Topic: Electrophysiology

Abstract
<div><h4>Atrial electro-functional predictors of incident atrial fibrillation in cardiac amyloidosis.</h4><i>Sinigiani G, De Michieli L, Porcari A, Zocchi C, ... Cappelli F, Cipriani A</i><br /><b>Background</b><br />Atrial fibrillation (AF) is common in patients with cardiac amyloidosis (CA) and is a significant risk factor for heart failure hospitalization and thromboembolic events.<br /><b>Objective</b><br />to investigate the atrial electro-functional predictors of incident AF in CA.<br /><b>Methods</b><br />A multicenter, observational study performed in 4 CA referral centers including sinus rhythm patients with light-chain (AL) and transthyretin (ATTR) CA undergoing electrocardiogram (ECG) and cardiac magnetic resonance (CMR). The primary endpoint was new-onset AF occurrence.<br /><b>Results</b><br />Overall, 96 patients (AL-CA: n=40; ATTR-CA n=56) were enrolled. During an 18-month median follow-up (Q1-Q3:7-29), 30 patients (29%) had incident AF. Compared with those without, patients with AF were older (79 vs 73 years, p=0.001) and more frequently with ATTR (73% vs 27%, p<0.001), ECG inter-atrial block (IAB), either partial (47% vs 21%, p=0.011) or advanced (17% vs 3%,p=0.017), and lower left atrium ejection fraction (LAEF) (29% vs 41%, p=0.004). Age (HR=1.059; 95%CI 1.002-1.118,p=0.042), any type of IAB (HR=2.211; 95%CI 1.03-4.75, p=0.041) and LAEF (HR=0.967; 95%CI 0.936-0.998, p=0.044) emerged as independent predictors of incident AF. Patients exhibiting any type of IAB, LAEF<40%, and aged>78 years showed a cumulative incidence for AF of 40% at 12 months. This risk was significantly higher than that carried by one (8.5%) or none (7.6%) of these three risk factors.<br /><b>Conclusions</b><br />In patients with CA, older age, IAB on 12-lead ECG and reduced LAEF on CMR are significant and independent predictors of incident AF. A closer screening for AF is advisable in CA patients carrying these features.<br /><br />Copyright © 2024. Published by Elsevier Inc.<br /><br /><small>Heart Rhythm: 01 Feb 2024; epub ahead of print</small></div>
Sinigiani G, De Michieli L, Porcari A, Zocchi C, ... Cappelli F, Cipriani A
Heart Rhythm: 01 Feb 2024; epub ahead of print | PMID: 38309449
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Abstract
<div><h4>Ablation of epicardial ventricular focus through coronary sinus using pulsed-field ablation. A case report.</h4><i>Mestrovic IP, Breskovic T, Markovic M, Kurtic E, Mestrovic T, Anic A</i><br /><b>Introduction</b><br />With the entry of pulsed-field ablation (PFA) into electrophysiology, new possibilities for ablation of different substrates such as epicardial foci of premature ventricular contractions (PVCs) from coronary venous system (CVS) have been opened.<br /><b>Methods</b><br />This article focuses on a case of a 27-year-old patient with frequent monomorphic PVCs of epicardial origin, treated by radiofrequency ablation, followed by PFA.<br /><b>Results</b><br />After unsuccessful focus ablation through CVS with RFA, successful ablations from the same region with PFA were achieved.<br /><b>Conclusion</b><br />This is the first described case of successful ablation of epicardial PVCs using PFA, which we hope will help in defining indications for this novel technology and enhance quality of treatment for patients with different arrhythmias.<br /><br />© 2024 Wiley Periodicals LLC.<br /><br /><small>J Cardiovasc Electrophysiol: 31 Jan 2024; epub ahead of print</small></div>
Mestrovic IP, Breskovic T, Markovic M, Kurtic E, Mestrovic T, Anic A
J Cardiovasc Electrophysiol: 31 Jan 2024; epub ahead of print | PMID: 38297424
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Abstract
<div><h4>Atrial Fibrillation Detection and Ischemic Stroke Recurrence in Cryptogenic Stroke: A Retrospective, Multicenter, Observational Study.</h4><i>Todo K, Okazaki S, Doijiri R, Yamazaki H, ... Mochizuki H, CRYPTON‐ICM Registry Investigators</i><br /><b>Background</b><br />Atrial fibrillation (AF) is known to be a strong risk factor for stroke. However, the risk of stroke recurrence in patients with cryptogenic stroke with AF detected after stroke by an insertable cardiac monitor (ICM) is not well known. We sought to evaluate the risk of ischemic stroke recurrence in patients with cryptogenic stroke with and without ICM-detected AF.<br /><b>Methods and results</b><br />We retrospectively reviewed patients with cryptogenic stroke who underwent ICM implantation at 8 stroke centers in Japan. Cox regression models were developed using landmark analysis and time-dependent analysis. We set the target sample size at 300 patients based on our estimate of the annualized incidence of ischemic stroke recurrence to be 3% in patients without AF detection and 9% in patients with AF detection. Of the 370 patients, 121 were found to have AF, and 110 received anticoagulation therapy after AF detection. The incidence of ischemic stroke recurrence was 4.0% in 249 patients without AF detection and 5.8% in 121 patients with AF detection (<i>P</i>=0.45). In a landmark analysis, the risk of ischemic stroke recurrence was not higher in patients with AF detected ≤90 days than in those without (hazard ratio, 1.47 [95% CI, 0.41-5.28]). In a time-dependent analysis, the risk of ischemic stroke recurrence did not increase after AF detection (hazard ratio, 1.77 [95% CI, 0.70-4.47]).<br /><b>Conclusions</b><br />The risk of ischemic stroke recurrence in patients with cryptogenic stroke with ICM-detected AF, 90% of whom were subsequently anticoagulated, was not higher than in those without ICM-detected AF.<br /><br /><br /><br /><small>J Am Heart Assoc: 06 Feb 2024; 13:e031508</small></div>
Todo K, Okazaki S, Doijiri R, Yamazaki H, ... Mochizuki H, CRYPTON‐ICM Registry Investigators
J Am Heart Assoc: 06 Feb 2024; 13:e031508 | PMID: 38240210
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Abstract
<div><h4>Risk Prediction in Male Adolescents With Congenital Long QT Syndrome: Implications for Sex-Specific Risk Stratification in Potassium Channel-Mediated Long QT Syndrome.</h4><i>Bjelic M, Goldenberg I, Younis A, Chen AY, ... Ackerman MJ, Goldenberg I</i><br /><b>Background</b><br />Sex-specific risk management may improve outcomes in congenital long QT syndrome (LQTS). We recently developed a prediction score for cardiac events (CEs) and life-threatening events (LTEs) in postadolescent women with LQTS. In the present study, we aimed to develop personalized risk estimates for the burden of CEs and LTEs in male adolescents with potassium channel-mediated LQTS.<br /><b>Methods and results</b><br />The prognostic model was derived from the LQTS Registry headquartered in Rochester, NY, comprising 611 LQT1 or LQT2 male adolescents from age 10 through 20 years, using the following variables: genotype/mutation location, QTc-specific thresholds, history of syncope, and β-blocker therapy. Anderson-Gill modeling was performed for the end point of CE burden (total number of syncope, aborted cardiac arrest, and appropriate defibrillator shocks). The applicability of the CE prediction model was tested for the end point of the first LTE (excluding syncope and adding sudden cardiac death) using Cox modeling. A total of 270 CEs occurred during follow-up. The genotype-phenotype risk prediction model identified low-, intermediate-, and high-risk groups, comprising 74%, 14%, and 12% of the study population, respectively. Compared with the low-risk group, high-risk male subjects experienced a pronounced 5.2-fold increased risk of recurrent CEs (<i>P</i><0.001), whereas intermediate-risk patients had a 2.1-fold (<i>P</i>=0.004) increased risk . At age 20 years, the low-, intermediate-, and high-risk adolescent male patients had on average 0.3, 0.6, and 1.4 CEs per person, respectively. Corresponding 10-year adjusted probabilities for a first LTE were 2%, 6%, and 8%.<br /><b>Conclusions</b><br />Personalized genotype-phenotype risk estimates can be used to guide sex-specific management in male adolescents with potassium channel-mediated LQTS.<br /><br /><br /><br /><small>J Am Heart Assoc: 06 Feb 2024; 13:e028902</small></div>
Bjelic M, Goldenberg I, Younis A, Chen AY, ... Ackerman MJ, Goldenberg I
J Am Heart Assoc: 06 Feb 2024; 13:e028902 | PMID: 38240206
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