Introduction
The presence of low‐voltage zones (LVZs) in the left atrium (LA) is associated with the recurrence of atrial fibrillation (AF) following pulmonary vein isolation (PVI). However, there is ...variability and conflict in the data regarding predictors of LVZs as reported in previous studies. The objective of this study was to identify predictors for the presence of LVZs in a cohort of patients with persistent AF.
Methods
The study prospectively enrolled 439 patients with persistent AF who were scheduled for ablation. Voltage map of the LA was collected using a multipolar catheter. An LVZ was defined as an area of ≥3 cm2 exhibiting a peak‐to‐peak bipolar voltage of <0.5 mV.
Results
The mean age of the cohort was 65.3 ± 8.6 years and 26.4% were female. Additionally, 25.7% had significant LVZs, most frequently located in the anterior wall of the LA. Multivariable analysis identified the following independent predictors for LVZ: advanced age (OR odds ratio = 1.08, 95% CI confidence interval = 1.03–1.13, p = .002); female sex (OR = 4.83, 95% CI = 2.66–8.76, p < .001); coronary artery disease (CAD) (OR = 3.20, 95% CI = 1.32–7.77, p = .01) and enlarged LA diameter (OR = 1.10, 95% CI = 1.04–1.17, p = .001). The area under the curve (AUC) of the receiver operating characteristic (ROC) curve for the final model was 0.829.
Conclusion
Approximately 25% of the patients with persistent AF had LVZs. Advanced age, female sex, CAD, and a larger LA were independent predictors for LVZs with the model demonstrating a very good AUC for the ROC curve. These findings hold the potential to be used to tailor the ablation procedure for the individual patient.
Voltage mapping of 439 patients with persistent atrial fibrillation undergoing their first‐time ablation procedure. Independent predictors for low‐voltage zones found were advanced age, female sex, coronary artery disease, and an enlarged left atrium.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Background
Intracardiac echocardiography (ICE) is frequently used to guide electrophysiology procedures. The novel automated algorithm Cartosoundfam is a model‐based algorithm which reconstructs a 3D ...anatomy of the left atrium (LA) based on a set of 2D intracardiac echocardiography (ICE) frames, without the need to manually annotate ultrasound (US) contours.
Objective
The aim of this study was to determine the feasibility of the Cartosoundfam module in routine clinical setting.
Methods
We included 16 patients undergoing LA mapping/catheter ablation. Two‐dimensional US frames were acquired from the right atrium (RA) and the right ventricular outflow tract. The Cartosoundfam map was validated in two steps: (1) identification of anatomical structures (pulmonary veins PV and LA body and appendage) by alignment of the ablation catheter to the automated map; and (2) analysis of the automated lesion tags (Visitag) location in relation to the PV antrum of the Cartosoundfam map in nine patients with paroxysmal atrial fibrillation (AF) undergoing first time pulmonary vein isolation (PVI).
Results
Mean 2D US frames per patient were 29 ± 6 and acquisition time was 16 ± 4 min. All anatomical structures were correctly identified in all patients (step 1). In the step 2 validation, the median distance to the map was 2.0 (IQR: 2.4) mm and the majority of the Visitags were classified as satisfactory (69%) but all PV segments had some Visitags classified as unsatisfactory.
Conclusion
The automated ICE‐based algorithm correctly identified the LA anatomical structures in all patients with a 69% anatomical accuracy of the Visitags alignments to the PV antrum segments.
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BFBNIB, DOBA, FSPLJ, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Aims
This study evaluates the incidence of procedural complications related to catheter ablation of atrial fibrillation (AF) to assess the potential feasibility and safety of same‐day discharge in a ...large cohort.
Methods
We performed an analysis of prospectively collected data of complications of all patients staying overnight after undergoing AF ablation between 2001 and 2020 at a tertiary center. Using medical records, we analyzed complications occurring intraprocedurally until 6 h postablation and between 6 h postablation and discharge the day after the ablation procedure.
Results
In 5414 AF ablations, we identified a total of 108 (2.0%) major complications occurring intraprocedural or before discharge. Most major complications occurred intraprocedurally or within 6 h after the procedure (n = 96, 1.8%). Twelve (0.2%) major complications occurred between 6 h Postablation and discharge. The most common of these major complications were congestive heart failure (n = 6) and transient ischemic attack (TIA, n = 4). During this time span, 61 (1.1%) minor complications occurred. Factors independently associated with major complications intraprocedurally and until discharge were body mass index (BMI) ≥ 30 kg/m2 (p = .009), significant valvular disease (p = .001), cardiomyopathy (p < .001), prior stroke or TIA (p = .014), first‐time procedure versus repeat procedure (p = .013), cryoablation versus radiofrequency (p < .001), and procedure duration (p < .001).
Conclusion
After AF ablation, very few complications occurred between 6 h postprocedure and discharge the next day. Therefore, same‐day discharge is a safe option for a majority of patients.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Aims
To investigate the significance of early recurrence (ER) of atrial tachyarrhythmias after pulmonary vein isolation (PVI) on the development of late recurrence (LR) and to redefine the blanking ...period during which an ER is considered nonspecific.
Methods
Data of 713 patients undergoing their first PVI for paroxysmal or persistent atrial fibrillation between January 2012 and December 2017 were included. All patients were followed‐up for 12 months according to clinical and outpatient routine and were screened for any atrial tachyarrhythmia lasting >30 seconds occurring during the first 3 months postablation (ER) and after the 3 months blanking period (LR).
Results
Patients with ER compared to those without ER had significantly more LR (74.5% vs 16.5% vs, P < .001). The occurrence of ER during the first, second and third months showed increasing LR rates of 35.2%, 67.9%, and 94.8%, respectively (P < .001). Receiver operator characteristic analysis revealed a blanking period of 46 days with the highest sensitivity (68.1%) and specificity (96.5%). Later timing and longer time span of ER were independent predictors for LR in multivariable analysis.
Conclusion
ER is a strong predictor for LR. Our study advocates a shortening of the post‐PVI blanking period followed by a “gray zone” up to 3 months where individualized therapeutic decisions based on additional risk factors should be considered. We suggest that the ER time span might serve as such a predictor identifying patients at the highest risk for LR.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Atrial Tachycardia Incidence After RF versus Cryoballoon PVI
Background
Postablation atrial tachycardia (AT) is a significant complication following radiofrequency (RF) pulmonary vein isolation ...(PVI). Cryoballoon (CB) ablation is an alternative technique for PVI that appears to have a low incidence of AT. No direct comparison between AT risk in RF and CB ablation has been made.
Objective
To compare the incidence and characteristics of ATs after PVI with RF and with CB ablation in patients with paroxysmal atrial fibrillation (AF).
Methods
All patients who underwent their first PVI between January 2006 and September 2012 using either RF or CB ablation were included. When a repeat ablation procedure for AT was performed, the arrhythmia was classified as typical cavotricuspid isthmus (CTI) flutter or left atrial tachycardia (LA‐AT) based on invasive mapping procedure findings and ECG P‐wave morphology.
Results
The study population consisted of 415 and 215 consecutive patients in the RF and CB groups, respectively. After a mean follow‐up of 38 ± 21 months, 52 (8.3%) patients presented ATs (9.4% and 6% in the RF and CB groups, respectively; P = 0.15). Of those, 26 (4.1%) were classified as LA‐AT with 20 (4.8%) in the RF group and 6 (2.8%) in the CB group (P = 0.23). In patients without a history of typical CTI flutter or CTI line (n = 458), the incidence for this type of arrhythmia during follow‐up was 3.5%.
Conclusion
In patients with paroxysmal AF undergoing either RF or CB PVI as the sole ablation strategy, the incidence of postprocedural AT was low and there was no significant difference between the 2 techniques.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Background:
Total sleep deprivation (TSD) combined with bright light therapy (BLT) has been suggested as a valuable add-on to standard treatment for rapid relief of depression. However, there is a ...lack of randomized controlled trials in real-life clinical settings. The aim of this pragmatic randomized clinical trial was to investigate the effectiveness, acceptance, and feasibility of TSD combined with BLT as add-on to standard treatment for depression in a real-life clinical setting.
Methods:
Thirty-three inpatients were randomly assigned to either: a) an intervention group receiving a single-night TSD followed by 6 days BLT (10.000 lux, 30 min/day) as add-on to standard treatment; or b) a control group receiving a short sleep-hygiene consultation in addition to standard treatment. The follow-up period was 1 week.
Results:
No statistical differences were found in response rates, reduction of depressive and insomnia symptoms, length of stay, readmission rate, and clinical improvement. Both groups reported positive experiences toward the received treatment with low drop-out rates.
Conclusions:
One-night TSD followed by BLT was not effective as a rapid relief for depression at 1-week follow-up; however, the treatment was feasible and well-tolerated.
Abstract Background The combined impact of multiple lifestyle factors on risk of atrial fibrillation (AF) remains unclear. We investigated the joint association of four modifiable lifestyle factors ...on incidence of AF in a prospective study of men and women. Methods The study cohort comprised 39 300 men in the Cohort of Swedish Men and 33 090 women in the Swedish Mammography Cohort who were 45–83 years of age and free from atrial fibrillation at baseline. Healthy lifestyle was defined as body mass index < 25 kg/m2 , regular exercise for ≥ 20 min/day, no or light-to-moderate alcohol consumption (≤ 2 drinks/day for men and ≤ 1 drink/day for women), and not smoking. Incident AF cases were identified through linkage with the Swedish National Inpatient Register. Results During a mean follow-up of 10.9 years, AF occurred in 4028 men and 2539 women. Compared with men and women with no healthy lifestyle factors, the multivariable relative risks (95% confidence interval) of AF were 0.83 (0.65–1.07) for one, 0.74 (0.58–0.94) for two, 0.62 (0.49–0.79) for three, and 0.50 (0.39–0.64) for four healthy lifestyle factors ( P for trend < 0.0001). The inverse association was similar in men and women. Conclusions Four healthy lifestyle factors combined were associated with a halving of the risk of AF.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
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