Background Left atrial (LA) arrhythmogenic substrate beyond the pulmonary veins (PV) seems to play a crucial role in the maintenance of atrial fibrillation (AF). The aim of this study was to evaluate the association of selected parameters with the presence and extent of voltage-defined LA fibrosis in patients with long-standing persistent AF (LSPAF) undergoing catheter ablation. Methods One hundred and sixteen consecutive patients underwent high density-high resolution voltage mapping of the LA with a multielectrode catheter following PV isolation and restoration of sinus rhythm with cardioversion. A non-invasive dataset, such as clinical variables, two- and three-dimensional echocardiography determined LA size and function and fibrillatory-wave amplitude on a standard surface electrocardiogram were obtained during AF before ablation. Results Low-voltage areas (LVA; 15 cm 2 [IQR 8–31]) were detected in 56% of patients. Twenty nine percent of them presented mild, 43% moderate and 28% severe global LVA burden. In univariate analysis, age ≥ 57 years old, female sex, body surface area ≤ 1.76 m 2 , valvular heart disease, moderate mitral regurgitation, chronic coronary syndrome, hypothyroidism, CHA 2 DS 2 -VASc score ≥ 3 and ≥ 4 predicted the presence of LVA. In multivariate analysis only female sex, valvular heart disease and CHA 2 DS 2 -VASc ≥ 4 remained statistically significant. AF duration, LA size and function and fibrillatory-waves amplitude were neither associated with the prediction of the LVA, nor severe LVA burden. Conclusions A LSPAF diagnosis does not indicate the presence of voltage defined fibrosis in many cases. Simple non-invasive screening of the LSPAF population could predict LVA prevalence.

It was hypothesised that left atrial (LA) fibrosis identified by the presence of low-voltage areas (LVA) may influence the mechanical and electrical function of the left (LAA) and right (RAA) atrial appendage among the long-standing persistent atrial fibrillation (LSPAF) population. 140 consecutive patients underwent voltage mapping of LA with a multielectrode catheter following pulmonary vein isolation and restoration of sinus rhythm with cardioversion. Echocardiography determined LAA peak outflow and inflow velocities and intracardiac catheter-based mean LAA and RAA AF cycle length (AFCL) were obtained during AF before ablation. The impact of flow velocities and AFCL on the prevalence and location of LVA was further evaluated. LVA were detected in 54% of the patients. 14% of the patients presented severe global LVA burden > 20% of the total LA surface area. 29% of the patients presented a disseminated pattern of remodelling as 3 out of 5 LA segments were affected. LAA AFCL, RAA AFCL, LAA flow velocities did not predict the absolute presence of LVA. However LAA AFCL > 155 ms predicted disseminated LVA pattern and LAA AFCL > 165 ms severe LVA incidence. LAA AFCL > 155 ms was predictive for existence of LVA within antero-septal LA segments whilst LAA emptying velocity ≤ 0.2 m/s within lateral wall. Moreover RAA AFCL > 165 ms was strongly related to the presence of LAA AFCL > 15 ms and > 165 ms. LAA and RAA functional assessment was predictive of the presence of advanced stages of voltage-defined LA fibrosis and its regional distribution among LSPAF population

PurposeTo evaluate the effects of atrial fibrillation (AF) and ablation procedures on electrophysiological function in the retina and optic nerve.MethodsThirty two eyes of 17 patients with AF were analyzed. The full-field electroretinogram (ERG), pattern electroretinogram (PERG) and pattern visual evoked potential (PVEP) were performed. The results were compared to age-matched healthy controls (n = 30). In 12 eyes, electrophysiological tests were performed before and 3 months after ablation treatment.ResultsStatistically significant differences between AF patients and healthy controls were detected. In the full-field ERG, a reduction in the oscillatory potentials wave index (OPs WI; p = 0.012) and scotopic (0 dB) a-wave amplitude (p = 0.009) was observed. The amplitude of b-waves, scotopic (24 dB; p = 0.011), photopic single flash (p = 0.008) and photopic flicker (p = 0.009), was decreased. The photopic flicker b-wave peak time was increased (p = 0.005). Other parameters of ERG/PERG/PVEP did not differ significantly from controls. After the ablation procedure, the only statistically significant change was an increase in the OPs WI (p = 0.002).ConclusionsIn the analyzed series of AF patients, retinal dysfunction was detected in the ERG test. The AF ablation may improve the retinal function as indicated by an increase in the OPs WI. The OPs WI has a potential value in the estimation of the effectiveness of AF ablation.

Background Systemic connective tissue diseases are still challenging for clinicians since they have a complex pathophysiology and diversified clinical presentations. Dermatomyositis and Polimyositis may often involve cardiovascular system resulting in arrhythmias and conduction disturbances [1]. Publications about non-invasive heart diagnostics methods (ECG and 24h Holter ECG) designed to examine large groups of dermatomyositis and polimyositis patients for arrhythmia and conduction disturbances are scarce. Objectives The aim of our study was to determine the ECG and Holter deviations among patients with documented dermatomyositis and polimyositis. Methods The study group consisted of 30 patients (7 males and 23 females). 19 patients were diagnosed with polimyositis, 11 with dermatomyositis. Mean disease duration was 6.5 years (SD ±4.7). None of the patients included in the study demonstrated symptoms of rhabdomyolysis. The patients in the study group had the following concomitant diseases: arterial hypertension in 13 patients, hyperthyroidism in 3 patients (in euthyrosis), hypothyroidism in 2 patients (in euthyrosis). The control group consisted of 30 healthy subjects (8 males and 22 females) with no autoimmune, metabolic, or cardiovascular diseases documented. All patients signed the study participation consent. Subjects in both groups (study and control) underwent twelve-lead ECG. We measured QRS complex, PQ interval, P wave and conduction disturbances assuming the following norms: for QRS complex ≤100ms, PQ interval ≤200ms, P wave ≤110ms. Blood samples were taken and the following were assessed: creatine kinase level (CK), aldolase level (ALD) and lactate dehydrogenase level (LDH). All patients were applied a three-channel Holter ECG (Oxford DMS-3). Holter recordings (with the use of Cardioscan ver. 12 software) were analyzed: SDDN, SDDNi, SDANN, rMSSD, pNN50, VLF, LF, HF, maximum QT/QTc interval in the recording, and ventricular extrasystolic beats. Results In the 12-lead resting ECG of the study group we did not observe any deviations from neither the range of PQ interval nor P wave. However bundle branches blocks were observed, i.e. right bundle branch block in three patients, left anterior fascicle block in one patient, and complete block of left bundle bunch in one patient. We did not observe any statistically significant differences in parameters assessing the autonomic system function (Table 1), the QT/QTc interval, ventricular rhythm disorders/extrasystolic beats (Table 2). We observed significant differences (p<0,0001) between the control and the study group when comparing enzymes activities (CPK, LDH, ALD) (Table 3). Conclusions 1. Higher values of the activity of enzymes (CPK, LDH and CK) compared to the control group do not correlate with the durinal variability of cardiac rhythm, which implies a lack of disease affinity to involve the autonomic system. 2. Conduction disturbances in DM and PM affect mainly the His-Purkinje system. 3. No significant differences in QT/QTc interval and th...

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