Dipen Shah

Prospective European Survey on Atrial Fibrillation Ablation: Clinical Characteristics of Patients and Ablation Strategies Used in Different Countries

Atrial fibrillation (AF) ablation is widely adopted. Our aim was to conduct a prospective multicenter survey to verify patients’ characteristics, approaches, and technologies adopted across Europe.

A rare cause of Bachmann interatrial block.

Primary cardiac lymphoma (PCL) is a rare malignancy, accounting for 1.3–2% of primary cardiac tumours. We report of a patient with a large PCL who presented with a very rare ECG: an advanced interatrial conduction disturbance of the Bachmann bundle highly suspicious to be due to tumours involvement of interatrial connections between both atria across the …

Intra- and interatrial conduction abnormalities: hemodynamic and arrhythmic significance

Alterations of normal intra- and interatrial conduction are a common outcome of multiple cardiovascular conditions. They arise most commonly in the context of advanced age, cardiovascular risk factors, organic heart disease, atrial fibrosis, and left atrial enlargement. Interatrial block (IAB), the most frequent and extensively studied atrial conduction disorder, affects up to 20% of the general primary care population. IAB can be partial (P wave duration ≥u2009120xa0ms on any of the 12 ECG leads) or advanced (P wave ≥u2009120xa0ms and biphasic morphology (positive-negative) in inferior leads). Advanced IAB is an independent risk factor for supraventricular tachyarrhythmias and embolic stroke in a variety of clinical settings. Advanced IAB is a cause of left atrial electromechanical dysfunction and left atrioventricular dyssynchrony and has been associated with left ventricular diastolic dysfunction. P wave duration is associated with cardiovascular and all-cause mortality in the general population. Atrial conduction abnormalities should be identified as markers of atrial remodeling, prognostic indicators, and, in the case of advanced IAB, a true arrhythmologic syndrome. IAB and other P wave abnormalities should prompt the search for associated conditions, the treatment of which may partially reverse atrial remodeling or prevent it if administered upstream. Future studies will help define the role of preventive therapeutic interventions in high-risk patients, including antiarrhythmic drug therapy and oral anticoagulation. Implications for the treatment of heart failure and for pacing should also be further investigated.

Biomarkers and arrhythmia recurrence following radiofrequency ablation of atrial fibrillation

Objective Atrial fibrillation (AF) is the most common cardiac arrhythmia, and radiofrequency catheter ablation of AF (RCAAF) has become increasingly popular. Cardiac stress and inflammation have been associated with AF. This study was performed to determine whether the pre- or post-AF ablation levels of high-sensitivity C-reactive protein (hs-CRP) and N-terminal pro–B-type natriuretic peptide (NT-proBNP) are predictive of AF recurrence. Methods This multicenter prospective cohort study involved patients undergoing RCAAF in Switzerland and Canada. The primary endpoint was the recurrence of AF or atrial flutter at 6 months. Results Of 202 patients, 195 completed follow-up (age, 57.5u2009±u20099 years; mean left ventricular ejection fraction, 62%; mean left atrial size, 19.4 cm2). Patients with AF recurrence had larger atrial surfaces and longer total RCAAF times. Both the pre-ablation hs-CRP level and 1-day post-RCAAF NT-proBNP level were significantly associated with an increased risk of recurrence. Conclusions The pre-ablation hs-CRP level and immediate post-ablation NT-proBNP level were markers for atrial arrhythmia recurrence after RCAAF. This confirms growing evidence of the role of inflammation in the pathogenesis of AF. These biomarkers appear to be promising stratification tools for selection and management of patients undergoing RCAAF.

Clinical Profile, Electrophysiological Characteristics, and Outcome after Radiofrequency Catheter Ablation of Atypical Atrial Flutter

Although radiofrequency (RF) catheter ablation is well accepted as the treatment of choice for typical atrial flutter, there is limited experience with its use in the treatment of atypical atrial flutter (AAF).