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Objectives: The relationship between left atrial (LA) size and atrial fibrillation (AF) is well-established. However, the specifics of LA regional remodeling and its connection to left atrial tachycardia (LA-AT) post-ablation in patients with non-paroxysmal AF are less understood. This study aims to explore how LA dimensions are related to the development of LA-AT following AF ablation procedures in these patients. Methods: This study focused on 73 patients with non-paroxysmal atrial fibrillation (average age 52, predominantly male, with a nearly even split between persistent and long-lasting persistent AF), all undergoing their first catheter ablation for AF. Prior to the ablation, left atrial dimensions were determined through computed tomography, measuring the maximal transverse, anteroposterior, and superoinferior diameters. Results: Over an average follow-up period of 23 months, 31.5% of the patients (Group 1) experienced left atrial tachycardia (LA-AT) that required a second linear ablation procedure. This group had significantly larger left atrial (LA) dimensions in terms of transverse, anteroposterior, and superoinferior measurements compared to the other group (Group 2). However, the recurrence of atrial fibrillation (AF) was not linked to any specific LA diameter. The anteroposterior diameter was identified as a significant predictor (p=0.002, HR 2.3, 95% CI 1.3-3.8) for LA-AT occurrence through multivariate analysis. Conclusions: Eccentric dilatation involving the anteroposterior diameter is a significant predictor for the occurrence of LA-AT in patients with non-paroxysmal AF after catheter ablation. Keywords Atrial fibrillation; Atrial flutter; Atrial tachycardia; Left atrial diameter; Catheter ablation; Computed tomography

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults. Valvular heart diseases (VHD), regardless of the arrhythmic problems, increase the risk of thromboembolism, which are even higher in those with associated atrial fibrillation. The EHRA (Evaluated Heartvalves, Rheumatic or Artificial) classification categorised AF patients with significant VHD into type 1 and type 2. Unfortunately, there are currently very limited data on risk prediction in stroke-related valvular AF, particularly in the Asian population. Aims: To investigate the clinical and echocardiographic risk factors for ischaemic stroke prediction in patients with EHRA type 2 VHD. Methods: This retrospective study enrolled 695 AF patients with EHRA type 2 VHD. The data were collected from patients' medical records who met the inclusion and exclusion criteria from 2015 until 2020. The primary outcome was ischaemic strokes within observation period. Results: There were 67 ischaemic stroke events (9,6%) of the total sample. Our analysis found that none of the analysed variables proved to be statistically significant risk factors in predicting the occurrence of ischaemic stroke. The median CHA2DS2-VASc risk prediction in the sample was 3, with an accuracy of AUC 0.502 (CI 95%; 0.429 – 0.576), sensitivity 56.7% and specificity 44.7%. Conclusion: Based on the parameters analysed in this study, no factor was statistically well-predictive to predict the ischaemic stroke incidence in EHRA type 2 VHD AF. In addition, the CHA2DS2-VAS accuracy was low in this population. Further exploration is needed to build an accurate ischaemic stroke risk prediction for EHRA type 2 VHD.

Purpose Dabigatran is a direct thrombin inhibitor approved for stroke prophylaxis in patients with non-valvular atrial fibrillation (NVAF). Real-world data about patient preference, satisfaction and convenience in patients in Asia are not available. The study aimed to explore the perception of patients with newly diagnosed NVAF regarding dabigatran versus vitamin K antagonists (VKAs), when used for stroke prevention.Patients and methods This was a multinational, multicentre, non-interventional study involving 49 sites across 5 countries in South East Asia and South Korea where 934 patients newly diagnosed with NVAF were initiated on either dabigatran (N=591) or VKA (N=343). Data were collected at baseline and over two follow-up visits across 6 months. Treatment satisfaction and patient convenience were evaluated using the Perception on Anticoagulant Treatment Questionnaire-2 (PACT-Q2).Results The mean age of the patients was 65.9±10.4 years, and 64.2% were male. Mean CHA2DS2-VASc score was 2.4±1.5, and mean HAS-BLED score was 1.2±0.9. At baseline, patients initiated on dabigatran had higher stroke risk, bleeding risk, creatinine clearance and proportion of patients with concomitant illnesses compared with patients initiated on VKAs. Treatment convenience was perceived to be significantly better with dabigatran versus VKAs at visits 2 and 3 (p=0.0423 and 0.0287, respectively). Treatment satisfaction was significantly better with dabigatran compared with VKAs at visit 3 (p=0.0300).Conclusion In this study, dabigatran is associated with better patient perception in terms of treatment convenience and satisfaction compared with VKAs when used for stroke prevention in newly diagnosed NVAF patients from South East Asia and South Korea.Trial registration number NCT02849509.Plain language summary Patient satisfaction with dabigatran versus VKAs in South East Asia. Patients with atrial fibrillation are at high risk of stroke and require anticoagulants for stroke prevention. Two such anticoagulants are dabigatran and VKAs. We wanted to compare the extent of satisfaction and treatment convenience among newly diagnosed patients with atrial fibrillation from the South East Asian region when they were given either dabigatran or VKAs. Consenting patients filled out a standardised questionnaire called the PACT-Q2 over three visits after they were started on either dabigatran (591 patients) or VKAs (343 patients). We found that satisfaction and convenience were significantly higher when patients received dabigatran than when they received VKAs.

Background and purpose Real-world data about treatment convenience and satisfaction in Asian non-valvular atrial fibrillation (NVAF) patients after switching from vitamin K antagonists (VKAs) to non-VKA oral anticoagulants were evaluated.Methods In this non-interventional study involving 49 sites across five countries in Southeast Asia and South Korea, 379 stable NVAF patients who switched from VKA therapy to dabigatran during routine clinical practice were recruited and followed up for 6 months. Treatment convenience and satisfaction were evaluated using Perception on Anticoagulant Treatment Questionnaire-2 (PACT-Q2). Through post hoc analysis, factors associated with improved treatment convenience scores at visit 2 were described.Results Treatment convenience and satisfaction significantly improved after switching from VKAs to dabigatran at visit 2 and visit 3 (convenience: p80th percentile) response on treatment convenience were female sex, younger age (

Latar Belakang: Fibrilasi atrium (FA) merupakan aritmia yang paling sering ditemukan. Fibrilasi atrium membutuhkan adanya pemicu untuk inisiasi dan substrat untuk mempertahankan aritmia. Fokus tunggal atau multipel sebagai pemicu, paling sering di vena pulmonal tetapi dapat juga berasal dari selain vena pulmonal, seperti di vena kava superior. Patofisiologi aritmia di vena kava superior masih belum dapat dipahami. Ilustrasi Kasus: Seorang perempuan, 72 tahun, datang ke poliklinik Pusat Jantung Nasional Harapan Kita (PJNHK) dengan keluhan utama sering berdebar-debar. Pasien pertama kali mengeluh berdebar-debar pada tahun 2000, namun baru pada tahun 2007 pasien melakukan pemeriksaan dan terapi dengan obat-obatan serta dilakukan tindakan ablasi FA. Pada tahun 2010, pasien mengeluh berdebar-debar kembali dan dapat dikontrol dengan terapi medikamentosa. Pada tahun 2016, pasien menjalani tindakan ablasi kedua dengan hasil berhasil dilakukan isolasi vena pulmonal dan angiografi koroner memperlihatkan arteri koroner normal. Pasien sempat datang ke UGD PJNHK bulan Mei 2017 dengan keluhan berdebar dan hasil pemeriksaan EKG saat di UGD menunjukkan irama FA. Dilakukan tindakan ablasi ketiga dengan hasil berhasil dilakukan isolasi vena kava superior. Kesimpulan: Vena kava superior dapat berperan sebagai pemicu atau substrat fibrilasi atrium. Sebagai fokus, selain vena pulmonal, yang paling sering menjadi sumber fibrilasi atrium, vena kava superior menjadi target penting saat tindakan ablasi fibrilasi atrium.

Background : Brugada syndrome is an inherited disease characterized by an increased risk of sudden cardiac death owing to ventricular arrhythmias in the absence of structural heart disease. It has been reported that this syndrome is more prevalent in South-East Asia than in Western countries. Furthermore, genetic studies showed important contributions of several gene mutations to the phenotype of BrS. These suggest that ethnic difference play significant roles in the pathogenesis of BrS. In addition, ICD implantation remains the cornerstone management with a low rate of appropriate shocked. Therefore, it is important to investigate patients’ characteristics for risk stratification. Our objective to investigate the clinical, electrocardiography (ECG) and electrophysiological characteristics that can be used as predictor of appropriate shock due to ventricular arrhythmia (VA) in Indonesian patients with BrS. Methods : We analyse data from Brugada syndrome registry at National Cardiovascular Centre Harapan Kita since January 2013. Total 22 patients were included. Characteristics of BrS that we analysed were baseline characteristics (age and sex), Clinical finding (syncope, cardiac arrest), ECG finding (spontaneous type 1 or drug induced) and Electrophysiology study result (inducible VA and RV ERP). We also added some new ECG characteristic (S wave in lead 1, S wave duration in V1, Fragmented QRS, Junction ST elevation and early repolarization pattern in infero-lateral) to be analysed. Our end point are appropriate shock during ICD interrogation for those who have been implanted an ICD, and documented VA for those who didn’t receive ICD. Result : We found high incidence of appropriate ICD’s shock in our population (50% in our study vs 5-11.5% in real world). Predictors of appropriate shock and documented VA are history of syncope (p = 0.045; OR 2.57 [1.44-4.59]), spontaneous type-1 ECG (p = 0.005) and right ventricular effective refractory period (RV ERP) of