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Introduction: Catheter ablation of atrial fibrillation (AF) is frequently studied in randomized trials, observational and registry studies. The aim of this expert opinion is to provide guidance for clinicians and industry regarding the development of future clinical studies on catheter ablation of AF, implement lessons learned from previous studies, and promote a higher degree of consistency across studies. Background: Studies on catheter ablation of AF may benefit from well‐described definitions of endpoints and consistent methodology and documentation of outcomes related to efficacy, safety and cost‐effectiveness. The availably of new, innovative technologies warrants further consideration about their application and impact on study design and the choice of endpoints. Moreover, recent insights gained from AF ablation studies suggest a reconsideration of some methodological aspects. Methods: A panel of clinical experts on catheter ablation of AF and designing and conducting clinical studies developed an expert opinion on the design and endpoints for studies on catheter ablation of AF. Discussions within the expert panel with the aim to reach consensus on predefined topics were based on outcomes reported in the literature and experiences from recent clinical trials. Results: A comprehensive set of recommendations is presented. Key elements include the documentation of clinical AF, medication during the study, repeated ablations and their effect on endpoint assessments, postablation blanking and the choice of rhythm‐related and other endpoints. Conclusion: This expert opinion provides guidance and promotes consistency regarding design of AF catheter ablation studies and identified aspects requiring further research to optimize study design and methodology. Recent insights from studies on catheter ablation of atrial fibrillation (AF) and the availability of new innovative technologies warrant reconsideration of methodological aspects related to study design and the choice and assessment of endpoints. This expert opinion, developed by clinical experts on catheter ablation of AF provides a comprehensive set of recommendations related to these methodological aspects. The aim of this expert opinion is to provide guidance for clinicians and industry regarding the development of clinical studies, implement lessons learned from previous studies, and promote a higher degree of consistency across studies. [ABSTRACT FROM AUTHOR]

Background: Early identification of individuals at risk of developing heart failure (HF) may improve poor prognosis. A dominant sympathetic activity is common in HF and associated with worse outcomes; however, less is known about the autonomic balance before HF. Hypothesis: A low frequency/high frequency (L‐F/H‐F) ratio, index of heart rate variability, and marker of the autonomic balance predict the development of HF and may improve the performance of the HF prediction model when added to traditional cardiovascular (CV) risk factors. Methods: Individuals in the PIVUS (Prospective Investigation of the Vasculature in Uppsala Seniors) study (n = 1016, all aged 70 years) were included. Exclusion criteria were prevalent HF, electrocardiographic QRS duration ≥130 millisecond, major arrhythmias, or conduction blocks at baseline. The association between the L‐F/H‐F ratio and incident HF was assessed using Cox proportional hazard analysis. The C‐statistic evaluated whether adding the L‐F/H‐F‐ratio to traditional CV risk factors improved the discrimination of incident HF. Results: HF developed in 107/836 study participants during 15 years of follow‐up. A nonlinear, inverse association between the L‐F/H‐F ratio and incident HF was mainly driven by an L‐F/H‐F ratio of <30. The association curve was flat for higher values (hazard ratio, HR for the total curve = 0.78 [95% confidence interval, CI: 0.69−0.88, p <.001]; HR = 2 for L‐F/H‐F ratio = 10). The traditional prediction model improved by 3.3% (p <.03) when the L‐F/H‐F ratio was added. Conclusions: An L‐F/H‐F ratio of <30 was related to incident HF and improved HF prediction when added to traditional CV risk factors. [ABSTRACT FROM AUTHOR]

Background: There are limited comparative data on safety and efficacy within commonly used Vaughan‐Williams (VW) class III antiarrhythmic drugs (AADs) for maintenance of sinus rhythm in adults with atrial fibrillation (AF). Hypothesis: We hypothesized that dronedarone and sotalol, two commonly prescribed VW class III AADs with class II properties, have different safety and efficacy effects in patients with nonpermanent AF. Methods: A systematic literature review was conducted searching MEDLINE®, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) up to June 15, 2021 (NCT05279833). Clinical trials and observational studies that evaluated safety and efficacy of dronedarone or sotalol in adults with AF were included. Bayesian random‐effects network meta‐analysis (NMA) was used to quantify comparative safety and efficacy. Where feasible, we performed sensitivity analyses by including only randomized controlled trials (RCTs). Results: Of 3581 records identified through database searches, 37 unique studies (23 RCTs, 13 observational studies, and 1 nonrandomized trial) were included in the NMA. Dronedarone was associated with a statistically significantly lower risk of all‐cause death versus sotalol (hazard ratio [HR] = 0.38 [95% credible interval, CrI: 0.19, 0.74]). The association was numerically similar in the sensitivity analysis (HR = 0.46 [95% CrI: 0.21, 1.02]). AF recurrence and cardiovascular death results were not significantly different between dronedarone and sotalol in all‐studies and sensitivity analyses. Conclusion: The NMA findings indicate that, across all clinical trials and observational studies included, dronedarone compared with sotalol was associated with a lower risk of all‐cause death, but with no difference in AF recurrence. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC‐EHRA EORP‐AF Long‐Term General Registry. Outcomes were analysed according to renal function by CKD‐EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all‐cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all‐cause death in patients with AF. [ABSTRACT FROM AUTHOR]

Background: Diagnosing arrhythmogenic right ventricular cardiomyopathy (ARVC) at an early stage can be challenging even after ECG recording and a combination of several imaging techniques. The purpose of this study was to explore if a body surface mapping (BSM) system with 252‐leads could identify repolarization abnormalities and thereby diagnose early stages of ARVC. Methods: ARVC patients, gene carriers without signs of ARVC and controls underwent a 12‐lead resting ECG, signal‐averaged ECG, echocardiography, 24‐hours Holter monitoring, and BSM with electrocardiographic imaging (ECGI). All 252‐leads, divided into four quadrants of the vest, were analyzed regarding concordances between T wave polarity and QRS main vector. Results: Of 40 patients included there were 12 ARVC patients, 20 gene carriers, and 8 controls. The ARVC patients had two different repolarization patterns, one with more pronounced negative T waves at the lower left panel and another with mixed changes that clearly differed from the controls, all of whom had a normal 12 lead ECGs and consistent repolarization patterns on their BSM recordings. The patterns observed in ARVC patients were also present in 5/20 (25%) gene carriers, three of whom had normal resting ECG. A novel repolarization index successfully detected all ARVC patients and 88% of gene carriers with pathologic repolarization pattern. Conclusions: The finding that abnormal repolarization patterns could be unmasked by BSM in 25% of healthy gene carriers, suggests that it may potentially be a useful tool for identifying early manifestations of ARVC. Further and larger studies are warranted to assess its diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Aims: To assess whether the prevailing rhythm at the time of replying to symptom and health‐related quality of life (HR‐QoL) questionnaires impacts the findings. Method: A total of 150 patients from the randomized Catheter Ablation Compared with Pharmacological Therapy for Atrial Fibrillation‐trial, comparing atrial fibrillation (AF) ablation versus drugs, were included. The effect of the prevailing rhythm on the outcome results of the HR‐QoL 36‐Item Short‐Form Health Survey, the symptom severity questionnaire (SSQ), and the European Heart Rhythm Association (EHRA) score for classification of AF‐related symptoms was assessed. Results: AF as the prevailing rhythm was independently associated with a significantly lower Vitality score; 18.4 points lower (95% confidence interval −32.7 to −4.1, p =.01) compared with sinus rhythm when adjusted for AF burden, median duration of episode, number of episodes, beta‐blocker use, type of AF, and sex. The presence of AF did not affect the General Health score compared with sinus rhythm, nor did it influence symptoms assessed by the SSQ or EHRA score. Conclusion: The observation that the presence of AF versus sinus rhythm when conducting HR‐QoL tests had a negative impact on its outcome, leaving symptom‐related questionnaires unaffected, implies that the prevailing rhythm should be taken into account when results of HR‐QoL questionnaires are interpreted. [ABSTRACT FROM AUTHOR]

Background: The diagnosis of ARVC remains complex requiring both imaging and electrocardiographic (ECG) techniques. The purpose was therefore to investigate whether QRS dispersion assessed by body surface mapping (BSM) could be used to detect early signs of ARVC, particularly in gene carriers. Methods: ARVC patients, gene carriers without a history of arrhythmias or structural cardiac changes and healthy controls underwent 12‐lead resting ECG, signal‐averaged ECG, echocardiographic examination, 24‐hours Holter monitoring, and BSM with electrocardiographic imaging. All 252‐leads BSM recordings and 12‐leads ECG recordings were manually analyzed for QRS durations and QRS dispersion. Results: Eight controls, 12 ARVC patients with definite ARVC and 20 healthy gene carriers were included. The ECG‐QRS dispersion was significantly greater in ARVC patients (42 vs. 25 ms, p <.05), but failed to fully differentiate them from controls. The BSM‐derived QRS dispersion was also significantly greater in ARVC patients versus controls (65 vs. 29 ms, p <.05) and distinguished 11/12 cases from controls using the cut‐off 40msec. The BSM derived QRS dispersion was abnormal (> 40 ms) in 4/20 healthy gene carriers without signs of ARVC, which may indicate early depolarization changes. Conclusions: QRS dispersion, when assessed by BSM versus 12‐lead ECG, seem to better distinguish ARVC patients from controls, and could potentially be used to detect early ARVC in gene carriers. Further studies are required to confirm the value of BSM‐QRS dispersion in this respect. [ABSTRACT FROM AUTHOR]

Background: The implantation rates of cardiac implantable electronic devices have steadily increased, accompanied by a steeper rise of device related infections (DRI). Hypothesis: The prevalence of DRI for cardiac resynchronization therapy (CRT) is higher in clinical practice than reported previously, even at a university hospital, and likely higher than reported to the national device registry. Methods: Electronic medical records of consecutive patients undergoing a CRT procedure between January 2016 and December 2017 were analyzed. Clinical history, procedure related variables and complications were reviewed by specialists in cardiology and infectious diseases. Results: A total of 171 patients, mean aged 74 years, 138 males (80.7%) were included. Twelve DRI occurred in 10 patients during mean 2.5 years follow‐up, giving a prevalence of 7% (incidence of 29/1000 person‐years). Reoperation, pocket haematoma, ≥3 procedures, previous device infection and indwelling central venous line were the strongest predictive factors according to univariate analysis. Out of 63/171 (36.8%) major complications, 31(49.2%) were lead‐related. There were 49/171 (28.7%) reoperations and 15/171 (8.8%) minor complications. The number major complications and DRI reported to the national device registry were 7/171 (4.1%) and 2/171 (0.6%), respectively, reflecting a 5‐fold underreporting. Conclusions: The high rate of CRT device infections is in sharp contrast to those reported by others and to the national device registry. Although a center specific explanation cannot be excluded, the high rates highlight a major issue with registries, reinforcing the need for better surveillance and automatic reporting of device related complications. [ABSTRACT FROM AUTHOR]

Background: The influence of risk factors on atrial fibrillation (AF) ablation recurrence is increasingly recognized. We present a sub‐analysis of the European Society of Cardiology‐European Heart Rhythm Association‐European Society of Cardiology AF ablation long‐term registry on the effect of traditional risk factors for AF on postablation recurrence, reablation, and complications using real‐world data. Methods: Risk factors for AF were defined as body mass index ≥27 kg/m², hypertension, chronic obstructive pulmonary disease, diabetes, alcohol ≥2 units/day, sleep apnea, smoking, no/occasional sports activity, moderate/severe mitral or aortic valve disease, any cardiomyopathy, peripheral vascular disease, chronic kidney disease, heart failure, coronary artery disease/infarction, and previous pacemaker/defibrillator implant. Patients were divided in two groups with ≥1 or without risk factors. Primary outcomes were arrhythmia recurrence after blanking period, reablation, and adverse events or death. Differences between the groups and the influence of individual risk factors were analyzed using multivariate Cox regression. Results: Three thousand sixty nine patients were included; 217 patients were without risk factors. Risk factor patients were older (58.4 vs 54.1 years), more often female (32% vs 19.8%) and had more often persistent AF (27.2% vs 23.5%). In a multivariate analysis, patients without risk factors had a hazard ratio of 0.70 (95% CI 0.49‐0.99) for recurrence compared to risk factor patients. The multivariate hazard ratios for reablation or adverse events/death were not different between the two groups. Hypertension and body mass index were univariate predictors of recurrence. Conclusions: Patients with ≥1 risk factor had a 30% higher risk for arrhythmia recurrence after ablation, but no differences in risk for repeat ablations and adverse events or death. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) promotes atrial remodeling that in turn promotes AF perpetuation. The aim of our study is to investigate the impact of AF history length on 1‐year outcome of AF catheter ablation in a cohort of patients enrolled in the Atrial Fibrillation Ablation Registry. Methods: We described the real‐life clinical epidemiology, therapeutic strategies, and the short‐ and mid‐term outcomes of 1948 patients (71.9% with paroxysmal AF) undergoing AF ablation procedures, stratified according to AF history duration (<2 years or ≥2 years). Results: The mean AF history duration was 46.2 ± 57.4 months, 592 patients had an AF history duration <2 years (mean 10.2 ± 5.9 months), and 1356 patients ≥2 years (mean 75.5 ± 63.5 months) (P < 0.001). Patients with AF history duration <2 years were younger; had a lower incidence of hypertension, coronary artery disease, and hypertrophic cardiomyopathy; and had a lower CHA2DS2‐VaSc Score. At 1 year, the logrank test showed a lower incidence of AF recurrence in patients with AF history duration <2 years (28.9%) than in patients with AF history duration ≥2 years (34.0%) (P = 0.037). AF history duration ≥2 years, overall ablation procedure duration, hypertension, and chronic kidney disease were all predictors of recurrences after the blanking period. Conclusions: In this multicenter registry, performing catheter ablation in patients with an AF history ≥2 years was associated with higher rates of AF recurrences at 1 year. Since cumulative time in AF in not necessarily equivalent to AF history, its role remains to be clarified. [ABSTRACT FROM AUTHOR]

Background: Cardiac resynchronisation therapy (CRT) reduces morbidity and mortality in appropriately selected patients with heart failure and is strongly recommended for such patients by guidelines. A European Society of Cardiology (ESC) CRT survey conducted in 2008-2009 showed considerable variation in guideline adherence and large individual, national and regional differences in patient selection, implantation practice and follow-up. Accordingly, two ESC associations, the European Heart Rhythm Association and the Heart Failure Association, designed a second prospective survey to describe contemporary clinical practice regarding CRT.Methods and Results: A survey of the clinical practice of CRT-P and CRT-D implantation was conducted from October 2015 to December 2016 in 42 ESC member countries. Implanting centres provided information about their hospital and CRT service and were asked to complete a web-based case report form collecting information on patient characteristics, investigations, implantation procedures and complications during the index hospitalisation. The 11 088 patients enrolled represented 11% of the total number of expected implantations in participating countries during the survey period; 32% of patients were aged ≥75 years, 28% of procedures were upgrades from a permanent pacemaker or implantable cardioverter-defibrillator and 30% were CRT-P rather than CRT-D. Most patients (88%) had a QRS duration ≥130 ms, 73% had left bundle branch block and 26% were in atrial fibrillation at the time of implantation. Large geographical variations in clinical practice were observed.Conclusion: CRT Survey II provides a valuable source of information on contemporary clinical practice with respect to CRT implantation in a large sample of ESC member states. The survey permits assessment of guideline adherence and demonstrates variations in patient selection, management, implantation procedure and follow-up strategy. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess if right atrial overdrive pacing can suppress symptomatic episodes of paroxysmal atrial fibrillation (PAF) in patients without bradyarrhythmias. Forty-two patients with frequent and symptomatic PAF without other pacing indication had a pacemaker implanted after a 4-week run-in period, during which the frequency of symptomatic PAF episodes and the mean heart rate were objectively documented. Depending on the mean heart rate recorded during run-in, the pacemaker was programmed in random order to right atrial AAI pacing at 10–19 beats/min > mean heart rate (medium overdrive [MO]), at 20–29 beats/min > mean heart rate (high overdrive [HO]) and to no pacing (OAO mode) for 4–12 weeks each using a crossover design. In the 35 patients who completed the protocol, the number of symptomatic episodes of PAF (>30-second duration) per week was significantly lower during MO pacing (median 0.88, P = 0.001, n = 35) and during HO pacing (median 0.75, P = 0.002, n = 20) than during OAO (median 2.02 and 2.04, respectively). There was no difference between MO and HO pacing in the 20 patients paced at both rates (0.97 vs 0.75, P = 0.33). Seven patients did not complete the protocol due to persistent atrial fibrillation (n = 4), angina pectoris requiring surgery (n = 1), and unwillingness to continue the study due to improvement (n = 1) or worsening (n = 1) of symptoms during the study periods. Right atrial overdrive pacing can reduce the number of symptomatic PAF episodes in patients with frequent and drug refractory PAF but without bradyarrhythmias. (PACE 2003; 26:1841–1848) [ABSTRACT FROM AUTHOR]

LÖNNERHOLM, S., et al.: Autonomic Denervation After the Maze Procedure.The Maze III procedure is a surgical operation for curative treatment of AF. The procedure is extensive, however, with multiple incisions in both atria, and its effects on autonomic regulation of the heart rhythm are not known. This study comprises 17 patients, 10 with paroxysmal AF and 7 with chronic AF, who had no concurrent cardiac disease known to affect heart rate variability (HRV). A 24‐hour Holter recording was performed preoperatively and 2 months (early) and 7 months (late) after surgery, for analysis of HRV in the time and frequency domains. Early after the Maze procedure all HRV components were markedly reduced compared to baseline (mean ± 1 SD): SDNN 73 ± 13 versus 148 ± 50 (ms), total power 168 ± 126 versus 560 ± 1567 (ms2), low frequency (LF) power 47 ± 67 versus 826 ± 677 (ms2), high frequency (HF) power 47 ± 40 versus 678 ± 666 (ms2), and LF:HF 1.22 ± 0.9 versus 2.55 ± 1.4. Late after the Maze procedure all variables were still reduced. Only total power increased significantly between early and late follow‐up (168 ± 126 vs 496 ± 435 ms2). Late after Maze surgery, values of the different HRV components did not differ between the patients with paroxysmal AF and chronic AF. Early after the Maze procedure there is a marked decrease of all HRV components, which is maintained 7 months after surgery, a pattern consistent with denervation of the heart. (PACE 2003; 26[Pt. I]:587–592) [ABSTRACT FROM AUTHOR]

Dual chamber lCDs are increasingly implanted nowadays, mainly to improve discrimination between supraventricular and ventricular arrhythmias but also to maint mix AV synchrony in patients with bradycardia. The aim of this study was to investigate a new single pass right ventricular defibrillation lead capable of true bipolar sensing and pacing in the right atrium and integrated bipolar sensing and pacing in the right ventricle. The performance of the lead was evaluated in 57 patients (age 61 + 12 years; New York Heart Association 1.9 ± 0.6, left ventricular ejection fraction 0.38 ± 0.15) at implant, at prehospital discharge. and during a 1-year follow-up. Sensing and pacing behavior of the lead was evaluated in six different body positions. In four patients, no stable position of the a trial electrode could intraoperatively be found. The intraoperative atrial sensing was 2.3 ± 1.6 mV arid the atrial pacing threshold 0.8 ± 0.5 V at 0.5 ms. At follow-up, the atrial sensing ranged from 1.5 mV to 2.2 mV and the atrial pacing threshold product from 0.8 to 1.7 V/ms. In 11 patients, an intermittent atrial sensing problem and in 24 patients an a trial pacing dysfunction were observed in at least one body position. In 565 episodes, a sensitivity of 100% and a specificity of 96.5% were found for ventricular arrhythmias. In conclusion, this single pass defibrillation lead performed well as a VDD lead and for dual chamber arrhythmia discrimination. however, loss of atrial capture in 45% of patients preclude its use in patients depending on atrial pacing. [ABSTRACT FROM AUTHOR]

A 22-year-old man under-went electrophysiological evaluation for incessant wide QRS complex tachycardia with a pattern of right bundle-branch block and left axis deviation. The right and left ventricles were enlarged and hypokinetic consistent with dilated cardiomyopathy. Ventricular tachycardia was diagnosed by demonstrating capture and fusion beats, atrioventricular dissociation, and His potential activation that began after the onset of each QRS complex. Atrial extrastimuli and rapid atrial pacing failed to terminate the tachycardia and, although ventricular stimulation was successful, the tachycardia spontaneously restarted after one or two sinus beats. The tachycardia was unexpectedly abolished during catheter manipulation in the left ventricle and has not recurred during three-years of follow-up. The picture of a cardiomyopathy resolved. The ease with which the tachycardia was abolished by catheter manipulation implicate a therapeutic potential for catheter ablation of this type of tachycardia. [ABSTRACT FROM AUTHOR]

Monophasic Action Potentials. Monophasic action potential (MAP) recordings reproduce the repolarization time course of intracellular action potentials with high accuracy and provide precise information on the local activation time. With the advantage of in vivo application and the development of the safer and simpler contact catheter technique, MAP recording has become the method of choice for evaluating myocardial repolarization changes. This review aims to provide information on practical application of MAP recording in the clinical setting. MAPs can easily be recorded from the endocardium with the contact catheter technique in the electrophysiology laboratory and from the epicardium with electrode probes during open heart surgery. The technical aspects are described in detail. The rate dependence of myocardial excitability and repolarization and the effect of antiarrhythmic drugs on MAP duration and effective refractory period are thoroughly reviewed. The use of MAPs in detecting myocardial ischemia, in studying early afterdepolarization and triggered arrhythmias, in measuring dispersion of repolarization, in identifying intracardiac conduction and the development of the T wave, and in verifying the arrhythmogenic effect of mechanoelectric feedback are presented. Computerized automatic analysis of MAPs and the limitations of the MAP technique are also discussed. [ABSTRACT FROM AUTHOR]

Computerized analysis of monophasic action potentials (MAPs) has rarely been reported in clinical setting. We developed a computer system featuring on-line acquisition and user-monitored automatic measurement of multichannel MAPs with the capability of manual corrections. This system has been used in 34 patients in whom two-channel MAPs and l-lead ECG were digitized during sinus rhythm, pacing, and programmed stimulation (PS). In total, 41,413 MAPs in 212 data files were measured. The correct determination rate was 100% for MAP onset and plateau, 99.78% (95.76% during PS) for MAP baseline, and 99.96% (54.29% during PS) for QRS onset. The comparison between the computerized and manual measurements in 292 MAPs showed that the former highly agreed with the latter, with the limits of agreement, defined as mean difference ± 2 SD, being from -4.8–4.9 ms for activation time and from -4.1–6.0 ms for MAP duration measurements. Using this system, two-channel MAPs of more than 300 consecutive beats can be measured in a few minutes, which made it possible to determine the steady state of MAP duration individually, and evaluate the MAP changes during intervention in detail. The clinical routine procedure far testing the effective refractory period and several new MAP parameters were also evaluated using this system. Conclusion: The MAP measurement using this computer system is reliable, rapid and accurate; it can therefore replace the manual method and provide more useful information for clinical research. [ABSTRACT FROM AUTHOR]

Focuses on the results of a non-randomized retrospective study comparing the outcome of rhythm control using a curative ablative approach to atrial fibrillation (AF) for sinus rhythm maintenance with that of rate control using AV junction ablation plus pacing therapy in elderly patients. Analysis of the clinical outcomes with respect to mortality, symptoms, morbidity, recurrent AF and progression to persistent AF; Occurrence of frequent heart failure and atrial enlargement; Determination of the rate of stroke and the use of anticoagulation therapy.