Search

Abstract Background Pulmonary vein isolation (PVI) using cryoballoon (CB) ablation has comparable efficacy and safety to the gold standard of radiofrequency ablation in the treatment of symptomatic atrial fibrillation (AF). Initial randomized control trials were performed using Arctic Front Advance Pro™ (AFr) (Medtronic, Dublin, Ireland) CB system. Novel CB systems have recently become available, including the POLARx™ (Px) (Boston Scientific, Marlborough, Massachusetts, USA) system. We aimed to compare PVI using the Px and the AFr CB systems in our patient population in terms of efficacy, safety and procedure characteristics in a routine clinical setting. Methods We performed a retrospective analysis of our internal AF ablation registry, containing 452 consecutive patients (pts) that underwent first procedure cryo-PVI for symptomatic AF. Primary endpoints were AF recurrence after 3 and 12 months, complication rate, procedure duration, fluoroscopy time and fluoroscopy dose. Secondary endpoints were minimal freeze temperature, time to isolation (TTI) and temperature at TTI for each of the pulmonary veins as well as minimal esophageal temperature during the procedure. Results The primary efficacy endpoints of AF recurrence after 3 and 12 months were similar between the AFr and the Px systems (25.5% vs 21.3%, p = 0.416 and 22.2% vs 20.6%, p = 0.794, respectively). Complication rates were similar (3.9% vs 6.8%, p = 0.18) between groups and consisted mostly of mild vascular complications. The AFr group showed a significantly shorter procedural duration (68 (55–77) vs 73 (60–80) min, p = 0.002), and lower fluoroscopy dose compared to the Px system. Fluoroscopy times remained similar, however. Minimal freeze temperatures and temperatures at time of isolation were significantly lower in the Px group. However, the time to isolation and minimal procedural esophageal temperature were similar in both groups. Conclusion PVI using the AFr and the Px systems showed comparable safety and efficacy. Procedural times were longer for the Px system. The Px system showed lower freeze temperature measurements but seemed to have a comparable biological effect.

Background. Cardiologists are today exposed to a growing dose of ionising radiation in their practice. Radiation awareness and correct management of X-ray use are the cornerstone to comply with the principles of exposure optimization and justification. Methods and Results. An investigator-initiated international voluntary-based survey including 28 questions was conducted across 19 European countries. 228 cardiologists participated in the survey. Invasive cardiology subspecialties were the most represented (83.6%). Radiation exposure is the cause of personal protective equipment-related orthopaedic injuries (personally or in coworkers) or anxiety in 68.5% and 62.9% of cases, respectively. 38.4% of participants have encountered difficulties in having their institutions recognizing periods off work for exceeding radiation exposure limit (16.3% usually and 22.1% on rare occasions). Gender was not associated with any difference in the answers. Age older than 40 years old was associated with an increased knowledge of personal dosimeter data (71.6% vs. 51.3%, p=0.008). Invasive cardiologists more frequently suffer from orthopaedic injuries (73.0% vs. 44.8%, p=0.006) and show greater participation to radioprotection courses (78.4 vs. 27.6%, p

IntroductionThe TeleCheck-AF approach is an on-demand mobile health (mHealth) infrastructure incorporating mobile app-based heart rate and rhythm monitoring through teleconsultation. We evaluated feasibility and accuracy of self-reported mHealth-based AF risk factors and CHA2DS2-VASc-score in atrial fibrillation (AF) patients managed within this approach.Materials and MethodsConsecutive patients from eight international TeleCheck-AF centers were asked to complete an app-based 10-item questionnaire related to risk factors, associated conditions and CHA2DS2-VASc-score components. Patient's medical history was retrieved from electronic health records (EHR).ResultsAmong 994 patients, 954 (96%) patients (38% female, median age 65 years) completed the questionnaire and were included in this analysis. The accuracy of self-reported assessment was highest for pacemaker and anticoagulation treatment and lowest for heart failure and arrhythmias. Patients who knew that AF increases the stroke risk, more often had a 100% or ≥80% correlation between EHR- and app-based results compared to those who did not know (27 vs. 14% or 84 vs. 77%, P = 0.001). Thromboembolic events were more often reported in app (vs. EHR) in all countries, whereas higher self-reported hypertension and anticoagulant treatment were observed in Germany and heart failure in the Netherlands. If the app-based questionnaire alone was used for clinical decision-making on anticoagulation initiation, 26% of patients would have been undertreated and 6.1%—overtreated.ConclusionSelf-reported mHealth-based assessment of AF risk factors is feasible. It shows high accuracy of pacemaker and anticoagulation treatment, nevertheless, displays limited accuracy for some of the CHA2DS2-VASc-score components. Direct health care professional assessment of risk factors remains indispensable to ensure high quality clinical-decision making.

Electrogram-based identification of the regions maintaining persistent Atrial Fibrillation (AF) is a subject of ongoing debate. Here, we explore the concept of local electrical dyssynchrony to identify AF drivers.Local electrical dyssynchrony was calculated using mean phase coherence. High-density epicardial mapping along with mathematical model were used to explore the link between local dyssynchrony and properties of wave conduction. High-density mapping showed a positive correlation between the dyssynchrony and number of fibrillatory waves (R2 = 0.68, p