AFSymposium 24: Long-Term Effects of PFA on Coronary Arteries

AF Symposium 24 — Dr Yury Malyshev (Mount Sinai Hospital, US) joins us to discuss the findings from three studies focusing on the long-term effects of pulsed-field ablation (PFA) on coronary arteries.


What is known currently about the effect of PFA in Coronary Arteries? What is the importance of this topic?What was the study design and cohort?What are the key findings?Who are the take-home messages?What research is still needed?

Recorded on-site at AF Symposium 2024, Boston.

Editor: Mirjam Boros
Videography: William Cadden, David Ramsey, Brad Wilson, Oliver Miles

AFSymposium 24: EMERGE LAA Post-Approval: Amulet LAA Occluder in US

AF Symposium 2024 – In this interview, Dr Christopher R Ellis (Vanderbilt University Medical Center, US) joins us to discuss the early findings from the EMERGE LAA Post-Approval Study.

The study investigated the early postapproval outcomes of the Amulet occluder device within the United States, using data from the Left Atrial Appendage Occlusion Registry.


What is the background of this study?Can you please tell us about the study device?What was the methodology of this study?What data did you present at AFSymposium?What are the key messages for practice?What are the next steps?

Recorded on-site at AF Symposium, Boston 2024.

Editor: Mirjam Boros
Videography: David Ramsey, Brad Wilson, William Cadden, Mike Knight

AFSymposium 24: 3 Studies that Will Change Your Practice

AF Symposium 2024 — Professor Angelo Auricchio (Fondazione Cardiocentro Ticino, CH), Editor-in-Chief of EP Europace and Arrhythmia Academy, has joined us to share the highlights from the latest data presented first at the AF Symposium.

In this brief summary, Professor Auricchio outlines the findings from the following studies:

Acute Kidney Injury Resulting From Hemoglobinuria Following Pulsed-Field Ablation In Atrial Fibrillation: Is It Preventable?, presented by Dr. Andrea NatalePulmonary Vein Narrowing after Pulsed Field vs Thermal Ablation: A Prespecified Secondary Endpoint of the Randomized ADVENT Trial, presented by Dr. Moussa MansourPredictive accuracy of PFA index on lesion depth, presented by Professor Luigi Di Biase.

Recorded on-site at AF Symposium 2024, Boston.

Support: This is an independent video conducted by Radcliffe Cardiology.

Editor: Mirjam Boros
Videography: David Ramsey, Willam Cadden, Brad Wilson, Mike Knight

AFSymposium 24: Impact of LAPW Ablation During PFA for Persistent AF

AF Symposium 2024 – In this interview, investigator Dr Mohit K Turagam (Icahn School of Medicine at Mount Sinai, US) discusses the findings of a sub-study of the MANIFEST-PF registry.

The study investigated the impact of left atrial posterior wall ablation during pulsed field ablation (PFA) for persistent atrial fibrillation.

1. What is the MANIFEST-PF registry?
2. What is the importance of this sub-study?
3. What was the study design and outcome measures?
4. What are the baseline characteristics of the cohort?
5. What are the findings?
6. What are the take-home messages for practice?
7. What are the next steps?

Recorded on-site at AF Symposium 2024, Boston.

Support: This is an independent interview conducted by Radcliffe Cardiology.

Editor: Mirjam Boros
Videography: David Ramsey, Brad Wilson, William Cadden, Mike Knight

AFSymposium 24: LAA Exclusion in Addition to PVI for Non-paroxysmal AFIB

AFSymposium 2024 — In this interview, investigator, Dr Dhanunjaya Lakkireddy (Kansas City Heart Rhythm Institute, US) shares the key findings from the aMAZE Continued Access Protocol (AtriCure).

This study is the extension of the aMAZE Trial investigation in the form of a nested, non-randomised registry. The study looked at the LARIAT System, which percutaneously isolates and ligates the left atrial appendage (LAA) as an add-on to pulmonary vein isolation (PVI) for persistent or longstanding persistent atrial fibrillation (AF).

1. What is the background to this study?
3. What are the findings to date?
4. Which patients would benefit from LAA exclusion?
5. What is the take-home message for practice?
6. What further research is required?

Recorded on-site at AF Symposium 2024, Boston.

Support: This is an independent interview conducted by Radcliffe Cardiology.

Editor: Mirjam Boros
Videography: David Ramsey, Bard Wilson, William Cadden

AFSymposium 24: Esophagus Deviation During Radiofrequency Ablation of AF

AF Symposium 2024 — Dr Emile Daoud (Chief Medical Officer of S4 Medical) joins us to talk about the data from the EASY AF study (NCT04659213).

This randomized, controlled study investigated the use of an esophageal deviating device versus no device. The study showed that the use of the esophageal deviating device (S4 Medical) resulted in a significantly lower rate of ablation-related esophageal lesions compared to the control group (5.7% vs. 35.4%).

What are some of the unmet needs in AF?Can you tell us about the esolution device?What was the study design, eligibility criteria, and outcome measures?What are the key findings?What are the take-home messages for practice? What are the next steps?

Videography: David Ramsey, William Cadden, Brad Wilson, Oliver Miles

Recorded on-site at AF Symposium 2024, Boston.

2023 ACC/AHA/ACCP/HRS Guideline on AF Diagnosis & Management: Highlights & Implementation

Dr Jose Joglar (UT Southwestern, US) joins us virtually to discuss the 2023 guidelines for atrial fibrillation (AF) diagnosis and management.

These guidelines are an update to the 2014 document covering the full spectrum of managing patients with AF, from prevention to lifetime interventions, to rhythm and rate control, as well as special populations. A new classification of AF has been created, with an emphasis on the complexity of the disease. The updated guidelines also highlight the importance of a multidisciplinary approach to AF Management, from prevention to lifestyle modification, as well as rhythm management.

1. What is the background for the update? What is the scope of the guideline?
2. What are the most impactful changes compared to previous guidelines?
3. Can you summarize the key recommendations?
4. What strategies can help clinicians incorporate the recommendations into practice?

Recorded remotely from Dallas, 2024.

Support: This is an independent interview conducted by Radcliffe Cardiology.

AHA 23: I-CLAS: Arrhythmic Risk in Biventricular Pacing Vs Left Bundle Branch Area Pacing

AHA 2023 — In this short interview, we are joined by Dr Pugazhendhi Vijayaraman (Geisinger Heart Institute, US) to discuss the findings of the I-CLAS study, an international collaborative investigation into left bundle branch area pacing.

This retrospective observational study compared the arrhythmic risk in biventricular pacing as compared to left bundle branch area pacing. 1778 Patients were enrolled in the trial. Investigators performed 1:1 propensity-matched scoring, with one group receiving biventricular pacing, and another receiving left bundle branch pacing.

Results suggest that left-bundle branch pacing reduced the risk and time to occurrence of ventricular tachycardia and ventricular fibrillation as compared to biventricular pacing.


What was the importance of this study?
What was the study design and the eligibility criteria?
What are your key findings?
What are your take-home messages?
What further study is needed?

Recorded on-site at AHA Scientific Sessions 2023, Philadelphia.

For more content from #AHA23 head to the Late-Breaking or the CardioNerds Conference Scholars Collection.

Support: This is an independent interview conducted by Radcliffe Cardiology.

Interviewer: Mirjam Boros
Editors: Jordan Rance, Mirjam Boros
Video Specialists: Tom Green, Dan Brent, Mike Knight

AHA 23: JEWEL-IDE: Jewel P-WCD in Pts at High Risk of Cardiac Arrest

AHA 2023 — In this short interview, we are joined by Dr John Hummel (Ohio State University, US) to discuss the findings from the JEWEL-IDE study, which investigated the use of the Jewel patch-wearable cardioverter defibrillator (PWCD) system in participants who were at high risk for sudden cardiac arrest. This was a multicenter, prospective, single-arm trial, with 290 participants.

Findings suggest that Jewel is safe and effective, with a high number of patient saves, no deaths or serious adverse events. There was a high patient compliance and low false alarm rate, and the device was well-tolerated for extended prescription durations.


What are the unmet needs for patients at high risk for cardiac arrest?
What was the study design and the patient population?
Could you tell us a bit more about the JEWEL system?
What were the key findings?
What are your take-home messages?
What further study is needed?

Recorded on-site at AHA Scientific Sessions 2023, Philadelphia.

For more content from #AHA23 head to the Late-Breaking or the CardioNerds Conference Scholars Collection.

This is an independent interview conducted by Radcliffe Cardiology.

Interviewer: Mirjam Boros
Editor: Jordan Rance
Video Specialists: Dan Brent

EASD 23: Epidemiologic Trends & Disparities in Diabetes Risk Among LGBTQ+ Population

EASD 2023 – Dr Carl G Streed (Boston University School of Medicine, US) joins us to summarise healthcare disparities among the LGBTQ+ population.

In this interview, Dr Streed discusses the available evidence and explains the minority stress model. This model suggests that experiences of discrimination and stress contribute to worse health outcomes in the LGBTQ community. This can lead to mental health issues, coping behaviours like substance use, and barriers to engaging in healthy activities.

Dr Streed notes that healthcare professionals can play a vital role in addressing these disparities by assessing risk factors, understanding patients’ motivations and barriers to healthier behaviour, and providing tailored care. Advocating for the removal of discriminatory policies and supporting additional community resources for LGBTQ populations is also crucial.

Dr Streed emphasizes the importance of collecting data on sexual orientation, gender identity and promoting research to better understand LGBTQ health.


Caceres AB, et al. Assessing and Addressing Cardiovascular Health in LGBTQ Adults: A Scientific Statement From the American Heart Association. Circulation 2020;142:e321–e332.

Disclosure: CGS reported serving as President-Elect of the US Professional Association for Transgender Health; receiving salary support from the Boston University School of Medicine Department of Medicine Career Investment Award, American Heart Association career development grant, Doris Duke Charitable Foundation, and National Heart, Lung, and Blood Institute career development grant; and receiving personal fees from EverlyWell, L’Oréal, and The Texas Health Institute.

Support: This is an independent interview conducted by Radcliffe Cardiology.

Interviewer: Mirjam Boros

Video Specialist: Dan Brent


Please note that the text below has not been copyedited.

Dr. Carl Streed:

I’m Dr Carl Streed. I’m the Research Lead in the Gender Care Centre at Boston Medical Centre and also a primary care clinician and funded researcher focused on cardiovascular health for LGBTQ populations.

The topic of our talk is going to be on the trends and understanding of diabetes risk factors and outcomes for broadly LGBTQ+ populations.

What is the existing evidence on the health of LGBTQ+ individuals?

For LGBTQ populations in general, we’re really trying to play catch up in understanding their health and well-being across a number of conditions and issues. A lot of the work that we are doing essentially models after what has been done understanding diabetes and racial and ethnic marginalized populations, particularly in the US.

What we are finding is that when we do have the data to really compare LGBTQ folks to their straight and cisgender peers, we’re seeing a number of disparities in issues in healthcare access, but also in actual healthcare outcomes. Including higher likelihood of diabetes, self-reported diabetes among gay and bisexual men, issues around risk factors for diabetes, such as lower physical activity, increased excess weight, or obesity among a number of subpopulations, including, for example, lesbian and bisexual women for some trans populations as well.
It’s one of those situations where we’re really characterizing something that we wish we could have characterized a few decades ago.

How do you explain the observed health disparities?

A lot of the disparities we feel are related to the experience of being marginalized in society. Again, similar to a lot of the research that has been done around racial and ethnic marginalized populations, there are effects for how society treats individuals and how people interact with society. What we see is through what we describe as the minority stress model, is that more experiences of stress or more experiences of discrimination lead to worse health outcomes.
This can be through particularly mental health issues in terms of higher rates of depression and anxiety related to discrimination, but it can also be tied to issues around coping behaviour such as tobacco or alcohol use, or even essentially not feeling like they can engage in physical activity that would be helpful for their health.

And lastly, where we’re seeing more research, thankfully is trying to understand how discrimination essentially gets under the skin. How does it get internalized in a way that affects people’s physiology?

We have some experimental studies that show that the experience of either anticipated discrimination or what’s called hypervigilance leads to higher and prolonged elevations in cortisol and other stress markers that can lead to immune dysregulation and a number of issues that predispose people to diabetes as well as other cardiovascular outcomes.
How can healthcare professional make a difference for LGBTQ+ patients?

Healthcare professionals have a lot of opportunities to help their patients. First, of course, in the one on one, in terms of assessing their risk factors, trying to understand them in a holistic manner, in terms of what may be motivating some of their coping behaviour, in terms of maybe alcohol use or inability to engage in recommended levels of physical activity.
All of those are things that we should be doing anyways. But I think it’s worth us trying to peel back and understand what might be some of the motivations or barriers to them engaging in what we describe as healthier behaviour. But also, there is a notion of when somebody is diagnosed, how do we engage them in care?

In terms of certain programs that really have been proven to help, in terms of one on one, maybe nutrition counselling or ensuring that they’re connected to a support group, I think we need to think about support groups that are specifically tailored around people’s identities and the need for additional community support.

So as an example, for some individuals, for a trans individual, a trans woman going to a women’s focused group may not actually be the most welcoming because their experience may be different compared to a lot of the cisgender individuals. Or again, trying to avoid making assumptions based on somebody’s sex assigned to birth and which support group they should be in. But then, lastly, healthcare professionals still carry a significant amount of power within society. They should be advocating for, at minimum avoidance of any kind of discriminatory policies or laws, but then also really trying to advocate for additional community support resources for broadly LGBTQ populations.

My experience is very much in the US context, but we definitely see this with a lot of our international partners where there is no place that has got it all right in terms of ensuring people are not being discriminated against. So there’s a lot of opportunities for healthcare professionals to weigh in and really advise folks on what is best for the population from their perspective.

What are the positive changes observed in the recent years?

In terms of the broader context, we definitely are seeing more larger healthcare organizations really speaking out against any kind of discriminatory policies, which is for me, as somebody who’s part of the community and who does work with the community, really appreciative, really makes a difference in terms of trying to stall some negative legislation.

I think it’s also important to recognize that as we have more evidence to really support these efforts, we need to really make sure that we are getting that in front of legislators and policymakers and people who are making the determinations that affect us. And I’m seeing again, more healthcare organizations really stepping up and doing that. I think it’s just a reminder. We always have to have our individual members do that as well and really thinking about how that work can be done locally, not only just at a larger national perspective, but also locally.

What are the resources available?

There are a number of resources. Again, from my perspective in the US context, there is the American Heart Association scientific statements on cardiovascular health for LGBTQ populations as well as specifically for trans and gender diverse populations. I help author those and provide an overview of the evidence. In terms of the clinical care issues, there are also opportunities to work more broadly around LGBTQ health within specific organizations within each nation, particularly a number of organizations, including the International Lesbian Gay Association, that covers most of Western Europe. That really provides a lot of insight and guidance for how to one, include better data collection, but also ensure that people are being protected.

There are plenty of opportunities to learn about the clinical effects and clinical ways we can do things, but also to get involved with a number of organizations that have been advocating for marginalized populations for decades.

How can we address the key data gaps?

There are a number of gaps in the data in terms of we just need people to actually be collecting sexual orientation, sexual identity, and gender identity information for us to begin to do better around population-level research. A lot of the research that I will present, it is really utilizing the most recent data just in the past 5-10 years around the experience of LGBTQ folks. What we need is just more data, and we need that data to exist in longitudinal studies. In the US context, for example, there’s only one of a dozen cardiovascular longitudinal studies that include sexual orientation, gender identity, and those questions are only added in the past two, three years.

We need so much more data to understand what’s going on and we need to remind researchers that participants actually really want to answer these questions. T
here’s been research specific to how comfortable people feel about answering questions around sex orientation, gender identity. Participants and patients are far more comfortable answering those questions than clinicians or researchers are asking them. I think we need to really get over our own discomfort and let our patients and research participants provide that information.
I think one last thing I would like to emphasize is that, as I mentioned earlier, we are really trying to fill in gaps in the data, really trying to catch up where we should be. That also requires us to train our clinicians and researchers now to be able to recognize that there are opportunities to do better for LGBTQ population health.

TCT 22: The AMULET-IDE Study: 3-year Outcomes of the Amulet Left Atrial Appendage Occluder in Patients With Atrial Fibrillation

TCT 2022 – Dr Dhanunjaya Lakkireddy (University of Kansas Hospital, Kansas City, US) joins us to discuss the safety and efficacy of the Amulet Left Atrial Appendage Occluder as suggested by the results of the AMULET-IDE Study.

AMULET-IDE was a prospective, multi-center study with a cohort of 1878 patients with non-valvular atrial fibrillation. Participants were randomized to receive either the Amulet device, or the commercially available WATCHMAN Left Atrial Appendage Closure. The safety and efficacy of the Amulet device was then monitored over a 5-year period.

Recorded remotely from Kansas City, 2022.
Interviewer: Jordan Rance
Videography: Dan Brent


“- Hi, my name is DJ Lakkireddy. I’m a Professor of Medicine at the University of Missouri Columbia, and I’m also the executive director for the Kansas City Heart Rhythm Institute in Kansas city, Kansas.

What is the importance of the AMULET-IDE Study?

Well, last year at the European Society of Cardiology, we presented the one year data. And we have shown the differences between the dual closure, Amulet closure device for the left atrial appendage, versus the single closure mechanism, Watchman device. And so this is an extension of that in terms of all the primary and secondary endpoints following these patients up to three years now. As you very well know, the story doesn’t end right at 12 months or 18 months, as most of the clinical trials are. The real effectiveness of these devices in mitigating stroke and protecting patients who have atrial fibrillation that are at very high risk for the strokes, it needs to be further followed along. And this is exactly what this three year follow up study does.

What was the study design and main findings of the trial?

So as you know, it’s a prospective randomised controlled trial that randomised the Amulet device to the Watchman 2.5 version. And so this study was conducted over five years. The intent was to create as homogeneous of a group as possible, and they got randomised between the two. A total of about 934 patients were enrolled in the Amulet, and 944 patients in the Watchmen arm. And of whom about 721 patients completed the three year follow up, and 659 patients in the Watchmen arm completed follow up. I mean, you really look at it for any major clinical trial this large, an interventional trial, 92% being followed up and 86.7 being followed up, at the end of this actually a pretty amazing number. Most of the times there is a lot of attrition because these trials are usually the elderly patients. They have difficulty with transportation, they move around. And so it’s actually a very powerful data set that provides us some amazing insights into the effectiveness of appendage closure devices in general, and also specify some specific differences between the Amulet and the Watchman devices. And in a lot of ways, the mechanism of action actually plays in really well in highlighting these differences. So for example, what are some of the discovered insights from the Amulet trial? Right? So what the major take home points here are the number of patients who withdrew from the trial were much higher in the Watchman group during the follow up. A lot of that happened because of increased patient mortality related to cardiovascular as well as non cardiovascular deaths. And then the cardiovascular and all cause trends were definitely higher in the Watchman arm than it was in the Amulet arm. And there were really no major pericardial effusions in a delayed fashion. There was an early concern for the dual-closure Amulet device. In the immediate postoperative period, there was a slightly higher incidence of pericardial effusions that was trending higher. But then this trend kind of stopped, and beyond six months, there were no pericardial effusions between the two devices, I mean as it should be, right? So as the device settles in and, and endothelializes the risk of subacute or chronic pericardial effusion is actually pretty rare with these type of endocardial closure devices. What they also learned was more patients were on oral anticoagulation in the Watchman arm, compared to that of the Amulet device. This partly could be because there was a relatively higher incidence of devices related to the thrombus in the Watchman group than it was with the Amulet arm, right? So anytime you have a higher incidence of DRT, the natural course of these patients is that you have to put these patients on oral anticoagulation to mitigate the risk of embolization and risk of stroke. So the, this once again, highlights that a dual-closure mechanism device like Amulet that has a nice, smoother, wider disc obviously has tremendous advantages in terms of helping a smooth, proper closure. As you see, the Amulet has a lobe on a disc and the smooth, rounded, outer disc really promotes a better closure of the ostium. So the opportunity to miss the crevices or the primary proximal lobes, are difficult anatomies that are oftentimes limited by the Watchman 2.5 version I think could be overcome by the, by the, by the mere design of the Amulet device. And then that’s a reason why you found these differences in lower risk of DRT. Even though there were a lower number of DRTs at the five year follow up mark, there was no significant difference in strokes or systemic thromboembolic events between those. But I think the longer you follow these patients, I think some of those trends in differences I think could become more exaggerated and become more obvious, really helping us understand how these two different devices behave when we follow them in the long term. The overall ischemic strokes and major bleeding rates were pretty comparable between the two groups.

What are the clinical implications of these findings?

What’s also interesting is, when you really look at and do analysis of the factors that kind of go into the mix of why do people develop strokes. We have patient-related factors and then you have device-related factors, and then you have implantation-related factors, and all of that, right? So when you zone in on some of the device-related factors, like, I mean, is it the DRT or is it the peri-device leak? All of that. What you would notice is that it’s a significantly higher incidence of peri-device leaks in patients in the Watchman arm, right? When you look at the the numbers, they’re actually pretty fascinating and relatively revealing because what you would notice is as we have presented this data in last year’s TCT, the number of patients who had complete closure of the appendage, like zero leak, were significantly higher in the Amulet arm than it was in the Watchman, 63% versus 46%. When you follow these patients long enough, at 12 months you will notice that the number of patients in the Watchman arm actually that had a complete closure improved significantly, right? So it’s 63% versus 53%. That means the Watchman 2.5 version device took a much longer time to settle in, to endothelialize, to really accomplish a zero leak. But when you really use the cutoffs of five millimetres or maybe more, like, three millimetres, or anything more than three millimetres nowadays, is considered as a reasonably large leak that we need to be paying attention to. So in those circumstances, I suggest that the number of patients who actually had a leak more than three millimetres was significantly higher in the Watchman arm, right? 22% versus 10%. That’s a pretty, pretty big number. So as the standards for accepting what is considered to be an acceptable leak continues to trend down, Amulet really plays out really well because of its design. And the dual-mechanism closure device definitely offers a lot more options, in some of these very wide, and large, and relatively difficult anatomies that are oftentimes hard to close with the help from Watchman device.

Where are the gaps in knowledge, and how can further research improve this?

So, I say this trial continues to offer amazing insights into improving the design of these closure devices, and perhaps we should still continue to work on minimising the risk of leak. And we should also continue to work on minimising the risk of device-related thrombus. So there are a lot of amazing clinical trials that are coming up that I think are going to fill some of these gaps that the current technologies are able to offer. And be able to really push the envelope in making left atrial appendage closure much more efficient, much more safer. And in our efforts to really reduce the risk of systemic thromboembolism in patients who have atrial fibrillation. So that’s kind of the, the meat and bones of this trial.

ESC 23: DANPACE II: Reducing Atrial Pacing in Sinus Node Disease

ESC 2023 — Dr Mads Brix Kronborg (Aarhus University Hospital, DE) joins us to discuss the findings from the DANPACE II Trial (NCT00236158).

DANPACE II (The DANPACE Investigator Group) trial aimed to compare patients who were randomised in a 1:1 ratio to either a base rate of 60 beats per minute and rate-adaptive DDD (DDDR-60 Group) or a base rate of 40bpm and non-rate adaptive DDD (DDD-40 Group). 539 patients were included in the analysis.

After 2 years, the primary endpoint of episodes of atrial fibrillation lasting over 6 minutes detected by the pacemaker had occurred in 248 (46%) of patients. Minimising atrial pacing in patients with sinus node dysfunction did not reduce the incidence of atrial fibrillation.


What was the reasoning behind this trial?
What was the patient population and study design?
What were the key findings?
What are your take-home messages?
What further study is still required?

Recorded on-site at ESC Congress 2023, Amsterdam.

For more content from ESC Congress 2023 head to the Hot Line & Late-breaking Science Video Collection.

Editors: Mirjam Boros and Jordan Rance
Video Specialists: Dan Brent, Tom Green, Mike Knight, Oliver Miles


“My name is Mads Brix Kronborg. I’m from the Department of Cardiology at the Aarhus University Hospital in Denmark, and I’m here to present the results from the DANPACE II trial. And it’s about minimizing atrial pacing in patients with sinus node disease to reduce atrial fibrillation.

Reasoning Behind the Study

In patients with sinus node disease are often also have atrial fibrillation, and there are some observational studies showing that the more you pace in the atrium, the more atrial fibrillation they have. And it’s not clear whether it’s the atrial pacing that causes atrial fibrillation or that these patients just have sicker atriums and therefore need more atrial pacing. And therefore, we wanted to see if we could reduce atrial pacing and if that could reduce atrial fibrillation in this specific population.

Patient Population and Study Design

This was a national, multicenter randomised investigator-initiated trial and it was on patients with sinus node disease who received a pacemaker for the first time. And we excluded patients that already had persistent or permanent atrial fibrillation. And if a device programming of DDD 40 was contradicted, if they had severe bradycardia or tropic incompetence.

Key Findings

So, we tried to reduce the amount of atrial pacing by in one of the groups programming it to DDD 40 and the other group we programmed to DDDR 60. So, they had a lower base rate of 60 in the one group and 40 in the other group. And that particularly reduced the amount of atrial pacing from 49 to one percentage. But we couldn’t see any effect on the incidence of atrial fibrillation. So, after following this patient by remote monitoring for two years, there were no difference in the incidence of atrial fibrillation. What we saw, though, was that a lot of patients crossed over from the DDD 40 group and that was mainly due to chronostropic incompetence and syncope or presyncope, which was also more present in patients that were randomised to DDD 40.

Take-Home Messages

Well, I think from this study is that even if you’re reducing the atrial pacing in this population does not prevent atrial fibrillation and there might be an increased risk of having presyncope or syncope.

Next Steps

Yeah, I think in this population we have done a lot of trials before, so I think at the moment, we are getting there to know how to program these devices and we are still continuing doing large national studies on device treatment to improve the efficacy and also to try to reduce the complications for these patients.”