Aims Despite the general adoption of a 3-month blanking period (BP), increasing scientific evidence suggests an association between early recurrences of atrial tachyarrhythmias (ERAT) and failure of atrial fibrillation catheter ablation (AFCA). The aim of the present study was to perform a diagnostic meta-analysis to derive the ideal BP cut-off following AFCA. Methods and results PubMed/MEDLINE databases were screened for articles reporting late recurrences of atrial tachyarrhythmias (LRAT) in AFCA patients experiencing an ERAT (with at least one time cut-off). Seventeen studies were finally included in the analysis, encompassing 5837 AF patients experiencing ERAT after AFCA. A random-effect meta-analysis of diagnostic test accuracy studies with multiple cut-offs was performed. The day at which the ERAT occurred was considered the diagnostic ‘test’, whereas the different time cut-offs reported in the singular studies were treated as cut-offs of interest in the meta-analysis. Overall, a 27.7 day (95% confidence interval: 10.4–45.1 days) cut-off was identified as the optimal BP duration [area under the summary receiver operating characteristic (AUC-SROC) curve: 0.66, 95% CI: 0.56–0.75]. Specificity (95% CI: 63–85%) and positive predictive value were 76%. At subgroup analysis, the optimal BP cut-off was 39.0 days (95% CI: 26.8–51.2 days, AUC-SROC: 0.63) following radiofrequency AFCA and 30.1 days (95% CI: 0–63.4 days, AUC-SROC: 0.76) after cryoballoon ablation. Conclusion The present meta-analysis indicates that a 4-week BP represents the optimal cut-off following AFCA. Altogether, these meta-analytic insights support the need of a revision of the actual 3-month BP duration.

Background: Atrial fibrillation (AF) is independently associated with the onset of cognitive decline/dementia. AF catheter ablation (AFCA) is the most effective treatment strategy in terms of sinus rhythm maintenance, but its effects on dementia prevention remain under investigation. The aim of the present study was to perform a systematic review and meta-analysis of the presently available studies exploring the effect of AFCA on dementia occurrence. Methods: PubMed/MEDLINE databases were screened for articles through 14 March 2022 reporting adjusted time-to-event outcome data comparing AFCA and non-AFCA cohorts in terms of de novo dementia occurrence. A random effect meta-analysis was performed to estimate the meta-analytic hazard ratio (HR) of dementia occurrence in AFCA vs. non-AFCA cohorts, as well as the meta-analytic incidence rate of dementia in the non-AFCA cohort. Based on the aforementioned estimates, the number needed to treat (NNT), projected at median follow-up, was derived. Results: Four observational studies were included in the analysis, encompassing 40,146 patients (11,312 in the AFCA cohort; 28,834 in the non-AFCA cohort). AFCA conferred a significant protection to the development of dementia with an overall HR of 0.52 (95% CI 0.35–0.76). The incidence rate of dementia in the non-AFCA group was 1.12 events per 100 person-year (95% CI 0.47–2.67). The derived NNT projected to the median follow-up (4.5 years) was 41. Conclusion: AFCA is associated with a nearly 50% reduction in dementia occurrence during a median 4.5-year follow-up. Future randomized clinical trials are needed to reinforce these findings.

Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice. Despite the frequent coexistence with coronary artery disease (CAD), the prognostic independent implication of AF in patients with stable CAD remains controversial. Our aim was to perform a pairwise meta-analysis of adjusted observational studies comparing cardiovascular outcomes in patients with stable CAD with and without concomitant AF, in search of AF-specific prognostic implications. We performed random effect meta-analysis of binary outcome events in studies comparing stable CAD patients with versus without AF providing risk estimates adjusted for confounding variables. Literature search was performed in PubMed/MEDLINE and Google Scholar. Death was the primary endpoint of the analysis, while myocardial infarction, coronary revascularization and stroke secondary endpoints. 5 studies were included in the meta-analysis, encompassing a total of 30230 stable CAD patients (2844 with AF, 27386 without AF). Stable CAD patients with AF presented an independent increased risk of death (HR 1.39, 95% CI: 1.17–1.66) and stroke (HR 1.88, 95% CI: 1.45–2.45) compared to those without AF. Instead, risk of myocardial infarction (HR 0.90, 95% CI: 0.66–1.22) and coronary revascularization (HR 0.96, 95% CI: 0.79–1.16) did not differ in stable CAD patients with and without the arrhythmia. In patients with stable CAD, AF exerts an independent negative prognostic effect, increasing the risk of death and stroke. However, the small number of eligible studies included in this analysis highlights the astonishing lack of data regarding prognostic implications of concomitant AF in patients with stable CAD.

Background and objectives: Atrial fibrillation (AF) and dementia are growing causes of morbidity and mortality, representing relevant medical and socioeconomic burdens. In this study, based on data from the Global Burden of Disease Injuries and Risk Factors Study (GBD) 2019, we focused on AF and dementia distribution and investigated the potential correlation between the two epidemiological trends. Materials and Methods: Crude and age-standardized incidence, prevalence, mortality rate, and disability-adjusted life years (DALYs) lost, derived from GBD 2019, were reported for AF and dementia. Global features were also stratified by high and low sociodemographic-index (SDI) countries. Granger test analysis was performed to investigate the correlation between AF and dementia incidence time trends. Results: From 1990 to 2019 crude worldwide incidence and prevalence showed a dramatic increase for both conditions (from 43.24 to 61.01 and from 528.72 to 771.51 per 100,000 individuals for AF, respectively; from 54.60 to 93.52 and from 369.88 to 667.2 per 100,000 individuals for dementia, respectively). In the same timeframe, crude mortality rate doubled for AF and dementia (from 2.19 to 4.08, and from 10.49 to 20.98 per 100,000 individuals, respectively). Age-standardized estimate showed a substantial stability over the years, highlighting the key role of the progressively aging population. Crude estimates of all of the investigated metrics are greater in high SDI countries for both conditions. This association was still valid for age-standardized metrics, albeit by a reduced magnitude, suggesting the presence of higher risk factor burden in these countries. Finally, according to Granger test, we found a significant association between the historical trends of AF and dementia incidence (p = 0.004). Conclusions: AF and dementia burden progressively increased in the last three decades. Given the potential association between these two conditions, further clinical data assessing this relationship is needed.

Funding Acknowledgements Type of funding sources: None. Background Pulmonary vein isolation (PVI) using cryoballoon (CB) ablation is associated with an increased radiation exposure compared with radiofrequency ablation. The novel high resolution wide-band dielectric imaging system improved our strategy of radiation exposure reduction without affecting acute efficacy and safety and giving additional insights on the atrial voltage mapping of the selected patients. Purpose To evaluated the reduction of fluoroscopy use over time during consecutive CB PVI performed with the use of a new 3D mapping system. Methods The study population comprised 89 consecutive patients who underwent in our Centre between Juni 2021 and Juli 2022 to third-generation CB-based PVI with the wide band dielectric system and X-Ray System with enhanced collimation, frame reduction and stored fluoroscopy. All included patients gave written informed consent for TEE and PVI and agreed to the anonymous evaluation of their data for research and quality control. We analyzed the reduction in fluoroscopy use among time. Results The mean radiation exposure data among all patients demonstrate a significant reduction compared with the literature data od CB-PVI: mean fluoroscopy time 3,95 ± 4,12 minutes and mean DAP 15,45 ± 27,18 cGy*cm2. Analysing the learning curve, we identified every 30 patients a significant reduction in X-Ray use achieving a reduction of ca. 80% in the last group of patients compared with the former one. The results are summarized in the Table and Graph. No major complications occurred Conclusion The analysis of the fluoroscopy utilization and exposure during CB-PVI performed with a novel 3D mapping system using wide-band dielectric imaging demonstrated a significant learning curve. A stepwise progressive reduction can be identified leading to a reduction of ca. 80% of radiation use among the last 30 procedures compared to the first 30 ones reflecting individual and team proficiency in using the new imaging system. A very low-radiation exposure during CB-PVI can be achieved with this approach.