Longer and better lives for patients with atrial fibrillation:the 9th AFNET/EHRA consensus conference

Aims: Recent trial data demonstrate beneficial effects of active rhythm management in patients with atrial fibrillation (AF) and support the concept that a low arrhythmia burden is associated with a low risk of AF-related complications. The aim of this document is to summarize the key outcomes of the 9th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Methods and results: Eighty-three international experts met in Münster for 2 days in September 2023. Key findings are as follows: (i) Active rhythm management should be part of the default initial treatment for all suitable patients with AF. (ii) Patients with device-detected AF have a low burden of AF and a low risk of stroke. Anticoagulation prevents some strokes and also increases major but non-lethal bleeding. (iii) More research is needed to improve stroke risk prediction in patients with AF, especially in those with a low AF burden. Biomolecules, genetics, and imaging can support this. (iv) The presence of AF should trigger systematic workup and comprehensive treatment of concomitant cardiovascular conditions. (v) Machine learning algorithms have been used to improve detection or likely development of AF. Cooperation between clinicians and data scientists is needed to leverage the potential of data science applications for patients with AF. Conclusions: Patients with AF and a low arrhythmia burden have a lower risk of stroke and other cardiovascular events than those with a high arrhythmia burden. Combining active rhythm control, anticoagulation, rate control, and therapy of concomitant cardiovascular conditions can improve the lives of patients with AF

4-D Motion Field Estimation by Combined Multiple Heart Phase Registration (CMHPR) for Cardiac C-arm Data

In interventional cardiology three-dimensional anatomical and functional information of the cardiac chambers would have an important impact on diagnosis and therapy. With the technology of C-arm CT it is possible to reconstruct intraprocedural 3-D images from angiographic projection data. In order to generate accurate and artifact-free reconstructions from dynamic cardiac projections, the motion needs to be taken into account. We present the novel Combined Multiple Heart Phase Registration (CMHPR) method. CMHPR is an iterative motion estimation and compensation algorithm that uses projection data acquired during a single C-arm sweep. Filtered-backprojection (FBP) volumes from electrocardiogram (ECG)-gated data are reconstructed for different motion states of the heart. According to an unknown 4-D motion vector field the ECG-gated FBP images are deformed and accumulated to a sum volume for representing the status of a particular heart phase. In an iterative optimization procedure the 4-D motion vector field is computed by registering the sum volume to a reference volume of the same heart phase. The negative normalized cross correlation (NCC) of both volumes is used as a cost function. In this paper, the reference image is generated using the prior image constrained compressed sensing (PICCS) algorithm combined with the improved total variation (iTV). First preliminary experiments on clinical porcine data sets show promising results. CMHPR reduces streak artifacts and simultaneously preserves sharp edges without producing the artificial comic-like appearance of the PICCS + iTV reference volume.status: publishe

Dronedarone in high-risk permanent atrial fibrillation

BACKGROUN