Catheter Ablation Approaches for the Treatment of Arrhythmia Recurrence in Patients with a Durable Pulmonary Vein Isolation

Junctional ectopic tachycardia revisited

Junctional ectopic tachycardia (JET) is an uncommon arrhythmia, but it can have devastating consequences when it occurs. Most physicians are not familiar with its diagnosis, which can seriously compromise management in emergency rooms. Many cases arise in the postoperative period following cardiovascular surgery. In this context, the arrhythmia significantly worsens the prognosis of patients. A particularly severe form of JET is congenital, which has a mortality rate of up to 35%. The diagnosis can be made from the fetal period to six months of age. JET is infrequently diagnosed in otherwise healthy adults. Some medical conditions have been associated with the occurrence of JET. In the electrocardiogram, the most prominent characteristics of the arrhythmia are atrioventricular dissociation, narrow QRS complexes, and R-R interval irregularity due to intermittent ventricular captures. A notable feature of JET is the lack of response to treatment in many patients. Management options are divided into general and specific measures. General measures include avoiding hyperthermia, pain control, and minimizing the use of exogenous catecholamines. Specific treatment involves antiarrhythmic drugs, temporary atrial pacing, and ablation.

Comparative assessment of left and right atrial deformation using 2D and 3D speckle-tracking echocardiography in healthy individuals and rheumatic mitral stenosis patients with/without atrial fibrillation

BACKGROUND

Rheumatic mitral stenosis continues to be a significant public health issue in developing countries. Advances in echocardiography have made it possible to non-invasively assess atrial physiomechanics. In our study, we aimed to evaluate the changes in left and right atrial phasic functions in patients with have mitral stenosis and to investigate the relationship of these changes with clinical signs, symptoms, and intervention decisions.

METHODS

Patients with rheumatic mitral stenosis who did not have comorbidities affecting cardiac function were included in this single-center, prospective study. The study population consisted of 122 subjects: 30 healthy controls with no chronic diseases and normal cardiac function confirmed by clinical and echocardiographic evaluations, 31 patients with moderate mitral stenosis, 31 patients with severe mitral stenosis and 30 patients with severe mitral stenosis with valvular atrial fibrillation. In addition to conventional echocardiographic parameters, biventricular deformation analyses were assessed using 2D-STE. Right and left atrial phasic functions were evaluated using both 2D and 3D-STE analysis and compared with clinical findings.

RESULTS

In the patient group with severe mitral stenosis in sinus rhythm, the contractile left atrial strain values were significantly higher. The left atrial peak longitudinal (reservoir) strain values were found to be significantly lowest in the group with severe mitral stenosis accompanied by atrial fibrillation. Similarly, in the group with severe mitral stenosis accompanied by atrial fibrillation, the right atrial phasic strain values were significantly lower in both 2D and 3D measurements.

CONCLUSION

Mitral stenosis, the increased left atrial afterload in patients with sinus rhythm is compensated by an increase in contractile function. However, this compensatory increase is insufficient to preserve left atrial reservoir function. Patients with mitral stenosis who develop atrial fibrillation lack the compensatory contractile function, and this deficiency underlies the increased clinical deterioration associated with the development of atrial fibrillation.

Construction and validation of a predictive model for intracardiac thrombus risk in patients with dilated cardiomyopathy: a retrospective study

BACKGROUND

Systemic embolic events due to exfoliation of intracardiac thrombus (ICT) are one of the catastrophic complications of dilated cardiomyopathy (DCM). This study intended to develop a prediction model to predict the risk of ICT in patients with DCM.

METHODS

Data from 632 patients with DCM from a hospital was collected. ICT was identified based on the results of transthoracic echocardiography. Basic information, vital signs, comorbidities, and biochemical data were measured and collected from each patient. The least absolute shrinkage and selection operator (LASSO) regression was used for the final model variable screening. Four classifiers including Logistic Regression, support vector machine (SVM), Random Forest, and eXtreme Gradient Boosting (XGBoost) were used for model construction respectively. The area under of the curve (AUC) with 95% confidence interval (CI), sensitivity, specificity, and accuracy of the models were calculated to assess the predictive ability of the models.

RESULTS

Of these 632 DCM patients, 88 (13.92%) had ICT and 544 (86.08%) did not. Eleven clinical variables were selected for the construction of predictive models. The AUC of the Logistic Regression model to predict ICT probability was 0.854 (95%CI: 0.811-0.896), the SVM model was 0.769 (95%CI: 0.715-0.824), the Random Forest model was 0.917 (95%CI: 0.887-0.947), and the XGBoost model was 0.947 (95%CI: 0.924-0.969). The Delong test demonstrated that the XGBoost model had the highest AUC for predicting the ICT probability compared to other models (P < 0.05). Moreover, D-dimer, age, and atrial fibrillation contributed the most to the XGBoost model among these 11 variables.

CONCLUSION

The XGBoost model has a good predictive ability in predicting ICT risk in patients with DCM and may assist clinicians in identifying ICT risk.

The clinical classification of patients with acute heart failure at emergency department and its relation with management and outcome: a cross sectional study from Syria

INTRODUCTION

To compare the clinical characteristics and outcomes of patients with acute heart failure (AHF) according to the 2016 European Society of Cardiology (ESC) guidelines taking into account isolated right HF (RHF) with left HF (LHF) phenotypes. Volume status was assessed by the clinical manifestations and lung ultrasound (LUS). The secondary aim was to study the role of echocardiography in congestion based on LUS and their relations with outcomes.

METHODS

This study included AHF patients, who referred to the emergency department (ED) at AL-Mouwasat and AL-Assad University Hospitals in Syria between May and August 2024. The same cardiologist reviewed medical reports, signs/ symptoms of decompensation, echocardiographic assessment, diagnosis, and treatment therapies.

RESULTS

Of 100 patients, 10 patients (10%) had isolated RHF and 90 patients (90%) had LHF, including warm-wet (n = 65, 65%), followed by cold-wet (n = 13, 13%), warm-dry (n = 10, 10%), and cold-dry (n = 2, 2%). Most discharged patients without admission were Warm-dry, meanwhile most of patients with cold-wet (76.9%) were admitted to intensive care unit (ICU). The longest in-hospital stays were in cold-wet (11.9 days) followed by isolated RHF (7.5 days). While in-hospital mortality was mainly in cold-wet (38.5%) followed by isolated RHF (20%). Diuretics dose was highest in cold-wet followed by isolated RHF, while hydration was predominantly in cold-wet. Using vasopressors and inotropes were predominantly in cold-wet. Systolic blood pressure (SBP), hemoglobin (Hb), sodium (Na), proximal right ventricular outflow tract (RVOT1), left ventricular end-diastolic internal diameter (LVIDd), Tricuspid annular systolic plane excursion (TAPSE), and systolic pulmonary atrial pressure (SPAP) correlated with hospital stays, while only SBP and Cr correlated with in-hospital mortality. The cut-off values of E/e' ratio, isovolumic relaxation time (IVRT), and deceleration time (DT) were (12.5, 55ms, and 131.5 ms; respectively) and could predict congestion (guided by LUS) with sensitivities of (96%, 74%, and 62%; respectively) and specificities of (53%, 92%, and 84%; respectively).

CONCLUSION

Classifying AHF patients into these five groups, based on clinical examination supporting by echocardiography and LUS evaluation can give better assessment of the AHF phenotypes and gives more details for management. The bedside diagnostic assessment by LUS and echocardiography is an easy tool and seems to be of great benefit in detecting congestion that enhances the treatment protocols.

Bioinformatics analysis of the expression of potential common genes and immune-related genes between atrial fibrillation and chronic kidney disease

Research objective

This study is based on bioinformatics analysis to explore the co-expressed differentially expressed genes (DEGs) between atrial fibrillation (AF) and chronic kidney disease (CKD), identify the biomarkers for the occurrence and development of the two diseases, investigate the potential connections between AF and CKD, and explore the associations with immune cells.

Methods

We downloaded Two AF gene chip datasets (GSE79768, GSE14975) and two CKD gene chip datasets (GSE37171, GSE120683) from the GEO database. After pre-processing and standardizing the datasets, two DEGs datasets were obtained. The DEGs were screened using R language, and the intersection was taken through Venn diagrams to obtain the co-expressed DEGs of AF and CKD. To obtain the signal pathways where the co-expressed DEGs were significantly enriched, GO/KEGG enrichment analyses were used to analysis the co-expressed DEGs. The Cytoscape software was used to further construct a PPI network and screen key characteristic genes, and the top 15 co-expressed DEGs were screened through the topological algorithm MCC. To further screen key characteristic genes, two machine-learning algorithms, LASSO regression and RF algorithm, were performed to screen key characteristic genes for the two disease datasets respectively to determine the diagnostic values of the characteristic genes in the two diseases. The GeneMANIA online database and Networkanalyst platform were used to construct gene-gene and TFs-gene interaction network diagrams respectively to predict gene functions and find key transcription factors. Finally, the correlation between key genes and immune cell subtypes was performed by Spearman analysis.

Research results

A total of 425 DEGs were screened out from the AF dataset, and 4,128 DEGs were screened out from the CKD dataset. After taking the intersection of the two, 82 co-expressed DEGs were obtained. The results of GO enrichment analysis of DEGs showed that the genes were mainly enriched in biological processes such as secretory granule lumen, blood microparticles, complement binding, and antigen binding. KEGG functional enrichment analysis indicated that the genes were mainly enriched in pathways such as the complement coagulation cascade, systemic lupus erythematosus, and Staphylococcus aureus infection. The top 15 DEGs were obtained through the MCC topological algorithm of Cytoscape software. Subsequently, based on LASSO regression and RF algorithm, the key characteristic genes of the 15 co-expressed DEGs of AF and CKD were further screened, and by taking the intersection through Venn diagrams, five key characteristic genes were finally obtained: PPBP, CXCL1, LRRK2, RGS18, RSAD2. ROC curves were constructed to calculate the area under the curve to verify the diagnostic efficacy of the key characteristic genes for diseases. The results showed that RSAD2 had the highest diagnostic value for AF, and the diagnostic values of PPBP, CXCL1, and RSAD2 for CKD were all at a relatively strong verification level. Based on AUC >0.7, co-expressed key genes with strong diagnostic efficacy were obtained: PPBP, CXCL1, RSAD2. The results of the GeneMANIA online database showed that the two biomarkers, BBPB and CXCL1, mainly had functional interactions with cytokine activity, chemokine receptor activity, cell response to chemokines, neutrophil migration, response to chemokines, granulocyte chemotaxis, and granulocyte migration. The TFs-gene regulatory network identified FOXC1, FOXL1, and GATA2 as the main transcription factors of the key characteristic genes. Finally, through immune infiltration analysis, the results indicated that there were various immune cell infiltrations in the development processes of AF and CKD.

Research conclusion

PPBP, CXCL1, and RSAD2 are key genes closely related to the occurrence and development processes between AF and CKD. Among them, the CXCLs/CXCR signaling pathway play a crucial role in the development processes of the two diseases likely. In addition, FOXC1, FOXL1, and GATA2 may be potential therapeutic targets for AF combined with CKD, and the development of the diseases is closely related to immune cell infiltration.

Hypertension and Atrial Fibrillation: Bridging the Gap Between Mechanisms, Risk, and Therapy

Background and objectives: Atrial fibrillation (AF), the most prevalent sustained arrhythmia, poses a significant public health challenge due to its links with stroke, heart failure, and mortality. Hypertension, a primary modifiable cardiovascular risk factor, is a well-established risk factor for AF that facilitates structural and electrical changes in the atria, including dilation, fibrosis, and pressure overload. Material and Methods: we conducted a literature search regarding the shared mechanisms, risks and treatments of hypertension and atrial fibrillation. Results: The renin-angiotensin-aldosterone system plays a pivotal role in this remodelling and inflammation, increasing AF susceptibility. Uncontrolled hypertension complicates AF management, diminishing the effectiveness of mainstay treatments, including antiarrhythmic drugs, catheter ablation, and cardioversion. Effective blood pressure management, particularly with therapies targeting the renin-angiotensin-aldosterone system (RAAS), can lower the risk of new-onset AF and reduce the incidence of recurrent AF, enhancing the success of rhythm control strategies. These antihypertensive therapies mitigate myocardial hypertrophy and fibrosis and attenuate both atrial pressure strain and the inflammatory response, mitigating the substrates for AF. Conclusion: This review highlights the urgent need for integrated strategies that combine BP control, AF screening, and lifestyle modifications to minimise the burden of AF and its complications. Future research should investigate the specific mechanisms of cellular-level interactions associated with a hypertensive predisposition to AF, including systematic inflammation and the role of genetics, the impact of blood pressure variations on AF risk, and individualised treatment strategies specifically targeting the shared mechanisms, simultaneously propagating hypertension and AF.

A bibliometric analysis of the 50 most cited articles about quality of life in patients with atrial fibrillation

BACKGROUND

Atrial fibrillation is a progressive arrhythmia that has become a global concern affecting the quality of life of millions of patients. This bibliometric analysis aims to highlight the top 50 most cited articles in the field of quality of life in atrial fibrillation patients, focusing on publication trends, citations, influential authors and journals, promising institutions, and key contributing countries.

RESULTS

The top 50 articles were published between 1995 and 2021 across 15 journals, with an average number of citations of 380.5 per article. The article with the highest number of citations, i.e., 1525, was published in the 'Circulation' journal. 'Natale Andrea' and 'Verma Atul' contributed the most to the field, with 7 articles each. The United States of America had the highest total number of publications among the countries, with 20 articles. The field is extensively researched; however, there remains a necessity for methodological enhancements in the assessment of quality of life.

CONCLUSIONS

This study assessed advancements in research regarding quality of life in atrial fibrillation patients and serves as an invaluable resource for clinicians and researchers to comprehend the existing body of knowledge in the field. Although quality of life in patients with atrial fibrillation has been the focus of interest in recent years, the management of patients still needs improvement.

Atrial Fibrillation as a Geriatric Syndrome: Why Are Frailty and Disability Often Confused? A Geriatric Perspective from the New Guidelines

Atrial Fibrillation can be considered a geriatric syndrome for its prevalence and incidence, its impact on patients' quality of life, and Health Systems' economy. The European Society of Cardiology 2024 guidelines introduce a recommendation for maintaining vitamin K antagonist therapy over switching to direct oral anticoagulants in clinically stable elderly patients with atrial fibrillation. This article explores the implications of this indication for the geriatric clinical context. The focus will also be devoted to the need for the stratification of older patients with atrial fibrillation, making an appropriate distinction between frailty and disability.

A Systematic Review on the Effectiveness of Machine Learning in the Detection of Atrial Fibrillation

Recent endeavors have led to the exploration of Machine Learning (ML) to enhance the detection and accurate diagnosis of heart pathologies. This is due to the growing need to improve efficiency in diagnostics and hasten the process of delivering treatment. Several institutions have actively assessed the possibility of creating algorithms for advancing our understanding of atrial fibrillation (AF), a common form of sustained arrhythmia. This means that artificial intelligence is now being used to analyze electrocardiogram (ECG) data. The data is typically extracted from large patient databases and then subsequently used to train and test the algorithm with the help of neural networks. Machine learning has been used to effectively detect atrial fibrillation with more accuracy than clinical experts, and if applied to clinical practice, it will aid in early diagnosis and management of the condition and thus reduce thromboembolic complications of the disease. In this text, a review of the application of machine learning in the analysis and detection of atrial fibrillation, a comparison of the outcomes (sensitivity, specificity, and accuracy), and the framework and methods of the studies conducted have been presented.

Correlation between triglyceride-glucose index and atrial fibrillation in acute coronary syndrome patients: a retrospective cohort study and the establishment of a LASSO-Logistic regression model

BACKGROUND

Insulin resistance (IR) is an independent predictor of atrial fibrillation (AF), but the specific utility of the triglyceride-glucose (TyG) index as a predictive marker for the incidence of AF in the acute coronary syndrome (ACS) population has not yet been explored.

OBJECTIVE

To explore the correlation between TyG index and the risk of AF in ACS patients and to establish a predictive model.

METHODS

A retrospective study was conducted on 613 ACS patients admitted to the Department of Cardiovascular Medicine at the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from January 2022 to September 2024. Patients were divided into four groups based on quartiles of TyG index. Patients were further divided into two groups based on the occurrence of AF: the AF group and the non-AF group. Patient information was collected through the hospital's HIS system. Variable selection was completed using LASSO regression algorithms. Multivariate logistic bidirectional stepwise regression analysis was used to explore the correlation between the TyG index and the risk of AF in ACS patients and to construct a regression model. Three different models were constructed by adjusting for confounding factors and restricted cubic spline plots were drawn to validate the significance of the TyG index combined with AF further. The predictive value of the LASSO-multivariate logistic bidirectional stepwise regression model and the TyG index alone for predicting AF in ACS patients was analyzed using the receiver operating characteristic curve.

RESULTS

The LASSO-multivariate logistic bidirectional stepwise regression algorithm showed that coronary heart disease (CHD), valvular heart disease (VHD), TyG, age (AGE), and diastolic blood pressure (DBP) were risk factors for AF in ACS. The restricted cubic spline model demonstrated a significant linear relationship between a higher TyG index and an increased risk of AF in the ACS patient population. The area under the curve (AUC) for predicting AF in ACS patients using the TyG index and the LASSO-multivariate logistic bidirectional stepwise regression model was 0.65(95%CI = 0.58 ~ 0.73) and 0.71(95%CI = 0.65 ~ 0.77) respectively. Additionally, the correlation between the TyG index and AF was consistent across different subgroups.

CONCLUSION

In ACS patients, the TyG index is a stable and independent predictor of AF, with specific clinical value in identifying the occurrence of AF in this population.

Transseptal Puncture and Cryoballoon Ablation of Atrial Fibrillation in Patients with Atrial Septal Occluder or Atrial Septal Defect Surgical Repair: A Single Center Experience

BACKGROUND

Atrial fibrillation (AF) is a common arrhythmia in patients with atrial septal defect (ASD). Cryoballoon ablation (CA) is a safe and efficient method for pulmonary vein (PV) isolation in the treatment of AF. Achieving left atrial access may be difficult in patients with atrial septal occluders (ASO) or surgical repair of ASD. The aim of this study was to present our experience with the efficacy and safety of transseptal puncture and AF ablation in CA in this subset of patients.

METHODS

We retrieved our data about patients with ASO or surgical repair of ASD undergoing cryoballoon AF ablation procedures at our center between August 2019 and January 2022.

RESULTS

Nine patients (age 43.88 ± 9.73 years) with AF (5 paroxysmal and 4 persistent) and ASO or surgical repair of ASD were enrolled. All three patients had a 28 mm Amplatzer ASO device which occupied the whole septum, and direct puncture through the ASO was performed. Sequential balloon dilatation was performed in 2 patients with surgical ASD repair and all 3 patients with ASO. Four of 6 patients (66.7%) in the surgical repair group required transesophageal echocardiography during transseptal puncture. The endpoint of the procedure, isolation of all PVs, was achieved in all 9 patients. None of the patients had evidence of an interatrial shunt or pericardial effusion at the end of the procedure. Total procedural time (123 ± 28 minutes vs. 63 ± 21 minutes, P = .024) and total fluoroscopy time (41 ± 5 minutes vs. 23 ± 8 minutes, P = .024) were significantly higher in the percutaneous closure group.

CONCLUSIONS

In patients with ASO or surgical repair of ASD, CA of AF might be feasible, safe, and effective. The balloon dilatation of the interatrial septum (IAS) might assist transseptal access through the ASO or a surgically repaired thickened IAS.

Clinical incidence and relevance of incomplete endothelialization in atrial fibrillation patients with Left Atrial Appendage Closure

BACKGROUND

The objective of this study is to investigate the incidence, potential risk factors, and clinical outcomes of incomplete device endothelialization (IDE) in atrial fibrillation (AF) patients undergoing Watchman left atrial appendage closure (LAAC).

METHODS

In this study, 68 AF patients who underwent successful implantation of the Watchman device without peri-device leak (PDL) during follow-up were included. The endothelialization status was assessed using Transesophageal echocardiography (TEE) and LAA computed tomography angiography (CTA) at 6 weeks and 6 months post-implantation. Adverse cerebro-cardiac events were documented at one-year follow-up. Baseline characteristics, including age, device sizes, and clinical indicators, were analyzed as potential predictors for IDE.

RESULTS

IDE was observed in 70.6% and 67.6% of patients at 6 weeks and 6 months after implantation, respectively. Higher levels of high-density lipoprotein cholesterol (HDL-C) [odds ratio (OR): 15.109, 95% confidence interval (CI): 1.637-139.478, p = 0.017 and OR: 11.015, 95% CI: 1.365-88.896, p = 0.024] and lower aspartate aminotransferase (AST) (OR 0.924, 95% CI: 0.865-0.986, p = 0.017 and OR: 0.930, 95% CI: 0.874-0.990, p = 0.023) at baseline were found to be significantly associated with IDE at 6 weeks and 6 months, respectively, although no significant difference in adverse cerebro-cardiac events was noted between incomplete and complete DE groups during 1-year follow-up CONCLUSIONS: IDE is found to be a prevalent occurrence in humans following LAAC. Elevated HDL-C and reduced AST levels are shown to be linked to an increased risk of IDE after LAAC.

NLRP3 Expression and Its Predictive Role in Heart Failure with Preserved Ejection Fraction among Non-Valvular Atrial Fibrillation Patients

INTRODUCTION

The aim of this study was to investigate the expression and predictive value of NOD-like receptor thermal protein domain-related protein 3 (NLRP3) in patients with non-valvular atrial fibrillation (NVAF) with heart failure with preserved ejection fraction (HFpEF).

METHODS

This was a retrospective analysis of 121 patients diagnosed with NVAF. According to the occurrence of HFpEF, 81 patients were assigned to the NVAF group and 40 patients to the NVAF/HFpEF group. The levels of NLRP3, B natriuretic peptide (BNP), and interleukin-1β (IL-1β) were determined using ELISA. Independent predictors for HFpEF in NVAF were determined using logistic regression. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of each factor.

RESULTS

Expression levels of NLRP3, BNP, and IL-1β in the NVAF/HFpEF group, as well as the H2FPEF score were significantly higher than those in the NVAF group. Pearson analysis showed that NLRP3, BNP, and IL-1β expression levels in NVAF patients and the H2FPEF score was positively correlated (r = 0.409, r = 0.244, r = 0.299, p < 0.001). Multivariate logistic regression analysis showed that the NLRP3, BNP, or H2FPEF score can be used as independent factor for predicting the occurrence of HFpEF in NVAF. ROC curves showed that the areas under the curve of NLRP3, BNP, and H2FPEF scores for predicting the occurrence of HFpEF in NVAF patients were 0.856, 0.831, and 0.811, respectively.

CONCLUSION

The NLRP3 level is elevated in the peripheral blood of NVAF patients with HFpEF and is positively correlated with the H2FPEF score. NLRP3 may serve as a potential predictor of HFpEF in patients with NVAF.

Effects of Renal Denervation on Gap Junction in High-Pacing-Induced Heart Failure Dogs

BACKGROUND

Gap junction remodeling is an important cause of ventricular arrhythmia in heart failure. However, it remains unclear whether renal denervation (RDN) regulates gap junction remodeling in heart failure. To explore the effect of RDN on gap junction remodeling in dogs with high-pacing-induced heart failure.

METHODS

Fifteen dogs were randomly divided into control (n = 5), heart failure (HF) (n = 5), and RDN+HF (n = 5) group. A high-pacing-induced-heart failure model was established using rapid right ventricular pacing for 4 weeks. The RDN+HF group underwent surgical and chemical ablation of both renal arteries before 4 weeks rapid right ventricular pacing. After 4 weeks, echocardiography, High-Performance Liquid Chromatography-Mass Spectrometry test for norepinephrine and epinephrine, and pathological analysis were performed in the above 3 groups. Further, immunohistochemical staining was used to detect tyrosine hydroxylase, ChaT, connexin 43 (Cx43), and connexin 40 (Cx40). Connexin 43 and Cx40 expression was detected by western blotting. Transmission electron microscopy was used to observe the gap junction.

RESULTS

Compared to the control group, myocardial fibrosis and sympathetic hyperactivity were observed in the HF group. Immunohistochemical staining and western blotting showed that Cx40 expression and Cx43 expression was significantly reduced in the HF group. Compared with the HF group, the RDN+HF group showed reduced sympathetic hyperactivity, Cx40 expression, Cx40/Cx43 ratio, and increased Cx43 expression.

CONCLUSION

Renal denervation alleviates gap junction remodeling in high-pacing-induced heart failure dogs.

Causal Effect of Atrial Fibrillation on Heart Failure Risk in East Asian Ancestry: A Bidirectional Mendelian Randomization Study Using Genome-wide Association Data

BACKGROUND

Atrial fibrillation (AF) and heart failure (HF) are prevalent cardiovascular conditions in East Asia, with a complex interrelationship. The directionality of the causal impact of AF on HF risk remains uncertain. This study employs Mendelian randomization (MR) to investigate the potential causal effect of AF on HF.

METHODS

Utilizing summary data from genome-wide association studies (GWAS) within the Medical Research Council Integrative Epidemiology Unit open GWAS database, we analyzed 8180 AF cases and 28 612 controls, alongside 9413 HF cases and 203 040 controls, all of East Asian descent. We conducted MR analysis using the inverse variance weighted (IVW) method, complemented by various sensitivity analyses, including bidirectional MR to assess causality in the reverse direction.

RESULTS

Genetically predicted AF was found to be causally associated with an increased risk of HF in East Asian populations (odds ratio = 1.14, 95% CI: 1.10-1.19, P <.001) as per the IVW method. These findings were consistent across multiple MR methods. Sensitivity analyses revealed no significant heterogeneity or pleiotropy. Notably, bidirectional MR analysis showed no causal effect of HF on the risk of developing AF.

CONCLUSIONS

The MR analysis supports a unidirectional causal relationship between AF and increased HF risk in East Asian individuals. The absence of a reverse causal effect reinforces the importance of maintaining sinus rhythm to mitigate HF risk. Further research is warranted to corroborate these findings and to explore their clinical implications in depth.

Management of Arrhythmias and Conduction Disorders in Amyloid Cardiomyopathy

Cardiac amyloidosis, a condition characterized by abnormal protein deposition in the heart, leads to restrictive cardiomyopathy and is notably associated with an increased risk of arrhythmias and conduction disorders. This article reviews the current understanding and management strategies for these cardiac complications, with a focus on recent advancements and clinical challenges. The prevalence and impact of atrial arrhythmias, particularly atrial fibrillation, are examined, along with considerations for stroke risk and anticoagulation therapy. The article also addresses the complexities of managing rate and rhythm control, outlining the utility and limitations of pharmacological agents and interventions such as catheter ablation. Furthermore, it reviews the challenges in the treatment of ventricular arrhythmias, including the contentious use of implantable cardioverter-defibrillators for primary and secondary prevention. Individualized approaches, considering the unique characteristics of cardiac amyloidosis, are paramount. Continuous research and clinical exploration are essential to refine treatment strategies and improve outcomes in this challenging patient population.

Catheter ablation versus medical therapy in atrial fibrillation: an umbrella review of meta-analyses of randomized clinical trials

This umbrella review synthesizes data from 17 meta-analyses investigating the comparative outcomes of catheter ablation (CA) and medical treatment (MT) for atrial fibrillation (AF). Outcomes assessed were mortality, risk of hospitalization, AF recurrence, cardiovascular events, pulmonary vein stenosis, major bleeding, and changes in left ventricular ejection fraction (LVEF) and MLHFQ score. The findings indicate that CA significantly reduces overall mortality and cardiovascular hospitalization with high strength of evidence. The risk of AF recurrence was notably lower with CA, with moderate strength of evidence. Two associations reported an increased risk of pulmonary vein stenosis and major bleeding with CA, supported by high strength of evidence. Improved LVEF and a positive change in MLHFQ were also associated with CA. Among patients with AF and heart failure, CA appears superior to MT for reducing mortality, improving LVEF, and reducing cardiovascular rehospitalizations. In nonspecific populations, CA reduced mortality and improved LVEF but had higher complication rates. Our findings suggest that CA might offer significant benefits in managing AF, particularly in patients with heart failure. However, the risk of complications, including pulmonary vein stenosis and major bleeding, is notable. Further research in understudied populations may help refine these conclusions.

Postoperative Coagulation Changes in Patients after Epicardial Left Atrial Appendage Occlusion Varies Based on the Left Atrial Appendage Size

Left atrial appendage occlusion affects systemic coagulation parameters, leading to additional patient-related benefits. The aim of this study was to investigate the differences in coagulation factor changes 6 months after epicardial left atrial appendage occlusion in patients with different LAA morphometries. This is the first study to analyze these relationships in detail. A prospective study of 22 consecutive patients was performed. Plasminogen, fibrinogen, tPA concentration, PAI-1, TAFI and computed tomography angiograms were performed. Patients were divided into subgroups based on left atrial appendage body and orifice diameter enlargement. The results of blood tests at baseline and six-month follow-up were compared. In a population with normal LAA body size and normal orifice diameter size, a significant decrease in analyzed clotting factors was observed between baseline and follow-up for all parameters except plasminogen. A significant decrease between baseline and follow-up was observed with enlarged LAA body size in all parameters except TAFI, in which it was insignificant and plasminogen, in which a significant increase was observed. Occlusion of the left atrial appendage is beneficial for systemic coagulation. Patients with a small LAA may benefit more from LAA closure in terms of stabilizing their coagulation factors associated with potential thromboembolic events in the future.

Arrhythmias in Patients with Congenital Heart Disease: An Ongoing Morbidity

With the aging of congenital heart disease (CHD) patients, the burden of arrhythmias is expanding. Atrial arrhythmias, especially intra-atrial reentrant tachycardia and atrial fibrillation, are the most prevalent forms of arrhythmia. Managing comorbidities, such as obesity, using pharmacotherapy, including antiarrhythmics and anticoagulants, and ablation therapy has become the cornerstone of arrhythmia management. Ventricular tachycardias are also not rare; however, except for tetralogy of Fallot patients, recommendations for the use of implantable cardioverter defibrillators for primary prevention in other CHD patients are still not well established. Patients with CHD might also present with atrioventricular blockages because of their anatomy or following a surgical procedure. The scope of this article is to review the current knowledge and discuss the future directions regarding arrhythmia management in CHD patients.