{"title":"Simple is Complicated.","authors":"Demosthenes G Katritsis","doi":"10.15420/aer.2021.40","DOIUrl":"10.15420/aer.2021.40","url":null,"abstract":"","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"10 3","pages":"131"},"PeriodicalIF":3.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/44/13/aer-10-131.PMC8576484.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39876847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Use of Electrocardiographic Imaging in Localising the Origin of Arrhythmias During Catheter Ablation of Ventricular Tachycardia.","authors":"Adam J Graham, Richard J Schilling","doi":"10.15420/aer.2021.27","DOIUrl":"https://doi.org/10.15420/aer.2021.27","url":null,"abstract":"<p><p>Non-invasive electrocardiographic imaging (ECGI) is a novel clinical tool for mapping ventricular arrhythmia. Using multiple body surface electrodes to collect unipolar electrograms and conventional medical imaging of the heart, an epicardial shell can be created to display calculated electrograms. This calculation is achieved by solving the inverse problem and allows activation times to be calculated from a single beat. The technology was initially pioneered in the US using an experimental torso-shaped tank. Accuracy from studies in humans has varied. Early data was promising, with more recent work suggesting only moderate accuracy when reproducing cardiac activation. Despite these limitations, the system has been successfully used in pioneering work with non-invasive cardiac radioablation to treat ventricular arrhythmia. This suggests that the resolution may be sufficient for treatment of large target areas. Although untested in a well conducted clinical study it is likely that it would not be accurate enough to guide more discreet radiofrequency ablation.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"10 3","pages":"211-217"},"PeriodicalIF":3.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6c/6e/aer-10-211.PMC8576495.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39891187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Suneet Mittal, David Golombeck, Jacqueline Pimienta
{"title":"Sleep Apnoea and AF: Where Do We Stand? Practical Advice for Clinicians.","authors":"Suneet Mittal, David Golombeck, Jacqueline Pimienta","doi":"10.15420/aer.2021.05","DOIUrl":"https://doi.org/10.15420/aer.2021.05","url":null,"abstract":"<p><p>AF is the most common sustained arrhythmia encountered in clinical practice. Among the largest contributing factors to the rapid increase in the incidence of AF are aging and obesity within the global population. Obstructive sleep apnoea (OSA) is a risk factor for AF that is clearly linked to obesity. Guidelines have advocated interrogation for clinical signs of OSA in all AF patients. The aim of this article is to provide practical advice for clinicians seeking to manage patients with AF and OSA. The authors discuss questionnaires to screen for OSA, various types of tests available for the diagnosis of OSA and data to assess the impact of treatment of OSA after various treatment options in AF patients. Finally, they outline the many areas that warrant further investigation in this patient population.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"10 3","pages":"140-146"},"PeriodicalIF":3.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ed/ec/aer-10-140.PMC8576511.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39876849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David B DeLurgio, Jaswinder S Gill, Syed Ahsan, Riyaz A Kaba, Kristen M Plasseraud, Michael E Halkos
{"title":"Hybrid Convergent Procedure for the Treatment of Persistent and Long-standing Persistent Atrial Fibrillation.","authors":"David B DeLurgio, Jaswinder S Gill, Syed Ahsan, Riyaz A Kaba, Kristen M Plasseraud, Michael E Halkos","doi":"10.15420/aer.2021.24","DOIUrl":"10.15420/aer.2021.24","url":null,"abstract":"<p><p>Recent advances have been made in AF treatment, including the role of early rhythm control and landmark clinical trials using ablation therapy. However, some treatment gaps remain, including the creation of durable lesions outside the pulmonary veins and effective treatment of longstanding persistent AF. A novel epicardial-endocardial ablation approach - the hybrid convergent procedure - was developed to combine surgical and catheter ablation techniques into a collaborative, multidisciplinary approach to managing AF. In this review, the authors discuss recently published data on hybrid convergent ablation, including results of the CONVERGE clinical trial, in the context of current challenges to treatment of persistent and long-standing persistent AF. The review also aims to provide perspective on outstanding questions and future directions in this area.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"10 3","pages":"198-204"},"PeriodicalIF":2.6,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/29/16/aer-10-198.PMC8576514.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39891185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tyson S Burnham, Monte L Scott, Benjamin A Steinberg, Daniel L Varela, Brian Zenger, T Jared Bunch
{"title":"Impact of Catheter Ablation on Stroke, Cognitive Decline and Dementia.","authors":"Tyson S Burnham, Monte L Scott, Benjamin A Steinberg, Daniel L Varela, Brian Zenger, T Jared Bunch","doi":"10.15420/aer.2021.42","DOIUrl":"https://doi.org/10.15420/aer.2021.42","url":null,"abstract":"<p><p>AF has been consistently associated with multiple forms of dementia, including idiopathic dementia. Outcomes after catheter ablation for AF are favourable and patients experience a better quality of life, arrhythmia-free survival, and lower rates of hospitalisation compared to patients treated with antiarrhythmic drugs. Catheter ablation is consistently associated with lower rates of stroke compared to AF management without ablation in large national and healthcare system databases. Multiple observational trials have shown that catheter ablation is also associated with a lower risk of cognitive decline, dementia and improved cognitive testing that can be explained through a variety of pathways. Long-term, adequately powered, randomised trials are required to define the role of catheter ablation in the management of AF as a means to lower the risk of cognitive decline, stroke and dementia.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"10 3","pages":"205-210"},"PeriodicalIF":3.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3b/da/aer-10-205.PMC8576494.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39891186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The DAPA Trial in the Context of Previous Prophylactic ICD Landmark Trials.","authors":"Danielle Haanschoten, Arif Elvan","doi":"10.15420/aer.2021.23","DOIUrl":"10.15420/aer.2021.23","url":null,"abstract":"<p><p>In patients with ischaemic cardiomyopathy and severely reduced left ventricular ejection fraction (LVEF), an arrhythmogenic milieu is created by a complex interplay between myocardial scarring (assessed by cardiac MRI) and multiple other factors (ventricular ectopy, ischaemia and autonomic imbalance), favouring the occurrence of arrhythmic sudden cardiac death (SCD). Currently, a dynamic and robust model of dichotomised SCD risk assessment after primary percutaneous coronary intervention (PCI) is lacking, underlining the urgent need for further refinement of the widely accepted and guidelines-based criteria (ischaemic cardiomyopathy, LVEF ≤35%) for primary prevention. This review addresses the potential additional value of the recently published Defibrillator After Primary Angioplasty (DAPA) trial results. The DAPA trial conveys important messages and provides novel perspectives regarding left ventricular function post-primary PCI as an (early) risk marker for SCD and the impact of prophylactic ICD implantation on survival in this cohort. In the context of other previous primary prevention trials, DAPA was the first trial including only ST-elevation MI patients all treated with acute PCI.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"10 3","pages":"154-158"},"PeriodicalIF":2.6,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fb/c6/aer-10-154.PMC8576491.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39876851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Residual Stroke Risk in Atrial Fibrillation.","authors":"Wern Yew Ding","doi":"10.15420/aer.2021.34","DOIUrl":"https://doi.org/10.15420/aer.2021.34","url":null,"abstract":"<p><p>AF contributes to increased stroke risk via various mechanisms, including deranged blood constituents, vessel wall abnormalities and abnormal blood flow. This excess risk is frequently managed with anticoagulation therapy, aimed at preventing thromboembolic complications. Yet, a significant proportion of patients with AF remain at high residual stroke risk despite receiving appropriate dose-adjusted anticoagulation. This article explores the residual stroke risk in AF and potential therapeutic options for these patients.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"10 3","pages":"147-153"},"PeriodicalIF":3.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ba/a0/aer-10-147.PMC8576486.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39876850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"ECG and Pacing Criteria for Differentiating Conduction System Pacing from Myocardial Pacing.","authors":"Marek Jastrzębski","doi":"10.15420/aer.2021.26","DOIUrl":"https://doi.org/10.15420/aer.2021.26","url":null,"abstract":"<p><p>During His-Purkinje conduction system (HPS) pacing, it is crucial to confirm capture of the His bundle or left bundle branch versus myocardialonly capture. For this, several methods and criteria for differentiation between non-selective (ns) capture - capture of the HPS and the adjacent myocardium - and myocardial-only capture were developed. HPS capture results in faster and more homogenous depolarisation of the left ventricle than right ventricular septal (RVS) myocardial-only capture. Specifically, the depolarisation of the left ventricle (LV) does not require slow cell-to-cell spread of activation from the right side to the left side of the interventricular septum but begins simultaneously with QRS onset as in native depolarisation. These phenomena greatly influence QRS complex morphology and form the basis of electrocardiographic differentiation between HPS and myocardial paced QRS. Moreover, the HPS and the working myocardium are different tissues within the heart muscle that vary not only in conduction velocities but also in refractoriness and capture thresholds. These last two differences can be exploited for the diagnosis of HPS capture using dynamic pacing manoeuvres, namely differential output pacing, programmed stimulation and burst pacing. This review summarises current knowledge of this subject.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"10 3","pages":"172-180"},"PeriodicalIF":3.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1e/a3/aer-10-172.PMC8576513.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39891182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
José-Ángel Cabrera, Robert H Anderson, Andreu Porta-Sánchez, Yolanda Macías, Óscar Cano, Diane E Spicer, Damián Sánchez-Quintana
{"title":"The Atrioventricular Conduction Axis and its Implications for Permanent Pacing.","authors":"José-Ángel Cabrera, Robert H Anderson, Andreu Porta-Sánchez, Yolanda Macías, Óscar Cano, Diane E Spicer, Damián Sánchez-Quintana","doi":"10.15420/aer.2021.32","DOIUrl":"https://doi.org/10.15420/aer.2021.32","url":null,"abstract":"<p><p>Extensive knowledge of the anatomy of the atrioventricular conduction axis, and its branches, is key to the success of permanent physiological pacing, either by capturing the His bundle, the left bundle branch or the adjacent septal regions. The inter-individual variability of the axis plays an important role in underscoring the technical difficulties known to exist in achieving a stable position of the stimulating leads. In this review, the key anatomical features of the location of the axis relative to the triangle of Koch, the aortic root, the inferior pyramidal space and the inferoseptal recess are summarised. In keeping with the increasing number of implants aimed at targeting the environs of the left bundle branch, an extensive review of the known variability in the pattern of ramification of the left bundle branch from the axis is included. This permits the authors to summarise in a pragmatic fashion the most relevant aspects to be taken into account when seeking to successfully deploy a permanent pacing lead.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"10 3","pages":"181-189"},"PeriodicalIF":3.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6d/70/aer-10-181.PMC8576516.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39891183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Considerations for the Assessment of Substrates, Genetics and Risk Factors in Patients with Atrial Fibrillation.","authors":"Dominik Linz, Sander Verheule, Aaron Isaacs, Ulrich Schotten","doi":"10.15420/aer.2020.51","DOIUrl":"https://doi.org/10.15420/aer.2020.51","url":null,"abstract":"<p><p>Successful translation of research focussing on atrial arrhythmogenic mechanisms has potential to provide a mechanism-tailored classification and to support personalised treatment approaches in patients with AF. The clinical uptake and clinical implementation of new diagnostic techniques and treatment strategies require translational research approaches on various levels. Diagnostic translation involves the development of clinical diagnostic tools. Additionally, multidisciplinary teams are required for collaborative translation to describe genetic mechanisms, molecular pathways, electrophysiological characteristics and concomitant risk factors. In this article, current approaches for AF substrate characterisation, analysis of genes potentially involved in AF and strategies for AF risk factor assessment are summarised. The authors discuss challenges and obstacles to clinical translation and implementation into clinical practice.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"10 3","pages":"132-139"},"PeriodicalIF":3.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/48/e1/aer-10-132.PMC8576487.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39876848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}