rate was the same whether the patient presented with a paroxysmal or persistent form of AF. Left atrial size is a major predictive factor of the arrhythmia-free survival in this population.