Nebojša Marković

Prediction of very late arrhythmia recurrence after radiofrequency catheter ablation of atrial fibrillation: The MB-LATER clinical score

Reliable prediction of very late recurrence of atrial fibrillation (VLRAF) occuring >12 months after catheter ablation (CA) in apparently “cured” patients could optimize long-term follow-up and modify decision-making regarding the discontinuation of oral anticoagulant therapy. In a single-centre cohort of consecutive patients post radiofrequency AFCA, we retrospectively derived a novel score for VLRAF prediction. Of 133 consecutive post AFCA patients (mean age 56.9u2009±u200911.8 years, 63.9% male, 69.2% with paroxysmal AF) who were arrhythmia-free at 12 months (excluding 3-month “blanking period”), 20 patients expirienced a VLRAF during a 29.1u2009±u200910.1-month follow-up, with a 3-year cumulative VLRAF rate of 31.1%. The MB-LATER score (Male, Bundle brunch block, Left atrium ≥47u2009mm, Type of AF [paroxysmal, persistent or long-standing persistent], and ER-AFu2009=u2009early recurrent AF), had better predictive ability for VLRAF (AUC 0.782) than the APPLE, ALARMc, BASE-AF2, CHADS2, CHA2DS2VASc or HATCH score (AUC 0.716, 0.671, 0.648, 0.552, 0.519 and 0.583, respectively), resulted in an improved net reclassification index (NRI) of 48.6–95.1% and better identified patients with subsequent VLRAF using decision-curve analysis (DCA). The MB-LATER score provides a readily available VLRAF risk assessment, and performs better than other scores. Validation of the MB-LATER score in other cohorts is underway.

Management and Outcome of Periprocedural Cardiac Perforation and Tamponade with Radiofrequency Catheter Ablation of Cardiac Arrhythmias: A Single Medium-Volume Center Experience

IntroductionCardiac tamponade (CT) is a life-threatening complication of radiofrequency ablation (RFA). The course and outcome of CT in low-to-medium volume electrophysiology centers are underreported.MethodsWe analyzed the incidence, management and outcomes of CT in 1500 consecutive RFAs performed in our center during 2011–2016.ResultsOf 1500 RFAs performed in 1352 patients (age 55xa0years, interquartile range: 41–63), 569 were left-sided procedures (nxa0=xa0406 with transseptal access). Conventional RFA or irrigated RFA was performed in 40.9% and 59.1% of procedures, respectively. Ablation was performed mostly for atrioventricular nodal reentrant tachycardia (25.4%), atrial fibrillation (AF; 18.5%), atrial flutter (18.4%), accessory pathway (16.5%) or idiopathic ventricular arrhythmia (VA; 12.3%), and rarely for structural VA (2.1%). CT occurred in 12 procedures (0.8%): 10 AF ablations, 1 idiopathic VA and 1 typical atrial flutter ablation. Factors significantly associated with CT were older age, pre-procedural oral anticoagulation, left-sided procedures, transseptal access, AF ablation, irrigated RFA and longer fluoroscopy time (on univariate analysis), and AF ablation (on multivariable analysis). The perforation site was located in the left atrium (nxa0=xa07), right atrium (nxa0=xa03), or in the left ventricle or coronary sinus (nxa0=xa01 each). Upon pericardiocentesis, two patients underwent urgent cardiac surgery because of continued bleeding. There was no fatal outcome. During the follow-up of 19xa0±xa014xa0months, eight patients were arrhythmia free.ConclusionIncidence of RFA-related CT in our medium-volume center was low and significantly associated with AF ablation. The outcome of CT was mostly favorable after pericardiocentesis, but readily accessible cardiothoracic surgery back-up should be mandatory in RFA centers.

Persistency of left atrial linear lesions after radiofrequency catheter ablation for atrial fibrillation: Data from an invasive follow-up electrophysiology study

Data on the roof line (RL) and mitral isthmus line (MIL) reconnections after atrial fibrillation (AF) catheter ablation (CA) are scarce.

The relationship of early recurrence of atrial fibrillation and the 3-month integrity of the ablation lesion set

Early recurrence of atrial fibrillation (ERAF) after catheter-ablation (CA) can be a transient phenomenon due to inflammation, or a harbinger of late AF recurrence due to CA lesion (re)conduction. We studied the relationship between ERAF and the 3-month CA lesions integrity. Forty one consecutive AF patients who underwent a pulmonary vein isolation (PVI), roof line (RL) and mitral isthmus line (MIL) CA were enrolled. At 3 months all patients underwent invasive assessment of the lesion set integrity irrespective of ERAF. The PVI, RL and MIL ablation was successful in 100.0%, 95.1% and 82.9% patients, respectively. At the 3-month remapping, a gap in PVI-lesion(s), RL or MIL was identified in 61.0%, 31.7% and 36.6% patients, respectively. Patients with (nu2009=u200917, 41.5%) compared to those without ERAF (nu2009=u200924) had a significantly higher rate of any PV-reconnection (88.2% vs. 41.7%), the right PV(s)-reconnection (82.5% vs. 29.2%) and the RL gap (52.9% vs. 16.7%), as well as a higher number of reconnected right PVI-segments, all pu2009<u20090.05. On multivariate analysis, only the number of reconnected right PVI-segments was associated with ERAF (OR 4.26, pu2009=u20090.004). The ERAF following PVIu2009+u2009RLu2009+u2009MIL ablation was significantly related to 3-month PV-reconnections and the presence of RL gaps.

Influence of bunch morphology on quality of wines produced from clones of grape variety Prokupac

Wine quality depends mainly on the characteristics of the grape it is made of, and one of the attributes affecting wine composition is cluster and berry morphology. The aim of this study was to represent variability of morphological characteristics between clones of the autochthonous grape variety Prokupac and performed chemical evaluation of wines obtained from them. Total phenolic content was generally low and it ranged from 33.0 to 114.5 mg GAE/100 mL. Six main anthocyanin compounds with malvidin as the main anthocyanidin were detected. Malvidin-3- O -glucoside was the most abundant anthocyanin ranging from 59.8 to 101.7 µg/mL. Clones 43/5 and 43/4 are marked as those from which wines with the highest quality are obtained. According to our results clonal selection makes a significant difference in Prokupac wine quality. On the other hand, there is a poor response of wine quality parameters to variation in morphological attributes of clusters and berries (bunch weight, proportion of stem, berry and seed weight, skin, pulp and seed weight per berry).

Fertility Variation of ‘Prokupac’ Cultivar Under Influence of Different Rootstocks

The examination was carried out in the vineyard on Radmilovac- Experimental field Faculty of Agriculture in Belgrade. The aim of the research was to detect the effects of three rootstocks (K 5BB, SO4 and S 41B) on Prokupac fertility. The paper presents the results of four years tests that showed variation of different fertility parameters depending on the rootstock. Rootstock K 5BB had the highest impact on the number of developed shoots per vine (14.1), number of productive shoots per vine (12) and the highest percent of developed shoot per vine (96%). Higher percentage of productive shoots was recorded on rootstock SO4 (93.7%). In comparison to other two rootstocks (5BB K and S 41B) on the same rootstock was recorded higher values for the following parameters: inflorescences number per bud (1.5), inflorescences number per developed shoot (1.6) and number of inflorescences per productive shoot (1.7). S 41B rootstock influenced cluster number per vine (20.5) and cluster mass (172.9 g).