Targeting non-pulmonary vein triggers in persistent atrial fibrillation: results from a prospective, multicentre, observational registry.

Aims: We evaluated the efficacy of an ablation strategy empirically targeting pulmonary veins (PVs) and posterior wall (PW) and the prevalence and clinical impact of extrapulmonary trigger inducibility and ablation in a large cohort of patients with persistent atrial fibrillation (PerAF).

Methods And Results: A total of 1803 PerAF patients were prospectively enrolled. All patients underwent pulmonary vein antrum isolation (PVAI) extended to the entire PW.

Anticoagulation After Catheter Ablation of Atrial Fibrillation: Is it time to Discontinue in Select Patient Population?

Background: Catheter ablation is an effective strategy for treatment of drug-refractory atrial fibrillation (AF). Continuation of oral anticoagulation (OAC) beyond 3 months after an apparently successful ablation of AF remains controversial.

Methods: A systematic electronic search of the scientific literature was performed in PubMed, EMBASE, SCOPUS and Google Scholar.

Surgical left atrial appendage occlusion during cardiac surgery: A systematic review and meta-analysis.

Aim: To evaluate the safety and efficacy of surgical left atrial appendage occlusion (s-LAAO) during concomitant cardiac surgery.

Methods: We performed a comprehensive literature search through May 31st 2018 for all eligible studies comparing s-LAAO vs no occlusion in patients undergoing cardiac surgery. Clinical outcomes during follow-up included: embolic events, stroke, all-cause mortality, atrial fibrillation (AF), reoperation for bleeding and postoperative complications.

Painful left bundle branch block syndrome treated with his bundle pacing.

This is a case report of a patient with painful LBBB Syndrome that responded favorably to His Bundle Pacing. This syndrome is largely under recognized despite 50 reports in the literature over the last 60 years. Both diagnosis and treatment are not well defined and represent a major challenge in patients with this entity.

Outcomes of patients admitted with ventricular arrhythmias and sudden cardiac death in the United States.

Background: Mortality caused by ventricular arrhythmias (VAs) remains a problem of epidemic proportions. Understanding current trends on admission of VA, patient characteristics, morbidity, mortality, and health care utilization could help us improve allocation of health care resources and risk prediction.

Objective: The purpose of this study was to investigate clinical outcomes of VA, including ventricular tachycardia (VT), implantable cardioverter-defibrillator (ICD) shocks, and sudden cardiac death (SCD); and to identify predictors of morbidity and mortality, patterns of utilization of ICD and VT ablation, and the impact of such metrics on overall health care utilization.

Cardiac Resynchronization Therapy in Inotrope-Dependent Heart Failure Patients: A Systematic Review and Meta-Analysis.

Objectives: The purpose of this study was to evaluate outcomes after cardiac resynchronization therapy (CRT) in inotrope-dependent patients with heart failure (HF) to ascertain the viability of CRT in these patients.

Background: During the last decade, significant numbers of trials have demonstrated the beneficial effect of CRT in the treatment of patients with HF and systolic dysfunction, prolonged QRS complex duration, and New York Heart Association functional class III or IV. However, it is currently undetermined whether CRT may benefit patients who require inotropic support.

Role of Cardiac Imaging in Evaluating Risk for Sudden Cardiac Death.

Sudden cardiac death (SCD) is a major cause of death from cardiovascular disease. Our ability to predict patients at the highest risk of developing lethal ventricular arrhythmias remains limited. Despite recent studies evaluating risk stratification tools, there is no optimal strategy.

Atrial Substrate and Triggers of Paroxysmal Atrial Fibrillation in Patients With Obstructive Sleep Apnea.

Background: Obstructive sleep apnea (OSA) is associated with atrial remodeling, atrial fibrillation (AF), and increased incidence of arrhythmia recurrence after pulmonary vein (PV) isolation. We aimed to characterize the atrial substrate, including AF triggers in patients with paroxysmal AF and OSA.

Methods And Results: In 86 patients with paroxysmal AF (43 with ≥moderate OSA [apnea-hypopnea index ≥15] and 43 without OSA [apnea-hypopnea index <5]), right atrial and left atrial voltage distribution, conduction velocities, and electrogram characteristics were analyzed during atrial pacing.

Atrial fibrillation: Utility of CHADS and CHADS-VASc scores as predictors of readmission, mortality and resource utilization.

Background: CHADS and CHADS-VASc scores are widely used for thromboembolic risk assessment in Atrial Fibrillation(AF) cohort, however further utilization to predict outcomes is understudied.

Method: HCUP's National Readmission Data(NRD) 2013 was queried for AF admissions using ICD-9-CM code 427.31 in principal diagnosis field.

Effects of Transendocardial Stem Cell Injection on Ventricular Proarrhythmia in Patients with Ischemic Cardiomyopathy: Results from the POSEIDON and TAC-HFT Trials.

Transendocardial stem cell injection in patients with ischemic cardiomyopathy (ICM) improves left ventricular function and structure but has ill-defined effects on ventricular arrhythmias. We hypothesized that mesenchymal stem cell (MSC) implantation is not proarrhythmic. Post hoc analyses were performed on ambulatory ECGs collected from the POSEIDON and TAC-HFT trials.

Long-term follow-up of patients with paroxysmal atrial fibrillation and severe left atrial scarring: comparison between pulmonary vein antrum isolation only or pulmonary vein isolation combined with either scar homogenization or trigger ablation.

Aims: Left atrial (LA) scarring, a consequence of cardiac fibrosis is a powerful predictor of procedure-outcome in atrial fibrillation (AF) patients undergoing catheter ablation. We sought to compare the long-term outcome in patients with paroxysmal AF (PAF) and severe LA scarring identified by 3D mapping, undergoing pulmonary vein isolation (PVAI) only or PVAI and the entire scar areas (scar homogenization) or PVAI+ ablation of the non-PV triggers.

Methods And Results: Totally, 177 consecutive patients with PAF and severe LA scarring were included.

Differences Between Access to Follow-Up Care and Inappropriate Shocks Based on Insurance Status of Implantable Cardioverter Defibrillator Recipients.

Differences in implantable cardioverter defibrillator (ICD) utilization based on insurance status have been described, but little is known about postimplant follow-up patterns associated with insurance status and outcomes. We collected demographic, clinical, and device data from 119 consecutive patients presenting with ICD shocks. Insurance status was classified as uninsured/Medicaid (uninsured) or private/Health Maintenance Organization /Medicare (insured).

Cryoballoon versus Radiofrequency Catheter Ablation in Atrial Fibrillation: A Meta-Analysis.

Introduction: Radiofrequency (RF) and cryoballoon (CB) catheter ablation are effective for pulmonary vein isolation (PVI) in atrial fibrillation (AF). This report presents an updated meta-analysis comparing the efficacy and safety of CB versus RF ablations in AF.

Methods: Databases and conference abstracts were systematically searched for studies that directly compared CB and RF PVI, and reported safety or efficacy outcomes in follow-up ≥12 months.

Contemporary utilization and safety outcomes of catheter ablation of atrial flutter in the United States: Analysis of 89,638 procedures.

Background: Atrial flutter (AFL) ablation has been increasingly offered as first-line therapy and safely performed over the last decades. However, limited data exist regarding current utilization and trends in adverse outcomes arising from this procedure.

Objective: The aim of our study was to examine the frequency of adverse events attributable to AFL ablation and influence of hospital volume on safety outcomes.

Trends in Use and Adverse Outcomes Associated with Transvenous Lead Removal in the United States.

Background: Transvenous lead removal (TLR) has made significant progress with respect to innovation, efficacy, and safety. However, limited data exist regarding trends in use and adverse outcomes outside the centers of considerable experience for TLR. The aim of our study was to examine use patterns, frequency of adverse events, and influence of hospital volume on complications.

New-onset versus prior history of atrial fibrillation: Outcomes from the AFFIRM trial.

Background: There are limited data on prognosis and outcomes of patients with new-onset atrial fibrillation (AF) compared with those with a prior history of AF.

Methods And Results: We conducted a comparison of these 2 groups in the AFFIRM trial. New-onset AF was the qualifying arrhythmia in 1,391 patients (34%).

Management of Ventricular Arrhythmias in Patients with Mechanical Ventricular Support Devices.

The use of mechanical ventricular support devices in the management of patients with advanced heart failure continues to increase. These devices have been shown to prolong life as a destination therapy and to increase survival when used as a bridge to transplantation. However, they are associated with a high rate of complications, including bleeding, infection, device malfunction, and ventricular arrhythmias (VAs).

Arrhythmias in chagasic cardiomyopathy.

Chagas disease, a chronic parasitosis caused by the protozoa Trypanosoma cruzi, is an increasing worldwide problem because of the number of cases in endemic areas and the migration of infected individuals to more developed regions. Chagas disease affects the heart through cardiac parasympathetic neuronal depopulation, immune-mediated myocardial injury, parasite persistence in cardiac tissue with secondary antigenic stimulation, and coronary microvascular abnormalities causing myocardial ischemia. A lack of knowledge exists for risk stratification, management, and prevention of ventricular arrhythmias in patients with chagasic cardiomyopathy.

Characteristics of ventricular tachycardia ablation in patients with continuous flow left ventricular assist devices.

Background: Left ventricular assist devices (LVADs) are increasingly used as a bridge to cardiac transplantation or as destination therapy. Patients with LVADs are at high risk for ventricular arrhythmias. This study describes ventricular arrhythmia characteristics and ablation in patients implanted with a Heart Mate II device.

Association between anti-human heat shock protein-60 and interleukin-2 with coronary artery calcium score.

Introduction: Based upon evidence suggesting that concentrations of anti-heat shock protein-60 (anti-HSP60) and interleukin-2 (IL-2) are associated with atherogenesis, we tested the hypothesis that anti-HSP60 and IL-2 are associated with coronary artery calcium (CAC) score, a marker of subclinical atherosclerosis.

Methods: We evaluated 998 asymptomatic adults, age 45-84 years, without known coronary disease from the Multi-Ethnic Study of Atherosclerosis (MESA), who had anti-HSP60 measured at baseline. Tertiles of serum anti-HSP60 were evaluated.

Utilization and adverse outcomes of percutaneous left atrial appendage closure for stroke prevention in atrial fibrillation in the United States: influence of hospital volume.

Background: Safety data on percutaneous left atrial appendage closure arises from centers with considerable expertise in the procedure or from clinical trial, which might not be reproducible in clinical practice. We sought to estimate the frequency and predictors of adverse outcomes and costs of percutaneous left atrial appendage closure procedure in the US.

Methods And Results: The data were obtained from the Nationwide Inpatient Sample from the years 2006 to 2010.