Is time to first recurrence of atrial fibrillation correlated with atrial fibrillation burden?

The time to the first recurrence of atrial fibrillation (AF) and the AF burden have commonly been used as end points for AF therapy. We conducted a retrospective analysis of data from a large pacemaker registry to assess the relation between the time to the first recurrence and the AF burden. Although a statistical association exists, the small correlation coefficients limit the clinical value of the time to first recurrence as an indicator of AF burden.     

A three-pulmonary vein isolation approach to treat paroxysmal atrial fibrillation

To investigate the safety and efficacy of a 3-pulmonary vein (PV) isolation approach in treatingparoxysmal atrial fibrillation (AF).Methods Radiofrequency catheter ablation was used to eliminate PVpotential in 11 patients with frequent paroxysmal AF refractory to anti-arrhythmic agents.During sinus rhythm,PVpotential was mapped in the left and right superior PVs and left inferior PV.The procedural success was defined asthe elimination of PV potential in the 3 PVs.Results PV potential was identified and abolished in a total of 24PVs,mostly in the left and fight superior PV.There was no pulmonary stenosis or other complications during or afterthe procedures.AF recurred in one patient after an average of 12±3 month follow-up.Conclusions PVpotentials were present mostly in the left or right superior PV.The 3-PVs isolation approach is safe and effective inpreventing drug-resistant paroxysmal AF.(J Ceriatr Cardiol 2004;1:29-34.)     

Mortality in atrial fibrillation. Is it changing?

Patients with atrial fibrillation experience higher mortality rates than those without this condition. Recent studies have explored whether mortality rates in atrial fibrillation patients and the overall impact of atrial fibrillation on mortality has changed. Overall, mortality in atrial fibrillation has decreased over the last few decades, with no strong differences between men and women. These improvements could be caused by advances in preventing thromboembolic complications of atrial fibrillation or better management of comorbidities in these patients. Understanding the mechanisms for these changes and developing novel approaches to improve survival in AF patients are areas deserving of future research.     

Is discharge to home after emergency department cardioversion safe for the treatment of recent-onset atrial fibrillation?

Recent-onset atrial fibrillation, defined as a first detected or recurrent episode of atrial fibrillation lasting less than 48 hours, is a commonly encountered dysrhythmia in the emergency department (ED). Cardioversion of stable patients in the ED with recent-onset atrial fibrillation without antecedent anticoagulation would allow for these patients to be discharged directly to home. We searched the literature to determine whether any studies have investigated the safety of this management strategy and identified five that addressed this question. These studies are reviewed herein; importantly, not one ED patient who was cardioverted in any of the five studies suffered a thromboembolic event - the feared complication responsible for most of the controversy surrounding the ED management of atrial fibrillation. According to the available evidence, we conclude that it would be within the standard of care to discharge home stable patients with recent-onset atrial fibrillation after cardioversion in the ED with adequate follow-up. It should be noted that although this strategy is safe and effective, the return visit rate for relapsed atrial fibrillation is 3% to 17%, and patients should be made aware of this possibility.