Arrhythmias/Electrophysiology
RCT: Propafenone leads to quicker sinus rhythm restoration than amiodarone in supraventricular arrhythmias related to septic shock
1 Oct, 2023 | 15:19h | UTCStudy Design & Population: The research was a two-center, prospective, controlled parallel-group, double-blind trial involving 209 septic shock patients who had new-onset supraventricular arrhythmia and a left ventricular ejection fraction above 35%. Patients were randomized to receive either intravenous propafenone (70 mg bolus followed by 400–840 mg/24 h) or amiodarone (300 mg bolus followed by 600–1800 mg/24 h).
Main Findings: The primary outcomes focused on the proportion of patients in sinus rhythm 24 hours post-infusion, time to the first sinus rhythm restoration, and arrhythmia recurrence rates. No significant difference was observed in 24-hour sinus rhythm rates between the propafenone (72.8%) and amiodarone (67.3%) groups (p=0.4). Time to the first rhythm restoration was significantly shorter for the propafenone group (median 3.7 hours) compared to the amiodarone group (median 7.3 hours, p=0.02). Recurrence of arrhythmia was notably lower in the propafenone group (52%) than in the amiodarone group (76%, p<0.001). In the subgroup of patients with a dilated left atrium, amiodarone appeared to be more effective.
Implications & Limitations: The study suggests that while propafenone doesn’t offer better rhythm control at 24 hours compared to amiodarone, it does provide faster cardioversion and fewer arrhythmia recurrences, especially in patients with a non-dilated left atrium. No significant differences were observed in clinical outcomes, such as ICU or long-term mortality, between propafenone and amiodarone in the trial. Limitations include potential underpowering of the study and the inability to fully account for the impact of multiple covariates involved in the complex therapy of septic shock.
Commentary on Twitter:
Propafenone?70 mg bolus+ 400-840 mg/24h vs amiodarone?300 mg + by 600-1800 mg/24h for SVA in septic shock, RCT
?propafenone not better for rhythm control at 24h but excellent hemodynamic safety profile, cardioverting faster & fewer recurrences#FOAMCc
?https://t.co/GVuoxPD7Hy pic.twitter.com/rRlj00x71p— Intensive Care Medicine (@yourICM) September 13, 2023
RCT – 2ry analysis | Omega-3 supplementation linked to increased AF risk in post-MI patients
3 Aug, 2023 | 13:45h | UTCRelated:
M-A: Omega-3 fatty acids supplementation is associated with increased risk of atrial fibrillation.
Commentary from the author on Twitter (thread – click for more)
RCT data consistently show that Omega-3 suppl increase AF risk https://t.co/LQVHfPNtKL
In this substudy of the #OMEMI trial we add novel data from thumb-ECG screening and serum EPA/DHA, supporting a causal relation between omega-3 (EPA) and AF!https://t.co/B9VoDNQpZi
? 1/4 pic.twitter.com/GFYGfVaNMq
— Peder L. Myhre ? (@pmyhre) July 28, 2023
RCT | High-power radiofrequency improves AF ablation results vs. standard-power, but may increase asymptomatic cerebral emboli
26 Jul, 2023 | 13:16h | UTCA Randomized Trial of High vs Standard Power Radiofrequency Ablation for Pulmonary Vein Isolation: SHORT-AF – JACC: Clinical Electrophysiology (link to abstract – $ for full-text)
RCT | Self-administered intranasal etripamil superior to placebo for acute supraventricular tachycardia conversion
12 Jul, 2023 | 13:54h | UTC
RCT | Supplementing CPVI with low-voltage-area ablation lowers atrial arrhythmia recurrence in elderly with paroxysmal AF
12 Jul, 2023 | 13:31h | UTCCircumferential Pulmonary Vein Isolation With vs Without Additional Low-Voltage-Area Ablation in Older Patients With Paroxysmal Atrial Fibrillation: A Randomized Clinical Trial – JAMA Cardiology (link to abstract – $ for full-text)
See also: Visual Abstract
Review | Management of premature ventricular complexes in the outpatient setting
7 Jul, 2023 | 16:22h | UTCManagement of Premature Ventricular Complexes in the Outpatient Setting – Mayo Clinic Proceedings
Review | Silent cerebral lesions following catheter ablation for atrial fibrillation
29 Jun, 2023 | 13:51h | UTC
Commentary on Twitter
What's the risk of silent cerebral lesions following catheter ablation for #AF?? https://t.co/GJsUziHLeu@EuropaceEiC @GiulioConte9 @AAuricchioMD @Dominik_Linz @FraSantoroMD @AndyZhangMD @marcovitoloMD @DhirajGuptaBHRS #AF #ablation #europace pic.twitter.com/ZYQP7oS9sS
— European Society of Cardiology Journals (@ESC_Journals) June 21, 2023
Cohort Study | Five-year safety and efficacy of leadless pacemakers
20 Jun, 2023 | 12:40h | UTCFive-year safety and efficacy of leadless pacemakers in a Dutch cohort – Heart Rhythm
SSAI Guideline | New-onset atrial fibrillation in critically ill adult patients
6 Jun, 2023 | 14:31h | UTC
RCT | Early initiation of DOACs not statistically superior to later use in atrial fibrillation-related stroke
31 May, 2023 | 14:17h | UTCEarly versus Later Anticoagulation for Stroke with Atrial Fibrillation – New England Journal of Medicine (link to abstract – $ for full-text)
Commentaries:
ELAN: Early DOACs Safe, May Help After Ischemic Stroke in AF Patients – TCTMD
Commentary on Twitter
Late breaking at #ESOC2023: In the ELAN trial, the estimated incidence of stroke, systemic embolism, hemorrhage, or death was 2.8 percentage points lower to 0.5 percentage points higher with early than with later use of direct oral anticoagulants. Full results:
— NEJM (@NEJM) May 24, 2023
Cohort Study | Amiodarone linked to higher bleeding risk vs. flecainide or sotalol in atrial fibrillation patients on anticoagulants
30 May, 2023 | 12:01h | UTCRisk for Bleeding-Related Hospitalizations During Use of Amiodarone With Apixaban or Rivaroxaban in Patients With Atrial Fibrillation: A Retrospective Cohort Study – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentary on Twitter
A study of older adults with #AFib who were treated with #anticoagulants found #amiodarone during apixaban/rivaroxaban use was associated with greater risk for bleeding-related #hospitalizations compared to flecainide or sotalol: https://t.co/cFb1rgGqjt pic.twitter.com/gKlgLXBdb2
— Annals of Int Med (@AnnalsofIM) May 25, 2023
Subepicardial Cardiomyopathy: a disease underlying J-wave syndromes and idiopathic ventricular fibrillation
29 May, 2023 | 10:38h | UTC
Commentary on Twitter
#StateOfTheArt: Subepicardial cardiomyopathy – a disease underlying J-wave syndromes and idiopathic ventricular fibrillation @BehrElijah @Chiara_Scrocco @bjboukens @DrCJMiles #AHAJournals https://t.co/brITevJfIh pic.twitter.com/HWw8gcmE33
— Circulation (@CircAHA) May 26, 2023
Consensus Statement | Management of arrhythmias during pregnancy
23 May, 2023 | 13:00h | UTC2023 HRS Expert Consensus Statement on the Management of Arrhythmias During Pregnancy – Heart Rhythm
News Release: Management of Arrhythmias During Pregnancy Consensus Statement Emphasizes Shared Decision-Making – European Heart Rhythm
Consensus Statement | Practical management of the remote device clinic
23 May, 2023 | 12:58h | UTC
Guideline | Cardiac physiologic pacing for the avoidance and mitigation of heart failure
23 May, 2023 | 12:55h | UTCNews Release: New clinical practice guideline on cardiac physiological pacing – Elsevier
Atrial fibrillation incidence associated with exposure to anticancer drugs used as monotherapy in clinical trials
10 May, 2023 | 15:54h | UTCEditorials:
Atrial Fibrillation With Modern Cancer Treatment: More Common Than We Think – JACC: CardioOncology
Commentary on Twitter
Annual incidence rate of #AFib assoc w/ anticancer drugs were ⬆️ in pts w/ hematologic malig. It was found for #ibrutinib 4.92 (95% CI: 2.91-8.31), #clofarabine 2.38 (95% CI: 0.66-8.55), & #ponatinib 2.35 (95% CI: 1.78-3.12) per 100 person-yrs https://t.co/W2RGMrE37F… pic.twitter.com/NnbmUVcci5
— JACC Journals (@JACCJournals) April 27, 2023
Review | Causes of sudden death
9 May, 2023 | 14:16h | UTCCauses of sudden death – European Heart Journal Supplements
See all articles in the series here
Review | The bidirectional association between atrial fibrillation and myocardial infarction
8 May, 2023 | 12:54h | UTCThe bidirectional association between atrial fibrillation and myocardial infarction – Nature Reviews Cardiology (if the link is paywalled, try this one)
Commentary on Twitter
In our latest Review, @JKornej, @EmeliaBenjamin et al. explore the bidirectional association between #AtrialFibrillation and myocardial infarction: https://t.co/K3iH24e57U pic.twitter.com/sKBrhRJXf3
— Nature Reviews Cardiology (@NatRevCardiol) April 17, 2023
M-A | Direct oral anticoagulants versus warfarin across the spectrum of kidney function in patients with AF
3 May, 2023 | 15:32h | UTCDirect Oral Anticoagulants Versus Warfarin Across the Spectrum of Kidney Function: Patient-Level Network Meta-Analyses From COMBINE AF – Circulation (free for a limited period)
Commentary on Twitter
Direct Oral Anticoagulants versus Warfarin Across the Spectrum of Kidney Function: Patient-Level Network Meta-Analyses from COMBINE AF @jlharrington_md #AHAJournals https://t.co/6Rzlt09m9W pic.twitter.com/2oknvnken8
— Circulation (@CircAHA) April 18, 2023
Oral anticoagulation in patients with advanced CKD and atrial fibrillation: beyond anticoagulation
2 May, 2023 | 13:20h | UTC
RCT | Comparison of three different substrate ablation strategies for persistent atrial fibrillation
26 Apr, 2023 | 14:18h | UTC
RCT | No difference in atrial fibrillation recurrence with early vs. delayed AF ablation at 12 months
24 Apr, 2023 | 13:49h | UTCImpact of Early Versus Delayed Atrial Fibrillation Catheter Ablation on Atrial Arrhythmia Recurrences – European Heart Journal (link to abstract – $ for full-text. Free PDF may be available here)
Commentary on Twitter
Early versus delayed ablation strategy in atrial fibrillation: read the impact on arrhythmia free survival on #EHJ!#EHRA2023 #EHJ #cardiotwitter #ablation #AF @ESC_Journals @escardio https://t.co/RW9RPry5Vi pic.twitter.com/2iHW49T3Wp
— EHJ Editor-in-Chief (@ehj_ed) April 18, 2023
Global Survey | Incidence, management and prognosis of esophageal fistula after atrial fibrillation catheter ablation
19 Apr, 2023 | 13:14h | UTCCommentary: Esophageal Fistula Still a Rare but Deadly Complication of AF Ablation: POTTER-AF – TCTMD
Commentary from the author on Twitter
?The POTTER-AF study
➡️published #EHJ online
➡️138 oesophageal fistulas
➡️incidence 0,025% overall, ?RF 0.038%, ❄️CRYO 0.0015%
☠️Mortality: 90% if treated conservative!
?V. Schmidt, @KeelaniAhmad @ChristianHeeger@AGEP_DGK @ESC_Journals #UKSHhttps://t.co/jTmC36wlYQ #EPeeps pic.twitter.com/3lntY6lR6H— Roland Tilz (@RolandTilz) April 16, 2023
EHRA expert consensus document on the management of arrhythmias in frailty syndrome
18 Apr, 2023 | 12:58h | UTC
Cohort Study | Value of screening for the risk of sudden cardiac death in young competitive athletes
12 Apr, 2023 | 13:11h | UTC