Atrial Fibrillation
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 MoreData/Registries: Aims: Oesophageal fistula represents a rare but dreadful complication of atrial fibrillation catheter ablation. Data on its incidence, management, and outcome are sparse. Methods and results: This international multicentre registry investigates the characteristics of oesophageal fistulae after treatment of atrial fibrillation by catheter ablation. A total of 553 729 catheter ablation procedures (radiofrequency: 62.9%, cryoballoon: 36.2%, other modalities: 0.9%) were performed, at 214 centres in 35 countries. In 78 centres 138 patients [0.025%, radiofrequency: 0.038%, cryoballoon: 0.0015% (P < 0.0001)] were diagnosed with an oesophageal fistula. Peri-procedural data were available for 118 patients (85.5%). Following catheter ablation, the median time to symptoms and the median time to diagnosis were 18 (7.75, 25; range: 0–60) days and 21 (15, 29.5; range: 2–63) days, respectively. The median time from symptom onset to oesophageal fistula diagnosis was 3 (1, 9; range: 0–42) days. The most common initial symptom was fever (59.3%). The diagnosis was established by chest computed tomography in 80.2% of patients. Oesophageal surgery was performed in 47.4% and direct endoscopic treatment in 19.8% and conservative treatment in 32.8% of patients. The overall mortality was 65.8%. Mortality following surgical (51.9%) or endoscopic treatment (56.5%) was significantly lower as compared to conservative management (89.5%) [odds ratio 7.463 (2.414, 23.072) P < 0.001]. Conclusion: Oesophageal fistula after catheter ablation of atrial fibrillation is rare and occurs mostly with the use of radiofrequency energyrather than cryoenergy. Mortality without surgical or endoscopic intervention is exceedingly high.
Read MorePulsed‑field ablation—are we ready for fast and furious atrial tachycardia ablation?
Read MoreGuidelines/Clinical Documents: Exclusion of the left atrial appendage to reduce thromboembolic risk related to atrial fibrillation was first performed surgically in 1949. Over the past 2 decades, the field of transcatheter endovascular left atrial appendage closure (LAAC) has rapidly expanded, with a myriad of devices approved or in clinical development. The number of LAAC procedures performed in the United States and worldwide has increased exponentially since the Food and Drug Administration approval of the WATCHMAN (Boston Scientific) device in 2015. The Society for Cardiovascular Angiography & Interventions (SCAI) has previously published statements in 2015 and 2016 providing societal overview of the technology and institutional and operator requirements for LAAC. Since then, results from several important clinical trials and registries have been published, technical expertise and clinical practice have matured over time, and the device and imaging technologies have evolved. Therefore, SCAI prioritized the development of an updated consensus statement to provide recommendations on contemporary, evidence-based best practices for transcatheter LAAC focusing on endovascular devices. (J Am Coll Cardiol Intv 2023;16:1384–1400) © 2023 Society for Cardiovascular Angiography and Interventions Foundation, Heart Rhythm Society and American College of Cardiology, published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Read MoreCare Pathways/CDS: Care pathway for patient visit related to AFib. Includes an overall AF management pathway, outpatient medication recommendations, and a CHA2DS2-VASc and a HAS-BLED decision support tool.
Read MoreGuidelines/Clinical Documents: Clinical research article from the European Society of Cardiology outlining the INDI-FREEZE trial, a prospective randomized trial aiming at assessing the acute efficacy and clinical outcome of an individualized vs. a fixed ablation protocol using the fourth-generation CB guided by PV potential recordings and CB temperature.
Read MoreEducation – Patient/Caregiver: One-page patient education resource explaining Pulmonary Vein Isolation. Includes procedure, post-procedure, procedural risk, and office follow up.
Read MoreEducation – Patient/Caregiver: Two-page patient education resources about LAAC. Includes information about the procedure, risk factors, and post-procedure instructions.
Read MoreEducation – Patient/Caregiver: Extensive collection of patient education sheets for 17 different medications used for anticoagulation, rate control, and rhythm control. Each sheet includes how to take the medication, potential interactions, side effects, and warnings.
Read MoreEducation – Patient/Caregiver: CHA2DS2-VASc and Your Risk of Stroke
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