Exploring New Frontiers in Atrial Fibrillation
Welcome to the June edition of JAFIB. Summer has been reasonably pleasant in continental United States so far. Hope our audience around the world had a wonderful professional and personal times.
In this issue we have several manuscripts that are thought provoking and provide solid review of many interesting topics in atrial fibrillation (AF). Massimo Santini’s group are presenting a small but practically useful study to discriminate between ventricular (VT) and supraventricular tachycardia (SVT) and the evaluation of their hemodynamic impact are essential issues in the arrhythmia management. A new pacing device features a tachycardia diagnostic system relying on simultaneous recording of the transvalvular impedance (TVI) and a special integrated electric signal derived by the whole set of endocardial electrodes (iECG). Karen Phillips and Hiroshi Nakagawa wrote two separate articles that highlight the role of appropriate levels of endocardial contact on two different systems – electrical coupling index (ECI) and contact force (CF) in pulmonary vein isolation and the potential role of adapting it in improving lesion set and longterm outcomes. Julian Chun and coworkers presented a very useful summary of various currently available endocardial left atrial appendage occlusion devices and the potential complications related to these procedures.
Higuchi etal presented a great review of current opinions on Superior vena cava isolation as a standard empiric strategy versus those who have triggers from this region as an adjunct to pulmonary vein isolation. They stressed the importance of a long SVC sleeve as a potential contributor to the benefit from its isolation. Marcin Kowalski and colleagues presented a small single institution experience of interrupted Dabigatran use during cryoballoon based AF ablation. Little is known about the use of pharmacologic rhythm or rate control in younger atrial fibrillation (AF) patients in clinical practice. Nancy LaPointe and others from Duke bring a very important epidemiological question on the real world differences in how the treatment for AF is approached in different age groups and the perceived differences in the morbidity of the arrhythmia and the choice of therapy in different demographic groups. Narendra Kumar etal presented a concise review of the current state of management of pulmonary vein stenosis. As we moved away from the PV ostia the issue of stenosis has become increasingly less prominent. Sharon Mulvagh and colleagues described some important techniques in improving the quality of imaging for LAA. Pappone and group published a good review on the use of Mediguide technology for cardiac resynchronization therapy of ablation.
There are several exciting heart rhythm related meetings including – 6th Kansas City Heart Rhythm Symposium in August and the Asia Pacific Heart Rhythm Society Annual sessions in New Delhi in October. We are sure we will see most of you soon. Have a great rest of the summer and cheers until the next issue.
Dhanunjaya (DJ)Lakkireddy MD, FACC, FHRS Associate Editor JAFIB
Andrea Natale MD, FACC, FHRS, FESC Editor-in-Chief JAFIB