Rhythm Management
Journal Articles: Atrial fibrillation (AF) is the most common cardiac arrhythmia diagnosed and treated in the world. The treatment of patients’ symptoms as well as the prevention of stroke and heart failure is dependent on accurate detection and characterization of AF. A variety of electrocardiographic (ECG) monitoring techniques are being used for these purposes. However, these intermittent ECG monitoring techniques have been shown to underdiagnose AF events while having limited ability to characterize AF burden and density. Continuous long-term implantable loop recorder (ILR)–based ECG monitoring has been designed to overcome these limitations. This technology is being increasingly used to diagnose episodes of AF in high-risk patients and to improve characterization of AF episodes in patients with known AF. This review aims to review the potential clinical utility of ILR-based ECG monitoring while highlighting some inherent limitations of the current technology. An understanding of these limitations is important when considering the use of ILR-based ECG monitoring and clinical decision making based on the information being stored within these devices.
Read MoreEducation – Patient/Caregiver: One-page patient education resource explaining Pulmonary Vein Isolation. Includes procedure, post-procedure, procedural risk, and office follow up.
Read MoreJournal Articles: Background: Pulmonary vein isolation (PVI) using the 2nd-generation cryoballoon (CB2) for the treatment of atrial fibrillation (AF) has demonstrated encouraging acute and mid-term results. However, follow-up data on outcomes beyond 1 year are sparse. We investigated the 3-year outcome after PVI using the CB2. Methods and Results: 100 patients with paroxysmal (PAF, 70/100 [70%] patients) or persistent AF (pAF, 30/100 [30%] patients) underwent CB2-based PVI in 2 experienced centers in Germany. Freeze-cycle duration was 240 s. After successful PVI a bonus freeze-cycle of the same duration was applied in the first 71 patients but was omitted in the following 29 patients. Phrenic nerve palsy occurred in 3 patients (3%); 2 patients were lost to follow-up. After a median follow-up of 38 (29–50) months, 59/98 (60.2%) patients remained in stable sinus rhythm (PAF: 48/70 (69%), pAF: 11/28 (39%) P=0.0084). In 32/39 (77%) patients with arrhythmia recurrence, a second ablation procedure using radiofrequency energy was conducted. Persistent PVI was noted in 76/125 (61%) PVs. After a mean of 1.37±0.6 procedures and a median follow-up of 35 (25–39) months, 77/98 (78.6%) patients remained in stable sinus rhythm (PAF: 56/70 (80%), pAF: 20/28 (71%), P=0.0276). Conclusions: CB2-based PVI resulted in a 60.2% single-procedure and a 78.6% multiple-procedure success rate after 3 years. Repeat procedures demonstrated a high rate of durable PVI.
Read MoreJournal Articles: Pulmonary vein isolation (PVI) is an effective strategy for patients with paroxysmal atrial fibrillation (AF).1 However, in patients with persistent AF and long-standing persistent AF, PVI is associated with limited success, with patients not responding to PVI.2 Recently, the BELIEF trial (Effect of Empirical Left Atrial Appendage Isolation on Long-term Procedure Outcome in Patients With Persistent or Longstanding Persistent Atrial Fibrillation Undergoing Catheter Ablation) showed that an electric isolation of the left atrial (LA) appendage (LAA) in addition to PVI could increase clinical success.3 Although potentially effective, this strategy causes electromechanical dissociation of the LAA and was assumed to be associated with increased risk for LAA thrombus and thromboembolism.4 We sought to investigate the incidence of LAA thrombus and thromboembolism and the impact of LAA closure on the prevention of thromboembolic events, in addition to the clinical benefit after left atrial appendage isolation (LAAI).
Read MoreOrder Sets: ED AF <48h Protocol
Read MoreOrder Sets: ED AF >48h/Unknown Duration Protocol
Read MoreCare Pathways/CDS: Care pathway and decision support tool for use in the outpatient management of AFib patients. Includes when to consider early consultation, AV nodal blocking therapies, modifiable risk factors, and need for anti-coagulation.
Read MoreCare Pathways/CDS: Care pathway and decision support tool for use in the emergency department when patient presents with ECG-confirmed AFib. Includes pathway exclusion criteria and link to full guideline.
Read MoreCare Pathways/CDS: A Multidisciplinary Approach to Managing Patients with AFib in the Emergency Department
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