In-hospital and 12-month follow-up outcome from the ESC-EORP EHRA Atrial Fibrillation Ablation Long-Term registry: sex differences.

AIM: The purpose of this study was to compare sex differences of atrial fibrillation (AF) catheter ablation (CA) and to analyse the opportunities for improved outcomes. METHODS AND RESULTS: All data were collected from the Atrial Fibrillation Ablation Long-Term registry, a prospective, multinational study conducted by the ESC-EORP European Heart Rhythm Association (EHRA) under the EURObservational Research Programme (ESC-EORP). A total of 104 centres in 27 European countries participated. Of 3593 included patients, 1146 (31.9%) were female. Female patients were older (61.0 vs. 56.4 years; P < 0.001), had more comorbidities (hypertension, diabetes, and obesity), more episodes of arrhythmias per month (6.9 vs. 6.2; P < 0.001), and a higher average EHRA score (2.6 vs. 2.4; P < 0.001). The duration of the procedure was shorter in females (160.1 min vs. 167.9 min; P < 0.001), irrespective of additional ablation lesions added to pulmonary vein isolation. Overall cardiovascular complications were more frequent in women than in men (5.7% vs. 3.4%; P < 0.001). Furthermore, cardiac perforations (3.8% vs. 1.3%; P = 0.011) and neurological complications (2.2% vs. 0.3%; P = 0.004) were found in females in less experienced centres than in experienced ones. On a final note, at 12 months, AF recurrence rate was similar in females and males (34.4% vs. 34.2%; P = 0.897), but more females were still on antiarrhythmic drugs (50.6% vs. 44.1%; P < 0.001) when compared with men. CONCLUSION: Females underwent CA procedures for AF less frequently than males throughout Europe, despite more recurrent symptoms. With the same success rate, severe acute complications remained considerable in females, especially in less experienced centres.

Role of Cardiac Magnetic Resonance in the Assessment of Patients with Premature Ventricular Contractions: A Narrative Review.

Premature ventricular contractions (PVCs) are a common finding in clinical practice, requiring a full diagnostic work-up in order to exclude an underlying cardiomyopathy. Still, in a substantial proportion of patients, these investigations do not identify any substrate, and the PVCs are labelled as idiopathic. Cardiac magnetic resonance (CMR) has proven in the last decades as the method of choice for the exploration of patients with cardiomyopathies, since it can identify subtle changes in the myocardial tissue and help with risk stratification. In patients with idiopathic PVCs and a high PVC burden, several studies report the presence of late gadolinium enhancement (LGE) at CMR, which can offer additional diagnostic and prognostic benefits, as well as assistance in catheter ablation procedures, as the risk for adverse cardiac and risk for arrhythmic events events is higher compared to patients without scar. This paper focuses on the impact of the presence of LGE in patients with idiopathic PVCs, reviewing all the relevant studies published so far, including randomized controlled clinical trials, prospective or retrospective cohort studies, case series and case reports as well as systematic reviews.

Gastro-Esophageal Reflux Disease and Paroxysmal Atrial Fibrillation Ablation.

Patients undergoing ablation for atrial fibrillation may be at increased risk of developing gastroesophageal reflux disease. We prospectively studied the presence of symptomatic gastroesophageal reflux disease in naïve patients who underwent atrial fibrillation ablation. METHODS: The presence of typical symptoms suggestive of gastroesophageal reflux disease was clinically assessed by the gastroenterologist at baseline and at 3 months after ablation. In addition to that, all patients underwent upper gastrointestinal endoscopy. RESULTS: Seventy-five patients were included in two groups: 46 patients who underwent atrial fibrillation ablation (study group) and 29 patients without ablation (control group). Patients with atrial fibrillation ablation were younger (57.76 ± 7.66 years versus 67.81 ± 8.52 years; p = 0.001), predominantly male (62.2% versus 33.3%; p = 0.030) and with higher body mass index (28.96 ± 3.12 kg/m2 versus 26.81 ± 5.19 kg/m2; p = 0.046). At three months after the ablation, in the study and control groups, there were 88.9% and 57.1% patients in sinus rhythm, respectively, (p = 0.009). Symptomatic gastroesophageal reflux disease was not more frequent in the study group (42.2% versus 61.9%; p = 0.220). There was no difference in terms of sinus rhythm prevalence in patients with versus without symptomatic gastroesophageal reflux disease (89.5% versus 88.5%; p = 0.709). CONCLUSION: In this small prospective study, typical symptoms suggestive of gastroesophageal reflux disease were not more frequent three months following atrial fibrillation ablation.

General practitioners' perceptions on opportunistic single-time point screening for atrial fibrillation: A European quantitative survey.

Background: There is no clear guidance on how to implement opportunistic atrial fibrillation (AF) screening in daily clinical practice. Objectives: This study evaluated the perception of general practitioners (GPs) about value and practicalities of implementing screening for AF, focusing on opportunistic single-time point screening with a single-lead electrocardiogram (ECG) device. Methods: A descriptive cross-sectional study was conducted with a survey developed to assess overall perception concerning AF screening, feasibility of opportunistic single-lead ECG screening and implementation requirements and barriers. Results: A total of 659 responses were collected (36.1% Eastern, 33.4% Western, 12.1% Southern, 10.0% Northern Europe, 8.3% United Kingdom & Ireland). The perceived need for standardized AF screening was rated as 82.7 on a scale from 0 to 100. The vast majority (88.0%) indicated no AF screening program is established in their region. Three out of four GPs (72.1%, lowest in Eastern and Southern Europe) were equipped with a 12-lead ECG, while a single-lead ECG was less common (10.8%, highest in United Kingdom & Ireland). Three in five GPs (59.3%) feel confident ruling out AF on a single-lead ECG strip. Assistance through more education (28.7%) and a tele-healthcare service offering advice on ambiguous tracings (25.2%) would be helpful. Preferred strategies to overcome barriers like insufficient (qualified) staff, included integrating AF screening with other healthcare programs (24.9%) and algorithms to identify patients most suitable for AF screening (24.3%). Conclusion: GPs perceive a strong need for a standardized AF screening approach. Additional resources may be required to have it widely adopted into clinical practice.

Abnormal atrioventricular node conduction and atrioventricular nodal reentrant tachycardia in patients older versus younger than 65 years of age.

STUDY OBJECTIVE: We examined the possible role of atrioventricular node (AVN) conduction abnormalities as a cause of AVN reentrant tachycardia (RT) in patients >65 years of age. STUDY POPULATION: Slow pathway radiofrequency catheter ablation (RFCA) was performed in 104 patients. Patients in group 1 (n = 14) were >65 years of age and had AV conduction abnormalities associated with structural heart disease. Patients in group 2 (n = 90) were <65 years of age and had lone AVNRT. RESULTS: Patients in group 1 versus group 2 (66% vs. 46% men) had a first episode of tachycardia at an older age than in group 2 (68 +/- 16.8 vs 32.5 +/- 18.8 years, P = 0.007). The history of arrhythmia was shorter in group 1 (5.4 +/- 3.8 vs 17.5 +/- 14, P = 0.05) and was associated with a higher proportion of patients with underlying heart disease than in group 2 (79% vs 3%, P < 0.001). The electrophysiological measurements were significantly shorter in group 2: atrial-His interval (74 +/- 17 vs 144 +/- 44 ms, P = 0.005), His-ventricular (HV) interval (41 +/- 5 vs 57 +/- 7 ms, P = 0.001), Wenckebach cycle length (329 +/- 38 vs 436 +/- 90 ms, P = 0.001), slow pathway effective refractory period (268 +/- 7 vs 344 +/- 94 ms, P = 0.005), and tachycardia cycle length (332 +/- 53 vs 426 +/- 56 ms, P = 0.001). The ventriculoatrial block cycle length was similar in both groups. The immediate procedural success rate was 100% in both groups, and no complication was observed in either group. One patient in group 2 had recurrence of AVNRT. One patient with a 98-ms HV interval underwent permanent VVI pacemaker implantation before RFCA procedure. CONCLUSION: In patients undergoing RFCA for AVNRT at >65 years of age had a shorter history of tachycardia-related symptoms than patients with lone AVNRT. The longer AVN conduction intervals and refractory period might explain the late development of AVNRT in group 1.

Postoperative atrial fibrillation prediction following isolated surgical aortic valve replacement.

OBJECTIVE: Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery, with increased risk of stroke and high mortality. Our aim was to identify patients at risk and to design a model that could predict POAF. METHODS: In this single center study, we evaluated 1191 patients requiring isolated surgical aortic valve replacement between January 2000 and June 2014. The patients were followed during the early postoperative period until discharge. RESULTS: AF occurred in 342 patients (28.71%). Six variables associated with high arrhythmic risk [advanced age, body mass index, tricuspid regurgitation, prolonged ventilation, longer intensive care unit stay, and dilated left atrium (LA; volume ≥35 ml/m2)] were selected to create a multivariate prediction model. This model predicted POAF in 64.7% of cases, with a moderate discriminative power (AUC=0.65; p=0.001; 95% CI, 0.571-0.771). We also developed the CHAID (Chi-square automatic interaction detection) model showing multilevel interactions among risk factors for POAF. Age had the greatest discriminative power, with patients aged >68 years at a higher risk for POAF. In low-risk patients, the subgroup with dilated LA (volume ≥40 ml) was more prone to develop POAF. For the intermediate-risk group, history of AF was the next deciding variable, whereas for the high-risk group, it was tricuspid regurgitation (at least moderate). CONCLUSION: The multivariate logistic model has an acceptable predictive value. CHAID-derived model is a new tool that could be easily applied to identify patients requiring prophylactic regimens.

Atrial fibrillation and sympathovagal balance in patients with gastroesophageal reflux disease.

BACKGROUND/AIMS: Similar autonomic innervation of the esophagus and left atrium with sympathovagal imbalance seems to explain the association between non-valvular atrial fibrillation (AF) and gastroesophageal reflux disease (GERD). We aimed to assess this association via parameters of heart rate variability in time (SDNN) and frequency (low-frequency (LF)/high-frequency (HF) ratio) domains by 24-hour electrocardiographic (ECG) Holter monitoring. MATERIALS AND METHODS: One hundred thirty-five patients were prospectively included by a joint team consisting of a gastroenterologist and a cardiologist on the basis of the patients' complaints. A diagnosis of GERD was assessed by the gastroenterologist clinically. All patients also underwent upper gastrointestinal endoscopy. RESULTS: The patients were included in two groups: 61 patients with GERD (group I) and 74 patients without GERD (group II), with demographic data of 41% male, age 61.5±9 years, and body mass index (BMI) 28.8±4 kg/m2 versus 46% male, age 58±9 years, and BMI 29±4 kg/m2 (all p>0.05). In groups I and II the percentages of patients with AF were 33% and 39%, respectively (p=0.52). Patients with GERD had a relative risk of AF of 1.17 (95% confidence interval [CI] 0.78-1.75; p=0.34). Heart rate variability in terms of the time-domain parameter (SDNN) was statistically significantly lower in the GERD group (97.6±13.7 ms versus 139.9±44.6 ms; p=0.001). The mean value of the frequency-domain parameter (LF/HF ratio) was also lower in the GERD group (0.75±0.17 ms versus 0.76±0.24 ms), but without statistical significance (p=0.930). CONCLUSION: Sympathovagal balance seems to be disrupted in patients with GERD, with dominance of the parasympathetic system and an increased risk of arrhythmias, although AF was not significantly more frequent in these patients.

Left ventricular non-compaction -challenges and controversies.

Cardiomyopathies classification is based on morphological and functional phenotypes and subcategories of familial/genetic and non-familial/non-genetic disease. The non-compaction cardiomyopathy is a rare disorder which is considered to be an unclassified cardiomyopathy according to the ESC Working Group on Myocardial and Pericardial Diseases and the World Health Organization or a primary genetically-determined cardiomyopathy according to the American Heart Association. The diagnosis of non-compaction is challenging and its nosology is debated since this morphological trait can be shared by different cardiomyopathies and non-cardiomyopathy conditions. Myocardial structure has a spectrum from normal variants to the pathological phenotype of non-compaction cardiomyopathy, which reflects the embryonic structure of the human heart due to an arrest in the compaction process during the first trimester. However, when a definite diagnosis of non-compaction is made, the diagnostic process should orient towards a genetic disease with a relatively high probability of sarcomere mutations. Non-compaction cardiomyopathy is a diagnostically challenging entity. Nowadays there are some controversies associated with this cardiomyopathy, that it worth to be discussed.

Antimicrobial activity of the surface coatings on TiAlZr implant biomaterial.

This study is devoted to antimicrobial activity of new surface coatings on TiAlZr. Ti alloys such as TiAlZr are used as implant biomaterials, but, despite the good behavior of such alloys in simulated conditions, bacterial infections appear after the introduction of an implant into the body. The infections are typically caused by the adherence and colonization of bacteria on the surfaces of the implants. The study presents preparation and surface morphology characterization of coatings obtained via anodizing, as well as biomimetic coatings with hydroxyapatite and silver ions with and without antibiotic. The percentage inhibition of Escherichia coli bacteria growth was evaluated for each of the studied coating, and a Trojan-horse model of silver nanoparticles (nAg) antibacterial activity at interface was proposed. Such coatings could be more important taking into account that antibacterial treatments with antibiotics are becoming less effective due to their intensive use.

[Comparative efficiency of externally-irrigated cooled-tip catheter vs. 8-mm-tip catheters in radiofrequency (RF) ablation of common atrial flutter]. / Eficacitatea comparativa a cateterului de irigatie externa versus cateter de 8 mm in ablatia prin radiofrecventa a flutterului atrial istmic.

UNLABELLED: Cooled-tip and 8-mm-tip catheters have been found to be more effective than conventional 4-mm-tip catheters for radiofrequency (RF) ablation of common atrial flutter. The aim of this study was retrospective comparison between cooled-tip and and 8-mm-tip catheters in terms of efficacy and safety of RF ablation in atrial flutter. MATERIAL AND METHOD: Among 148 consecutive patients (pts) referred for common atrial flutter, cavotricuspid ablation was performed with an externally-irrigated cool tip catheter in 100 pts, and with an 8-mm-tip ablation catheter in 48 patients. RF current was applied for 60 seconds at powers of 50 W with the cooled-tip catheter, and in a temperature-controlled mode (65 degrees C/70 W) with the 8-mm-tip catheter, until bidirectional isthmus block was reached, or a total of 35 unsuccessful RF applications were performed. RESULTS: A higher initial failure rate with 8-mm-tip catheters was significant, compared to the externally-irrigated catheter (18% vs 4% ; p < 0.01). Significant differences were also found in some procedure parameters, such as the number of RF applications (26 +/- 8 vs 35 +/- 10; p < 0.04), fluoroscopy time (11 +/- 15 min vs 27 +/- 10 min; p < 0.01) and total procedure duration (95 +/- 23 min vs 145 +/- 35 min; p < 0.09). No major complications occurred. In a mean follow-up of 30 +/- 11 months atrial flutter recurred only in group treated with 8 mm catheter (10 patients among 48). CONCLUSION: In achieving cavotricuspid isthmus block, RF ablation performed through cooled-tip catheters is more efficient than application through 8-mm-tip catheters.

[Effectiveness of prostaglandin treatment in idiopathic pulmonary hypertension]. / Eficienta tratamentului cu prostaglandine in hipertensiunea pulmonara idiopatica.

UNLABELLED: Calcium channel blockers are the only vasodilators that proved their efficiency in idiopathic pulmonary hypertension (IPH). However, not every patient is responsive to this therapy. Only in isolated cases of IPH was proved the good effect of prostaglandins in lowering the pulmonary pressure by inhibiting the proliferation of smooth muscle cells. The follow up of a patient, male, 66 years, with IPH, NYHA IV class global cardiac decompensation, mostly the right heart, cyanotic, with 85% SaO2 at rest, massive edema, with "hair cut" aspect of pulmonary circulation, cardiomegaly assessed radiologically (CTI 0.55) and echocardiographically (important dilation of right heart chambers, RV 50/44 mm, compressing the left heart chambers, IVth grade tricuspid insufficiency and 160/90 mmHg pulmonary pressure) is presented. It was excluded a secondary cause of pulmonary hypertension, both by echocardiography and by cardiac catheterization, which eventually confirms the angiographic diagnosis of IPH (dilation of pulmonary artery and its branches, with no peripheral circulation). The progress was spectacular after introducing iloprost as therapy (two i.v. sessions at one month interval (28 days))--excellent clinical amelioration until IInd NYHA class, 96% SaO2 at rest, disappearance of pleural and pericardial effusion, with the diminishing of heart dimensions in radiological (CTI 0.44) and echography exams (RV 46/38 mm), amelioration of tricuspid regurgitation (grade II) and also the significant decrease of pulmonary pressure (90/60 mmHg). CONCLUSION: The therapy with iloprost is particularly effective in treating IPH.

Does treatment with ACE inhibitors prevent the long term recurrences of lone atrial fibrillation after cardioversion?

UNLABELLED: This study aimed to prove that angiotensin-converting enzyme inhibitor (ACEI) could improve sinus rhythm maintenance after conversion of atrial fibrillation (AF). METHODS AND RESULTS: A study of 36 patients with lone AF who undertook electrical conversion was conducted. Group 1 included 20 patients treated exclusively with a class I C antiarrhythmic (Propafenona, 450 mg daily) and group 2 included 16 patients treated with antiarrhythmic plus ACEI after cardioversion. These two groups were comparable, with mean age 56.2+/-11.8 vs. 57.7+/-6.1 years (P 0.709), onset of AF 2.47+/-3.72 vs. 5.5+/-7.37 months (P 0.205) and echocardiografic parameters: left atrium diameter 45.1+/-5.8 vs. 45.0+/-6.1 mm (P 0.995); LVTDV 48.5+/-5.0 vs. 48.6+/-6.4 mm (P 0.998); LVTSV 35.1+/-5.0 vs. 36.0+/-7.0 mm (P 0.737) and EF 59.0+/-6.9% vs. 54.8+/-6.1% (P 0.135). The patients were followed up clinically and electrocardiographically 12 months after conversion. Kaplan-Meier analysis showed a higher probability of remaining in sinus rhythm one year after cardioversion for group 2 compared to group 1 (37.5% vs. 20%). The mean time interval for the appearance of recurrences was significantly higher in patients treated with ACEI and antiarrhythmics compared to the patients treated only with antiarrhythmics (7.06+/-1.02 vs. 4.50+/-0.93 months; Breslow test (generalized Wilcoxon) - 4.473, P 0.034). CONCLUSION: The addition of ACEI to an antiarrhythmic decreases the rate of AF recurrences and facilitates the maintenance of sinus rhythm after cardioversion.

[Effectiveness of angiotensin-converting enzyme inhibitors in the maintenance of sinus rythm after conversion of arterial fibrillation]. / Eficienta inhibitorilor enzimei de conversie a angiotensinei în mentinerea ritmului sinusal post-conversie a fibrilatiei atriale.

UNLABELLED: This study aimed to prove that angiotensin-converting enzyme inhibitors (ACEI) could improve sinus rhythm maintenance after electrical or chemical conversion of atrial fibrillation (AF). METHODS: A prospective study of 36 patients with lone AF which undertook chemical or electrical conversion was conducted. Group 1 included 20 patients treated exclusively with a class I C antiarrhythmic (Propafenone, 450 mg daily) and group 2 included 16 patients treated with antiarrhythmic plus ACEI pre- and after cardioversion. RESULTS: These two groups were comparable, with mean age 56.2 +/- 11.8 vs. 57.7 +/- 6.1 years (P 0.709), onset of AF 2.47 +/- 3.72 vs. 5.5 +/- 7.37 months (P 0.205) and echocardiographic parameters: left atrium diameter 45.1 +/- 5.8 vs. 45.0 +/- 6.1 mm (P 0.995); LVTDV 48.5 +/- 5.0 vs. 48.6 +/- 6.4 mm (P 0.998); LVTSV 35.1 +/- 5.0 vs. 36.0 +/- 7.0 mm (P 0.737) and EF 59.0 +/- 6.9% vs. 54.8 +/- 6.1% (P 0.135). The patients were followed up clinically and electrocardiographically 12 months after conversion. Kaplan-Meier analysis showed a higher probability of remaining in sinus rhythm one year after cardioversion for group 2 compared to group 1 (37.5% vs. 20%). The mean time interval for the appearance of recurrences was significantly higher in patients treated with ACEI and antiarrhythmics compared to the patients treated only with antiarrhythmics (7.06 +/- 1.02 vs. 4.50 +/- 0.93 months; Breslow test (generalized Wilcoxon)--4.473, P 0.034). CONCLUSION: The addition of ACEI to an antiarrhythmic decreases the rate of AF recurrences and facilitates the maintenance of sinus rhythm after cardioversion.

[Radiofrequency treatment of cardiac arrhythmias at the Cardiology Center in Iasi ]. / Tratamentul tahicardiilor prin radiofrecventa experienta Centrului de Cardiologie Iasi.

UNLABELLED: It is well known that the radiofrequency catheter ablation (RFCA) treatment of cardiac arrhythmias is effective and devoid of significant complications. However, in our country, the experience of this technique is not so large and requires more clinical studies to validate it. OBJECTIVES: The aim of this was to present our experience in the RFCA of cardiac tachycardias. METHODS: Between July 2002 and February 2003, in Iasi Cardiology Center, we performed a total of 79 diagnosis procedures. Of these 57 (72%) were radiofrequency ablation procedures at 51 patients, mean age 48 +/- 16 years (12-81), men majority 32 (63%). The electrophysiology diagnosis was: 22 (39%) common atrial flutter, 3 (5%) atrial tachycardias, 13 (23%) atrioventricular nodal reentrant tachycardia, 12 (21%) Wolff-Parkinson-White syndrome, 4 (7%) orthodromic tachycardia using concealed accessory pathway, 2 (3%) ventricular tachycardias and 1 (2%) ablation of the atrioventricular junction. RESULTS: The initial ablation procedure was effective in 44/ 51 patients (86%), with a total duration of 130 +/- 42 min, using 24 +/- 10 min of radioscopy. During follow-up 13 +/- 1.3 (11-16 months), recurrence occurred in 7 patients 14%. In 7 of them a second effective procedure was performed in 4 patients. Finally, radiofrequency ablation was effective in 48/51 of patients (94%), improving the procedural success rate at 95% (54/57 patients). No complications occurred during follow-up. CONCLUSION: The treatment of cardiac arrhythmias by radiofrequency catheter ablation is effective and safe and is the only way to cure the supraventricular and ventricular tachyarrhythmias.

Radiofrequency catheter ablation of an incessant supraventricular tachycardia in a premature neonate.

A 32-week, premature neonate with incessant supraventricular tachycardia and hemodynamic compromise who failed to respond to antenatal and postnatal antiarrhythmic therapy underwent successful radiofrequency catheter ablation (RCA) of a concealed left free-wall accessory pathway when the infant was 4-days-old and weighed only 1,840 grams. At follow-up performed 60 days after the procedure, the infant remained free of any drug, in sinus rhythm, and in normal hemodynamic condition.

[Arrhythmic cardiomyopathy. Case report]. / Cardiomiopatia aritmica. Prezentare de caz.

An 11 year-old boy was admitted with incessant sinus node reentrant tachycardia and secondary dilated arrhythmic cardiomyopathy, treated by radiofrequency ablation. Two years later he was admitted with incessant automatic atrial tachycardia and arrhythmic cardiomyopathy; a second catheter ablation procedure failed, but the third one, performed four month later, was successfully and resulted in a restoration of a normal sinus rhythm and a complete regression of arrhythmic cardiomyopathy.