scholarly journals Benefits of prescribing low-dose digoxin in atrial fibrillation

2021 ◽  
Vol 35 ◽  
pp. 205873842110519
Author(s):  
Ciprian Ilie Rosca ◽  
Nilima Rajpal Kundnani ◽  
Anca Tudor ◽  
Maria-Silvia Rosca ◽  
Violeta-Ariana Nicoras ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Low Dose ◽  
Beta Blockers ◽  
Treatment Protocol ◽  
Factor Xa ◽  
Group 2 ◽  
Clinical Records ◽  
The Impact ◽  
Group 1

Introduction The role of digoxin (cardiac glycoside) in controlling the heart rate (HR) for the treatment of atrial fibrillation (AF) patients has not been explored in depth. Methods To contribute to the limited data, our team conducted retrospective analysis of the clinical records of 1444 AF patients. We divided the AF patients into two groups, wherein group 1 patients were treated with beta-blockers (BB), low-dose digoxin, and an anticoagulant (vitamin K antagonist/factor-IIa inhibitor/factor-Xa inhibitor), and group 2 patients were treated with just BB and an anticoagulant. Our objectives were to compare the impact of combination therapy of BB and digoxin on the resting HR in patients with permanent AF and the patients’ quality of life (QOL) at periodic intervals. Results The findings of our study showed a better control of the resting HR rate (<110bpm) and an improved QOL among the group 1 patients when compared with group 2 patients. Conclusion Our findings are indicative of the favorable clinical outcomes that resulted from the addition of a low-dose of digoxin to the AF treatment regimen. However, larger studies/trials elucidating the outcomes of AF patients treated with the dual rate control therapy are required, to clarify the role of digoxin, guide the choice of agents, and standardize the AF treatment protocol.

scholarly journals Factors That Determine the Prothrombin Time in Patients With Atrial Fibrillation Receiving Rivaroxaban

2018 ◽  
Vol 24 (9_suppl) ◽  
pp. 188S-193S
Author(s):  
Jen-Hung Huang ◽  
Yung-Kuo Lin ◽  
Cheng-Chih Chung ◽  
Ming-Hsiung Hsieh ◽  
Wan-Chun Chiu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Prothrombin Time ◽  
Factor Xa ◽  
International Normalized Ratio ◽  
Biochemical Properties ◽  
Study Patient ◽  
Group 3 ◽  
Multiple Variables ◽  
Group 2 ◽  
Group 1

Rivaroxaban, a direct factor Xa inhibitor, is widely used to reduce the chance of stroke in patients with atrial fibrillation (AF). It is not clear why the prothrombin time (PT) of the international normalized ratio (INR) fails to correlate with treatment using rivaroxaban in patients with AF. In this study, patient characteristics, the rivaroxaban dosage, AF type, drug history, biochemical properties, and hematological profiles were assessed in patients treated with rivaroxaban. In 69 patients with AF receiving rivaroxaban, 27 (39.1%) patients had a normal INR (≤1.1, group 1), 27 (39.1%) patients had a slightly prolonged INR (1.1∼1.5, group 2), and 15 (21.7%) patients had a significantly prolonged INR (>1.5, group 3). Group 1 patients had a higher incidence of a stroke history than did patients in group 2 ( P = .026) and group 3 ( P = .032). We scored patients with a persistent AF pattern (1 point), paroxysmal AF pattern (0 point), renal function (ie, the creatinine clearance rate in mL/min/1.73 m2 of >60 as 0 points, of 30∼60 as 1 point, and of <30 as 2 points), and no history of stroke (1 point), and we found that group 3 had a higher score than groups 2 or 1 (2.9 ± 0.8, 2.4 ± 0.7, and 2 ± 0.7, respectively; P < .05). There were similar incidences of bleeding, stroke, and unexpected hospitalizations among the 3 groups. The PT of the INR is determined by multiple variables in patients with AF receiving rivaroxaban. Rivaroxaban-treated patients with AF having different INR values may have similar clinical outcomes.

Abstract 15948: Impact of Age on Safety of Radiofrequency Ablation in Patients With Atrial Fibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Janet W Elcano ◽  
Hui Nam Pak
Keyword(s):  
Atrial Fibrillation ◽  
Phrenic Nerve Palsy ◽  
Adjusted Risk ◽  
Ablation Time ◽  
Group 4 ◽  
Major Complications ◽  
Group 3 ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Background: The incidence of atrial fibrillation (AF) is increasing in the elderly population, however, there is paucity of data on the safety outcomes of this patient subgroup thus we sought to investigate on the impact of age on the safety of catheter ablation for AF. Methods and Results: We included 1,293 (male 75%) patients enrolled in Yonsei AF Ablation Cohort database in Seoul, South Korea, from March 2009 to November 2013. We divided the patients into 4 groups according to age (Group 1, aged 17-49, N=295 ; Group 2 50-59, N=421; Group 3 60-69 N=408; and Group 4 ≥ 70, N=169) and evaluated the incidence of procedure related complications. No procedure-related death occurred in this study. There was a trend of increasing incidence of procedure related complications with age noted as follows: Group 1= 3.7%; Group 2= 4.0%; Group 3=6.6%; and Group 4 7.1%, (p= 0.15). There were 28 cases (2.2%) of major complications (Group 1=1.7%, Group 2=1.9%, Group 3=2%, Group 4 4.1%), tamponade being the most common. Major complications in group 4 include: tamponade 4 cases, phrenic nerve palsy 1 case, atrioesophaeal fistula 1 and 3rd degree AV block in 1 patient. Multivariate regression analysis shows ablation time (odds ratio (OR) 1.2 confidence interval (CI)1.0-1.017, p=0.017), procedure time (OR 1.008, CI 1.0-1.15, p=0.04), decreasing eGFR (OR 1.013, CI 1.002-1.026 p=0.018), coronary artery disease (CAD) (OR 1.847, CI 1.003-3.524, p0.04) and age (OR 1.028, CI 1.003-1.055, p=0.03) were associated with increased adjusted risk of total complications. Predictors of major complications include age (OR 1.044, CI 1.003-1.086, p0.02) and ablation time (OR 1.009, CI 0.999-1.000, p=0.033). Conclusion: Our data suggest that incidence of procedural complications in RFA of AF increase with age. Ablation time and age are independent predictors of a major complication.

Identification of circumferential pulmonary vein isolation responders among patients with persistent atrial fibrillation: clinical value of the sequential low-dose ibutilide test

EP Europace ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. 1197-1205
Author(s):  
Shu-Nan He ◽  
Ying Tian ◽  
Liang Shi ◽  
Yan-Jiang Wang ◽  
Bo-Qia Xie ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Low Dose ◽  
Persistent Atrial Fibrillation ◽  
Control Group ◽  
Clinical Value ◽  
Group 2 ◽  
Circumferential Pulmonary Vein Isolation ◽  
Group 1

Abstract Aims Circumferential pulmonary vein isolation can be effective as sole treatment for persistent atrial fibrillation. However, identifying those patients who will respond to this therapy remains a challenge. We investigated the clinical value of the sequential low-dose ibutilide test for identifying patients with persistent atrial fibrillation in whom pulmonary vein isolation is effective as sole therapy. Methods and results In a prospective cohort of 180 consecutive patients with persistent atrial fibrillation, intravenous low-dose (0.004 mg/kg) ibutilide was administered 3 days before ablation and after the completion of circumferential pulmonary vein isolation. In patients in whom ibutilide did not terminate atrial fibrillation pre-procedurally, but successfully terminated it intraprocedurally, no further atrial substrate modification was performed. Pre-procedural low-dose ibutilide failed to terminate the arrhythmia in all patients with persistent atrial fibrillation, while pulmonary vein isolation ± low-dose ibutilide terminated persistent atrial fibrillation in 55 (30.6%) of them (PsAF group 1). The remaining 125 (69.4%) patients underwent electrogram-based ablation (PsAF Group 2). The control group comprised 379 consecutive patients with paroxysmal atrial fibrillation who underwent pulmonary vein isolation over the same period. At 24 months follow-up, 39 (70.9%) patients in PsAF Group 1 and 276 (72.8%) patients in the control group were free from atrial tachyarrhythmias (P = NS); the arrhythmia-free rates in both groups were higher than that in PsAF group 2 (58.4%, P = 0.005). Conclusion The sequential low-dose ibutilide test is a simple method for identifying patients with persistent atrial fibrillation in whom pulmonary vein isolation alone is an appropriate treatment strategy.

The Role of Age at First Exposure and Therapy Regimen on the Development of Neutralizing FVIII Antibodies in Hemophilia A.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3082-3082 ◽  
Author(s):  
Carmen Escuriola Ettingshausen ◽  
Alexandra Zyschka ◽  
Inmaculada Martinez Saguer ◽  
Christine Heller ◽  
Thomas Klingebiel ◽  
...  
Keyword(s):  
Hemophilia A ◽  
Inhibitor Development ◽  
Therapy Regimen ◽  
On Demand ◽  
Intron 22 Inversion ◽  
Group 2 ◽  
A Prospective Study ◽  
The Impact ◽  
Group 1

Abstract In order to assess the impact of age at first exposure to F VIII and therapy regimen on neutralizing FVIII-antibodies in previously untreated patients (PUP) with hemophilia A a prospective study was performed. Over a 23-years study period a total of 74 severely affected hemophilia A -PUPs have been consecutively recruited, treated with F VIII and investigated for inhibitor development. The patients were divided into two groups according to their treatment regimen: Group 1 (n=23) started prophylaxis at the age of 1 year (before or immediately after the first relevant bleed). Group 2 (n=43) was treated on-demand or prophylaxis was started after more than 2 bleeds. The following parameters were equally distributed among both groups: caucasian ethnicity, intron-22-inversion, age at 1st ED >0.5 years. Out of 74 hemophilia A patients 23 developed inhibitors (31%). Inhibitor incidence was 0% (1 transient inhibitor out of 23 patients) in those patients who received early prophylaxis (group 1) and 42% (18/43 patients) in case of delayed prophylaxis or on-demand treatment (group 2) (p=0.002). No linear correlation was found between the age at first exposure and inhibitor formation. However, patients treated before the age of 0.5 years showed a significantly higher inhibitor incidence (62%) than those treated at an more advanced age. Our data confirm that very early age at first exposure is a risk factor for inhibitor development in severe hemophilia A patients. Early prophylaxis might be protective against inhibitor development. To confirm the data a larger patient cohort has to be investigated.

scholarly journals Rola dużych gospodarstw rolnych we wzroście produktywności pracy rolnictwa polskiego na tle sytuacji w innych wybranych krajach Unii Europejskiej

2018 ◽  
Vol 105 (1) ◽  
pp. 32-46 ◽  
Author(s):  
Wojciech Józwiak ◽  
Zofia Mirkowska ◽  
Wojciech Ziętara
Keyword(s):  
Czech Republic ◽  
Labor Productivity ◽  
Productivity Growth ◽  
The Czech Republic ◽  
Group 2 ◽  
Large Farms ◽  
The Impact ◽  
The Eu ◽  
Group 1

The study focuses on the analysis of labor productivity in Polish agriculture in 2005 and 2016 in comparison to selected EU-15 countries (group 1) and some countries that joined the EU after 2004. In group 1, Austria, Belgium, Denmark, the Netherlands and Germany are included, while in group 2 - the Czech Republic, Slovakia, Lithuania, Latvia and Hungary. The analysis particularly considers the role of large farms, the size of which was contractually agreed at 30 ha of UAA. The aim of the study was to determine the impact of large farms on the level of labor productivity in total farms and to determine the possibility of reducing the differences between labor productivity in Polish large farms in relation to analogous farms in EU-15 countries, and determining whether changes occurring in Poland differ from those occurring in large farms in other post-socialist countries. In both groups of countries there was a decrease in the number of farms and an increase in labor productivity in agriculture in general and in surveyed classes in large farms. In the countries of group 2. the rate of labor productivity growth was higher than in group 1. However, it slightly reduced the differences. Labor productivity in agriculture in the countries of Group 1 was significantly higher than in Group 2. The increase in the number and share of large farms in the structure of farms was positively correlated with labor productivity in agriculture.

scholarly journals The Role of the Psychooncology Team in the Multidisciplinary Team Management of Breast Cancer Patients - From Diagnosis to After Treatment: A Qualitative Study at MISR Cancer Center

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 114s-114s
Author(s):  
I. Sallam ◽  
G. Amira ◽  
A. Youssri
Keyword(s):  
Breast Cancer ◽  
Qualitative Study ◽  
Cancer Center ◽  
Team Management ◽  
Breast Cancer Patients ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Background: According to the cultural and socioeconomic factors, breast cancer patients (BCP) experienced a relatively low health-related quality of life (Qol) during the journey of breast cancer treatment, that influence patient adaptation to the situation from diagnosis to after treatment. And the further effect on either starting the treatment or its continuation. This merited conducting a qualitative study to explore the importance of the psychooncological approach to BCP and the impact on commencing and continuation of treatment and follow-up. Aim: To describe the impact and importance of the psychooncology team in the cancer center and the effect of their approach on the BCP's Qol. Methods: The study involved 114 interviewed participants, excluding patients with wide variety of chronic illnesses, only 91 patients are the focused study group. Of which 11 patients group (1) refused to join the psychooncological approach due to cultural, and socioeconomic issues, and 80 patients group (2) joined and followed up by the team. Both groups are regularly surveyed. Qualitative and quantitative measurements were used. Data were collected as follows, at time of diagnosis, after surgery and after chemo-radiation therapies from group (1) and for group (2) after the psychooncology team management and care. Developing the psychooncology team for the cancer center. 2 psychooncologists, 5 psychoeducating nurses and a group therapy sessions at a world standard levels of care with ethics committee approvals, and caring for patients' privacy. Close follow-up and evaluation of the performance and Qol of our BCP, raising the awareness about psychoeducation and psychological approach importance for BCP that would help them cope with daily life challenges to improve Qol. Results: Category Group N. Diagnosis related depression N. Surgery related depression N. Treatment related depression Free of depression Group (1) No= 11 3 (27%) 2 (18%) 5 (45%) 1 (10%) Group (2) No= 80 12 (15%) 9 (11.3%) 23 (28.7%) 36 (45%) Conclusion: Results indicate that the most critical depressing points is at time of diagnosis and chemo-radiation therapy. Group (2) has positive indication and alternation on the level of Qol and a significant improvement on level of depression when compared with group (1). This study highlighted the importance of psychooncology team in BCPs' survivorship. It also brings to attention the important role of the government, health policy makers and health plans toward enriching all cancer centers with the psychooncology team. To maximize health and health care for BCP.

The impact of different preventive counseling programs on medication adherence in patients with paroxysmal atrial fibrillation after catheter ablation

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
N Pogosova ◽  
AI Ovchinnikova ◽  
YM Yufereva ◽  
OY Sokolova ◽  
KV Davtyan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Medication Adherence ◽  
Catheter Ablation ◽  
Group Support ◽  
Counseling Programs ◽  
Preventive Counseling ◽  
Group 2 ◽  
The Impact ◽  
E Mail ◽  
Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Background Poor medication adherence is a major contributor to suboptimal health outcomes and increased costs in cardiovascular (CV) diseases including atrial fibrillation (AF). Purpose To assess the impact of different preventive counseling programs on medication adherence in AF patients (pts) after catheter ablation (CA). Methods A prospective randomized controlled study with 3 parallel groups of pts with paroxysmal AF after CA (radiofrequency or cryoablation).  Pts were randomized (1:1:1) into 3 groups. Before discharge, pts from all groups received 1 preventive counseling session with focus on their individual risk factors profile. After discharge both intervention groups received 6 sessions of biweekly remote preventive counseling by phone (Group 1) or via email(Group 2) for 3 months after enrollment. Group 3 received usual care. Medication adherence was assessed using the 4-item Morisky-Green scale at baseline and at 12 months.  Results A total of 135 pts aged 35 to 80 years were enrolled (mean age, 57.3 ± 9.1 years, men, 51.8%). The groups were well balanced according to demographic and clinical features. Baseline levels of non-adherenсe and partial adherence were high in all groups (53.4%, 71.1% and 73.3% respectively). At 1 year of follow-up pts from both intervention groups demonstrated a significant improvement of medication adherence vs control (table).  Conclusions Preventive counseling programs with remote support via phone or e-mail improve medication adherence in AF pts after CA. Мedication adherence 1 group (support via phone) 2 group (support via e-mail) Control group P for Group 1 vs. control at 12 months P for Group 2 vs. control at 12 months Baseline After 12 months Baseline After 12 months Baseline After 12 months Adherence,% 46.7 60 28.9 60 26.7 31.1 &lt;0.01 &lt;0.01 Partial adherence ,% 17.8 20 31.1 20 24.4 33.3 n/s n/s Non-adherence,% 35.6 60 40 20 48.9 35.6 n/s n/s

The effects of different preventive counseling programs on physical activity in patients with paroxysmal atrial fibrillation after catheter ablation

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
N Pogosova ◽  
AI Ovchinnikova ◽  
AI Ovchinnikova ◽  
YM Yufereva ◽  
YM Yufereva ◽  
...  
Keyword(s):  
Physical Activity ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Controlled Study ◽  
Group Support ◽  
Counseling Programs ◽  
Preventive Counseling ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Background Physical activity (PA) is associated with lower risk of all-cause death in atrial fibrillation (AF), so interventions to increase PA in AF patients (pts) has a potential to improve their outcomes. Purpose To assess the impact of different preventive counseling programs on PA in pts after catheter ablation (CA) of paroxysmal AF. Methods A prospective randomized controlled study with 3 parallel groups of pts with paroxysmal AF after CA (radiofrequency or cryoablation).  Pts were randomized (1:1:1) into 3 groups. Before discharge, pts from all groups received 1 preventive counseling session with focus on their individual risk factors profile. After discharge both intervention groups received 6 sessions of biweekly remote preventive counseling by phone (Group 1) or via email(Group 2) for 3 months after enrollment. Group 3 received usual care. PA was assessed using the International Questionnaire on Physical Activity (IPAQ) at baseline and after 12 months. Results A total of 135 pts aged 35 to 80 years were enrolled (mean age, 57.3 ± 9.1 years, men, 51.8%). The groups were well balanced according to demographic and clinical features and PA level. The baseline proportion of pts with sufficient (moderate or high) PA was high in all 3 groups (86.6%, 88.9% and 91.1%, respectively). At 1 year of follow-up both intervention groups had a significantly higher proportion of pts maintaining high PA levels vs control (table).  Conclusions Preventive counseling programs combining in-hospital and remote counseling via phone or e-mailsupport higher physical activity levels in AF pts after CA. Different counseling programs and PA Levels of physical activity 1 group (support via phone) 2 group (support via e-mail) Control group P for Group 1 vs. control at 12 Months P for Group 2 vs. control at 12 Months Baseline After 12 months Baseline After 12 months Baseline After 12 months Low,% 13.3 2.2 11.1 0 8.9 2.2 n/s n/s Moderate,% 62.2 71.1 71.1 82.2 60 93.3 &lt;0.01 n/s High,% 24.4 26.7 17.8 17.8 31.1 4.4 &lt;0.005 &lt;0.05

The role of site of metastatic resection (MR) in metastatic colorectal cancer (mCRC) patients (PTS): A mono-institutional cohort study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e15558-e15558
Author(s):  
Marta Ribelli ◽  
Francesco Ardito ◽  
Filippo Lococo ◽  
Maria Bensi ◽  
Brunella Di Stefano ◽  
...  
Keyword(s):  
Curative Intent ◽  
Primary Tumor Site ◽  
Ras Status ◽  
Retrospective Nature ◽  
Group 3 ◽  
Group 2 ◽  
Multimodal Management ◽  
The Impact ◽  
Group 1

e15558 Background: Approximately 50%-60% of CRC pts develop metastases, usually to liver and lung. When feasible, MR is the only potentially curative option in the multimodal management of mCRC pts. Few studies have compared survival outcomes based on different surgical sites with contrasting data. Hence, we retrospectively analyzed mCRC pts, underwent radical lung and/or liver resection at our Institution, investigating the impact of resection site on overall survival (OS). Methods: mCRC pts underwent radical liver (group 1), lung (group 2) or liver and lung (group 3) resection were included. The following variables were collected: age ( > vs ≤ 65 years); gender (male vs female); primary tumor site (right vs left); synchronous vs metachronous; RAS/BRAF status; number (N) of MR (1, 2 or ≥3); chemotherapy treatment (No treatment vs Post-operative vs Peri-operative/pre-operative treatment) and chemotherapy regimen (5FU monotherapy, Oxaliplatin-based, Irinotecan-based regimen, FOLFOXIRI, Bevacizumab, Anti-EGFR). The association of MR site and OS was evaluated. Univariate and multivariate analyses for OS were performed. Results: A total of 191 mCRC pts underwent radical MR were included in the analysis: 112 (59%) pts in group 1, 38 pts (20 %) in group 2, 41 pts (21 %) in group 3. 145 (76%) pts had a left-sided tumor and 46 (24%) a right-sided tumor. Out of 156 evaluable pts, 73 (47%) pts harbored a RAS mutation, while out of 136 evaluable pts, 4 (3%) pts had a BRAF mutation. Regarding the N of MR, 125 pts (65%) underwent 1 radical MR, 43 (23%) pts 2 MR and 23 (12%) ≥3 MR. In the overall population, median OS was 77.2 months. According to MR site, median OS was 59.4, not reached (NR) and 99.1 months, in group 1, 2 and 3, respectively (p = 0.075). At the multivariate analysis no significant association with OS was shown for MR site, while the N of MR and RAS status were indipendently associated with OS. Median OS was 58.5, 97.7 months and NR in pts underwent 1, 2 and ≥3 MR, respectively (p = 0.02). Median OS was 58.5 and 83.1 months in RAS mutated and RAS wild-type pts, respectively (p = 0.12). Conclusions: Despite the limited number of pts and the retrospective nature of our study, these results confirmed that surgery represents the only option with curative intent for mCRC pts, independently of metastatic site (liver vs lung vs liver and lung). Based on our analysis, a higher number of MR is associated to a better outcome, and this could be explained with an accurate selection of patients that could benefit from multiple radical resections. Thus, a multidisciplinary approach is essential for the management of mCRC pts and surgery should be evaluated case by case and always performed when possible, even several times, independently of site of MR.

Abstract 741: Atrial Fibrillation Begets Atrial Fibrillation: Acute Autonomic Remodeling Leads to Enhanced Inducibility for Atrial Fibrillation

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Zhibing Lu ◽  
Benjamin J Scherlag ◽  
Guo-Dong Niu ◽  
Jiaxiong Lin ◽  
Muhammad Ghias ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Veins ◽  
Atrial Pacing ◽  
Time Period ◽  
Before And After ◽  
Rapid Pacing ◽  
Group 2 ◽  
Window Of Vulnerability ◽  
Group 1

Introduction: There have been many forms of remodeling reported to play a role in the concept of “atrial fibrillation (AF) begets atrial fibrillation.” The role of intrinsic cardiac nervous system (ICNS) in this remodeling process was evaluated in this study. Methods: Continuous rapid pacing (1200 bpm, 2× threshold, TH) was performed at the left atrial appendage to maintain AF. Group 1 (N=7): 6-hours of pacing followed by ganglionated plexi (GP) ablation, both left and right side; Group 2 (N=7): GP ablation followed by 6-hours of pacing. At 2x and 10x TH, the effective refractory period (ERP) and window of vulnerability (WOV), i.e., longest-shortest coupling of premature stimulus which induced AF in milliseconds (ms), were measured at the left atrium, right atrium and pulmonary veins (PVs) every hour during the 6-hours of pacing before and after GP ablation. Results: In group 1 (rapid pacing with GP intact) ERP progressively shortened in the first two hours and then stabilized both at 2×TH and 10×TH (Figure 1A ), however, WOV progressively widened throughout the time period (Figure 1B ). After GP ablation, ERP was significantly longer than prior to ablation and AF could not be induced (WOV=0, p<0.01) at any pacing site at either 2×TH or 10×TH (Figure 1B ). In group 2 (initial GP ablation), ERP exhibited a slightly increasing trend as the pacing time increased. AF could not be induced in 6/7 dogs during the 6-hour pacing, and was inducible in 1/7 with a cumulative WOV of only 10 ms. Conclusion: The ICNS is crucial for the process of “AF begets AF” in the acute stages of remodeling by rapid atrial pacing.

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