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We present a case of persistent complete atrioventricular block that occurred during the diagnostic portion of a premature ventricular contractions’ radiofrequency ablation in a complex heart failure patient. The case was managed by bailout deep left ventricular septal pacing after bipolar radiofrequency elimination of premature ventricular contractions.

Introduction: Obesity, a known risk factor for atrial fibrillation (AF), is potentially reversible through lifestyle changes, including diet and physical activity. However, lack of compliance is a major obstacle in attaining sustained weight loss. We investigated the impact of patient engagement using a digital monitoring system on compliance for lifestyle-change measures and subsequent outcome. Methods: A total of 105 consecutive patients with coexistent AF and obesity (body mass index ≥28) were classified into 2 groups based on the monitoring method: group 1, use of digital platform (n = 20); group 2, conventional method (n = 85). Group 1 used the RFMx digital monitoring platform (smartphone app) that sets weekly goals for exercise and weight loss, tracks patient compliance data continuously, and sends regular text reminders. Conventional method included monitoring patients’ adherence to diet and change in weight during in-person clinic visits or monthly phone calls from staff. Results: Baseline characteristics of groups 1 and 2 were comparable. At 6 months of follow-up, 12 (60%) and 28 (33%) from group 1 and 2, respectively, were compliant with the physician instructions regarding diet and exercise (P = .025). Weight loss was observed in 9 of 12 (75%) from group 1 and 11 of 28 (39%) from group 2 (P = .038) and mean reduction in weight was 9.9 ± 8.9 lb and 4.0 ± 2.1 lb (P = .042). Conclusion: In this series, continuous digital monitoring was seen to be associated with significant improvement in compliance through better patient engagement, resulting in more weight loss compared to the conventional method.

Atrial fibrillation (AF) is the most common clinical arrhythmia, and it results in adverse outcomes and increased healthcare costs. Racial and ethnic differences in AF management, although recognized, are poorly understood. This review summarizes racial differences in AF epidemiology, genetics, clinical presentation, and management. In addition, it highlights the underrepresentation of racial and ethnic populations in AF clinical trials, especially trials focused on stroke prevention. Specific strategies are proposed for future research and initiatives that have potential to eliminate racial and ethnic differences in the care of patients with AF. Addressing racial and ethnic disparities in healthcare access, enrollment in clinical trials, resource allocation, prevention, and management will likely narrow the gaps in the care and outcomes of racial and ethnic minorities suffering from AF. Résumé: La fibrillation auriculaire (FA) est la forme clinique d’arythmie la plus fréquente, et elle entraîne des résultats défavorables ainsi qu’une augmentation du coût des soins de santé. Les différences liées à la race et à l’origine ethnique qui existent dans la prise en charge de la FA, bien que reconnues, sont mal comprises. Le présent article de synthèse résume les différences liées à la race observées sur le plan de l’épidémiologie, de la génétique, du tableau clinique et de la prise en charge de la FA. En outre, il met en lumière la sous-représentation de groupes raciaux et ethniques dans les études cliniques sur la FA, en particulier celles axées sur la prévention des accidents vasculaires cérébraux. Des stratégies ad hoc sont proposées pour que la recherche et les initiatives futures favorisent l’éradication des différences liées à la race et à l’origine ethnique dans les soins prodigués aux patients atteints de FA. Le fait de s’attaquer aux disparités liées à la race et à l’origine ethnique qui touchent l’accès aux soins de santé, l’inscription aux essais cliniques, l’allocation des ressources, la prévention et la prise en charge des patients permettra probablement de réduire les lacunes en matière de soins et de résultats chez les personnes atteintes de FA issues de minorités raciales et ethniques.

Background We evaluated long‐term outcome of isolation of pulmonary veins, left atrial posterior wall, and superior vena cava, including time to recurrence and prevalent triggering foci at repeat ablation in patients with paroxysmal atrial fibrillation with or without cardiovascular comorbidities. Methods and Results A total of 1633 consecutive patients with paroxysmal atrial fibrillation that were arrhythmia‐free for 2 years following the index ablation were classified into: group 1 (without comorbidities); n=692 and group 2 (with comorbidities); n=941. We excluded patients with documented ablation of areas other than pulmonary veins, the left atrial posterior wall, and the superior vena cava at the index procedure. At 10 years after an average of 1.2 procedures, 215 (31%) and 480 (51%) patients had recurrence with median time to recurrence being 7.4 (interquartile interval [IQI] 4.3–8.5) and 5.6 (IQI 3.8–8.3) years in group 1 and 2, respectively. A total of 201 (93.5%) and 456 (95%) patients from group 1 and 2 underwent redo ablation; 147/201 and 414/456 received left atrial appendage and coronary sinus isolation and 54/201 and 42/456 had left atrial lines and flutter ablation. At 2 years after the redo, 134 (91.1%) and 391 (94.4%) patients from group 1 and 2 receiving left atrial appendage/coronary sinus isolation remained arrhythmia‐free whereas sinus rhythm was maintained in 4 (7.4%) and 3 (7.1%) patients in respective groups undergoing empirical lines and flutter ablation (P

Background We compared the cognitive status and quality of life in patients with atrial fibrillation undergoing left atrial appendage occlusion (LAAO) or remaining on oral anticoagulation (OAC) after atrial fibrillation ablation. Methods and Results Cognition was assessed by the Montreal Cognitive Assessment (MoCA) survey at baseline and follow‐up. Consecutive patients receiving LAAO or OAC after atrial fibrillation ablation were screened, and patients with a score of ≤17 were excluded from the study. Quality of life was measured at baseline and 1 year using the Atrial Fibrillation Effect on Quality of Life survey. A total of 50 patients (CHA2DS2‐VASc [congestive heart failure, hypertension, age≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65–74 years, sex category] score: 3.30±1.43) in the LAAO group and 48 (CHA2DS2‐VASc score 2.73±1.25) in the OAC group were included in this prospective study. Mean baseline MoCA score was 26.18 and 26.08 in the LAAO and OAC groups, respectively (P=0.846). At 1 year, scores were 26.94 and 23.38 in the respective groups. MoCA score decreased by an estimated −2.74 (95% CI, −3.61 to −1.87; P

Although pharmacological rhythm control of AF in patients with heart failure with reduced ejection fraction (HFrEF) does not seem to provide any benefit over rate control, catheter ablation of AF has been shown to improve clinical outcomes. These results can be explained with higher success rates of catheter ablation in restoring and maintaining sinus rhythm compared with antiarrhythmic drugs. In addition, pharmacotherapy is not void of side-effects, which are thought to offset its potential antiarrhythmic benefits. Therefore, efforts should be made towards optimisation of ablation techniques for AF in patients with HFrEF.

A recent surveillance analysis indicates that cardiac arrest/death occurs in ≈1:50,000 professional or semi-professional athletes, and the most common cause is attributable to life-threatening ventricular arrhythmias (VAs). It is critically important to diagnose any inherited/acquired cardiac disease, including coronary artery disease, since it frequently represents the arrhythmogenic substrate in a substantial part of the athletes presenting with major VAs. New insights indicate that athletes develop a specific electro-anatomical remodeling, with peculiar anatomic distribution and VAs patterns. However, because of the scarcity of clinical data concerning the natural history of VAs in sports performers, there are no dedicated recommendations for VA ablation. The treatment remains at the mercy of several individual factors, including the type of VA, the athlete’s age, and the operator’s expertise. With the present review, we aimed to illustrate the prevalence, electrocardiographic (ECG) features, and imaging correlations of the most common VAs in athletes, focusing on etiology, outcomes, and sports eligibility after catheter ablation.

BACKGROUND: More than 35 million people in developing countries are living with HIV infection. An enormous global effort is now underway to bring antiretroviral treatment to at least 3 million of those infected. While drug prices have dropped considerably, the cost and technical complexity of laboratory tests essential for the management of HIV disease, such as CD4 cell counts, remain prohibitive. New, simple, and affordable methods for measuring CD4 cells that can be implemented in resource-scarce settings are urgently needed. METHODS AND FINDINGS: Here we describe the development of a prototype for a simple, rapid, and affordable method for counting CD4 lymphocytes. Microliter volumes of blood without further sample preparation are stained with fluorescent antibodies, captured on a membrane within a miniaturized flow cell and imaged through microscope optics with the type of charge-coupled device developed for digital camera technology. An associated computer algorithm converts the raw digital image into absolute CD4 counts and CD4 percentages in real time. The accuracy of this prototype system was validated through testing in the United States and Botswana, and showed close agreement with standard flow cytometry (r = 0.95) over a range of absolute CD4 counts, and the ability to discriminate clinically relevant CD4 count thresholds with high sensitivity and specificity. CONCLUSION: Advances in the adaptation of new technologies to biomedical detection systems, such as the one described here, promise to make complex diagnostics for HIV and other infectious diseases a practical global reality.