Atrial fibrillation (AF) ablation is most commonly performed using radiofrequency (RF) and cryoballoon (CB) catheters. Ablation Index is a novel lesion-quality marker associated with improved outcomes in RF ablation. Due to lack of direct comparative evidence between the latest generations of technologies, there is uncertainty regarding the best treatment option. Aim: To conduct a network meta-analysis to evaluate the comparative effectiveness of RF with Ablation Index to other catheter ablation devices in the treatment of AF. Methods: Searches for randomized and nonrandomized prospective comparative studies of ablation catheters were conducted in multiple databases. The outcome of interest was 12-month freedom from atrial arrhythmias after a single ablation procedure. Studies were grouped as high-, low- and unclear-quality based on study design and balanced baseline patient characteristics. Bayesian hierarchical network meta-analysis was conducted and results presented as relative risk ratios with 95% credible intervals (CrIs). Results: 12 studies evaluating five different catheter ablation devices were included. Radiofrequency ablation with Ablation Index was associated with statistically significantly greater probability of 12-month freedom from atrial arrhythmias than Arctic Front (relative risk: 1.77; 95% CrI: 1.21–2.87), Arctic Front Advance™ (1.41; 1.06–2.47), THERMOCOOL™ (1.34; 1.17–1.48) and THERMOCOOL SMARTTOUCH™ (1.09; 1–1.3). Results were robust in multiple sensitivity analyses. Conclusion: Radiofrequency catheter with Ablation Index is superior to currently available options for 12-month freedom from atrial arrhythmias after AF ablation. This study provides decision-makers with robust, pooled, comparative evidence of the latest ablation technologies.

Atrial fibrillation (AF), the most common form of arrhythmia, is fast becoming one of the world’s most significant health issues. It is well established that AF increases the risk of mortality, and is associated with significant morbidity, including an increased risk of stroke. AF also worsens quality of life for patients, which can also be a burden for caregivers. As a result of Europe’s ageing population, the prevalence of AF is expected to rise substantially in the future. With more patients expected to be affected by AF, rates for AF-related strokes, hospitalisations, and doctor visits are also expected to rise, ultimately raising healthcare system costs across Europe. It is estimated that up to 2.6% of total annual healthcare expenditure is associated with AF in European countries. The high cost of AF is largely attributable to hospitalisations and complications such as stroke, i.e., in 2015, stroke was estimated to cost €45 billion a year in the European Union (EU). The purpose of this review is to highlight the current scale and growing burden of this new millennium epidemic in Europe. This review aims to foster a greater awareness and understanding of the magnitude of the clinical, patient, and economic burden of AF. An understanding of the burden of AF is imperative for directing care pathway management and healthcare policies that can help alleviate the burden of AF experienced by patients, caregivers, and healthcare systems in Europe.

Background and Aims Intracardiac echocardiography (ICE) is a useful but operator-dependent tool for left atrial (LA) anatomical rendering during atrial fibrillation (AF) ablation. The CARTOSOUND FAM Module, a new deep learning (DL) imaging algorithm, has the potential to overcome this limitation. This study aims to evaluate feasibility of the algorithm compared to cardiac computed tomography (CT) in patients undergoing AF ablation. Methods In 28 patients undergoing AF ablation, baseline patient information were recorded and 3D shells of LA body and anatomical structures (LAA/LSPV/LIPV/RSPV/RIPV) were reconstructed using the DL algorithm. The selected ultrasound frames were gated to end-expiration and max LA volume. Ostial diameters of these structures and carina-to-carina distance between left and right pulmonary veins were measured and compared with CT measurements. Anatomical accuracy of the DL algorithm was evaluated by three independent electrophysiologists using a 3-anchor scale for LA anatomical structures and a 5-anchor scale for LA body. Ablation related characteristics were summarized. Results The algorithm generated 3D reconstruction of LA anatomies and 2D contours overlaid on ultrasound input frames. Average calculation time for LA reconstruction was 65s. Mean ostial diameters and carina-to-carina distance were all comparable to CT without statistical significance. Ostial diameters and carina-to-carina distance also showed moderate to high correlation (r=0.52-0.75) except for RIPV (r=0.20). Qualitative ratings showed good agreement without between-rater differences. Average procedure time was 143.7±43.7min, with average RF time 31.6±10.2min. All patients achieved ablation success and no immediate complications were observed. Conclusion DL algorithm integration with ICE demonstrated considerable accuracy compared to CT and qualitative physician assessment. The feasibility of ICE with this algorithm can potentially further streamline AF ablation workflow.

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ObjectiveEvaluation of rheumatoid hand-associated metacarpophalangeal joint silicone arthroplasty most often relies on functional scores alone. This study aimed to understand the correlation between perceived and observed function, strength, and alignment.MethodsCross-sectional study including all 11 women (15 hands) submitted to second to fifth metacarpophalangeal joint arthroplasty due to rheumatoid arthritis involvement for a time period of seven years. Measurements relied on the Michigan Hand Outcomes Questionnaire, Lafayette Purdue Pegboard, pinch and grip strength, and analysis of a lateral “OK-sign” X-ray view. Correlation analysis used Spearman's coefficient, assuming statistical significance for p-values < 0.05.ResultsObjective function was strongly correlated with all other variables (p < 0.05), while perceived function failed to correlate with articular alignment in both measurements (p = 0.240 and p = 0.354). Strength and alignment were also strongly correlated (p < 0.05).ConclusionsMost measurements strongly correlate with each other, with emphasis on objective dexterity measurement.