Introduction Chemical ablation by retrograde infusion of ethanol into the vein of Marshall (VOM‐EI) can facilitate the achievement of mitral isthmus block. This study sought to describe the efficacy and safety of this technique. Methods and Results Twenty‐two consecutive patients (14 males, median age 71 years) with attempted VOM‐EI for mitral isthmus ablation were included in the study. VOM‐EI was successfully performed with a median of 4 ml of 96% ethanol in 19 patients (86%) and the mitral isthmus was successfully blocked in all (100%). Touch up endocardial and/or epicardial ablation after VOM‐EI was necessary for 12 patients (63%). Perimitral flutter was present in 12 patients (63%) during VOM‐EI and terminated or slowed by VOM‐EI in 4 and 3 patients, respectively. The low‐voltage area of the mitral isthmus region increased from 3.1 cm2 (interquartile range [IQR] 0–7.9) before to 13.2 cm2 (IQR: 8.2–15.0) after VOM‐EI and correlated significantly with the volume of ethanol injected (p = .03). Median high‐sensitive cardiac troponin‐T increased significantly from 330 ng/L (IQR: 221–516) the evening of the procedure to 598 ng/L (IQR: 382–769; p = .02) the following morning. A small pericardial effusion occurred in three patients (16%), mild pericarditis in one (5%), and uneventful VOM dissection in two (11%). After a median follow‐up of 3.5 months (IQR: 3.0–11.0), 10 of 18 patients (56%) with VOM‐EI and available follow‐up had arrhythmia recurrence. Repeat ablation was performed in five patients (50%) and peri‐mitral flutter diagnosed in three (60%). Conclusion VOM‐EI is feasible, safe, and effective to achieve acute mitral isthmus block.

Background: The prevalence of atrial fibrillation (AF) is high in older patients. The present study aimed to estimate the age and sex specific prevalence of clinical and screen-detected atrial fibrillation (AF) in hospitalized patients. Methods: The STAR-FIB cohort study was a prospective cohort study recruiting participants from a large source population of hospitalized patients aged 65–84 years. The estimated size of the source population was 26,035 (95% CI 25,918–26,152), and 795 consenting patients without clinical AF were included in the cohort study after stratification by sex and age (49.2% females; mean age 74.7 years). Patients in the cohort study underwent three seven-day Holter ECGs in intervals of two months to screen for AF. Results: In the source population, the estimated prevalence of clinical AF was 22.2% (95% CI 18.4–26.1), 23.8% for males (95% CI 20.9–26.6) and 19.8% for females (95% CI 17.3–22.4; p for difference between sexes, 0.004). There was a linear trend for an increase in the prevalence of clinical AF with increasing age, overall and in both sexes. In the cohort study, AF was newly diagnosed in 38 patients, for an estimated prevalence of screen-detected AF of 4.9% overall (95% CI 3.3–6.6), 5.5% in males (95% CI 3.2–7.8) and 4.0% in females (95% CI 2.0–6.0; p for difference between sexes, 0.041). The estimated prevalence of screen-detected AF in the source population was 3.8% overall, 4.2% in males and 3.2% in females. Conclusion: In a large hospital-based patient population aged 65–84 years, the prevalence of clinical AF and of screen-detected AF was 22.2% and 3.8%, respectively, and significantly higher in males than females.

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Background: Hypertrophic cardiomyopathy (HCM), hypertensive heart disease (HHD) and athletes’ heart share an increased prevalence of atrial fibrillation. Atrial cardiomyopathy in these patients may have different characteristics and help to distinguish these conditions. Methods: In this single-center study, we prospectively collected and analyzed electrocardiographic (12-lead ECG, signal-averaged ECG (SAECG), 24 h Holter ECG) and echocardiographic data in patients with HCM and HHD and in endurance athletes. Patients with atrial fibrillation were excluded. Results: We compared data of 27 patients with HCM (70% males, mean age 50 ± 14 years), 324 patients with HHD (52% males, mean age 75 ± 5.5 years), and 215 endurance athletes (72% males, mean age 42 ± 7.5 years). HCM patients had significantly longer filtered P-wave duration (153 ± 26 ms) and PR interval (191 ± 48 ms) compared to HHD patients (144 ± 16 ms, p = 0.012 and 178 ± 31, p = 0.034, respectively) and athletes (134 ± 14 ms, p = 0.001 and 165 ± 26 ms, both p < 0.001, respectively). HCM patients had a mean of 4.9 ± 16 premature atrial complexes per hour. Premature atrial complexes per hour were significantly more frequent in HHD patients (27 ± 86, p < 0.001), but not in athletes (2.7 ± 23, p = 0.639). Left atrial volume index (LAVI) was 43 ± 14 mL/m2 in HCM patients and significantly larger than age- and sex-corrected LAVI in HHD patients 30 ± 10 mL/m2; p < 0.001) and athletes (31 ± 9.5 mL/m2; p < 0.001). A borderline interventricular septum thickness ≥13 mm and ≤15 mm was found in 114 (35%) HHD patients, 12 (6%) athletes and 3 (11%) HCM patients. Conclusion: Structural and electrical atrial remodeling is more advanced in HCM patients compared to HHD patients and athletes.