Catheter Ablation of Paroxysmal Atrial Fibrillation and Disease Progression: Magnitude of the anti-progression effect and role of intervention timing.

Background: Recent randomized controlled trials(RCT) have shown that catheter ablation of paroxysmal atrial fibrillation(AF) is associated with a lower incidence of progression to persistent AF compared to the use of antiarrhythmic drug(AAD) therapy.

Objective: This meta-analysis aimed to investigate the magnitude of the anti-progression effect of catheter ablation, as well as the effect of intervention timing.

Methods: MEDLINE/EMBASE databases were searched until April 1 2024 for RCTs comparing catheter ablation and AAD therapy for the treatment of paroxysmal AF and reporting the rate of progression to persistent AF at 3 years (PROSPERO CRD42024534288).

Long-Term Differences in Autonomic Alterations After Cryoballoon vs Radiofrequency Atrial Fibrillation Ablation.

Background: The long-term natural history of autonomic alterations following catheter ablation of drug-refractory paroxysmal atrial fibrillation is poorly defined.

Objectives: The authors sought to define the long-term impact of thermal catheter ablation on the cardiac autonomic system.

Methods: The study included 346 patients with drug-refractory paroxysmal atrial fibrillation undergoing pulmonary vein isolation using thermal ablation energy (radiofrequency or cryoballoon ablation).

Overcoming Access Challenges to Treat Arrhythmias in Patients with Congenital Heart Disease Using Robotic Magnetic-Guided Catheter Ablation.

The prevalence of congenital heart disease (CHD) has surged in recent decades, owing to a substantial reduction in mortality. As individuals with CHD age, they become increasingly susceptible to late complications including arrhythmias. These arrhythmias often arise decades after surgical intervention and significantly impact quality of life, hospitalizations, and mortality.

Prediction of incident atrial fibrillation using deep learning, clinical models, and polygenic scores.

Background And Aims: Deep learning applied to electrocardiograms (ECG-AI) is an emerging approach for predicting atrial fibrillation or flutter (AF). This study introduces an ECG-AI model developed and tested at a tertiary cardiac centre, comparing its performance with clinical models and AF polygenic score (PGS).

Methods: Electrocardiograms in sinus rhythm from the Montreal Heart Institute were analysed, excluding those from patients with pre-existing AF.

Representation of obesity in contemporary atrial fibrillation ablation randomized controlled trials.

Background: The prevalence and impact of obesity on outcomes of atrial fibrillation (AF) ablation randomized controlled trials (RCTs) have not been well studied.

Objective: To examine the proportion of participants with obesity enrolled in RCTs of AF ablation and outcomes of ablation when subgroup analysis of participants with obesity were available.

Methods: We systematically searched PubMed and EMBASE for AF ablation RCTs published between January 1, 2015 to May 31, 2022.

Innovative approaches to atrial fibrillation prediction: should polygenic scores and machine learning be implemented in clinical practice?

Atrial fibrillation (AF) prediction and screening are of important clinical interest because of the potential to prevent serious adverse events. Devices capable of detecting short episodes of arrhythmia are now widely available. Although it has recently been suggested that some high-risk patients with AF detected on implantable devices may benefit from anticoagulation, long-term management remains challenging in lower-risk patients and in those with AF detected on monitors or wearable devices as the development of clinically meaningful arrhythmia burden in this group remains unknown.

Distinct Substrates of Idiopathic Ventricular Fibrillation Revealed by Arrhythmia Characteristics on Implantable Cardioverter-Defibrillator.

Background: Idiopathic ventricular fibrillation (IVF) can be associated with undetected distinct conditions such as microstructural cardiomyopathic alterations (MiCM) or Purkinje (Purk) activities with structurally normal hearts.

Objectives: This study sought to evaluate the characteristics of recurrent VF recorded on implantable defibrillator electrograms, associated with these substrates.

Methods: This was a multicenter collaboration study.

Clinical Genetic Testing for Atrial Fibrillation: Are We There Yet?

Important progress has been made toward unravelling the complex genetics underlying atrial fibrillation (AF). Initial studies were aimed to identify monogenic causes; however, it has become increasingly clear that the most common predisposing genetic substrate for AF is polygenic. Despite intensive investigations, there is robust evidence for rare variants for only a limited number of genes and cases.

Rationale and Design of the Randomized Bayesian Multicenter COME-TAVI Trial in Patients With a New Onset Left Bundle Branch Block.

Patients with new-onset left bundle branch block (LBBB) after transcatheter aortic valve implantation (TAVI) are at risk of developing delayed high-degree atrioventricular block. Management of new-onset LBBB post-TAVI remains controversial. In the mparison of a Clinical onitoring Strategy Versus lectrophysiology-Guided Algorithmic Approach in Patients With a New LBBB After (COME-TAVI) trial, consenting patients with new-onset LBBB that persists on day 2 after TAVI, meeting exclusion/inclusion criteria, are randomized to an electrophysiological study (EPS)-guided approach or 30-day electrocardiographic monitoring.

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

Background And Aims: Atrial fibrillation (AF) is a chronic progressive disorder. Persistent forms of AF are associated with increased rates of thromboembolism, heart failure, and death. Catheter ablation modifies the pathogenic mechanism of AF progression.

Assessment and management of asymptomatic atrial fibrillation.

Atrial fibrillation (AF) is the most common sustained cardiac dysrhythmia encountered in practice. It is currently estimated that AF affects approximately 2% of the general population; however, the true prevalence of AF is likely to be at least 3%-4% when asymptomatic AF is considered. For clinically apparent AF, the investigations and management are relatively well established.

Epicardial connections and bi-atrial tachycardias: From anatomy to clinical practice.

Bi-atrial tachycardia (BiAT) is not rare after extensive atrial ablation or cardiac surgery. The complexity of bi-atrial reentrant circuits poses a great challenge for clinical practice. With recent advances in mapping technologies, we are now able to characterize atrial activation in detail.

Procedure-Related Complications of Catheter Ablation for Atrial Fibrillation.

Background: Catheter ablation of atrial fibrillation (AF) is a commonly performed procedure. However, it is associated with potentially significant complications. Reported procedure-related complication rates are highly variable, depending in part on study design.

Approach to atrial fibrillation: Essentials for primary care.

Objective: To support family physicians in preventing atrial fibrillation (AF) in patients at risk and in identifying and managing those with established AF; and to summarize key recommendations for ideal screening and care of patients.

Sources Of Information: The 2020 Canadian Cardiovascular Society and Canadian Heart Rhythm Society comprehensive guidelines for the management of AF, based on current evidence and clinical experience related to AF.

Main Message: Atrial fibrillation, which is estimated to affect at least 500,000 Canadians, is associated with high risks of stroke, heart failure, and death.

Recurrences of Atrial Fibrillation Despite Durable Pulmonary Vein Isolation: The PARTY-PVI Study.

Background: Recurrences of atrial fibrillation (AF) after pulmonary vein isolation (PVI) are mainly due to pulmonary vein reconnection. However, a growing number of patients have AF recurrences despite durable PVI. The optimal ablative strategy for these patients is unknown.