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  • In this case series no clinical thromboembolic events were d

    2019-04-22

    In this case series, no clinical thromboembolic events were detected in a cohort with a mean CHA2DS2-VASc score of 2.6 ±1 over a follow-up time of up to 5 years. The overall stroke rate was 0.5% per year. The authors concede that the very low stroke rate could have been the outcome of successful ablation and freedom from AF in the majority of patients. A body of evidence now points to catheter ablation therapy for AF conferring stroke risk reduction [21,22]. However, AF recurrence, cardiovascular morbidity, and stroke, are still observed to correlate with CHA2DS2-VASc score of 2 or greater over long-term follow-up [21–23]. The stroke rate in the current study compares similarly with the 0.72% event rate at mid-term follow-up of a large cohort of patients on anticoagulants with a mean CHA2DS2-VASc score of 2.1±1.4 from the Leipzig Heart Center AF Ablation Registry [22] and contrasts with a much higher reported event rate of 5.1% for patients with CHA2DS2-VASc score of 2 who did not receive anticoagulation over a follow-up adenosine receptor of 39 months following catheter ablation [23]. This suggests that the two-pronged strategy may provide long-term cardiovascular benefits to patients with non-valvular AF, that is at least equivalent to ongoing oral anticoagulation strategy for patients with a CHA2DS2-VASc score of 2 or greater. While the long-term follow-up of Watchman®-implanted patients in the PROTECT-AF randomized -controlled trial demonstrated superiority over warfarin for all cause stroke and mortality [1], concern has been raised over sub-analysis of the more recently conducted PREVAIL trial which showed a relatively higher rate of ischemic strokes during follow-up in the Watchman® group [10]. The single case of late ischemic stroke in the current study points to the difficulty of judging the mechanism of stroke in a patient group that frequently also has risk factors for atherothrombotic or hypertensive occlusive events. The authors are encouraged by the patient outcomes of the current series, and believe that catheter ablation for AF and LAA device occlusion will be complementary to a multi-faceted approach to long-term stroke prevention. However, further randomized controlled trials are required to define their respective roles.
    Conclusions
    Conflict of interest
    Introduction Prolongation of total atrial conduction time (TACT) has been shown to increase the risk of atrial fibrillation in many studies [1–3]. Many different methods can be used to evaluate the TACT. Although 12-lead, signal-averaged, M-mode, and tissue Doppler echocardiography are usually used, intracardiac measurements using the electrophysiological study (EPS) remain the gold standard method. In recent years, 2-dimensional echocardiographic tissue Doppler has been used for measuring the ACT (atrial conduction time) in many clinical studies. Although nondisjunction is not the gold standard, this non-invasive method is usually preferred for ACT measurements [1,2,4]. However, to the best of our knowledge, no study has directly compared the TDI TACT measurements with the currently accepted gold standard electrophysiological TACT measurements for validation, except one where conventional Doppler echocardiography was used instead of TDI in healthy subject [5]. Moreover, no validation study has been performed among different age and sex groups in subjects with normal EPS results. In this study, we aimed to compare the TACT measured by TDI and EPS according to age and sex among healthy individuals without cardiovascular and systemic diseases for the purpose of validation of TDI use in the evaluation of TACT.
    Methods
    Statistical analysis All analyses were performed using the adenosine receptor SPSS (SPSS Inc., Chicago, IL, USA) software package. All data were presented as the mean±standard deviation. Total atrial conduction time measurements by the two methods were compared using the paired t tests. The comparison of echocardiographic data between the two groups were performed using one-way analysis of variance (ANOVA) with post hoc analysis by Tukey׳s Honestly Significant Difference (HSD) or independent sample t-tests, and Kruskal–Wallis tests or Mann–Whitney U test for normally and abnormally distributed data, respectively. Correlations between variables were tested by means of Pearson׳s bivariate correlation testing. We used a univariate logistic regression analysis to quantify the association of variables with TACT. Variables that were found to be statistically significant in the univariate analysis and other potential confounders were used in a multiple logistic regression model using the forward stepwise method, in order to determine the independent prognostic factors. Analyses of the differences in the TDI and EPS measurements were performed according to the Bland–Altman technique. A value of p<0.05 was considered statistically significant.