Catheter ablation versus standard conventional treatment in patients with left ventricular dysfunction and atrial fibrillation (CASTLE-AF) - study design. Women hospitalized with atrial fibrillation: gender differences, trends and outcome from a 20-year registry in a Middle Eastern country (1991-2010). Rationale and Design of FIRE AND ICE: A multicenter randomized trial comparing efficacy and safety of pulmonary vein isolation using a cryoballoon versus radiofrequency ablation with 3D-reconstruction. Clinical Significance of Chronic Kidney Disease and Atrial Fibrillation on Morbidity and Mortality in Patients with Acute Myocardial Infarction Impact of intensive glycemic control on the incidence of atrial fibrillation and associated cardiovascular outcomes in patients with type 2 diabetes mellitus (from the Action to Control Cardiovascular Risk in Diabetes Study). Should digoxin be proscribed in elderly subjects in sinus rhythm free from heart failure? A population-based study. Atrial fibrillation postcardiac surgery: a common but a morbid complication. Prevention of atrial fibrillation in patients with symptomatic chronic heart failure by candesartan in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. Substrate and Trigger Ablation for Reduction of Atrial Fibrillation (STAR AF): a randomized, multicentre, international trial† Atrial fibrillation in patients with heart failure: Role of catheter ablation therapies. Effects of atrial fibrillation on treatment of mitral regurgitation in the EVEREST II (Endovascular Valve Edge-to-Edge Repair Study) randomized trial. Prognostic importance of atrial fibrillation in implantable cardioverter-defibrillator patients. A cross-sectional study of quality of life in an elderly population (75 years and over) with atrial fibrillation: secondary analysis of data from the Birmingham Atrial Fibrillation Treatment of the Aged study. Surgical vs. transcatheter pulmonary vein isolation as first invasive treatment in patients with atrial fibrillation: a matched group comparison. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Atrial fibrillation and risk of clinical events in chronic heart failure with and without left ventricular systolic dysfunction: results from the Candesartan in Heart failure-Assessment of Reduction in Mortality and morbidity (CHARM) program. Atrial fibrillation: the rate versus rhythm management controversy. Adjunctive renal sympathetic denervation to modify hypertension as upstream therapy in the treatment of atrial fibrillation (H-FIB) study: clinical background and study design. The usefulness of global left atrial strain for predicting atrial fibrillation recurrence after catheter ablation in patients with persistent and paroxysmal atrial fibrillation. Long-term single procedure efficacy of catheter ablation of atrial fibrillation Gender-related differences in catheter ablation of atrial fibrillation. Impact of atrial fibrillation on early complications and one year-survival after cardioverter defibrillator implantation: results from the German DEVICE registry. Complex fractionated atrial electrogram or linear ablation in patients with persistent atrial fibrillation--a prospective randomized study.
BACKGROUND Electrical isolation of the pulmonary veins by catheter ablation is an emerging treatment modality for the treatment of atrial fibrillation ( AF ) and is increasingly used in patients with heart failure . METHODS The catheter ablation versus st and ard conventional treatment in patients with left ventricular dysfunction and atrial fibrillation trial ( CASTLE-AF ) is a r and omized evaluation of ablative treatment of atrial fibrillation in patients with left ventricular dysfunction . The primary endpoint is the composite of all-cause mortality or worsening of heart failure requiring unplanned hospitalization using a time to first event analysis . Secondary endpoints are all-cause mortality , cardiovascular mortality , cerebrovascular accidents , worsening of heart failure requiring unplanned hospitalization , unplanned hospitalization due to cardiovascular reason , all-cause hospitalization , quality of life , number of therapies ( shock and antitachycardia pacing ) delivered by the implantable cardioverter-defibrillator ( ICD ) , time to first ICD therapy , number of device-detected ventricular tachycardia and ventricular fibrillation episodes , AF burden , AF free interval , left ventricular function , exercise tolerance , and percentage of right ventricular pacing . CASTLE-AF will r and omize 420 patients for a minimum of 3 years at 48 sites in the United States , Europe , Australia , and South America BACKGROUND Most of the published research on atrial fibrillation ( AF ) is limited to studies in the developed world and included mainly Caucasian patients . Data about women with AF among other ethnicities is very limited . OBJECTIVES The aim of this study was to compare the clinical characteristics , treatment and outcome of women to men hospitalized with AF in a middle-eastern country . METHODS Retrospective analysis of prospect i ve registry of all patients hospitalized with AF in Qatar from 1991 through 2010 was made . Clinical characteristics , management , and outcomes of AF patients were compared according to gender . RESULTS During the 20-years period ; 1417 women and 2432 men were hospitalized for AF . Women were 5 years older and more likely to have diabetes mellitus , hypertension , and chronic renal impairment and were also less likely to be current smokers and to have ischemic heart disease and impaired left ventricular function when compared to men . There was no gender preference in the use of anticoagulation . The prevalence of concomitant ischemic heart disease and hypertension increased , while the prevalence of valvular heart disease and heart failure decreased among patients hospitalized with AF over the study period . In-hospital mortality and stroke rates were comparable between the two groups . CONCLUSIONS Women hospitalized with atrial fibrillation were older in age and had higher prevalence of co-morbid cardiovascular risk factors compared to men whereas , mortality and stroke rates were comparable BACKGROUND Atrial fibrillation ( AF ) is the most common sustained cardiac arrhythmia imposing substantial morbidity and mortality . Catheter-based pulmonary vein isolation ( PVI ) using radiofrequency current ( RFC ) has become a st and ard treatment for drug-resistant and symptomatic paroxysmal AF ( PAF ) . In recent years , the cryoballoon-based technique is increasingly used as a promising alternative with a short learning curve . METHODS The FIRE AND ICE trial is a prospect i ve , r and omized , controlled , open , blinded outcome assessment , noninferiority trial comparing cryoballoon- , and RFC-based PVI .  Patients with drug-resistant PAF will be r and omized in a 1:1 matrix in multiple European centers . The primary hypothesis is that cryoballoon ablation is not inferior to RFC ablation using 3-dimensional mapping with respect to clinical efficacy . The primary endpoint is defined as the time to first documented clinical failure , including : ( 1 ) recurrence of AF ; ( 2 ) atrial flutter or atrial tachycardia ; ( 3 ) prescription of class I or III antiarrhythmic drugs ; or ( 4 ) re-ablation , whichever comes first , following a blanking period of 3 months after the index ablation procedure . The primary safety endpoint is a composite of death , stroke/transient ischemic attack , cardiac arrhythmias ( apart from AF recurrence ) causally related to the therapeutic intervention , and procedure-related serious adverse events . CONCLUSION The FIRE AND ICE trial compares 2 different technologies to perform catheter ablation of PAF with respect to efficacy and safety . It aims at providing objective data to guide selection and usage of ablation catheters in the treatment of AF Background / Aims : Atrial fibrillation ( AF ) often coexists with acute myocardial infa rct ion ( AMI ) , and chronic kidney disease ( CKD ) is a major risk for AMI . However , the combined impact of CKD and AF on the mortality and morbidity in AMI population has not been determined . Methods : Between January 2004 and December 2009 , a total of 4,738 AMI patients were enrolled prospect ively . Patients were divided into four groups according to the combined status of CKD and AF . The primary endpoint was a combination of 5-year major adverse cardiac and cerebrovascular events ( MACCE ) . Results : The prevalence of AF was significantly higher in CKD patients than in non-CKD patients ( 6.76 vs. 3.31 % , p < 0.001 ) . The highest cumulative event rate of MACCE and death was observed in patients with both CKD and AF ( 68.5 and 64.0 % ) , respectively . In multivariable analyses , compared with patients with neither AF nor CKD , hazard ratios ( HR ) for composite of MACCE were 1.66 ( 95 % CI , 1.14 - 2.41 ) , 1.24 ( 95 % CI , 1.06 - 1.46 ) , and 2.10 ( 95 % CI , 1.42 - 3.13 ) for patients with AF only , those with CKD only , and those with both CKD and AF , respectively ( p for interaction = 0.935 ) . Patients with both CKD and AF had a greatest risk for all-cause mortality ( HR 2.54 ; 95 % CI , 1.60 - 4.53 ) , and the significant synergistic interaction was observed between CKD and AF ( p for interaction = 0.015 ) . Conclusion : The combined effect of AF and CKD on the risk of MACCE after an AMI is stronger than any separate condition , and it confers a synergistic effect on the all-cause mortality risk Atrial  fibrillation ( AF )  is prevalent in patients with type 2 diabetes mellitus ( DM ) and is associated with markers of poor glycemic control ; however , the impact of glycemic control on incident AF and outcomes is unknown . The aims of this study were to prospect ively evaluate if intensive glycemic control in patients with DM affects incident AF and to evaluate morbidity and mortality in patients with DM and incident AF . A total of 10,082 patients with DM from the Action to Control Cardiovascular Risk in Diabetes ( ACCORD ) cohort were studied in a r and omized , double-blind fashion . Participants were r and omized to an intensive therapeutic strategy targeting a glycated hemoglobin level of < 6.0 % or a st and ard strategy targeting a glycated hemoglobin level of 7.0 % to 7.9 % . Incident AF occurred in 159 patients ( 1.58 % ) over the follow-up period , at a rate of 5.9 per 1,000 patient-years in the intensive-therapy group and a rate of 6.37 per 1,000 patient-years in the st and ard-therapy group ( p = 0.52 ) . In a multivariate model , predictors of incident AF were age , weight , diastolic blood pressure , heart rate , and heart failure history .  Patients with DM and new-onset AF  had a hazard ratio of 2.65 for all-cause mortality ( 95 % confidence interval 1.8 to 3.86 , p < 0.0001 ) , a hazard ratio of 2.1 for myocardial infa rct ion ( 95 % confidence interval 1.33 to 3.31 , p = 0.0015 ) , and a hazard ratio of 3.80 for the development of heart failure ( 95 % confidence interval 2.48 to 5.84 , p < 0.0001 ) . In conclusion , intensive glycemic control did not affect the rate of new-onset AF .  Patients with DM and incident AF had an increased risk for morbidity and mortality compared with those without AF Increased mortality in digoxin-treated subjects has been demonstrated in patients with recent myocardial infa rct ion . Those with congestive heart failure ( CHF ) due to causes other than myocardial infa rct ion seem to be free from this effect . No information is currently available concerning mortality in elderly people who are frequently prescribed digitalis even in the absence of CHF . The aim of this study was to investigate whether subjects improperly receiving digoxin were worse off than those not receiving this drug . This analysis is a part of CASTEL , a population -based prospect i ve study that has enrolled a cohort of 2,254 subjects aged > or = 65 years . CHF was diagnosed in 187 subjects and atrial fibrillation ( AF ) in 90 . The remaining 1,977 were free from CHF and in sinus rhythm , but 447 were treated with digitalis .  Cumulative mortality and morbid events by digitalis treatment were calculated in all these categories . Among subjects free from CHF and AF ( improper use ) , all-cause and cardiovascular mortality was significantly higher among those taking digitalis than in those who did not . Non-fatal events including CHF were also more apparent in the former than in the latter . Cox analysis confirmed digitalis as a predictor of mortality in these subjects . No effect of digitalis on survival was found in patients with CHF or AF ( proper use ) . In elderly subjects without atrial fibrillation or CHF , the use of digitalis worsens morbidity and mortality OBJECTIVES Despite all the advances in cardiac surgery , atrial fibrillation ( AF ) remains a common postoperative complication with unclear predisposing factors . Postoperative AF is often a short-lived and a self-limiting condition , but can result in debilitating and even lethal consequences . The aim of this study is to assess the effect of AF on patients postcardiac surgery . METHODS In this retrospective study , we prospect ively review ed patient data for our institution for a 10-year period ; a total of 17,379 patients with preoperative sinus rhythm ( SR ) who underwent cardiac surgery were included , of which 4984 ( 28.7 % ) had developed postoperative AF for any length of time . After propensity matching for the preoperative characteristics between the two groups ; the group with AF and the group who remained in SR , postoperative complications , in-hospital mortality , mid-term survival rate ( five years ) , and long-term survival rate ( 10 years ) were compared . RESULTS Before and after adjusting for the preoperative characteristics and type of the operation , postoperative complications , such as renal failure , surgical wound infection , stroke and myocardial infa rct ion were significantly higher in the AF group compared to the SR group ( P < 0.001 ) . Inotropic support , use of intra-aortic balloon pump , and ventilation time were also considerably higher in the AF patients ( P < 0.001 ) . In-hospital mortality was also higher in the AF group . Likewise , 30-day , mid-term and long-term mortality rates were found to be considerably higher in the AF group . CONCLUSIONS Despite all the modern anti-arrhythmic drugs , the incidence of AF remains unchanged . Patients who develop AF postcardiac surgery show a significantly worse outcome compared to those without AF . This study also highlights the importance of anticoagulation in AF to prevent the devastating consequences as a result of a cerebral stroke . We believe that not only immediate treatment of AF postoperatively should be implemented , but also measures should be taken to identify the risk factors of AF and to prevent AF postcardiac surgery BACKGROUND Atrial fibrillation ( AF ) is frequent in patients with chronic heart failure ( CHF ) . Experimental and small patient studies have demonstrated that blocking the renin-angiotensin-aldosterone system may prevent AF . In the CHARM program , the effects of the angiotensin receptor blocker c and esartan on cardiovascular mortality and morbidity were evaluated in a broad spectrum of patients with symptomatic CHF . CHARM provided the opportunity to prospect ively determine the effect of c and esartan on the incidence of new AF in this CHF population . METHODS 7601 patients with symptomatic CHF and reduced or preserved left ventricular systolic function were r and omized to c and esartan ( target dose 32 mg once daily , mean dose 24 mg ) or placebo in the 3 component trials of CHARM . The major outcomes were cardiovascular death or CHF hospitalization and all-cause mortality . The incidence of new AF was a prespecified secondary outcome . Median follow-up was 37.7 months . A conditional logistic regression model for stratified data was used . RESULTS 6379 patients ( 83.9 % ) did not have AF on their baseline electrocardiogram . Of these , 392 ( 6.15 % ) developed AF during follow-up , 177 ( 5.55 % ) in the c and esartan group and 215 ( 6.74 % ) in the placebo group ( odds ratio 0.812 , 95 % CI 0.662 - 0.998 , P = .048 ) . After adjustment for baseline covariates , the odds ratio was 0.802 ( 95 % CI 0.650 - 0.990 , P = .039 ) . There was no heterogeneity of the effects of c and esartan in preventing AF between the 3 component trials ( P = .57 ) . CONCLUSIONS Treatment with the angiotensin receptor blocker c and esartan reduced the incidence of AF in a large , broadly-based , population of patients with symptomatic CHF Aims This multicentre , r and omized trial compared three strategies of AF ablation : ablation of complex fractionated electrograms ( CFE ) alone , pulmonary vein isolation ( PVI ) alone , and combined PVI + CFE ablation , using st and ardized automated mapping software . Methods and results Patients with drug-refractory , high-burden paroxysmal ( episodes > 6 h , > 4 in 6 months ) or persistent atrial fibrillation ( AF ) were enrolled at eight centres . Patients ( n = 100 ) were r and omized to one of three arms . For CFE alone ( n = 34 ) , spontaneous/induced AF was mapped using vali date d , automated CFE software and all sites < 120 ms were ablated until AF termination/non-inducibility . For PVI ( n = 32 ) , all four PV antra were isolated and confirmed using a circular catheter . For PVI + CFE ( n = 34 ) , all four PV antra were isolated , followed by AF induction and ablation of all CFE sites until AF termination/non-inducibility . Patients were followed at 3 , 6 , and 12 months with a visit , ECG , 48 h Holter . Atrial fibrillation symptoms were confirmed by loop recording . Repeat procedures were allowed within the first 6 months . The primary endpoint was freedom from AF > 30 s at 1 year . Patients ( age 57 ± 10 years , LA size 42 ± 6 mm ) were 35 % persistent AF . In CFE , ablation terminated AF in 68 % . Only 0.4 PVs per patient were isolated as a result of CFE . In PVI , 94 % had all four PVs successfully isolated . In PVI + CFE , 94 % had all four PVs isolated , 76 % had inducible AF with additional CFE ablation , with 73 % termination of AF . There were significantly more repeat procedures in the CFE arm ( 47 % ) vs. PVI ( 31 % ) or PVI + CFE ( 15 % ) ( P = 0.01 ) . After one procedure , PVI + CFE had a significantly higher freedom from AF ( 74 % ) compared with PVI ( 48 % ) and CFE ( 29 % ) ( P = 0.004 ) . After two procedures , PVI + CFE still had the highest success ( 88 % ) compared with PVI ( 68 % ) and CFE ( 38 % ) ( P = 0.001 ) . Ninety-six percent of these patients were off anti-arrhythmics . Complications were two tamponades , no PV stenosis , and no mortality . Conclusion In high-burden paroxysmal/persistent AF , PVI + CFE has the highest freedom from AF vs. PVI or CFE alone after one or two procedures . Complex fractionated electrogram alone has the lowest one and two procedure success rates with a higher incidence of repeat procedures . Clinical Trials.gov identifier number NCT00367757 Atrial fibrillation ( AF ) represents the most common sustained cardiac arrhythmia in patients with heart failure ( HF ) . AF in HF patients is associated with worsening of symptoms and also results in a substantial increase in mortality . Although HF patients in sinus rhythm have a better outcome than patients with AF , several r and omized studies investigating pharmacological rhythm control versus rate control have shown no advantage of one strategy over the other in terms of patient outcomes . Catheter-based ablation therapy is a newer therapeutic option with a rapidly evolving and changing role in the management of this arrhythmia . In the present review , the authors discuss the epidemiology , pathophysiology and prognostic significance of AF in patients with HF . Exclusively addressed are studies investigating catheter-based ablation for rhythm-control and rate-control therapies in the management of AF in HF patients OBJECTIVES The purpose of this study was to characterize patients with mitral regurgitation ( MR ) and atrial fibrillation ( AF ) treated percutaneously using the MitraClip device ( Abbott Vascular , Abbott Park , Illinois ) and compare the results with surgery in this population . BACKGROUND The EVEREST II ( Endovascular Valve Edge-to-Edge Repair Study ) r and omized controlled trial compared a less invasive catheter-based treatment for MR with surgery , providing an opportunity to assess the impact of AF on the outcomes of both the MitraClip procedure and surgical repair . METHODS The study population included 264 patients with moderately severe or severe MR assessed by an independent echocardiographic core laboratory . Comparison of safety and effectiveness study endpoints at 30 days and 1 year were made using both intention-to-treat and per- protocol ( cohort of patients with MR ≤2 + at discharge ) analyses . RESULTS Pre-existing AF was present in 27 % of patients . These patients were older , had more advanced disease , and were more likely to have a functional etiology . Similar reduction of MR to ≤2 + before discharge was achieved in patients with AF ( 83 % ) and in patients without AF ( 75 % , p = 0.3 ) . Freedom from death , mitral valve surgery for valve dysfunction , and MR > 2 + was similar at 12 months for AF patients ( 64 % ) and for no-AF patients ( 61 % , p = 0.3 ) . At 12 months , MR reduction to < 2 + was greater with surgery than with MitraClip , but there was no interaction between rhythm and MR reduction , and no difference in all-cause mortality between patients with and patients without AF . CONCLUSIONS Atrial fibrillation is associated with more advanced valvular disease and noncardiac comorbidities . However , acute procedural success , safety , and 1-year efficacy with MitraClip therapy is similar for patients with AF and without AF OBJECTIVES This study aim ed to assess the prevalence of different types of  atrial fibrillation ( AF ) and their prognostic importance in  implantable cardioverter-defibrillator ( ICD ) patients . BACKGROUND The prevalence of AF has taken epidemic proportions in the population with cardiovascular disease . The prognostic importance of different types of AF in ICD patients remains unclear . METHODS Data on 913 consecutive patients ( 79 % men , mean age 62 + or - 13 years ) receiving an ICD at the Leiden University Medical Center were prospect ively collected . Among other characteristics , the existence and type of AF ( paroxysmal , persistent , or permanent ) were assessed at implantation . During follow-up , the occurrence of appropriate or inappropriate device therapy as well as mortality was noted . RESULTS At implantation , 73 % of patients had no history of AF , 9 % had a history of paroxysmal AF , 7 % had a history of persistent AF , and 11 % had permanent AF . During 833 + or - 394 days of follow-up , 117 ( 13 % ) patients died , 228 ( 25 % ) patients experienced appropriate device discharge , and 139 ( 15 % ) patients received inappropriate shocks . Patients with permanent AF exhibited more than double the risk of mortality , ventricular arrhythmias triggering device discharge , and inappropriate device therapy .  Patients with paroxysmal or persistent AF did not show a significant increased risk of mortality or appropriate device therapy but demonstrated almost 3 times the risk of inappropriate device therapy . CONCLUSIONS In the population currently receiving ICD treatment outside the setting of clinical trials , a large portion has either a history of AF or permanent AF . Both types of AF have prognostic implication s for mortality and appropriate as well as inappropriate device discharge AIMS To compare the quality of life ( QoL ) of those in atrial fibrillation ( AF ) aged 75 years and over with that of the general population , to explore what factors affect the QoL of those with AF , and to assess the sensitivity of the EuroQol ( EQ-5D ) and Short-Form 12 ( SF-12 ) generic health question naires in detecting differences in health status in those with AF in this age group . METHODS AND RESULTS The study population was 1762 men and women aged 75 years and over with confirmed AF who attended a r and omization clinic for the Birmingham Atrial Fibrillation Treatment of the Aged ( BAFTA ) study , a primary care based trial of stroke prevention . Patients self-completed the EQ-5D and SF-12 question naires , and a simple measure of disability ( Rankin ) . Cardiovascular co-morbidities were collected and number of drugs used as an additional proxy for co-morbidity . Quality -of-life outcomes were compared with general population sample s of the same age . On multiple regression , female gender , greater medication use , and disability were independently associated with lower QoL scores in AF . Those in AF with a Rankin score ≥2 had lower QoL scores , while those with a Rankin score < 2 had higher scores than the general population . Increasing co-morbidity was associated with reduced QoL scores , with the EQ-5D and SF-12 Physical Component Score showing similar sensitivity to these associations , and the SF-12 Mental Component Score showing less sensitivity . CONCLUSION In the absence of co-morbidity , chronic AF has little impact on generic QoL in an elderly non-acutely ill population AIMS Pulmonary vein isolation ( PVI ) can be considered for treatment of symptomatic atrial fibrillation ( AF ) . Nowadays , in addition to transcatheter ablation , thoracoscopic surgical PVI is available . The aim of this study is to compare clinical outcome of surgical with transcatheter PVI as first invasive treatment strategy of AF . METHODS AND RESULTS From June 2009 to November 2011 , 33 patients underwent minimally invasive surgical PVI , and were matched ( 1:2 fashion ) retrospectively according to age , sex , and AF type , with 66 patients who underwent transcatheter PVI .  Success was defined as freedom from atrial arrhythmias on 24 h Holter monitoring without use of anti-arrhythmic drugs ( AADs ) at 1 year . Mean age was 52 ± 10 years , 82 % were male . Paroxysmal AF was present in 76 patients ( 77 % ) , persistent AF in 23 ( 23 % ) patients . None underwent prior ablations , and failed on 1.2 ± 0.6 AADs . At 12 months , complete freedom from atrial arrhythmias without AADs in the surgical PVI group was 88 % compared with 41 % in the transcatheter PVI group ( P < 0.001 ) . Freedom from atrial arrhythmias with AADs was 91 vs. 62 % , in the surgical vs. transcatheter PVI group , respectively ( P = 0.002 ) . Complications occurred in seven ( 21 % ) surgical PVI patients , and three ( 5 % ) transcatheter PVI patients ( P = 0.015 ) . CONCLUSION In present matched study comparing a surgical with transcatheter PVI treatment strategy in symptomatic AF patients failed on AADs , but without prior ablations , a surgical PVI strategy was more effective to prevent recurrence of atrial arrhythmias , than a transcatheter PVI treatment strategy . However , complications were more frequent with surgical PVI AIMS Since atrial fibrillation ( AF ) is associated with increased risks of cardiovascular and cerebrovascular complications , estimations on the number of individuals with AF are relevant to healthcare planning . We aim ed to project the number of individuals with AF in the Netherl and s and in the European Union from 2000 to 2060 . METHODS AND RESULTS Age- and sex-specific AF prevalence estimates were obtained from the prospect i ve community-based Rotterdam Study . Population projections for the Netherl and s and the European Union were obtained from the European Union 's statistics office . In the age stratum of 55 - 59 years , the prevalence of AF was 1.3 % in men ( 95 % CI : 0.4 - 3.6 % ) and 1.7 % in women ( 95 % CI : 0.7 - 4.0 % ) . The prevalence of AF increased to 24.2 % in men ( 95 % CI : 18.5 - 30.7 % ) , and 16.1 % in women ( 95 % CI : 13.1 - 19.4 % ) , for those > 85 years of age . This age- and sex-specific prevalence remained stable during the years of follow-up . Furthermore , we estimate that in the European Union , 8.8 million adults over 55 years had AF in 2010 ( 95 % CI : 6.5 - 12.3 million ) . We project that this number will double by 2060 to 17.9 million ( 95 % CI : 13.6 - 23.7 million ) if the age- and sex-specific prevalence remains stable . CONCLUSION We estimate that from 2010 to 2060 , the number of adults 55 years and over with AF in the European Union will more than double . As AF is associated with significant morbidities and mortality , this increasing number of individuals with AF may have major public health implication OBJECTIVES We assessed the risk of adverse cardiovascular ( CV ) outcomes associated with atrial fibrillation ( AF ) in the C and esartan in Heart failure- Assessment of Reduction in Mortality and morbidity ( CHARM ) program , which enrolled patients with chronic heart failure ( CHF ) and a broad range of ejection fractions ( EFs ) . BACKGROUND Atrial fibrillation is associated with an increased risk of adverse CV outcomes in patients with CHF and reduced EF . The risk of AF in patients with CHF and preserved left ventricular ejection fraction ( PEF ) is unknown . METHODS A total of 7,599 patients with symptomatic CHF were r and omized to c and esartan or placebo . Patients were divided by baseline EF ( < or = 40 % or > 40 % ) in low or preserved EF groups . Major outcomes were cardiovascular death or hospitalization for worsening heart failure , and all-cause mortality . Median follow-up was 37.7 months . RESULTS A total of 670 ( 17 % ) patients in the low EF group and 478 ( 19 % ) in the PEF group had AF at baseline . Atrial fibrillation predicted a high risk of cardiovascular morbidity and mortality regardless of baseline EF . Patients with AF and low EF had the highest absolute risk for adverse CV outcomes . However , AF was associated with greater relative increased risk of the major outcomes in patients with PEF than in patients with low EF : hazard ratio 1.72 ( 95 % confidence interval [ CI ] 1.45 to 2.06 ) versus 1.29 ( 95 % CI 1.14 to 1.46 ) , respectively . The same was true for the risk of all-cause mortality . C and esartan was associated with similar treatment effects regardless of baseline rhythm . CONCLUSIONS Atrial fibrillation is associated with an increased risk of CV outcomes in patients with CHF and either reduced EF or PEF . C and esartan improved outcomes similarly regardless of baseline rhythm The fundamental management strategy for atrial fibrillation ( AF ) is still debated . There is no doubt that those patients at risk of thromboembolic events should be offered anticoagulant therapy . However , it is uncertain whether rhythm control ( restoration and maintenance of sinus rhythm ) or rate control ( adjustment to a physiological ventricular rate while allowing AF to continue ) is the preferred primary treatment option for the reduction of symptoms and major cardiovascular ( CV ) outcomes associated with AF . Several well conducted trials comparing the two strategies led to the conclusion that there was little to choose between them . However , guidelines leaned towards recommending rate control as the initial strategy , and reserved rhythm control for those who remained symptomatic . Recently this status quo is being increasingly challenged by the clear demonstration that left atrial catheter ablation is effective at suppressing AF resistant to traditional antiarrhythmic drugs , such as those that failed to demonstrate any superiority when compared with rate control . Also , recently introduced antiarrhythmic therapy may have superior efficacy with regard to reducing unexpected CV hospitalization , CV mortality and stroke . In addition , there is a growing perception that atrial remodelling should be best prevented by early rhythm control rather than delaying until rate control has proven unsatisfactory . For these reasons the results of large r and omised clinical trials , which recruit patients soon after the presentation of AF and compare ' aggressive ' modern rhythm control against the guideline approach of primary rate control , are eagerly awaited . In the meantime the pendulum of clinical opinion has begun to swing towards a rhythm control strategy BACKGROUND Hypertension is the most important risk factor directly attributable to the high prevalence of atrial fibrillation ( AF ) , and is one of the few modifiable risk factors for AF . Activation and overactivity of the sympathetic nervous system ( SNS ) have been implicated in the pathogenesis of both essential hypertension and AF . Catheter-based renal sympathetic denervation ( RSDN ) appears to be an effective adjunctive treatment for refractory hypertension , and may be beneficial in other conditions characterized by SNS overactivity , such as left ventricular hypertrophy and atrial arrhythmias . OBJECTIVE The H-FIB study is a multicenter prospect i ve , double-blind , r and omized ( 1:1 ) controlled trial . The primary efficacy endpoint is antiarrhythmic drug-free freedom from AF recurrence through 12 months . METHODS Patients with a history of significant hypertension who are receiving treatment with at least one antihypertensive agent who are planned for a first time ablation for symptomatic paroxysmal or persistent AF will be r and omized to either AF ablation alone ( control group ) or AF ablation + RSDN ( study group ) . CONCLUSIONS H-FIB is a multicenter , r and omized trial that will test the hypothesis that adjunctive renal sympathetic denervation , at the time of AF ablation , will increase the freedom from recurrent AF BACKGROUND Given the potential complications of atrial fibrillation ( AF ) recurrence after ablation , better predictors of the effectiveness of the procedure are necessary to guide patient selection . AIM This prospect i ve study was conducted to evaluate the clinical relevance of global left atrial longitudinal strain ( GLAS ) and AF recurrence after catheter ablation . METHODS In 115 consecutive patients with AF ( persistent , n=62 ; paroxysmal , n=53 ) ,  transthoracic echocardiography was performed before catheter ablation to assess baseline left atrial mechanical function using speckle tracking echocardiography ( STE ) . RESULTS After 12 months of follow-up , 22 ( 35.5 % ) patients in the persistent AF group and 15 ( 28.3 % ) in the paroxysmal AF group exhibited AF recurrence . In both the paroxysmal and persistent AF population s , patients with recurrence presented with significantly impaired GLAS compared with patients without recurrence . Patients with recurrence also had a significantly higher pro-B-type natriuretic peptide concentration . A receiver operator curve analysis yielded area under the curve values of 0.94 and 0.86 for paroxysmal and persistent AF , respectively . In a multivariable Cox proportional-hazards analysis , GLAS was an independent predictor of AF recurrence after catheter ablation in both the paroxysmal AF group ( hazard ratio : 0.79 , 95 % confidence interval : 0.67 - 0.96 ; P=0.01 ) and the persistent AF group ( hazard ratio : 0.81 , 95 % confidence interval : 0.71 - 0.93 ; P=0.004 ) . CONCLUSIONS In both paroxysmal and persistent AF , decreased baseline left atrial deformation capabilities assessed by two-dimensional STE can help to identify patients at high risk of AF recurrence after catheter ablation . This variable may help to guide c and i date selection and improve therapeutic strategies Background Two important limitations of the data regarding the outcomes of catheter ablation of atrial fibrillation ( AF ) are the short-term follow-up used in most published studies and the lack of single-procedure outcomes . Objective The objective was to report the long-term single-procedure outcomes at our center . Material s and methods The patient population was comprised of 200 consecutive patients who underwent ablation ( 133 men ; age 56 ± 11 years ) . Atrial fibrillation was paroxysmal in 92 ( 46 % ) . Success was defined as absence of symptomatic AF , off antiarrhythmic drug ( AAD ) after a single procedure . Results After a follow-up of 26 ± 11 months , the single-procedure long-term success rate was 28 % with an additional 7 % of patients demonstrating improvement . After including repeat procedures in 64 patients , the overall long-term success rate was 41 % with 11 % demonstrating improvement . Further subgroup analysis of 48 paroxysmal AF patients considered to be optimal c and i date s for the procedure , revealed a long-term success rate of 69 % with an additional 4 % demonstrating improvement . A major complication occurred in 7.9 % of patients . Conclusion The results reveal that the long-term single-procedure success rate  of catheter ablation of AF in a cohort of patients with predominantly non-paroxysmal AF is less than 40 % . The inclusion of redo procedures result ed in an improvement in outcomes . A much higher success rate of 69 % was achieved in patients with paroxysmal AF considered to be optimal c and i date s for this procedure . These results make it clear that further advances in the technique of catheter ablation of AF are needed to improve the safety and efficacy of this procedure . In order to be able to compare outcomes of various techniques in differing patient population s , we urge investigators to report long-term single procedure outcomes AIMS Women have an increased risk for atrial fibrillation (AF)-related complications and there is evidence towards a reduced efficacy of the rhythm control strategy than men . A catheter-based strategy is therefore widely attractive , but the impact of gender on catheter ablation ( CA ) of AF remains undefined . METHODS AND RESULTS We included 221 consecutive patients ( 150 men ) who underwent CA of drug-refractory AF .  Gender differences in clinical presentation and outcomes were compared . Women were older ( P = 0.002 ) , had a longer history of AF ( P = 0.04 ) , and were more likely to have hypertension ( P = 0.04 ) . Moreover , a concomitant valvular heart disease tended to be more common in women ( 32.4 vs. 23.3 % ; P = 0.28 ) and left atrium dimensions were significantly larger ( P = 0.003 ) . However , acute success rate and complications rate were similar between genders . After 22.5 + /- 11.8 months of follow-up , the overall freedom from arrhythmia recurrences was similar ( 83.1 vs. 82.7 % in men ) , and a similar improvement in SF-36 quality of life scores was achieved in both groups . CONCLUSION Women are referred for AF ablation later with a more complex clinical pre-operative presentation . Despite this higher risk profile in women , no differences were detected in clinical outcomes . Our findings indicate that CA of AF appears to be safe and effective in women as in men AIMS AND OBJECTIVE Outcome data of patients with implantable cardioverter defibrillators ( ICD ) and atrial fibrillation ( AF ) are conflicting . The German DEVICE registry aims to add further information on this particular cohort . METHODS AND RESULTS The German DEVICE registry is a nationwide prospect i ve multicenter data base of ICD implantations . 3261 patients are included ( 81 % males , 2701 ( 82.8 % ) first ICD implantations , 560 ( 17.2 % ) ICD replacements ) .  Cardiac resynchronization therapy ( CRT-D ) was performed in 882 patients ( 27.0 % ) . Sinus rhythm ( SR ) was present in 2654 ( 81.4 % ) and atrial fibrillation ( AF ) in 607 ( 18.6 % ) . Left ventricular ejection fraction ( LVEF ) did not differ between groups ( SR 32.3 % , AF 30.4 % ; p = 0.09 ) . AF patients were older ( AF 70.9 versus SR 63.9 years ; p < 0.0001 ) , presented with more co-morbidities ( diabetes , hypertension , chronic kidney disease ; all p < 0.001 ) . In-hospital complications were not significantly different between groups ( p = 0.58 ) . Follow-up information after one year was available in 2967 patients ( 91 % ) . One-year overall mortality after first ICD implantation was 4.9 % for SR and 11.2 % for AF patients ( p < 0.0001 ) ; mortality one year after ICD replacement was 8.4 % for SR and 12.0 % for AF ( p = 0.34 ) . No statistically significant difference between SR and AF patients receiving a CRT device was observed ( SR 6.9 % , AF 10.7 % , p = 0.16 ) in terms of one-year mortality . CONCLUSION The German DEVICE registry demonstrates that patients with AF who receive ICD devices are older , have more co-morbidity and more severe heart failure . AF carries an independent 1.39 fold risk ( 95 % CI 1.02 - 1.89 ) of death after one year in patients only with first ICD implantation BACKGROUND Catheter ablation of complex fractionated atrial electrograms ( CFAE ) for persistent atrial fibrillation ( AF ) is a promising treatment strategy . We tested the hypothesis that CFAE ablation is superior to linear ablation in patients with persistent or long-st and ing persistent AF . METHODS In this study , 116 patients with persistent AF were r and omly assigned to undergo circumferential PVI plus additional lines ( linear ablation group ; 59 patients ) or CFAE ablation plus ostial pulmonary vein isolation ( PVI ) ( spot ablation group ; 57 patients ) . Primary endpoint was freedom from atrial tachyarrhythmia after a single ablation procedure ( clinical and repeat 7-day Holter ) , 12 months after ablation without antiarrhythmic medication . RESULTS The primary endpoint was reached in 22 of 59 ( 37 % ) patients of the linear ablation group and in 22 of 57 ( 39 % ) patients of the spot ablation group ( P = 0.9 ) . Freedom from atrial tachyarrhythmias , including reablations , was achieved in 54 % of patients ( linear ablation group ) versus 56 % of patients ( spot ablation group ; P = 0.8 ) . The incidence of recurrent persistent AF was higher after linear ablation than after spot ablation ( 21/37 vs 11/35 patients ; P = 0.03 ) ; atrial tachycardia ( AT ) was seen more often after spot ablation ( 10/35 vs 4/37 patients ; P = 0.03 ) . CONCLUSION In patients with persistent AF , CFAE ablation plus PVI reaches the same results as circumferential PVI plus lines , in terms of freedom from symptomatic atrial tachyarrhythmias within the first year after a single ablation procedure . Arrhythmia recurrences in patients after spot ablation were caused more often by AT , whereas recurrent persistent AF was more prevalent after the linear ablation approach
Subgroup analysis demonstrated similar trends , with higher freedom from AF in the surgical ablation group for paroxysmal AF patients .
The incidence of pacemaker implantation was higher , while no difference in stroke or cardiac tamponade was demonstrated for the surgical versus catheter ablation groups .
Current evidence suggests that epicardial ablative strategies are associated with higher freedom from AF , higher pacemaker implantation rates and comparable neurological complications and cardiac tamponade incidence to catheter ablative treatment .
BACKGROUND Atrial fibrillation ( AF ) is an increasingly prevalent condition in the ageing population , with significantly associated morbidity and mortality .
Surgical and catheter ablative strategies both aim to reduce mortality and morbidity through freedom from AF .
This review consoli date s all currently available comparative data to evaluate these two interventions .