Atrial fibrillation ablation timing: where is the sweet spot?

Convincing evidence for the efficacy of ablation as first-line therapy in paroxysmal AF (PAF) and its clear superiority to medical therapy for rhythm control in both PAF and persistent AF (PsAF) has generated considerable interest in the optimal timing of ablation. Based on this data, there is a widespread view that the principle of 'the earlier the better' should be generally applied. However, the natural history of AF is highly variable and non-linear, and for this reason, it is difficult to be emphatic that all patients are best served by ablation early after their initial AF episodes.

Challenges and strategies for effective recruitment and retention of participants in clinical research studies.

Effective recruitment and retention of participants in clinical research studies are critical to be able to draw meaningful and valid conclusions in research studies. However, there are multiple challenges related to communication, generalizability, and logistics. Researchers must address and overcome these challenges to ensure robust research outcomes.

Patients perspectives on integrating eHealth in regular care pathways for atrial fibrillation: evaluating photoplethysmography for remote self-assessment.

Aims: Smartphone applications for heart rate and rhythm assessment are increasingly used for the management of atrial fibrillation (AF). Although the use of a photoplethysmography (PPG)-based smartphone application with subsequent (tele)consultations for AF management has been proven feasible in the TeleCheck-AF project, specific needs, and expectations of patients with AF are unclear. The aim of this study is to evaluate patients' perspectives on the use of remote PPG-based electronical health (eHealth) integrated in regular care pathways for AF.

Spotlight on the 2024 ESC/EACTS management of atrial fibrillation guidelines: 10 novel key aspects.

Atrial fibrillation (AF) remains the most common cardiac arrhythmia worldwide and is associated with significant morbidity and mortality. The European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) have recently released the 2024 guidelines for the management of AF. This review highlights 10 novel aspects of the ESC/EACTS 2024 Guidelines.

Upstream targeting for the prevention of atrial fibrillation: Targeting Risk Interventions and Metformin for Atrial Fibrillation (TRIM-AF)-rationale and study design.

Background: Despite advances in ablation and other therapies for AF, progression of atrial fibrillation (AF) remains a significant clinical problem, associated with worse prognosis and worse treatment outcomes. Upstream therapies targeting inflammatory or antifibrotic mechanisms have been disappointing in preventing AF progression, but more recently genetic and genomic studies in AF suggest novel cellular and metabolic stress targets, supporting prior studies of lifestyle and risk factor modification (LRFM) for AF. However, while obesity is a significant risk factor, weight loss and risk factor modification have not been successfully applied in a US population with AF.

2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation.

In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017.

Development of a Multivariable Prediction Model to Estimate Probability of Sleep-Disordered-Breathing in Patients With AF: MOODS-AF.

Background: Sleep-disordered breathing (SDB) is common in patients with atrial fibrillation (AF) and negatively impacts treatment outcomes. Optimal tools for AF patient selection for SDB testing are lacking.

Objectives: This study sought to develop and validate a prediction tool to detect patients who have AF with moderate-to-severe SDB.

Comparison of Procedural Outcomes of Lumenless Fixed-Helix Versus Stylet-Driven Extendable-Helix Lead Systems in Left Bundle Branch Pacing: COMPARE LBBP.

Background: Left bundle branch pacing (LBBP) has emerged as a safe and effective alternative to right ventricular pacing. Traditionally, LBBP is performed with lumenless lead (LLL); however, the use of stylet-driven lead (SDL) is on rise. We aimed to assess acute success and procedural outcomes of SDL versus LLL for LBBP.

Association of obesity and metabolic syndrome with incident primary open angle glaucoma in the UK Biobank.

Background: We sought to investigate the association between obesity, metabolic syndrome, and metabolic health with incident primary open-angle glaucoma (POAG).

Methods: We included 103 249 UK Biobank participants without previously diagnosed glaucoma or glaucoma-related procedures at enrolment. The primary outcome was POAG identified from diagnostic coding via linked hospital inpatient and primary care data.

Area-Level Socioeconomic Status Impacts Health Care Visit Frequency by Australian Patients With Inflammatory Arthritis: Results From the Australian Rheumatology Association Database.

Objective: Individuals with inflammatory arthritis require long-term rheumatologist care for optimal outcomes. We sought to determine if socioeconomic status (SES) influences general practitioner (GP) and specialist physician visit frequency and out-of-pocket (OOP) visit costs.

Methods: We linked data from Australian Rheumatology Association Database (ARAD) participants with rheumatoid arthritis or psoriatic arthritis to the Pharmaceutical Benefits (PBS) and Medicare Benefits Schedule from 2011 to 2018.

Managing elderly patients with atrial fibrillation and multimorbidity: call for a systematic approach.

Introduction: Atrial fibrillation (AF) is often accompanied by comorbidities. Not only cardiovascular but also non-cardiovascular comorbidities have been associated with AF. Multimorbidity is therefore a common finding in patients with AF, especially in elderly patients.

Coronary Sinus Isolation for High-Burden Atrial Fibrillation: A Randomized Clinical Trial.

Background: The coronary sinus is an arrhythmogenic structure that can initiate and maintain atrial fibrillation (AF). Coronary sinus ablation has been shown to be effective in prolonging the AF cycle length and terminating AF in patients with both paroxysmal and persistent AF who have persistent AF after pulmonary vein isolation (PVI).

Objectives: The objective of this study was to undertake a randomized controlled trial to investigate the efficacy of coronary sinus isolation (CSI) as an adjunctive ablation strategy for the treatment of high-burden AF.

Research Priorities for Atrial Fibrillation in Australia: A Statement From the Australian Cardiovascular Alliance Clinical Arrhythmia Theme.

Atrial fibrillation (AF) is highly prevalent in the Australian community, ranking amongst the highest globally. The consequences of AF are significant. Stroke, dementia and heart failure risk are increased substantially, hospitalisations are amongst the highest for all cardiovascular causes, and Australians living with AF suffer from substantial symptoms that impact quality of life.