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Background Approximately 90% of intracardial thrombi originate from the left atrial appendage in non-valvular atrial fbrillation patients. Even with anticoagulant therapy, left atrial appendage thrombus (LAAT) still occurs in 8% of patients. While left atrial appendage closure (LAAC) could be a promising alternative, the current consensus considers LAAT a contraindication to LAAC. However, the feasibility and safety of LAAC in patients with LAAT have yet to be determined. Methods This systematic review synthesizes published data to explore the feasibility and safety of LAAC for patients with LAAT. Results This study included a total of 136 patients with LAATs who underwent successful LAAC. The Amulet Amplatzer device was the most frequently utilized device (48.5%). Among these patients, 77 (56.6%) had absolute contraindications to anticoagulation therapy. Cerebral protection devices were utilized by 47 patients (34.6%). Transesophageal echocardiography (TEE) is the primary imaging technique used during the procedure. Warfarin and novel oral anticoagulants were the main anticoagulant medications used prior to the procedure, while dual antiplatelet therapy was primarily used post-procedure. During a mean follow-up period of 13.2±11.5 months, there was 1 case of fatality, 1 case of stroke, 3 major bleeding events, 3 instances of device-related thrombus, and 8 cases of peri-device leakage. Conclusions This review highlights the preliminary efectiveness and safety of the LAAC procedure in patients with persistent LAAT. Future large-scale RCTs with varied LAAT characteristics and LAAC device types are essential for evidence-based decision-making in clinical practice. [ABSTRACT FROM AUTHOR]

Background and aimsRight phrenic nerve palsy is the most frequent complication of cryoballoon procedures. The SMARTFREEZE™ console (Boston Scientific, St. Paul, MN, USA) has integrated a new tool for diaphragm monitoring—the Diaphragm Movement Sensor; however, it has not been evaluated in clinical practice. We aimed to assess the diagnostic performance of the Diaphragm Movement Sensor based on compound motor action potential data recorded simultaneously.MethodsThirty consecutive patients (mean age 63.2 ± 10.2 years) were included. We simultaneously recorded the compound motor action potential and the Diaphragm Movement Sensor during cryoapplications in the right pulmonary veins. The right phrenic nerve was paced at 60 per minute, 12 V and 2.9 ms. Compound motor action potential monitoring with a 30% decrease cutoff for the diagnosis of phrenic nerve threatening was considered the gold standard. The Diaphragm Movement Sensor decrease threshold was also set at 30%.ResultsConsidering compound motor action potential monitoring, phrenic nerve threatening occurred 11 times (in seven patients) among 84 cryoapplications (13.1%) at the right pulmonary veins. The sensitivity and specificity of the Diaphragm Movement Sensor were, respectively, 33% (95% CI: 7%–70%) and 49% (95% CI: 38%–61%; P

Most published studies have aimed to compare the effectiveness of different treatment strategies for atrial fibrillation (AF), while few articles have comprehensively compared the safety of therapeutic measures.The aim of the article was to assess the safety of different therapeutic measures (different ablation techniques, antiarrhythmic drugs and surgery) in patients with AF. A comprehensive and systematic search was undertaken across various databases, namely PubMed, Embase, Cochrane Library, and Web of Science, with the aim of identifying pertinent randomized controlled trials (RCTs) that delve into the safety aspects of diverse atrial fibrillation treatment strategies. The search was conducted up until December 1st, 2023. R4.2.3 software gemtc package was used for data analysis, Review Manager 5.3 was used for quality assessment of included studies, and stata15.0 was used for publication bias.Safety is defined as the adverse outcomes that occur in different treatment strategies for atrial fibrillation, with specific adverse events as described below. 22 RCTs (involving 5073 subjects) with interventions including cryoballoon ablation (CA), radiofrequency ablation (RF), laser balloon ablation (LB), pulmonary vein ablation catheter (PVAC), antiarrhythmic drugs (AADS), and surgery (SA) were included in this study. In this article, medication and surgery were combined into the same intervention (non-traditional treatment measure, UT). UT was not associated with pericardial effusion (OR:4.27e-10, 95%CI:4.91e-30–0.0663), infections (OR:0.248, 95%CI:0.0584–0.89), arrhythmias (OR:0.609,95%CI:0.393–0.936), pseudoaneurysms (OR:5.57e-10, 95%CI:1.16e-31–0.934) and pulmonary vein stenosis (OR:1.16e-09, 95%CI:6.56e-24–0.194). Complications of the procedure were mainly mechanical injuries. Among the various ablation strategies, radiofrequency ablation had a lower incidence of phrenic nerve palsy and pain (OR:4.01e-06, 95%CI:1.18e-17–0.710) than cryoballoon ablation, which was superior to radiofrequency ablation in terms of infection rates. Finally, there were no significant differences between the various ablation techniques in terms of other complication rates. Because the interventions in the UT group were predominantly AADS and antiarrhythmic drug therapy didn't have some of the common aggressive complications of ablation strategies, the UT group had a low rate of complications such as pericardial effusion, postprocedural arrhythmia, pseudoaneurysm, and pulmonary vein stenosis compared with various catheter ablation strategies. Additionally, we also discovered between the various ablation technology groups, there was no significant difference in the incidence of major adverse events. PROSPERO registry number:CRD42024566530. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is the most often observed arrhythmia linked to COVID-19 pneumonia. Analysis of left atrial strain (LAS), a measure of LA contractility, has been applied in numerous therapeutic contexts, has been linked to the onset of AF. Objective: The current study aimed to focus on correlation between left atrial strain and subtle cardiac arrhythmias detected by holter monitoring in noncardiac individual recovering from COVID-19. Patients and Methods: From March 2022 to August 2022, the Cardiology Department of the Faculty of Medicine at Zagazig University conducted a cross-sectional study on all COVID-19 survivors who had no cardiac issues. An automated piece of software was used to analyse the LA strain. Three phases of LA strain were reported: reservoir phase (LASr), conduit phase (LAScd), and contraction phase (LASct). The main result was the onset of AF. Results: A total 76 patients were recruited for the current study. Patients were divided into two groups; Group I 15 patients with AF and Group II 61 Patients without AF. LAVI, LA strain reservoir, LA strain contraction and CRP were the most significant predictors of AF in post COVID patients. Conclusion: We found high incidence of LAS impairment using speckle tracking echocardiography that can predict AF in post COVID patients. [ABSTRACT FROM AUTHOR]

Bacground. Obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with increased incidence and progression of atrial fbrillation (AF). Experimental studies indicate that OSAHS can modify the cardiac extracellular matrix (ECM). However, signifcant mechanisms of cardiac remodeling in AF patients with OSAHS have not been uncovered. The aim: to evaluate the impact of OSAHS on serum levels of tissue inhibitor of matrix metalloproteinase- 1(TIMP-1) and hypoxia-inducible factor-1α (HIF-1α) in AF patients with ischemic heart disease (IHD) and/or arterial hypertension (AH), suffering from OSAHS. Material and methods. We examined 140 non-valvular AF patients with IHD and/or AH. Cardiorespiratory monitoring was conducted in the studied subjects and they were divided into 2 groups according to the presence of OSAHS: group 1 – non-OSAHS patients; group 2 – patients with OSAHS. Serum levels of TIMP-1 and HIF-1α were assayed using commercially available ELISA kit. Results. The patients with OSAHS had higher levels of TIMP-1 and HIF-1α than non-OSAHS patients (p

Atrial fbrillation is one of the most common cardiac arrhythmias, which is dangerous for its complications. This article presents the most common risk factors for the development of arrhythmias: obesity, hypertension, diabetes, smoking and others. The analysis of modifable risk factors will enable to elaborate preventive measures and reduce the incidence of atrial fbrillation.

Background Obesity increases and surgical weight reduction decreases the risk of atrial fibrillation (AF) and heart failure (HF). We hypothesized that surgically induced weight loss may favorably affect left atrial (LA) mechanical function measured by longitudinal strain, which has recently emerged as an independent imaging biomarker of increased AF and HF risk. Methods We retrospectively evaluated echocardiograms performed before and 12.2±2.2 months after bariatric surgery in 65 patients with severe obesity (mean age 39 [36; 47] years, 72% of females) with no known cardiac disease or arrhythmia. The LA mechanical function was measured by the longitudinal strain using the semi-automatic speckle tracking method. Results After surgery, body mass index decreased from 43.72±4.34 to 30.04±4.33 kg/m2 . We observed a significant improvement in all components of the LA strain. LA reservoir strain (LASR) and LA conduit strain (LASCD) significantly increased (35.7% vs 38.95%, p=0.0005 and−19.6% vs−24.4%, p<0.0001) and LA contraction strain (LASCT) significantly decreased (−16% vs−14%, p=0.0075). There was a significant correlation between an increase in LASR and LASCD and the improvement in parameters of left ventricular diastolic and longitudinal systolic function (increase in E’ and MAPSE). Another significant correlation was identified between the decrease in LASCT and an improvement in LA function (decrease in A’). Conclusions The left atrial mechanical function improves after bariatric surgery. It is partially explained by the beneficial effect of weight reduction on the left ventricular diastolic and longitudinal systolic function. This effect may contribute to decreased risk of AF and HF after bariatric surgery. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to assess stroke risk and Cardio-cerebrovascular symptom knowledge in patients with atrial fibrillation, and to determine the relationship between knowledge and self-management in these patients. Methods: Using a cross-sectional study design, 120 patients from an outpatient clinic were recruited from two medical centers. Data were collected using a structured questionnaire, and data on risk factors and clinical characteristics were collected from patients' medical records. The data were analyzed by one-way analysis of variance, Pearson correlation coefficient, and hierarchical multiple linear regression analysis. Results: The risk of stroke was estimated to be 82.5%. For the assessment of patient cardio-cerebrovascular symptom knowledge the correct answer rate was as 37%. Hierarchical regression analysis showed that knowledge about cardio-cerebrovascular disease symptoms was a significant predictor, explaining an additional 28.3% of the variance of self-management behaviors. Conclusions: These results suggest the need for education programs that include information about cardiocerebrovascular disease symptoms and the risks of stroke occurring as a complication, in order to enhance self-management behaviors in patients with atrial fibrillation. [ABSTRACT FROM AUTHOR]

Objective: Catheter ablation combined with left atrial appendage closure (LAAC) has emerged as a promising strategy for atrial fibrillation (AF) patients at high risk for stroke or with contraindications for oral anticoagulants (OACs). But the evidence for the long-term safety and efficacy of a combined procedure using cryoballoon ablation (CBA) with LAAC is still insufficient.Methods: From October 2015 to December 2017, a total of 76 consecutive non-valvular, drug-refractory AF patients who underwent a combined procedure of CBA and LAAC are included. Peri- and post-procedural safety and efficacy were evaluated through scheduled follow-ups and transesophageal echocardiography (TEE).Results: A total of 74 patients (97.4%) underwent the combined procedure and achieved instant pulmonary vein isolation and satisfactory LAAC. With a mean follow-up time of 23.7 ± 11.0 months, the recurrence of atrial arrhythmia was recorded in 35 patients (48.0%). In addition, a survival analysis shows a non-significant higher recurrence in persistent AF (p = 0.48). The overall OAC withdrawal rate was 97.2%, and one patient (1.4%) had a lethal hemorrhagic stroke while on single antiplatelet therapy. For safety concerns, the overall mortality was 2.7%, which resulted from one case of myocardial infarction on OAC and one hemorrhagic stroke, as mentioned. No other major hemorrhagic events occurred. Among the 72 patients (94.7%) who underwent TEE, one patient (1.4%) had device-related thrombosis and one patient (1.4%) had prominent residual flow (over 3 mm). Both were prescribed long-term OACs without severe complications occurring.Conclusions: Combining CBA with LAAC in a single procedure achieved considerable long-term safety and efficacy, providing a promising strategy for AF management.

Arterial and venous thromboembolism are both more common in older adults. The use of anticoagulants, the mainstay to prevent thromboembolism, requires consideration of the balance between risk and benefit. Such consideration is even more important in the very elderly in whom the risk of anticoagulant-related bleeding and thrombosis are higher. This review will focus on the challenges of implementing and managing anticoagulant therapy in older patients in an era when the options for anticoagulants include not only vitamin K antagonists (VKAs), but also direct-acting oral anticoagulants (DOACs).

Background and Aims: Right phrenic nerve palsy is the most frequent complication of cryoballoon procedures. The SMARTFREEZE™ console (Boston Scientific, St. Paul, MN, USA) has integrated a new tool for diaphragm monitoring-the Diaphragm Movement Sensor; however, it has not been evaluated in clinical practice. We aimed to assess the diagnostic performance of the Diaphragm Movement Sensor based on compound motor action potential data recorded simultaneously., Methods: Thirty consecutive patients (mean age 63.2 ± 10.2 years) were included. We simultaneously recorded the compound motor action potential and the Diaphragm Movement Sensor during cryoapplications in the right pulmonary veins. The right phrenic nerve was paced at 60 per minute, 12 V and 2.9 ms. Compound motor action potential monitoring with a 30% decrease cutoff for the diagnosis of phrenic nerve threatening was considered the gold standard. The Diaphragm Movement Sensor decrease threshold was also set at 30%., Results: Considering compound motor action potential monitoring, phrenic nerve threatening occurred 11 times (in seven patients) among 84 cryoapplications (13.1%) at the right pulmonary veins. The sensitivity and specificity of the Diaphragm Movement Sensor were, respectively, 33% (95% CI: 7%-70%) and 49% (95% CI: 38%-61%; P  < 0.001). The predictive positive and negative values for the Diaphragm Movement Sensor were, respectively, 7% (95% CI: 2%-20%) and 86% (95% CI: 72%-95%). The Diaphragm Movement Sensor gave an erroneous diagnosis in 44/84 cryoapplications (52.4%)., Conclusions: The diagnostic performance of the Diaphragm Movement Sensor is low, and the relevance of its use in clinical practice may be debated., Competing Interests: FF is consultant for the company Circle Safe. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Schemoul, Tovmassian, Mancini, Koutbi, Biermé, Deharo, Franceschi and Maille.)

Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and associated with an elevated risk of thromboembolic stroke and systemic embolization. The evidence suggests that ~90% of thrombi in patients with non-valvular AF are localized to the left atrial appendage (LAA). Therefore, it seems reasonable to consider LAA exclusion in selected patients with AF for stroke prevention. LAA exclusion can be achieved through a variety of surgical and percutaneous techniques. Surgical methods include LAA amputation, ligation, clipping and stapling. Whereas percutaneous strategies consist of endocardial closure using an LAA occlusion device and epicardial LAA ligation using a snare device. Even though several trials and registries of LAA exclusion have yielded promising outcomes, at this time evidence for long term safety and efficacy seems insufficient to recommend this approach to all patients with non-valvular AF. Future prospective randomized trials are needed to assess the precise role for these therapeutic options. Furthermore, there is a paucity of data on the comparison of these strategies to the novel oral anticoagulants which also deserves further attention. This review will carefully examine the current LAA exclusion techniques and the available data. [ABSTRACT FROM AUTHOR]

In this review, we focus on the important newly recognized appreciation for the paradoxical increase in stroke and TIA as a result of intervention meant to treat atrial fbrillation (AF) with the hope of decreasing stroke risk in the long term. The impact of silent cerebral lesions recently appreciated as a potentially major limitation and risk with AF ablation is explained. We categorize our present understanding of how we can minimize risk and provide a platform for what will undoubtedly be newer study, changes in the way procedures are done today, and possibly vascular-based stroke-reduction strategies. [ABSTRACT FROM AUTHOR]

Abstract: Atrial fibrillation (AF) is the most common arrhythmia with multi-factorial pathogenesis. A number of studies of genetic epidemiology have assessed the association of Gl12A (G38S) single nucleotide polymorphisms (SNPs) in Mink gene with AF in different populations. However, the results are inconsistent and inconclusive. We performed a Meta-analysis of the association between Gl12A polymorphisms of MinK gene and AF to estimate the magnitude of the gene effect. Six case-control studies with a combined 854 cases and 1079 controls were summarized. Subgroups in different races were separately analyzed. Heterogeneity and publication bias were also explored. When all groups were pooled, the individuals with G allele had an over 40% higher risk of AF compared with individuals with the A allele. The GG genotype (versus AA genotype) was found to be significant association with increased AF risk. The significant associations were also found in both dominant and recessive genetic model. For subgroup analysis, the results were consistent with above, except that the pooled OR for Chinese population was not significant in a recessive genetic model. In conclusion, Gl12A polymorphisms in Mink gene may have an important effect on the pathogenesis of AF. This warrants further investigation in large multi-center studies with precise design. [Copyright &y& Elsevier]

The article describes the case of a 41 year old female with a history of parxysmal atrial fibrillation and cavotricuspid isthmus (CTI)-dependent flutter who was returned to the electrophysiology laboratory for repeat ablation due to recurrent atrial fibrillation and flutter despite antiarryhythmic therapy. Topics discussed include the difficulty of distinguishing very slow conduction against CTI conduction block and the importance of performing multiple techniques to assess block.

Arterial and venous thromboembolism are both more common in older adults. The use of anticoagulants, the mainstay to prevent thromboembolism, requires consideration of the balance between risk and benefit. Such consideration is even more important in the very elderly in whom the risk of anticoagulant-related bleeding and thrombosis are higher. This review will focus on the challenges of implementing and managing anticoagulant therapy in older patients in an era when the options for anticoagulants include not only vitamin K antagonists (VKAs), but also direct-acting oral anticoagulants (DOACs)., Competing Interests: PG has received consulting fees from Bayer, Bristol-Myers-Squibb, Pfizer, Leo Pharma, Servier Canada and Valeo Pharma. NC reports a speaker fee from Bayer outside the submitted work., (Copyright © 2021 Gross and Chan.)

Objective: Catheter ablation combined with left atrial appendage closure (LAAC) has emerged as a promising strategy for atrial fibrillation (AF) patients at high risk for stroke or with contraindications for oral anticoagulants (OACs). But the evidence for the long-term safety and efficacy of a combined procedure using cryoballoon ablation (CBA) with LAAC is still insufficient. Methods: From October 2015 to December 2017, a total of 76 consecutive non-valvular, drug-refractory AF patients who underwent a combined procedure of CBA and LAAC are included. Peri- and post-procedural safety and efficacy were evaluated through scheduled follow-ups and transesophageal echocardiography (TEE). Results: A total of 74 patients (97.4%) underwent the combined procedure and achieved instant pulmonary vein isolation and satisfactory LAAC. With a mean follow-up time of 23.7 ± 11.0 months, the recurrence of atrial arrhythmia was recorded in 35 patients (48.0%). In addition, a survival analysis shows a non-significant higher recurrence in persistent AF ( p = 0.48). The overall OAC withdrawal rate was 97.2%, and one patient (1.4%) had a lethal hemorrhagic stroke while on single antiplatelet therapy. For safety concerns, the overall mortality was 2.7%, which resulted from one case of myocardial infarction on OAC and one hemorrhagic stroke, as mentioned. No other major hemorrhagic events occurred. Among the 72 patients (94.7%) who underwent TEE, one patient (1.4%) had device-related thrombosis and one patient (1.4%) had prominent residual flow (over 3 mm). Both were prescribed long-term OACs without severe complications occurring. Conclusions: Combining CBA with LAAC in a single procedure achieved considerable long-term safety and efficacy, providing a promising strategy for AF management., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Ren, Zhang, Wang, Jia, Li, Zhang, Guo, Li, Li, Yang, Zheng, Meng, Xu and Zhao.)