Treatment Of Atrial Fibrillation Research Articles

Near-zero fluoroscopy workflow for pulmonary vein isolation in atrial fibrillation using a variable loop, 3D-integrated circular PFA catheter (Varipulse™): initial single-center experience with the first 35 patients.

Catheter ablation is a standard atrial fibrillation (AF) treatment, traditionally using radiofrequency (RF) or cryoablation, which carries the risk of damaging nearby structures. Pulsed field ablation (PFA) offers partly tissue-selective energy application with minimal collateral damage. This study evaluated a near-zero fluoroscopy workflow with the novel VARIPULSE™ catheter, combining advanced mapping for optimized PFA delivery and reduced radiation. Here, we investigate the safety, efficiency, and effectiveness of this approach in the first 35 patients treated. This study aimed to assess the procedural characteristics, safety, and acute efficacy of pulmonary vein isolation (PVI) using the VARIPULSE™ PFA catheter in patients with AF, while specifically evaluating a near-zero fluoroscopy workflow to minimize radiation exposure during the procedure. Thirty-five consecutive patients with paroxysmal or persistent AF underwent pulmonary vein isolation (PVI) using the VARIPULSE™ PFA catheter. Procedures were conducted under general anesthesia or deep sedation. Key procedural endpoints included acute pulmonary vein isolation, total procedure time, left atrial (LA) dwell time, fluoroscopy time and dose, and safety outcomes, with a focus on assessing the feasibility of a near-zero fluoroscopy workflow. Thirty patients underwent near-zero fluoroscopy atrial fibrillation ablation using the novel VARIPULSE™ Pulsed Field Ablation catheter. Patients had a median age of 70 years and typical cardiovascular comorbidities, with 54% presenting with paroxysmal AF. Thirty-three of 35 patients (94%) had a normal left ventricular systolic function (> 60%). The median CHA2DS2-VA score was 2 (IQR 1-3.75). Sinus rhythm was observed in 66% of cases at procedure start. Median fluoroscopy time was 0.8 min, total median procedure time 53 min, median LA dwell time 38 min, and median fluoroscopy dose 20.4 µGym2. Pulmonary vein isolation was achieved in 100% of cases without radiofrequency touch-up. No major complications occurred. The VARIPULSE™ Pulsed Field Ablation system enables an efficient, nearly fluoroscopy-free atrial fibrillation ablation with a simple, easily integrable workflow in the electrophysiology lab. Complete pulmonary vein isolation was achieved in all cases without radiofrequency touch-ups, and the procedure was safe with no major complications. This demonstrates the potential for widespread adoption of this technology and workflow.

Non-invasive prediction of atrial cardiomyopathy characterized by multipolar high-density contact mapping.

Atrial cardiomyopathy (AC) establishes links between atrial fibrillation (AF), left atrial (LA) mechanical dysfunction, structural remodeling, and thromboembolic events. Early diagnosis of AC may impact AF treatment and stroke risk prevention. Modern endocardial contact-mapping provides high-resolution electro-anatomical (EA) maps of the LA, thus allowing to display the myocardial substrate based on impaired signal amplitude and to characterize AC. Correlation of invasively assessed AC using a novel, multipolar mapping catheter (OCTARAY™, Biosense Webster, limited market release) and LA echocardiographic parameters could form the basis for a set of echo parameters for non-invasive prediction of AC. We retrospectively identified 50 adult patients who underwent primary pulmonary vein isolation (PVI) for paroxysmal or persistent AF between 08/22 and 05/23 fulfilling the selection criteria: (i) EA mapping with a novel multipolar mapping catheter (Octaray®); (ii) acquisition of voltage maps in sinus rhythm (SR) with ≥ 5000 points/map; and (iii) transthoracic echocardiography acquired in SR ≤ 48h before PVI. Exclusion criterion was previous LA ablation. We generated EA maps with two sets of upper voltage thresholds (0.2-0.5mV and 0.2-1.0mV) and assessed total LA low voltage area (LVA). As LVA thresholds for the classification of AC are not yet established, an unsupervised machine learning cluster analysis was performed using a Gaussian mixture model (GMM), and two groups of patients with mild and severe AC were identified. Based on these two groups, we selected echo parameters for further analysis by applying the Boruta algorithm. The predictive capacity of the selected parameters was evaluated using a support vector machine. The mean age of the studied sample (n = 50) was 63 ± 11years, 62% were men, 64% showed persistent AF, median CHA2DS2-VASc score was 2 (quartiles 1, 3), and NT-proBNP was 190 (71, 391) pg/ml. A median of 5771 (5217, 6988) points/map were acquired. GMM yielded clusters of mild AC (n = 28) and severe AC (n = 22). Median LVA was 0.6 cm2 (< 0.5mV) resp. 4.1 cm2 (< 1.0mV) in group mild AC and 6.9 cm2 (< 0.5mV) resp. 27.2 cm2 (< 1.0mV) in group severe AC. Several echocardiographic parameters differed between the groups of mild and severe AC: dynamic LA parameters (end diastolic LA reservoir strain: 24.5% (22, 29) vs 15% (12, 19), p < 0.001; LA reservoir strain at atrial contraction: 22% (19, 25) vs 15% (11, 18), p < 0.001, end diastolic LA contraction strain: 13% (8, 15) vs 7.5% (3, 13), p < 0.01) as well as LA end-systolic volume index to a´ ratio (LAVI/a': 297 (231,365) vs 510 (326,781), p < 0.01). Consistent distribution of NT-proBNP (mild AC: 125 (48,189) pg/ml, severe AC: 408 (254,557) pg/ml, p < 0.0001) and CHA2DS2-VASc score (mild AC: 1 (1-2), severe AC: 3 (3-4), p < 0.0001) served as proof of concept. Applying the selected echocardiographic parameters, the machine learning algorithm correctly identified both subgroups with a mean AUC of 0.9 (95% CI 0.83-0.99). At 12months, AF recurrence rate was 10.7% in mild AC and 40.9% in severe AC (p < 0.05). Among patients qualifying for PVI, machine learning analysis of high-resolution LA maps allowed to identify subgroups with mild and severe AC avoiding the use of arbitrary LVA thresholds. The subgroups were predicted non-invasively with good accuracy using a machine learning approach that incorporated a set of echocardiographic markers. This data could advance the clinical triage of patients with AF.

Convergent procedure for long-standing persistent atrial fibrillation in heart failure with reduced ejection fraction.

Catheter ablation for atrial fibrillation in patients with heart failure with reduced ejection fraction is associated with a significant reduction in morbimortality. The convergent procedure is a valid ablation option for the treatment of long-standing persistent atrial fibrillation. To describe the outcomes of patients with heart failure with reduced ejection fraction and long-standing persistent atrial fibrillation who underwent the convergent procedure. We studied consecutive patients included in two French centres between 2009 and 2020. Primary endpoint was freedom from any atrial arrhythmia assessed on 24-hour Holter electrocardiogram at 3, 6 and 12 months after the procedure. Left ventricular ejection fraction was assessed on transthoracic echocardiography before and 1 year after the procedure. All patients had at least 12 months of follow-up. Forty-three patients were included (86% were men). Baseline left ventricular ejection fraction was 38±10.5% and indexed left atrial volume was 50±27mL/m2. Among the study population, 34 patients (79%) were free from atrial fibrillation/tachycardia at the end of follow-up. No periprocedural death occurred. We observed two groin haematomas and four mild pericardial effusions. At 12-month follow-up, 21 patients (49%) were still on antiarrhythmic drug therapy, and a reduction in antiarrhythmic drug dosage was achieved in 10 patients (23%). The absolute median improvement in left ventricular ejection fraction was 8% at 12 months (P=0.003). The convergent procedure has been shown to be effective and safe for patients with patients with heart failure with reduced ejection fraction and long-standing persistent atrial fibrillation, with significant left ventricular function improvement.

Spontaneous echo contrast in the left atrial appendage is linked to a higher risk of thromboembolic events and mortality in patients with atrial fibrillation.

Cardioversion, a rhythm control treatment for atrial fibrillation (AF), requires ruling out cardiac embolic sources, often originating from the left atrial appendage (LAA). Transesophageal echocardiography (TEE) is used for LAA evaluation, but it is invasive and not widely available. This study aimed to identify cardiovascular risk factors linked to LAA abnormalities and predictors of thromboembolic events and all-cause mortality. A single-center retrospective analysis included AF patients admitted to the University Hospital Würzburg between 2009 and 2018 undergoing TEE. Among 2400 AF patients (median age 72; 36% women), 469 (20%) had LAA abnormalities: 282 (60%) had spontaneous echo contrast (SEC), 72 (15%) had thrombus formation (THR), and 115 (25%) had both. Predictors of LAA abnormalities included age (OR 1.04; p=0.002), congestive heart failure (OR 1.70; p=0.009), diabetes (OR 1.74; p=0.007), stroke history (OR 3.36; p=0.001), vascular disease (OR 1.57; p=0.026), elevated alkaline phosphatase (OR 1.15; p=0.003), prior VKA intake (OR 1.53; p=0.002), and DOAC intake (OR 0.57; p=0.038). SEC with or without THR independently predicted thromboembolic events (HR 1.74, p=0.031 and HR 1.53, p=0.006) and all-cause mortality (HR 1.77, p=0.011 and HR 1.57, p=0.002), adjusted for cardiovascular risk factors, anticoagulation, and laboratory data. In AF patients undergoing TEE, SEC, often overlooked in cardioversion decisions, independently predicted thromboembolic events and mortality.

Abstract WP87: Keeping Everyone In The Loop: A Nurse Navigator’s Role in Tracking, Reporting, and Ensuring Treatment of Atrial Fibrillation in Ischemic Stroke Patients after Implantable Loop Recorder Insertion

Abstract WP87: Keeping Everyone In The Loop: A Nurse Navigator’s Role in Tracking, Reporting, and Ensuring Treatment of Atrial Fibrillation in Ischemic Stroke Patients after Implantable Loop Recorder Insertion

Combination of the pulsed field ablation with the EnSite Precision cardiac mapping system in the treatment of atrial fibrillation.

Combination of the pulsed field ablation with the EnSite Precision cardiac mapping system in the treatment of atrial fibrillation.

Effectiveness of first-pass pulmonary vein isolation with index-guided ablation compared to very-high-power, short-duration ablation: A retrospective single-center study.

Pulmonary vein isolation is the cornerstone of atrial fibrillation treatment. First-pass pulmonary vein isolation is defined as isolation achieved with only a single lesion in every part of the isolation lines. The primary aim was to assess the frequency of first-pass pulmonary vein isolation after ablation index-guided (AI) and very-high-power, short-duration (vHPSD) ablation. The secondary goals were to detect areas of additional lesions and the correlation between them and used methods and to access efficiency of the procedure. In this retrospective, single-center study, we included 105 consecutive patients undergoing pulmonary vein isolation for paroxysmal or persistent atrial fibrillation. Based on the operators' decisions, 51 patients underwent AI-guided, and 54 patients underwent vHPSD ablation. The ipsilateral pulmonary veins were divided into four areas, and the anatomical region and several additional applications were evaluated. Bilateral first-pass pulmonary vein isolation was achieved in 34.3% of patients, with no significant difference between AI-guided and vHPSD ablation (37.0% vs. 31.4%; P = 0.68). In both groups, the most common region of additional applications was the posterior part of the right-sided carina (AI: 25.5% [13/51] vs. vHPSD: 25.9% [14/54]; P = 0.89). There was a significant difference (P = 0.049) between techniques in the highest frequency of additional applications in the left-sided pulmonary veins: in the anterior part of the carina (AI: 15.7% vs. vHPSD: 7.4%) and the posterior part of the carina (AI: 5.9% vs. vHSPD: 22.2%). Lesions made with AI-guided and vHPSD protocols differed in areas of additional applications, which was most significant in the left-sided pulmonary veins.

Reverse structural and functional left atrial remodeling after successful catheter ablation for paroxysmal atrial fibrillation.

Abstract Background Catheter ablation is considered the most effective method for restoring sinus rhythm in patients with atrial fibrillation (AF). However, data on the reverse structural and functional remodeling of the left atrium (LA) after a successful procedure are still inconclusive, especially in patients with sinus rhythm during catheter ablation. The aim of the present study was to investigate echocardiographic parameters indicating the presence of reverse LA remodeling, following a successful procedure and long-term follow-up of sinus rhythm maintenance. Methods Of the 106 patients who had undergone successful catheter ablation (between January 2021 and May 2023) for paroxysmal AF (with sinus rhythm on echocardiography during ablation), 49 patients were included in the study up to now. The absence of AF recurrence was assessed during a follow-up consisting of outpatient visits/televisits and 7-day Holter monitoring (at 6 and 12 months after ablation). All patients underwent conventional and 2D speckle tracking echocardiography on the day of ablation and after the long-term of follow-up period of maintanance of sinus rhythm. Results A total of 48 patients were included in the study. The mean age of the study population was 60±11 years, of which 62.5% were male. The follow-up period was 17 ± 4month. A significant increase in LA reservoir strain (LASr) (median 23 vs. 25%, p&amp;lt;0.001) and e’ average (median 7.5 vs. 8.5 cm/s, p=0.02) was noted from baseline to follow-up. LA stiffness index (defined as E/e’average/LASr ratio) (median 0.33 vs. 0.28, p=0.001), LA area (median 23.8 vs. 22.1cm2, p=0.003) and LA volume index (median 35.9 vs. 32.9ml/m2, p&amp;lt;0.001) showed significant reduction over the same time period. In addition, left ventricular (LV) end-diastolic diameter, indexed LV mass index and right atrial area, decreased significantly (51 vs. 49 mm, p&amp;lt;0.001; 123 vs. 109g/m2, p&amp;lt;0.001, 17.2 vs. 15.5cm2, p=0.02, respectively). Left ventricular function parameters, such as LV ejection fraction or global LV longitudinal strain, remained unchanged. Conclusions During the long-term follow-up period after restoration and maintenance of sinus rhythm following catheter ablation for AF, both structural and functional echocardiographic parameters of the LA improved. Our preliminary results also suggest the possibility of reverse structural LV and RA remodeling after successful AF treatment.

Incidence, Predictors, and Management of Femoral Vascular Complications Following Catheter Ablation for Atrial Fibrillation: A Systematic Duplex Ultrasound Study

Background/Objectives: Catheter ablation is an effective treatment for atrial fibrillation (AF) but is associated with femoral vascular complications. While anticoagulation therapy has been linked to these complications, specific risk factors remain unclear. This study assessed the incidence and predictors of vascular complications after catheter ablation using systematic duplex ultrasound (DUS) as well as their outcomes. Methods: A single-center observational study was conducted with 404 consecutive AF patients who underwent catheter ablation between March 2023 and February 2024. DUS was performed systematically post-procedure in all patients to identify complications; these were primarily treated with DUS-guided manual compression. Results: Vascular complications were observed in 6.4% of patients, higher than reported in previous studies. Hematomas (3.5%) and arteriovenous fistulas (AVFs, 2.0%) were the most common such complications. Multivariate analysis identified repeat ablation (odds ratio [OR] 3.09, 95% confidence interval [CI] 1.10–8.64, p = 0.03) and months of experience &lt;6 months (OR 3.42, 95% CI 1.36–8.63, p = 0.01) as significant predictors of complications. DUS-guided compression managed most complications successfully, with three pseudoaneurysms resolved through compression and one through embolization. However, AVFs were relatively resistant to conservative management, often necessitating prolonged observation or intervention. Conclusions: Systematic DUS following catheter ablation revealed a higher-than-expected incidence of vascular complications. Repeat ablation and months of experience &lt;6 months are potential predictors of femoral vascular complications. DUS-guided compression is effective for most complications, although AVFs present greater treatment challenges.

Efficacy and safety of intracardiac echocardiography-guided "one-stop" procedures combining radiofrequency catheter ablation and left atrial appendage closure in elderly patients with atrial fibrillation

Objective: To assess the efficacy and safety of "one-stop" procedures combining radiofrequency catheter ablation and left atrial appendage closure by guidance of intracardiac echocardiography(ICE) in elderly patients with atrial fibrillation. Methods: A retrospective cohort study was conducted on patients who underwent ICE-guided "one-stop" procedures at the Department of Cardiology, General Hospital of Northern Theater Command between December 2020 and January 2023. Patients were divided into elderly group (age≥60 years old) and non-elderly group (age 18-59 years old). The clinical characteristics, acute success rate, peri-operative complications and follow-up data between two groups were compared. Multivariate logistic regression analysis was used to analyze whether age was the influencing factor for perioperative complications and atrial fibrillation recurrence. Results: A total of 213 atrial fibrillation patients were enrolled, including 158 (74.18%) in the elderly group (age: (68.3±5.0) years; 56.96% male) and 55 (25.82%) in the non-elderly group (age: (53.7±5.2) years; 81.82% male). The elderly group had lower proportions of males, persistent atrial fibrillation, and left atrial spontaneous echocardiographic contrast compared to the non-elderly group (P<0.05). CHA2DS2-VASc and HAS-BLED scores were higher in elderly group (P<0.05). The acute success rate,"one-stop" procedure time, fluoroscopy time and the rate of peri-operative complications (6 (3.80%) in elderly group vs. 2 (3.64%) in non-elderly group) were similar between two groups (all P>0.05). The average time of clinical and telephone interviews in elderly group and non-elderly group was (16.9±6.1) months and (17.9±5.9) months, respectively. There was no significant difference in the rate of atrial fibrillation recurrence or clinical events between two groups (47 (30.72%) vs. 14 (26.42%), P=0.554; 10 (6.54%) vs. 2(3.77%), P=0.689, respectively). Iatrogenic atrial septal defects in 3-month transesophageal echocardiography follow up were detected in 44 patients (36.97%) in elderly group and 9 patients (19.57%) in non-elderly group (P=0.032). Multivariate logistic regression analysis results showed that age was not the influencing factor for peri-operative complications and atrial fibrillation recurrence (P=0.905 and P=0.676, respectively). Conclusion: Intracardiac echocardiography-guided "one-stop" procedures in the treatment of atrial fibrillation in elderly patients are safe and effective.

Rationale and Design of the InsightPFA Trial: A Prospective, Multicenter, Randomized Controlled Trial of the Irreversible Electroporation-Based Pulsed Field Ablation Versus Radiofrequency Ablation in Chinese Patients With Symptomatic Paroxysmal Atrial Fibrillation.

Pulsed field ablation (PFA) is gaining recognition as a nonthermal, tissue-specific technique for the treatment of atrial fibrillation (AF). The preclinical evaluation of the investigated novel PFA system from Insight Medtech Co. Ltd has demonstrated feasibility, safety, and 30-day efficacy for pulmonary vein isolation (PVI) in the swine model. We are currently conducting a randomized controlled trial to compare the PFA directly with ablation-index (AI)-guided radiofrequency ablation (RFA) for PVI. The InsightPFA trial is a prospective, multicenter, randomized controlled trial to compare the effectiveness and safety of PFA versus RFA for PVI in Chinese patients with symptomatic paroxysmal AF. Two hundred and ninety-two patients diagnosed with symptomatic paroxysmal AF will be randomly assigned to either the PFA group or the RFA group in a 1:1 ratio. All subjects will undergo PVI using PFA or AI-guided RFA and be followed up to 12 months. The primary endpoint is defined as freedom from any episodes of AF/AFL/AT without Class I or III antiarrhythmic drugs during the 9-month follow-up period after a 90-day blank period. The secondary endpoints of effectiveness include acute treatment success and procedural data. The safety evaluation includes a composite of death, stroke and transient ischemic attack, procedure-related complications, device-related adverse events, and serious adverse events. A noninferiority comparison will be conducted between the novel PFA system and the existing RFA system in terms of both effectiveness and safety. This trial aims to determine whether the InsightPFA for PVI is as effective and safe as standard RFA in the treatment of symptomatic paroxysmal AF. https://www. gov/study/NCT06014996; NCT06014996.

Establishment and evaluation of a nomogram prediction model for risk of atrial fibrillation recurrence after the cox-maze IV procedure

The Cox-Maze IV (CMIV) procedure is the mainstay in surgical treatment of atrial fibrillation (AF), but the rate of AF recurrence after the CMIV procedure in patients with persistent AF is difficult to accurately evaluate. In this study, we aimed to develop and validate a risk prediction model of AF recurrence within 1 year after undergoing the Cox-Maze IV procedure. We retrospectively enrolled 303 consecutive patients who underwent the Cox-Maze IV procedure for persistent AF concomitant with other cardiac procedures at our institute between 2019 and 2021. A nomogram was developed using multivariate logistic regression analysis, and the concordance statistic (C-statistic) was computed. Differentiation, calibration, clinical suitability, and bootstrapping were performed to verify the model. Among the 303 patients, 71 developed recurrent AF within 1 year of CMIV. Factors predictive of postoperative AF recurrence included age, left ventricular hypertrophy (LVH), early atrial tachyarrhythmias (ATAs), and congenital heart disease surgery (namely, ventricular septal defect repair and atrial septal defect repair). Based on the training dataset, the nomogram had a C-statistic of 0.864 (95% CI 0.811–0.918) for predicting AF recurrence. According to the receiver operating characteristic curve, (ROC curve), the cutoff value of the model was 0.293, and the specificity and sensitivity were 0.841 and 0.789, respectively. This model can predict the risk of AF recurrence after the CMIV procedure. Its discrimination, calibration, and clinical applicability are strong, and its clinical application is simple and easy to promote.

Melatonin lessens the susceptibility to atrial fibrillation in sleep deprivation by ameliorating Ca2+ mishandling in response to mitochondrial oxidative stress.

The antiarrhythmic effect of melatonin(MLT) has been demonstrated in several studies; however, this hypothesis has recently been contested. Our research seeks to determine if exogenous MLT supplementation can reduce atrial fibrillation (AF) susceptibility due to sleep deprivation (SD) by addressing Ca2+ mishandling and atrial mitochondrial oxidative stress. Adult rats received daily MLT or vehicle injections and were exposed to a modified water tank. We evaluated MLT's impact on AF susceptibility by analyzing atrial electrical and structural changes, calcium handling, and oxidative stress markers. Techniques used included electrophysiological recording, echocardiography, optical mapping, histopathology, and molecular assays to understand MLT's protective effects against sleep deprivation-induced AF. Our findings indicate that MLT treatment effectively mitigates SD-induced AF, safeguards against atrial structural alterations, diminishes mitochondrial oxidative stress and normalizes calcium dynamics. Notably, MLT corrected calcium transient duration (CaD), action potential duration (APD), and conduction heterogeneity, shortened calcium transient refractoriness, and improved arrhythmogenic atrial alternans and spatially discordant alternans, thereby lowering the arrhythmogenic potential of the atria during sleep deprivation. In terms of mechanisms, MLT prevents SD-induced activation of ROS/CaMKII in atrial cardiomyocytes, reversing calcium transient refractoriness and inhibiting arrhythmogenic alternans. MLT significantly decreases the susceptibility to SD-induced AF by ameliorating mitochondrial oxidative stress and Ca2+ mishandling. These findings suggest a potential therapeutic application of MLT as an antiarrhythmic intervention for SD-related AF and underscore the need for further investigation, including clinical studies, to validate these mechanisms.

Decision model to evaluate the cost of clinical events associated with switching from Apixaban to Rivaroxaban among patients with non-valvular atrial fibrillation in the United States and Germany

ABSTRACT Aims Direct-acting oral anticoagulants (DOACs) have emerged as the preferred treatment for nonvalvular atrial fibrillation (NVAF). However, evidence concerning the economic outcomes of DOAC switching remains limited. This study aimed to assess the economic outcomes of DOAC switching in the US and Germany, two countries with a high AF prevalence and DOAC utilization. Methods A decision model was developed to assess the incidence and cost of stroke/systemic embolism (SE) and major bleeding (MB) associated with switching from apixaban to rivaroxaban in patients with NVAF. The model compared two scenarios: continuers (patients continuing apixaban) and switchers (patients switching from apixaban to rivaroxaban). Model inputs on clinical event rates were sourced from a published real-world study, costs inputs were from a standard costing database and published literature. The analysis was conducted over a 1-year time horizon from US Medicare fee-for-service and German public healthcare payer perspectives. Results Over one year, 47,036 patients among a hypothetical plan size of 1,000,000 US Medicare fee-for-service members and 1,019,079 patients among the German adult population size of 70,107,122 were estimated to be treated for NVAF with apixaban. Switching all patients from apixaban to rivaroxaban resulted in 1,498 and 32,447 additional clinical events (stroke/SE and MB) and deaths in the US and Germany, respectively, compared to continuing with apixaban. This led to a total incremental cost of $17.3 million and €153 million from Medicare fee-for-service and German public healthcare perspectives, respectively. Limitations The incidence and hazard ratios of clinical events informing this analysis were based on a US commercial and Medicare Advantage population and may not be generalizable to other populations. Conclusions Switching from apixaban to rivaroxaban was associated with increased clinical events, deaths, and higher medical care costs, potentially representing a less favorable strategy economically compared to continuing apixaban among patients with NVAF.

Integrated Management of Persistent Atrial Fibrillation.

The global incidence of atrial fibrillation is on the rise. Atrial fibrillation, a complex disease, heightens the likelihood of heart failure, stroke, and mortality, necessitating careful attention. Controlling heart rate and rhythm, addressing risk factors, and preventing strokes are fundamental in treating atrial fibrillation. Catheter ablation stands out as the primary approach for atrial fibrillation rhythm control. Nevertheless, the limited success rates pose a significant challenge to catheter ablation, particularly for persistent atrial fibrillation. Various adjunctive ablation techniques are currently under investigation to enhance the effectiveness of catheter ablation. This review provides an overview of the current state of the art and the latest optimized treatments for persistent atrial fibrillation in the areas of rhythm control, heart rate control, and risk factor management.

A randomized double-blind placebo-controlled clinical trial on the efficacy and safety of herbal medicine San-jia-fu-mai (SJFM) in the treatment of atrial fibrillation and heart failure with preserved ejection fraction (yin depletion syndrome)

A randomized double-blind placebo-controlled clinical trial on the efficacy and safety of herbal medicine San-jia-fu-mai (SJFM) in the treatment of atrial fibrillation and heart failure with preserved ejection fraction (yin depletion syndrome)

Research Progress on the Mechanism of Action and Efficacy of Sacubitril/Valsartan in the Treatment of Atrial Fibrillation

Research Progress on the Mechanism of Action and Efficacy of Sacubitril/Valsartan in the Treatment of Atrial Fibrillation

The Southern Brazilian Registry of Atrial Fibrillation (SBR-AF Registry): Predictors of Atrial Arrhythmia Recurrence after First-Time Catheter Ablation.

Treatment of atrial fibrillation (AF) with catheter ablation (CA) has evolved significantly. However, real-world data on long-term outcomes are limited, particularly in low- and middle-income countries. This multicenter prospective cohort of consecutive patients aimed to evaluate the safety and efficacy of first-time CA for AF in Southern Brazil from 2009 to 2024. The primary outcome was any atrial tachyarrhythmia (ATA) recurrence. Multivariable Cox proportional hazards model assessed independent predictors of recurrence. Among 1,043 patients (mean age 67.3 ± 11.3 years, 27.9% female), 75.5% had paroxysmal AF. At a median follow-up of 1.4 (1.0 - 3.4) years, 21.4% had ATA recurrence. Recurrence rates were 18.6% for paroxysmal and 29.8% for persistent AF, and 67.3% of events occurred within the first year after CA. Predictors of recurrence were persistent AF at baseline (hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.15-2.13; p = 0.004), enlargement of left atrial diameter (HR 1.03, 95% CI 1.00-1.05; p = 0.033), and higher EHRA score of AF symptoms (HR 1.60, 95% CI 1.18-2.18; p = 0.003). Recurrence rates decreased over time according to the procedure's calendar year, with a 9% relative reduction per consecutive year (HR 0.91; p < 0.001). There was a 2.1% rate of procedure-related adverse events. In the largest cohort study of consecutive AF ablations in Latin America, predictors of ATA recurrence were related to later stages of AF. Complication and recurrence rates were comparable to those in high-income countries, underscoring the global applicability of CA for AF management.

Posterior left atrial wall isolation for treatment of persistent atrial fibrillation during first-time catheter ablation: An updated systematic review and meta-analysis.

Although catheter ablation (CA) by mean of pulmonary vein isolation (PVI) is nowadays the mainstay treatment for atrial fibrillation (AF), its success-rate in persistent AF remains suboptimal. Results from studies evaluating whether adding posterior wall isolation (PWI) to PVI can increase the success-rate of CA in persistent AF have yielded conflicting data. The aim of this meta-analysis was to assess whether PWI plus PVI might be beneficial in patients with persistent AF. Electronic databases were searched for randomized control trials (RCTs) and observational studies that compared clinical outcomes between patients with persistent AF who underwent PVI with or without PWI. Fifteen studies, including a total of 3072 patients, were considered (1533 treated with PVI and 1539 with PWI + PVI). Comparing patients treated with or without PWI, no statistically significant difference was found in the risk of any atrial tachyarrhythmias recurrence after CA (RR 0.83; 95 % CI 0.66-1.03). The analyses detected a statistically significant reduction in the risk of AF in patients treated with PWI (RR 0.63; 95 % CI 0.48-0.84) balanced by a trend towards an increased risk of atrial flutter/atrial tachycardia (RR 1.51; 95 % CI 0.92-2.49). No statistically significant differences were identified in the risk of major procedural complications (RR 0.94; 95 % CI 0.50-1.78). According to our updated meta-analysis, the addition of PWI to PVI was not associated with a reduction of atrial arrhythmia recurrences. A reduction of the risk of AF recurrence and a trend towards an increased risk of atrial flutter/atrial tachycardia were identified.

MVP Risk score y nuevo diagnóstico de fibrilación auricular: estudio de cohorte prospectivo PREFATE

ObjectiveTo assess the association between electrocardiogram (ECG) patterns according to the MVP ECG risk score (morphology-voltage-P-wave duration) and a diagnosis of Atrial Fibrillation (AF). DesignProspective observational cohort study (1/01/2023-31/12/2024). SitePrimary care. ParticipantsRandomized sample of 150 patients aged 65-85 years without prior diagnosis of AF, stroke, or current anticoagulant treatment; high risk of future AF; CHA2DS2-VASc ≥2; and ability to use the FibricheckR application (App). MeasurementsAt baseline, a standard ECG, MVP risk score assessment, and cardiac rhythm monitoring for 15 days using the FibricheckR App were performed. The dependent variables were the presence of P-wave patterns on the electrocardiogram according to MVP risk score and a new diagnosis of AF. ResultsThe diagnosis of AF was confirmed in 14 cases (9.3%, 95% CI 5.6-15.1), 3 men and 11 women. In 3 cases, the arrhythmia was diagnosed on the baseline ECG, and in 11 cases by Holter after being reported as possible AF by the FibricheckR App. A higher prevalence of atypical advanced interatrial block (A-AIB) (p 0.007) was detected among participants with AF, as well as the prevalence of P-wave <0.1mV. (p=0.006). All new diagnoses of AF were made at scores ≥4 in the MVP risk score. ConclusionsUsing scales for identifying ECG patterns in high-risk subjects in primary care can facilitate the diagnosis of unknown AF.