Left Atrial Appendage Fibrosis and 3-Year Clinical Outcomes in Atrial Fibrillation After Endoscopic Ablation: A Histologic Analysis
This study aimed to analyze the histologic relationship between atrial fibrosis and development or recurrence of NVAF after endoscopic ablation.MethodsPatients (n = 136) with NVAF undergoing endoscopic ablation and 10 patients in sinus rhythm were enrolled in this study. Left atrial appendage was harvested from all patients. Collagen volume fraction (CVF) and fibrosis biomarkers were evaluated. Linear regression analysis was performed to determine the correlation between clinical variables and atrial fibrosis. The association between atrial fibrosis and NVAF recurrence was evaluated with the Cox proportional hazards model.ResultsA significant difference was found in the degree of atrial fibrosis between patients with NVAF and sinus rhythm (CVF: median 15 [interquartile range (IQR), 13-17] vs median 6.5 [IQR, 5-10.25]; P
Publication date: Available online 21 January 2020Source: American Heart JournalAuthor(s): Kotaro Miura, Nobuhiro Ikemura, Takehiro Kimura, Yoshinori Katsumata, Ikuko Ueda, Kojiro Tanimoto, Takahiro Ohki, Daisuke Shinmura, Koji Negishi, Keiichi Fukuda, Seiji Takatsuki, Shun KohsakaAbstractBackgroundRhythm-control strategy, including catheter ablation (CA) application, constitutes an integral part of atrial fibrillation (AF) management. However, elderly patients are underrepresented in clinical trials, and reports on patient-reported outcome of various rhythm-control treatments remain limited. Therefore, we aimed to investi...
ConclusionsThese results compare favorably to those reported by ECCG. MIE can be the standard approach for surgical management of esophageal cancer. Introduction of the approach in each surgeon’s practice should be benchmarked to international standards.
The device touted as the world's smallest pacemaker is now FDA approved for patients with AV block, a condition in which the electrical signals between the chambers of the heart are impaired. FDA approved the original Micra Transcatheter Pacing SystemÂ in 2016 for patients with atrial fibrillation or other dangerous arrhythmias such as bradycardia-tachycardia syndrome. The Micra AV is identical in size and shape to the original device, but has several additional internal sensing algorithms which detect cardiac movement, allowing the device to adjust pacing in the ventricle to coordinate with the atrium, providin...
Editor's Summary by Howard Bauchner, MD, Editor in Chief of JAMA, the Journal of the American Medical Association, for the January 21, 2020 issue
This randomized trial compares the effects of pulmonary vein isolation with vs without renal denervation on freedom from atrial fibrillation, atrial flutter, or atrial tachycardia at 1 year among patients with atrial fibrillation and hypertension.
Atrial fibrillation and hypertension represent 2 of the most important national public health priorities. Atrial fibrillation is the most common sustained cardiac arrhythmia among adults, affecting up to 2% of the US population. The prevalence of atrial fibrillation is expected to increase 3-fold in the next 3 decades. Robust data have identified hypertension as an independent modifiable risk factor for atrial fibrillation and as the most common cardiovascular condition associated with it. Hypertension is present in up to 80% of individuals with atrial fibrillation. Fulfilling a fundamental principle of evidence-based medi...
The use of an intraprocedural observation and pharmacologic challenges have been proposed as a means to differentiate permanent pulmonary vein (PV)-left atrial conduction block from inadequate ablation lesions.
Atrial Fibrillation (AF) is a common arrhythmia with serious clinical sequelae, but despite its significance little is known about the genetic origins. Recently, the untranscribed 98% of the human genome has been increasingly implicated in important processes like cardiac organogenesis, physiology, and pathophysiology. Specifically, long non-coding RNAs (lncRNA) have been shown to interact with the transcriptome in various ways that alter gene expression. Previously, multiple lncRNAs have been identified in disease processes such as heart failure, coronary artery disease, diabetes, and more.
Alcohol ingestion can be a trigger for atrial fibrillation (AF) episodes. In this randomized trial performed at 6 Australian centers, Voskoboinik et al (N Engl J Med 2020;382:20, PMID 31893513) sought to assess the effect of alcohol abstinence on AF occurrence. They enrolled patients aged 18–85 years with symptomatic AF who drank ≥10 standard drinks/wk. Those with paroxysmal AF needed to have ≥2 episodes in 6 months before enrollment and those with persistent AF were undergoing a rhythm control strategy, and these subjects needed to be in sinus rhythm at the beginning of the study.
Diederichsen et al (J Am Coll Cardiol 2019;74:2771, PMID 31779791) evaluated the natural history of subclinical atrial fibrillation (AF) in at-risk patients from the general population. The authors studied 590 individuals ≥70 years of age with ≥1 of hypertension, diabetes, previous stroke, or heart failure; w ithout a history of AF; and with long-term implantable loop recorder monitoring. End points included AF burden, AF progression, symptoms, and heart rate during AF. In a total of 685,445 monitoring days, AF lasting ≥6 minutes was detected in 205 participants (35%).