Greater distance between ablation lines reduces the arrhythmia recurrence rate after pulmonary vein isolation.

INTRODUCTION: Pulmonary vein isolation (PVI) is a recommended strategy for rhythm control in atrial fibrillation (AF), but its success rate remains unsatisfactory. Continuous research is being conducted to explore new technologies and modifications to the existing ablation workflow in order to reduce the arrhythmia recurrence rate. OBJECTIVES: This study aimed to determine the influence of the distance between ablation lines (DBL) on AF recurrence rate in patients undergoing their first PVI; and thus to optimize the procedure outcomes. PATIENTS AND METHODS: This is a retrospective cohort study conducted at a tertiary care center in Poland. A total of 146 patients (median age, 62 years; women, 34.3%) referred for a first PVI for either paroxysmal (n = 103) or persistent (n = 43) AF were evaluated. The procedures were performed with the use of a very­high­power, short­duration catheter (QDot MicroTM, Biosense Webster, Inc., Irvine, California, United States) or a conventional, ablation index-guided ThermoCool Smarttouch SF catheter (Biosense Webster, Inc.). Freedom from AF recurrence was used as a primary end point. The impact of DBL on the outcome of PVI, accounting for conventional risk factors, was evaluated. RESULTS: Greater distance between opposite circumferential PVI lines and its ratio to the transverse diameter of the left atrium (DLB/TD) were associated with a lower risk of AF recurrence (hazard ratio [HR], 0.966; 95% CI, 0.935-0.998 [per 1 mm]; P = 0.04 and HR, 0.968; 95% CI, 0.944-0.993 [per 1%]; P = 0.01, respectively). There was no correlation between DBL or DBL/TD ratio and the impedance level. CONCLUSIONS: Close distance between PVI lines contributes to AF recurrence; thus, increasing the DBL and ensuring a higher DBL/TD ratio may be an advantageous ablation strategy.

Sex-Related Differences in Ventricular Tachyarrhythmia Events in Patients With Implantable Cardioverter-Defibrillator and Prior Ventricular Tachyarrhythmias.

BACKGROUND: Data on the risk of ventricular tachycardia (VT), ventricular fibrillation (VF), and death by sex in patients with prior VT/VF are limited. OBJECTIVES: This study aimed to assess sex-related differences in implantable cardioverter-defibrillator (ICD)-treated VT/VF events and death in patients implanted for secondary prevention or primary prevention ICD indications who experienced VT/VF before enrollment in the RAID (Ranolazine Implantable Cardioverter-Defibrillator) trial. METHODS: Sex-related differences in the first and recurrent VT/VF requiring antitachycardia pacing or ICD shock and death were evaluated in 714 patients. RESULTS: There were 124 women (17%) and 590 men observed during a mean follow-up of 26.81 ± 14.52 months. Compared to men, women were at a significantly lower risk of VT/VF/death (HR: 0.67; P = 0.029), VT/VF (HR: 0.68; P = 0.049), VT/VF treated with antitachycardia pacing (HR: 0.59; P = 0.019), and VT/VF treated with ICD shock (HR: 0.54; P = 0.035). The risk of recurrent VT/VF was also significantly lower in women (HR: 0.35; P < 0.001). HR for death was similar to the other endpoints (HR: 0.61; P = 0.162). In comparison to men, women presented with faster VT rates (196 ± 32 beats/min vs 177 ± 30 beats/min, respectively; P = 0.002), and faster shock-requiring VT/VF rates (258 ± 56 beats/min vs 227 ± 57 beats/min, respectively; P = 0.30). There was a significant interaction for the risk of VT/VF by race (P = 0.013) with White women having significantly lower risk than White men (HR: 0.36; P < 0.001), whereas Black women had a similar risk to Black men (HR: 1.06; P = 0.851). CONCLUSIONS: Women with a history of prior VT/VF experienced a lower risk recurrent VT/VF requiring ICD therapy when compared to men. Black Women had a risk similar to men, whereas the lower risk for VT/VF in women was observed primarily in White women. (Ranolazine Implantable Cardioverter-Defibrillator Trial; NCT01215253).

Clinical outcomes and predictors of long-term mortality, hemorrhagic and thromboembolic events in atrial fibrillation patients at different stages of chronic kidney disease: The CRAFT trial.

Background Chronic kidney disease (CKD) coexisting with atrial fibrillation (AF) increases the risk of hemorrhage and ischemia. The study aimed to determine the relationship between different CKD stages and clinical outcomes of patients suffering from both CKD and AF and to determine the predictors of outcome. Methods The data was derived from multicenter CRAFT trial (NCT02987062). We have conducted a retrospective analysis of hospital records of 2663 AF patients divided in three groups according to their estimated glomerular filtration rate (eGFR) which was <30ml/min/1,73 m2 for group I (n=63), ≥30 and <60 ml/min/1,73 m2 for group II (n=947) and ≥60 ml/min/1,73 m2 for group III (n=1653). The primary study endpoint was major adverse event (MAE) during the mean four-year follow-up. Results The highest rate of MAE was observed in group I followed by group II and III. The rate of all-cause death was 60% in group I, 32% in group II and 15% in group III (p<0.001). Bleeding complications occurred in 25% of patients from group I, 23% from group II and 21% from group III (p=0.14). Thromboembolic events occurred in those groups at the rate of 21%, 14% and 12% respectively (p=0.011). The risk of death was 5 times higher in patients with eGFR<30 treated with vitamin K antagonists (VKA) (HR: 5.016, 95% CI: 1.533-16.417; p=0.007). Conclusions AF patients with CKD are at higher risk of MAE and that risk depends on the CKD stage. VKA treatment was linked to a higher mortality in AF patients with the lowest eGFR values.

Antiarrhythmic drugs for pharmacological cardioversion of atrial fibrillation and sex differences: Insights from the CANT II Study.

BACKGROUND: Data on sex differences in terms of action of antiarrhythmic agents (AADs) are limited. This study aimed to evaluate the clinical profile of patients with atrial fibrillation (AF), and efficacy and safety of AADs used for pharmacological cardioversion (PCV) of AF. METHODS: This research was a sub-analysis of the retrospective multicenter Cardioversion with ANTazoline II (CANT) registry, which comprised 1365 patients with short-duration AF referred for urgent PCV with the use of AAD. Patients were categorized according to and compared in terms of clinical parameters and PCV outcomes. The primary endpoint was return of sinus rhythm within 12 hours after drug infusion, and the composite safety endpoint involved bradycardia <45 bpm, hypotension, syncope, or death. RESULTS: The sex distribution of patients qualified for PCV was even (men, n = 725; 53.1%). Females were older and more symptomatic and had higher CHA2DS2-VASc scores, higher prevalence of tachyarrhythmia, and higher use of chronic anticoagulation. The overall efficacy (71.4% vs. 70.1%; P = 0.59) and safety (5.2% vs. 4.6%; P = 0.60) of PCV was comparable in men and women. Amiodarone (68.3% vs. 65.9%; P = 0.66) and antazoline (77.1% vs. 80.0%; P = 0.19) had similar efficacy in men and women, but propafenone had a lower rate of rhythm conversion in men (64.7% vs. 79.3%; P = 0.046). None of the assessed AADs differed in terms of safety profile in both sexes. CONCLUSION: Female patients with AF have different clinical profiles but similar efficacy and safety of AADs as compared to male participants. Propafenone has significantly lower efficacy in men, which requires further investigation.

Impact of AfterAMI Mobile App on Quality of Life, Depression, Stress and Anxiety in Patients with Coronary Artery Disease: Open Label, Randomized Trial.

mHealth solutions optimize cardiovascular risk factor control in coronary artery disease. The aim of this study was to investigate the influence of mobile app AfterAMI on quality of life in patients after myocardial infarction. 100 participants were randomized (1:1 ratio) into groups: (1) with a rehabilitation program and access to afterAMI or (2) standard rehabilitation alone (control group, CG). 3 questionnaires (MacNew, DASS21 and EQ-5D-5L) were used at baseline, 1 month and 6 months after discharge. Median age was 61 years; 35% of patients were female. At 1 month follow up patients using AfterAMI had higher general quality of life scores both in MacNew [5.78 vs. 5.5 in CG, p = 0.037] and EQ-5D-5L [80 vs. 70 in CG, p = 0.007]. At 6 months, according to MacNew, the app group had significantly higher scores in emotional [6.09 vs. 5.45 in CG, p= 0.017] and physical [6.2 vs. 6 in CG, p = 0.027] aspects. The general MacNew quality of life score was also higher in the AfterAMI group [6.11 vs. 5.7 in CG, p = 0.015], but differences in EQ-5D-5L were not significant. There were no differences between groups in the DASS21 questionnaire. mHealth interventions may improve quality of care in secondary prevention, however further studies are warranted.

Mobile App and Digital System for Patients after Myocardial Infarction (afterAMI): Results from a Randomized Trial.

Cardiac rehabilitation after acute myocardial infarction is crucial and improves patients' prognosis. It aims to optimize cardiovascular risk factors' control. Providing additional support via mobile applications has been previously suggested. However, data from prospective, randomized trials evaluating digital solutions are scarce. In this study, we aimed to evaluate a mobile application-afterAMI-in the clinical setting and to investigate the impact of a digitally-supported model of care in comparison with standard rehabilitation. A total of 100 patients after myocardial infarction were enrolled. Patients were randomized into groups with either a rehabilitation program and access to afterAMI or standard rehabilitation alone. The primary endpoint was rehospitalizations and/or urgent outpatient visits after 6 months. Cardiovascular risk factors' control was also analyzed. Median age was 61 years; 65% of the participants were male. This study failed to limit the number of primary endpoint events (8% with app vs. 27% without app; p = 0.064). However, patients in the interventional group had lower NT-proBNP levels (p = 0.0231) and better knowledge regarding cardiovascular disease risk factors (p = 0.0009), despite no differences at baseline. This study showcases how a telemedical tool can be used in the clinical setting.

Mobile application and digital system for patients after myocardial infarction: early results from a randomized trial.

INTRODUCTION: Cardiac rehabilitation (CR) is a complex program aimed at better control of cardiovascular risk factors. It can be supported by mobile applications. Despite promising results from previous studies on telemedicine tools, there is a paucity of evidence when it comes to prospective randomized trials. OBJECTIVES: The aim of this study was to comprehensively evaluate a newly­developedmobile application called "afterAMI" in the clinical setting, and to assess the impact of the application-supported model of care in comparison with standard rehabilitation. PATIENTS AND METHODS: A total of 100 patients with myocardial infarction were recruited on admission to the Department of Cardiology at the Medical University of Warsaw. The patients were randomized into the group with an access to the afterAMI application or to the standard CR. Cardiovascular risk factors were analyzed along with the number of rehospitalizations and patient knowledge regarding cardiovascular risk factors. The analysis focused on the results obtained 30 days after discharge. RESULTS: Median age of the patients was 61 years (interquartile range, 51-67 years), and 65% of the participants were men. There were no differences in cardiovascular risk factor control between the study groups, apart from low­density lipoprotein cholesterol levels, which were lower in the group using the afterAMI application (P <0.001), despite no differences being found at the beginning of the study. Similarly, a significant difference in N­terminal pro-B­type natriuretic peptide levels was observed after 30 days (P = 0.02), despite a lack of significant differences at randomization. CONCLUSIONS: This study serves as an example of a telemedicine tool being implemented into everyday practice. The augmented rehabilitation program resulted in better control of cholesterol level. Longer follow­up is required to establish prognosis in this population.

Safety and effectiveness of very-high-power, short-duration ablation in patients with atrial fibrillation: Preliminary results.

BACKGROUND: Pulmonary vein isolation (PVI) is at the forefront of rhythm control strategies in patients with atrial fibrillation (AF). A very-high-power, short-duration (vHPSD) catheter, QDot MicroTM (Biosense Webster) was designed to improve the effectiveness of AF ablation within a shorter procedure time. The aim of this study was to compare the effectiveness and safety of PVI ablation between this vHPSD ablation mode and conventional ablation-index-guided ablation (ThermoCool Smarttouch SF catheter). METHODS: This single-center, retrospective, observational study enrolled 108 patients with AF, referred for catheter ablation between December 16, 2019 and December 3, 2021. In 54 procedures (mean age: 58.0 ± 12.3; 66.67% male), a QDot MicroTM catheter was used (vHPSD-group), and 54 patients (mean age: 57.2 ± 11.8; 70.37% male) were treated with a ThermoCool SmarttouchTM SF catheter (AI-group). The primary endpoint was freedom from AF 3 months after ablation. RESULTS: Atrial fibrillation was found to recur in 14.81% of patients in the vHPSD-group and in 31.48% of patients in the AI-group (p = 0.07). There was no difference in treatment-emergent adverse events between the two groups (6.3% vs. 0%; p = 0.10). One severe adverse event (a cerebral vascular accident) was observed in the vHPSD-group. The mean dose of remifentanil was reported to be lower during QDot MicroTM catheter-based PVI (p < 0.01). The vHPSD-based PVI was associated with shorter radiofrequency application time (p < 0.001), fluoroscopy time (p < 0.0001), and total procedure time (p < 0.0001). CONCLUSIONS: This study suggests vHPSD ablation is safe, can reduce the dosage of analgesics during significantly shorter procedures and may enhance the success rate of catheter-based PVI.

Patient motivation and adherence to an on-demand app-based heart rate and rhythm monitoring for atrial fibrillation management: data from the TeleCheck-AF project.

AIMS: The aim of this TeleCheck-AF sub-analysis was to evaluate motivation and adherence to on-demand heart rate/rhythm monitoring app in patients with atrial fibrillation (AF). METHODS AND RESULTS: Patients were instructed to perform 60 s app-based heart rate/rhythm recordings 3 times daily and in case of symptoms for 7 consecutive days prior to teleconsultation. Motivation was defined as number of days in which the expected number of measurements (≥3/day) were performed per number of days over the entire prescription period. Adherence was defined as number of performed measurements per number of expected measurements over the entire prescription period.Data from 990 consecutive patients with diagnosed AF [median age 64 (57-71) years, 39% female] from 10 centres were analyzed. Patients with both optimal motivation (100%) and adherence (≥100%) constituted 28% of the study population and had a lower percentage of recordings in sinus rhythm [90 (53-100%) vs. 100 (64-100%), P < 0.001] compared with others. Older age and absence of diabetes were predictors of both optimal motivation and adherence [odds ratio (OR) 1.02, 95% coincidence interval (95% CI): 1.01-1.04, P < 0.001 and OR: 0.49, 95% CI: 0.28-0.86, P = 0.013, respectively]. Patients with 100% motivation also had ≥100% adherence. Independent predictors for optimal adherence alone were older age (OR: 1.02, 95% CI: 1.00-1.04, P = 0.014), female sex (OR: 1.70, 95% CI: 1.29-2.23, P < 0.001), previous AF ablation (OR: 1.35, 95% CI: 1.03-1.07, P = 0.028). CONCLUSION: In the TeleCheck-AF project, more than one-fourth of patients had optimal motivation and adherence to app-based heart rate/rhythm monitoring. Older age and absence of diabetes were predictors of optimal motivation/adherence.

The Path of a Cardiac Patient-From the First Symptoms to Diagnosis to Treatment: Experiences from the Tertiary Care Center in Poland.

Cardiovascular diseases (CVDs) are major concerns in the healthcare system. An individual diagnostic approach and personalized therapy are key areas of an effective therapeutic process. The major aims of this study were: (1) to assess leading patient problems related to symptoms, diagnosis, and treatment of CVDs, (2) to examine patients' opinions about the healthcare system in Poland, and (3) to provide a proposal of practical solutions. The 27-point author's questionnaire was distributed in the Cardiology Department of the Tertiary Care Centre between 2nd September-13th November 2021. A total of 132 patients were recruited, and 82 (62.12%; nmale = 37, 45.12%; nfemale = 45, 54.88%) was finally included. The most common CVDs were arrhythmias and hypertension (both n = 43, 52.44%). 23 (28.05%) patients had an online appointment. Of the patients, 66 (80.49%) positively assessed and obtained treatment, while 11 (13.41%) patients declared they received a missed therapy. The participants identified: (1) waiting time (n = 31; 37.80%), (2) diagnostic process (n = 18; 21.95%), and (3) high price with limited availability of drugs (n = 12; 14.63%) as the areas that needed the strongest improvement. Younger patients more often negatively assessed doctor visits (30-40 yr.; p = 0.02) and hospital interventions (40-50 yr.; p = 0.008). Older patients (50-60 years old) less often negatively assessed the therapeutic process (p = 0.01). The knowledge of the factors determining patient adherence to treatment and satisfaction by Medical Professionals is crucial in providing effective treatment. Areas that require the strongest improvement are: (1) waiting time for an appointment and diagnosis, (2) limited availability and price of drugs, and (3) prolonged, complicated diagnostic process. Providing practical solutions is a crucial aspect of improving CVDs therapy.

Assessment of a new KoMaWo electrode-patch configuration accuracy and review of the literature.

INTRODUCTION: Standard 12­lead electrocardiogram (ECG) is a basic element of routine everyday clinical practice. Traditional cardiac monitoring devices are associated with considerable limitations. Adhesive patches, novel digital solutions, may become a useful diagnostic tool for several cardiovascular diseases. MATERIALS AND METHODS: We propose a new variation of ECG electrodes positioning called KoMaWo. 15 consecutive patients presenting with ST segment deviations due to coronary artery disease were enrolled. The accuracy and utility of the new configuration was assessed and compared with the Mason-Likar configuration, as well as with a standard 12­lead ECG recording. The scans were blinded and interpreted by two independent cardiologists. RESULTS: There were no statistically significant differences in morphology, as well as in the duration of individual waves, complexes, segments, and intervals between the scans obtained using all three methods. In a subgroup analysis, with regard to age, body mass and left ventricle ejection fraction (LVEF), KoMaWo was non-inferior to standard ECG with a 0.2 mm margin. DISCUSSION: The role of traditional cardiac monitoring devices is recognized as the gold standard of patient management. However, certain limitations should be considered. Adhesive patches are light-weight, well-tolerated and do not interfere with daily activities of patients. These novel devices allow for extended monitoring, facilitating increased diagnostic accuracy, regarding cardiac arrhythmias. CONCLUSIONS: The KoMaWo configuration is not inferior to standard electrode placement, nor to Mason-Likar configuration, including its ability to capture ST segment deviations. Adhesive patches may become a valid alternative for traditional cardiac monitoring methods.

Mobile app and digital system for patients after myocardial infarction (afterAMI): study protocol for a randomized controlled trial.

BACKGROUND: Treatment of acute myocardial infarction has been the subject of studies over the past years. However, the initial months after myocardial infarction are crucial from the perspective of the patient's prognosis. It is extremely important to take care of all cardiovascular risk factors and undergo a full rehabilitation program. Telemedical solutions are becoming more and more relevant in everyday practice. We describe a protocol of a study evaluating the use of the mobile application "afterAMI" in patients after myocardial infarction. The app offers an educational mode, calendar, vital signs diary, medication reminders, medical history card, and healthcare professional contact panel. It offers several solutions, which individually proved to be effective and improve a patient's prognosis. Despite general promising results from previous studies regarding telemedical tools, there is a paucity of evidence when it comes to prospective randomized trials. Our aim was to perform a comprehensive evaluation of a newly developed mobile application in the clinical setting. METHODS: A group of 100 patients with myocardial infarction on admission at the 1st Chair and Department of Cardiology, Medical University of Warsaw, will be recruited into the study. The project aims to assess the impact of the application-supported model of care in comparison with standard rehabilitation. At the end of the study, cardiovascular risk factors will be analyzed, along with rehospitalizations, the patients' knowledge regarding cardiovascular risk factors, returning to work, and quality of life. In this prospective, open-label, randomized, single-center study, all 100 patients will be observed for 6 months after discharge from the hospital. Endpoints will be assessed during control visits 1 and 6 months after inclusion into the study. DISCUSSION: This project is an example of a telemedical solution application embracing everyday clinical practices, conforming with multiple international cardiac societies' guidelines. Cardiac rehabilitation process enhancements are required to improve patients' prognosis. The evidence regarding the use of the mobile application in the described group of patients is limited and usually covers a small number of participants. The described study aims to discuss whether telemedicine use in this context is beneficial for the patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT04793425 . Registered on 11 March 2021.

Smartphone Apps for Managing Antithrombotic Therapy: Scoping Literature Review.

BACKGROUND: Antithrombotic therapy is complex and requires informed decisions and high therapy adherence. Several mobile phone apps exist to either support physicians in the management of antithrombotic therapies or to educate and support patients. For the majority of these apps, both their medical evidence and their development background are unknown. OBJECTIVE: This review aims to investigate the available literature describing high-quality apps for managing antithrombotic therapy based on professional scientific information. METHODS: Keywords and Medical Subject Heading terms were used to search MEDLINE via PubMed and Ovid between December 2019 and January 2022. Inclusion criteria were the availability of full text and publications in the English language. Apps that solely focused on atrial fibrillation were excluded. Qualitative findings were thematically synthesized and reported narratively. RESULTS: Out of 149 identified records, 32 were classified as eligible. We identified four groups: (1) apps for patients supporting self-management of vitamin K antagonists, (2) apps for patients increasing therapy adherence, (3) educational apps for patients, and (4) apps for physicians in supporting guideline adherence. CONCLUSIONS: Throughout the evaluated data, patients from all age groups receiving antithrombotic drugs expressed the desire for a digital tool that could support their therapy management. In addition, physicians using mobile guideline-based apps may have contributed to decreased adverse event rates among their patients. In general, digital apps encompassing both user-friendly designs and scientific backgrounds may enhance the safety of antithrombotic therapies. However, our evaluation did not identify any apps that addressed all antithrombotic drugs in combination with perioperative stratification strategies. Currently, strict regulations for smartphone apps seem to negatively affect the development of new apps. Therefore, new legal policies for medical digital apps are urgently needed.

Pharmacological Cardioversion in Patients with Recent-Onset Atrial Fibrillation and Chronic Kidney Disease Subanalysis of the CANT II Study.

Pharmacological cardioversion (PCV) is commonly a primary option for termination of recent-onset atrial fibrillation (AF) in emergency departments (ED). This is a subanalysis of the CANT II study, evaluating the effectiveness and safety of antazoline in patients (n = 777) at three stages of chronic kidney disease (CKD): Group I > 60 mL/min (n = 531), Group II 45−59 mL/min (n = 149), and Group III < 45 mL/min (n = 97). Patients in Group III were older and with a higher prevalence of co-morbidities; however, we did not find statistically significant differences in the overall effectiveness of PCV in comparison with the other groups. In patients receiving amiodarone, the PCV success rate was similar in all the studied groups, but along with a renal function decline, it decreased in patients receiving antazoline (79.1 vs. 35%; p < 0.001), and it increased almost significantly in patients receiving propafenone (69.9 vs. 100%; p = 0.067). In patients in Group I, antazoline restored a sinus rhythm as effectively as propafenone and amiodarone; however, in patients in Group III, both antazoline and amiodarone became less effective in restoring a sinus rhythm than propafenone (p = 0.002 and p = 0.034, respectively). The rate of safety endpoint was the highest in patients in Group III (eGFR < 45 mL/min), and it was significantly higher than in patients in Groups I and II (p = 0.008 and p = 0.036, respectively). We did not observe antazoline-related adverse events in any of the studied groups of patients. This real-world registry analysis revealed a different influence of CKD on the effectiveness of individual drugs, and while propafenone and amiodarone maintained their AF termination efficacy, antazoline became significantly less effective in restoring sinus rhythm.

Efficacy and safety of antazoline for cardioversion of atrial fibrillation: propensity score matching analysis of a multicenter registry (CANT II Study).

INTRODUCTION: Due to safety concerns about available antiarrhythmic drugs (AADs), reliable agents for termination of atrial fibrillation (AF) are requisite. OBJECTIVES: The aim of the study was to evaluate the efficacy and safety of antazoline, a first­generation antihistamine, for cardioversion of recent­onset AF in the setting of an emergency department. PATIENTS AND METHODS: This multicenter, retrospective registry covered 1365 patients (median [interquartile range] age, 69.0 [61.0-76.0] years, 53.1% men) with new­onset AF submitted to urgent pharmacological cardioversion. AAD allocation was performed by the attending physician: antazoline alone was utilized in 600 patients (44%), amiodarone in 287 (21%), propafenone in 150 (11%), and ≥2 AADs in 328 patients (24%). Antazoline in monotherapy or combination was administered to 897 patients (65.7%). Matched antazoline and nonantazoline groups were identified using propensity score matching (PSM, n = 330). The primary end point was return to sinus rhythm within 12 hours after initiation of the treatment. RESULTS: Before PSM, antazoline alone was superior to amiodarone (78.3% vs 66.9%; relative risk [RR], 1.17; 95% CI, 1.07-1.28; P <0.001) and comparable to propafenone (78.3% vs 72.7%; RR, 1.08; 95% CI, 0.97-1.20; P = 0.14) in terms of rhythm conversion rate. In the post­PSM population, the rhythm conversion rate was higher among patients receiving antazoline alone than in the nonantazoline group (84.2% vs 66.7%; RR, 1.26; 95% CI, 1.11-1.43; P <0.001), and the risk of adverse events was comparable (P = 0.2). CONCLUSIONS: Antazoline appears to be an efficacious agent for termination of AF in real­world setting. Randomized controlled trials are required to evaluate its safety in specific patient populations.

The Use of Machine Learning Algorithms in the Evaluation of the Effectiveness of Resynchronization Therapy.

BACKGROUND: Cardiovascular disease remains the leading cause of death in the European Union and worldwide. Constant improvement in cardiac care is leading to an increased number of patients with heart failure, which is a challenging condition in terms of clinical management. Cardiac resynchronization therapy is becoming more popular because of its grounded position in guidelines and clinical practice. However, some patients do not respond to treatment as expected. One way of assessing cardiac resynchronization therapy is with ECG analysis. Artificial intelligence is increasing in terms of everyday usability due to the possibility of everyday workflow improvement and, as a result, shortens the time required for diagnosis. A special area of artificial intelligence is machine learning. AI algorithms learn on their own based on implemented data. The aim of this study was to evaluate using artificial intelligence algorithms for detecting inadequate resynchronization therapy. METHODS: A total of 1241 ECG tracings were collected from 547 cardiac department patients. All ECG signals were analyzed by three independent cardiologists. Every signal event (QRS-complex) and rhythm was manually classified by the medical team and fully reviewed by additional cardiologists. The results were divided into two parts: 80% of the results were used to train the algorithm, and 20% were used for the test (Cardiomatics, Cracow, Poland). RESULTS: The required level of detection sensitivity of effective cardiac resynchronization therapy stimulation was achieved: 99.2% with a precision of 92.4%. CONCLUSIONS: Artificial intelligence algorithms can be a useful tool in assessing the effectiveness of resynchronization therapy.

Radiation Safety and Electrophysiologists: Radiation Protection Status - Go for Zero Fluoroscopy European Heart Rhythm Association Registry.

BACKGROUND: The purpose of this study was to analyze electrophysiologists' radiation-protective devices for occupational exposure across European countries. METHODS: Data reported herein were gathered from the international, multicenter prospective Go for Zero Fluoroscopy registry performed in years 2018-2019. The registry encompassed 25 European electrophysiological centers from 14 countries and up to 5 operators from each center. RESULTS: The analysis included 95 operators (median age: 39 years, 85% of male, median training time: 5 years). The most frequently used X-ray protection tools (used by ≥80% of the group) were lead aprons, thyroid shields, screens below the table, glass in the laboratory, and least often (<7%) protective gloves and cabin. No statistically significant differences regarding the number of procedures performed monthly, electrophysiologists' experience and gender, and radiation exposure dose or radiation protection tools were observed, except lead thyroid shields and eyeglasses, which were more often used in case of fewer electrophysiological procedures performed (<20 procedures per month). Operators who were protected by >4 X-ray protection tools were exposed to lower radiation levels than those who were protected by ≤4 X-ray protection tools (median radiation exposure: 0.6 [0.2-1.1] vs. 0.2 [0.1-0.2] mSv per month, p < 0.0001; 1.1 [0.1-12.0] vs. 0.5 [0.1-1.1] mSv per year, p < 0.0001), respectively. CONCLUSIONS: Electrophysiologists' radiation-protective devices for occupational exposure are similar across European centers and in accordance with the applicable X-ray protection protocols, irrespective of the level of experience, number of monthly performed EP procedures, and gender.

District versus academic hospitals: clinical outcomes of patients with atrial fibrillation.

Introduction: Atrial fibrillation (AF) is associated with increased hospitalization. Objectives: We aimed to compare long-term outcomes in patients with AF hospitalized in academic and district hospitals. Patients and methods: This retrospective observational study included data from the Multicenter Experience in Atrial Fibrillation Patients Treated with Oral Anticoagulants (CRAFT; NCT02987062) study which included AF patients hospitalized between 2011 and 2016 in academic and district hospitals. The primary end point was a major adverse event (MAE) defined as all-cause death and thromboembolic and hemorrhagic events during the median 4-year follow-up. Results: We analyzed 2983 patients with AF: 2271 (76%) from academic and 712 (24%) from district hospitals. Patients treated in district hospitals, as compared with patients treated in academic hospitals, more often experienced MAEs (53% vs 37%; P <⁠0.001), all-cause death (40% vs 24%; P <⁠0.001), and thromboembolic events (13% vs 7.8%; P <⁠0.001), with similar rates of hemorrhagic events (15% vs 15%; P = 1.00). In multivariable logistic regression, female sex, coronary artery disease, smoking, and antiplatelet drug therapy were associated with greater likelihood of thromboembolic events in academic hospitals. Heart failure, renal failure, and vitamin K antagonist (in academic hospitals), and coronary artery disease (in district hospitals) were associated with greater likelihood of hemorrhagic events. District (vs academic) conditions were associated with higher risk of MAEs and all-cause death in men and those with low risk of bleeding, and with higher incidence of thromboembolic events in women, elderly patients, and those with high risk of bleeding and with diabetes. Conclusions: Patients with AF treated at district hospitals had worse long-term outcomes than those treated in academic conditions.

Antithrombotic Management and Long-Term Outcomes of Patients with Atrial Fibrillation. Insights from CRAFT Trial.

BACKGROUND: We aimed to compare long-term outcomes in Polish patients with atrial fibrillation (AF) according to oral anticoagulation (OAC) type and to evaluate the predictive value of common thromboembolic and bleeding risk scores. METHODS: Data from the CRAFT trial (NCT02987062) were included. The primary study endpoint was major adverse event (MAE; all-cause death, thromboembolic and hemorrhagic event) during the mean four-year follow-up period. RESULTS: Out of 2983 patients with available follow-up data, 1686 (56%) were prescribed with vitamin K antagonist (VKA), 891 (30%) with rivaroxaban and 406 (14%) with dabigatran. Predominance of elderly and female patients with previous history of thromboembolic and hemorrhagic events was observed within rivaroxaban (vs. other OAC) group. Higher rate of MAEs and its components was observed in patients on VKA followed by rivaroxaban as compared to patients on dabigatran (43% vs. 42% vs. 31%, p < 0.01). After group matching based on clinical characteristics, higher risk of hemorrhagic events in VKA (vs. dabigatran) and rivaroxaban (vs. dabigatran) group were observed. The available thromboembolic (CHA2DS2-VASs, ATRIA, R2CHADS2) and bleeding (HAS-BLED, ATRIA, ORBIT) risk scores showed poor prediction value. CONCLUSIONS: Despite no difference in the thromboembolic event rate, treatment with VKA and rivaroxaban was associated with a significant increase in the risk of hemorrhagic events.