Inflammation has been widely recognized as one of the major pathophysiological drivers of the development of atrial fibrillation (AF), which works in tandem with other risk factors of AF including obesity, diabetes, hypertension, and heart failure (HF). Our current understanding of the role of inflammation in the natural history of AF remains elusive; however, several key players, including the NLRP3 (NLR family pyrin domain containing 3) inflammasome, have been acknowledged to be heavily influential on chronic inflammation in the atrial myocardium, which leads to fibrosis and eventual degradation of its electrical function. Nevertheless, our current methods of pharmacological modalities with reported immunomodulatory properties, including well-established classes of drugs e.g., drugs targeting the renin–angiotensin–aldosterone system (RAAS), statins, and vitamin D, have proven effective in reducing the overall risk of developing AF, the onset of postoperative atrial fibrillation (POAF), and reducing overall mortality among patients with AF. This might bring hope for further progress in developing new treatment modalities targeting cellular checkpoints of the NLRP3 inflammasome pathway, or revisiting other well-known anti-inflammatory drugs e.g., colchicine, vitamin C, nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticosteroids, and antimalarial drugs. In our review, we aim to find relevant upstream anti-inflammatory treatment methods for the management of AF and present the most current real-world evidence of their clinical utility.

A two centre clinical study was performed to analyse exposure levels of cardiac physicians performing electrophysiology and haemodynamic procedures with the use of state of the art Zero-Gravity™ radiation protective system (ZG). The effectiveness of ZG was compared against the commonly used ceiling suspended lead shield (CSS) in a haemodynamic lab. The operator’s exposure was assessed using thermoluminescent dosimeters (TLDs) during both ablation (radiofrequency ablation (RFA) and cryoablation (CRYA)) and angiography and angioplasty procedures (CA/PCI). The dosimeters were placed in multiple body regions: near the left eye, on the left side of the neck, waist and chest, on both hands and ankles during each measurement performed with the use of ZG. In total 29 measurements were performed during 105 procedures. To compare the effectiveness of ZG against CSS an extra 80 measurements were performed with the standard lead apron, thyroid collar and ceiling suspended lead shield during CA/PCI procedures. For ZG, the upper values for the average eye lens and whole body doses per procedure were 4 µSv and 16 µSv for the left eye lens in electrophysiology lab (with additionally used CSS) and haemodynamic lab (without CSS), respectively, and about 10 µSv for the remaining body parts (neck, chest and waist) in both labs. The skin doses to hands and ankles non-protected by the ZG were 5 µSv for the most exposed left finger and left ankle in electrophysiology lab, while in haemodynamic lab 150 µSv and 17 µSv, respectively. The ZG performance was 3 times (p < 0.05) and at least 15 times (p < 0.05) higher for the eye lenses and thoracic region, respectively, compared to CSS (with dosimeters on the apron/collar). However, when only ZG was used slightly higher normalised doses were observed for the left finger compared to CSS (5.88e − 2 Sv/Gym² vs. 4.31 e − 2 Sv/Gym², p = 0.016). The study results indicate that ZG performance is superior to CSS. It can be simultaneously used with the ceiling suspended lead shield to ensure the protection to the hands as long as this is not obstructive for the work.

DOI: 10.20452/pamw.15309, Published online: April 24, 2020, Authors: Izabela Warchoł, Agnieszka Dębska-Kozłowska, Iwona Karcz-Socha, Marcin Książczyk, Karolina Szymańska, Andrzej Lubiński

Atrial fibrillation is the most commonly reported arrhythmia and, if undiagnosed or untreated, may lead to thromboembolic events. It is therefore desirable to provide screening to patients in order to detect atrial arrhythmias. Specific mobile apps and accessory devices, such as smartphones and smartwatches, may play a significant role in monitoring heart rhythm in populations at high risk of arrhythmia. These apps are becoming increasingly common among patients and professionals as a part of mobile health. The rapid development of mobile health solutions may revolutionize approaches to arrhythmia screening. In this viewpoint paper, we assess the availability of smartphone and smartwatch apps and evaluate their efficacy for monitoring heart rhythm and arrhythmia detection. The findings obtained so far suggest they are on the right track to improving the efficacy of early detection of atrial fibrillation, thus lowering the risk of stroke and reducing the economic burden placed on public health.

BACKGROUND:Catheter radiofrequency ablation for typical atrial flutter is considered to be safe and effective. However, atrial fibrillation (AF) following cavotricuspid isthmus ablation for atrial flutter has been reported in patients without a previ...