High-density Mapping Guided Pulmonary Vein Isolation for Treatment of Atrial Fibrillation-Two-year clinical outcome of a single center experience

Pulmonary vein isolation (PVI) as interventional treatment for atrial fibrillation (AF) aims to eliminate arrhythmogenic triggers from the PVs. Improved signal detection facilitating a more robust electrical isolation might be associated with a better outcome. This retrospective cohort study compared PVI procedures using a novel high-density mapping system (HDM) with improved signal detection vs. age-and sex-matched PVIs using a conventional 3D mapping system (COM). Endpoints comprised freedom from AF and procedural parameters. In total, 108 patients (mean age 63.9 +/- 11.2 years, 56.5% male, 50.9% paroxysmal AF) were included (n = 54 patients/group). Our analysis revealed that HDM was not superior regarding freedom from AF (mean follow-up of 494.7 +/- 26.2 days), with one- and two-year AF recurrence rates of 38.9%/46.5% (HDM) and 38.9%/42.2% (COM), respectively. HDM was associated with reduction in fluoroscopy times (18.8 +/- 10.6 vs. 29.8 +/- 13.4 min;p < 0.01) and total radiation dose (866.0 +/- 1003.3 vs. 1731.2 +/- 1978.4 cGy;p < 0.01) compared to the COM group. HDM was equivalent but not superior to COM with respect to clinical outcome after PVI and resulted in reduced fluoroscopy time and radiation exposure. These results suggest that HDM-guided PVI is effective and safe for AF ablation. Potential benefits in comparison to conventional mapping systems, e.g. arrhythmia recurrence rates, have to be addressed in randomized trials

Rare truncating variants in the sarcomeric protein titin associate with familial and early-onset atrial fibrillation

Common genetic variants in structural proteins contribute to risk of atrial fibrillation (AF). Here, using whole-exome sequencing, the authors identify rare truncating variants in TTN that associate with familial and early-onset AF and show defects in cardiac sarcomere assembly in ttn.2-mutant zebrafish

Post-traumatic stress disorder among COVID-19-affected high-risk cardiac patients

Background During the first coronavirus disease 2019 (COVID-19) wave there was a high prevalence of mental health impairments and post-traumatic stress disorder (PTSD), particularly in patients with comorbid cardiac diseases. Methods During waves 2-5, all hospitalized patients with cardiac problems and suspected COVID-19 were eligible to participate in this study. Results The prevalence of PTSD was 31.4 (n=48) in 153 participants. No age- and gender-related differences for PTSD were found. Conclusions The prevalence is lower than during the first wave but higher than in patients reported in other studies who were isolated at home. Routine mental health assessments are strongly recommended for patients at risk

Post-traumatic stress disorder among COVID-19-affected high-risk cardiac patients

Background During the first coronavirus disease 2019 (COVID-19) wave there was a high prevalence of mental health impairments and post-traumatic stress disorder (PTSD), particularly in patients with comorbid cardiac diseases. Methods During waves 2-5, all hospitalized patients with cardiac problems and suspected COVID-19 were eligible to participate in this study. Results The prevalence of PTSD was 31.4 (n=48) in 153 participants. No age- and gender-related differences for PTSD were found. Conclusions The prevalence is lower than during the first wave but higher than in patients reported in other studies who were isolated at home. Routine mental health assessments are strongly recommended for patients at risk

Health related quality of life and Device-Acceptance in patients with implantable cardioverter-defibrillators and telemonitoring

Siebermair J, Martens E, Leppert F, et al. Health related quality of life and Device-Acceptance in patients with implantable cardioverter-defibrillators and telemonitoring. Clinical Research in Cardiology. 2014;103(Suppl 1):V548

Saturation recovery-prepared magnetic resonance angiography for assessment of left atrial and esophageal anatomy.

OBJECTIVES: Magnetic resonance angiography (MRA) has been established as an important imaging method in cardiac ablation procedures. In pulmonary vein (PV) isolation procedures, MRA has the potential to minimize the risk of severe complications, such as atrio-esophageal fistula, by providing detailed information on esophageal position relatively to cardiac structures. However, traditional non-gated, first-pass (FP) MRA approaches have several limitations, such as long breath-holds, non-uniform signal intensity throughout the left atrium (LA), and poor esophageal visualization. The aim of this observational study was to validate a respiratory-navigated, ECG-gated (EC), saturation recovery-prepared MRA technique for simultaneous imaging of LA, LA appendage, PVs, esophagus, and adjacent anatomical structures. METHODS: Before PVI, 106 consecutive patients with a history of AF underwent either conventional FP-MRA ( RESULTS: EC-MRA demonstrated significantly better image quality than FP-MRA in every quality category. Esophageal visibility using the new MRA technique was markedly better than with the conventional FP-MRA technique (median 3.5 [IQR 1] CONCLUSION: Our ECG-gated, respiratory-navigated, saturation recovery-prepared MRA technique provides significantly better image quality and esophageal visibility than the established non-gated, breath-holding FP-MRA. Image quality of EC-MRA technique has the additional advantage of being unaffected by heart rate. ADVANCES IN KNOWLEDGE: Detailed information of cardiac anatomy has the potential to minimize the risk of severe complications and improve success rates in invasive electrophysiological studies. Our novel ECG-gated, respiratory-navigated, saturation recovery-prepared MRA technique provides significantly better image quality of LA and esophageal structures than the traditional first-pass algorithm. This new MRA technique is robust to arrhythmia (tachycardic, irregular heart rates) frequently observed in AF patients