Background: The global burden of atrial fibrillation (AF) and diabetes mellitus (DM) is constantly rising, leading to an increasing healthcare burden of stroke. AF often remains undiagnosed due to the occurrence in an asymptomatic, silent form, i.e., silent AF (SAF). The study aims to evaluate the relationships between DM and AF prevalence using a mobile long-term continuous ECG telemonitoring vest in a representative Polish and European population ≥ 65 years for detection of AF, symptomatic or silent. Methods: A representative sample of 3014 participants from the cross-sectional NOMED-AF study was enrolled in the analyses (mean age 77.5, 49.1% female): 881 (29.2%) were diagnosed with DM. AF was screened using a telemonitoring vest for a mean of 21.9 ± 9.1days. Results: Overall, AF was reported in 680 (22.6%) of the whole study population. AF prevalence was higher among subjects with concomitant DM (DM+) versus those without DM (DM−) [25%, 95% CI 22.5-27.8% vs 17%; 95% CI 15.4–18.5% respectively, p < 0.001]. DM patients were commonly associated with SAF [9%; 95% CI 7.9–11.4 vs 7%; 95% CI 5.6–7.5 respectively, p < 0.001], and persistent/permanent AF [12.2%; 95% CI 10.3–14.3 vs 6.9%; 95% CI 5.9–8.1 respectively, p < 0.001] compared to subjects without DM. The prolonged screening was associated with a higher percentage of newly established AF diagnosis in DM+ vs DM− patients (5% vs 4.5% respectively, p < 0.001). In addition to shared risk factors, DM+ subjects were associated with different AF and SAF independent risk factors compared to DM− individuals, including thyroid disease, peripheral/systemic thromboembolism, hypertension, physical activity and prior percutaneous coronary intervention/coronary artery bypass graft surgery. Conclusions: AF affects 1 out of 4 subjects with concomitant DM. The higher prevalence of AF and SAF among DM subjects than those without DM highlights the necessity of active AF screening specific AF risk factors assessment amongst the diabetic population. Trial registration: NCT03243474

Atrial fibrillation (AF) is associated with substantially increased risk of cardiovascular events and overall mortality. The Atrial fibrillation Better Care (A—Avoid stroke, B—Better symptom management, C—Cardiovascular and comorbidity risk management) pathway provides a simple and comprehensive approach for integrated AF therapy. This study’s goals were to evaluate the ABC pathway compliance and determine the main gaps in AF management in the Middle East population, and to assess the impact of ABC pathway adherence on the all-cause mortality and composite outcome in AF patients. 2021 patients (mean age 57; 52% male) from the Gulf SAFE registry were studied. We evaluated: A—appropriate implementation of OACs according to CHA₂DS₂-VASc score; B—symptom control according to European Heart Rhythm Association (EHRA) symptom scale; C—proper cardiovascular comorbidities management. The primary endpoints were the composite cardiovascular outcome (ischemic stroke or systemic embolism, all-cause death and cardiovascular hospitalization) and all-cause mortality. One-hundred and sixty-eight (8.3%) patients were optimally managed according to adherence with the ABC pathway. Over the one-year follow up (FU), there were 578 composite outcome events and 224 deaths. Patients managed with integrated care had significantly lower rates for the composite outcome and mortality comparing to non-ABC group (20.8% vs. 29.3%, p = 0.02 and 7.3% vs. 13.1%, p = 0.033, respectively). On multivariable analysis, ABC compliance was independently associated with reduced risk of composite outcome (HR 0.53; 95% CI 0.36–0.8, p = 0.002) and death (HR 0.46; 95% CI 0.25–0.86, p = 0.015). Integrated ABC pathway adherent care resulted in the reduced composite outcome and all-cause mortality in AF patients from Middle East, highlighting the necessity of promoting comprehensive holistic and integrated care management of AF.

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and a major risk factor for stroke. The number of patients with AF is predicted to increase in the next few decades. AF has also negative impact on quality of life as well as it significantly increases the risk of cardiovascular disease and overall mortality. Because the stroke is a pivotal outcome of AF, its prevention with the use of anticoagulation therapy constitutes an important component of AF management. The decision on oral anticoagulants' prescription should be based on appropriate risk stratification to allow for comprehensive assessment of benefit/hazard ratio of stroke and bleeding along with patients' preference. Several risk scores for stroke and bleeding as well as for stroke and systemic embolism have been developed, mainly in patients on vitamin K antagonists. AF guidelines stress the need for repetitive evaluation of thromboembolic and bleeding risks to tailor optimal AF management. Indeed, risk is not a static “one off” process and it should be adjusted for dynamic nature of risk factors. However, most risk scores are calculated according to baseline characteristics of patients, but the older the patients get, the more comorbidities they acquire, which influences stroke risk significantly. Hence, the default management of every patient with AF should include a regular reassessment of stroke and bleeding risk factors.

Background: Pulmonary vein isolation with cryobaloon catheter ablation (CCB) is an effective method of treatment in patients with atrial fibrillation (AF) but in patients with heart failure (HF) the role of CCB remains unknown. Aims: To assess feasibility, effectiveness and safety of CCB in patients with HF and cardiac electronic devices (CIED), the impact of the procedure on symptoms and echocardiographic parameters. Methods: Thirty consecutive HF patients with left ventricular ejection fraction (EF) ≤ 40% and CIED, referred for CCB of AF were included. Procedural parameters were compared to the group of 59 consecutive patients with healthy heart referred for CCB (control gr). Results: The number of veins ablated per patient was smaller and application was performed less frequently in right inferior pulmonary vein in HF group (66.7% vs. 88.1% vs. the control group; P = 0.01). In two patients (6.7%) from HF group, and five (8.5%) from the control gr procedure-related complications occurred (P = 0.76). After 6 months 21/30 HF patients (70%), after 1 year 13 (43%), and after 625 days only 3 (10%) were free from arrhythmia. AF burden was significantly reduced after 6 months compared to the pre-ablation period (18.5 vs. 52.9%; P = 0.001). NYHA and EHRA class were both significantly (P < 0.001) reduced, and EF was higher after 6 months. Conclusions: Safety and feasibility of CCB for AF in HF patients with CIED are comparable to subjects with structurally normal heart, however stable positioning of baloon in the right inferior pulmonary vein may be more challenging. Although late recurrences are common, ablation reduces arrhythmia burden and leads to a long-term improvement of symptoms and echocardiographic indices. Background: Pulmonary vein isolation with cryobaloon catheter ablation (CCB) is an effective method of treatment in patients with atrial fibrillation (AF) but in patients with heart failure (HF) the role of CCB remains unknown. Aims: To assess feasibility, effectiveness and safety of CCB in patients with HF and cardiac electronic devices (CIED), the impact of the procedure on symptoms and echocardiographic parameters. Methods: Thirty consecutive HF patients with left ventricular ejection fraction (EF) ≤ 40% and CIED, referred for CCB of AF were included. Procedural parameters were compared to the group of 59 consecutive patients with healthy heart referred for CCB (control gr). Results: The number of veins ablated per patient was smaller and application was performed less frequently in right inferior pulmonary vein in HF group (66.7% vs. 88.1% vs. the control group; P = 0.01). In two patients (6.7%) from HF group, and five (8.5%) from the control gr procedure-related complications occurred (P = 0.76). After 6 months 21/30 HF patients (70%), after 1 year 13 (43%), and after 625 days only 3 (10%) were free from arrhythmia. AF burden was significantly reduced after 6 months compared to the pre-ablation period (18.5 vs. 52.9%; P = 0.001). NYHA and EHRA class were both significantly (P < 0.001) reduced, and EF was higher after 6 months. Conclusions: Safety and feasibility of CCB for AF in HF patients with CIED are comparable to subjects with structurally normal heart, however stable positioning of baloon in the right inferior pulmonary vein may be more challenging. Although late recurrences are common, ablation reduces arrhythmia burden and leads to a long-term improvement of symptoms and echocardiographic indices.