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Background Ascertainment of hospitalizations is critical to assess quality of care and the effectiveness and adverse effects of various therapies. Smartphones, mobile geo-locators that are ubiquitous, have not been leveraged to ascertain hospitalizations. Therefore, we evaluated the use of smartphone-based “geofencing” to track hospitalizations. Methods and Results Participants ages ≥ 18 years installed a mobile application programmed to “geofence” all hospitals using global positioning systems and cell phone tower triangulation and to trigger a smartphone-based questionnaire when located in a hospital for ≥ 4 hours. An “in-person” study included consecutive consenting patients scheduled for electrophysiology and cardiac catheterization procedures. A “remote” arm invited Health eHeart Study participants that consented and engaged with the study via the internet only. The accuracy of application-detected hospitalizations was confirmed by medical record review as the reference standard. Of 22 eligible “in-person” patients, 17 hospitalizations were detected (sensitivity 77%; 95% confidence interval [CI] 55-92%). The length of stay according to the application was positively correlated with the length of stay ascertained via the electronic medical record (r=0.53, p=0.03). In the remote arm, the application was downloaded by 3,443 participants residing in all 50 U.S. states; 243 hospital visits at 119 different hospitals were detected through the application. The positive predictive value for an application-reported hospitalization was 65% (95% CI 57-72%). Conclusions Mobile application-based ascertainment of hospitalizations can be achieved with modest accuracy. This first proof of concept may ultimately be applicable to “geofencing” other types of prespecified locations to facilitate healthcare research and patient care.

A woman in her late 30s recently diagnosed with viral myopericarditis presented with 1 month of worsening fatigue, diffuse myalgias and chest pain radiating to her back. While undergoing work-up for chest wall myositis, she rapidly decompensated, developing heart failure and acute hypoxaemic respiratory failure. Her clinical course was complicated by cardiac arrest and severe cardiogenic shock requiring intra-aortic balloon pump support.

Purpose Early recurrence of atrial tachyarrhythmia (ER) is predictive of late recurrence of atrial tachyarrhythmia (LR) after first-time atrial fibrillation (AF) ablation, but the association in patients undergoing repeat AF ablation is unknown. We aim to determine the incidence and prognostic significance of ER after repeat ablation. Methods A total of 259 consecutive patients (mean age 64 years, 75.3% male) undergoing repeat AF ablation with complete follow-up data were included at a single institution from 2010 to 2015. ER and LR were defined as atrial tachyarrhythmia (AF, atrial flutter or atrial tachycardia) > 30 s within the 3-month blanking period (BP) and after the 3-month BP, respectively. Results ER occurred in 79/259 (30.5%), and LR occurred in 138/259 (53%) at a median follow-up of 1221 (IQR: 523–1712) days. Four-year freedom from LR was 22% and 56% in patients with and without ER, respectively (p < 0.001). After multivariate adjustment, ER was strongly associated with LR, cardioversion post BP, and repeat ablation, but not associated with hospitalization. Compared to those with no ER, there was a higher risk of LR when ER occurred within the first month of the BP [month 1: hazard ratio (HR) 2.32, confidence interval (CI) 1.57–3.74, p < 0.001; month 2: HR 2.01, CI 1.13–3.83, p = 0.02; month 3: HR 1.46, CI 0.5–3.36, p = 0.37], however the prediction of LR based on timing within the BP was poor (area under curve 0.64). Conclusion Following repeat AF ablation, ER is strongly associated with LR, cardioversion post BP, and repeat ablation.

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Purpose of review To review the shared pathology of atrial fibrillation and heart failure with preserved ejection fraction (HFpEF) and the prognostic, diagnostic, and treatment challenges incurred by the co-occurrence of these increasingly prevalent diseases. Recent findings Multiple risk factors and mechanisms have been proposed as potentially linking atrial fibrillation and HFpEF, with systemic inflammation more recently being invoked. Nonvitamin K oral anticoagulants, left atrial appendage occlusion devices, and catheter ablation have emerged as alternative treatment options. Other novel pharmacological agents, such as neprilysin inhibitors, need to be studied further in this patient population. Summary Atrial fibrillation and HFpEF commonly co-occur because of their shared risk factors and pathophysiology and incur increased morbidity and mortality relative to either condition alone. Although the presence of both diseases can often make each diagnosis difficult, it is important to do so early in the disease course as there are now a variety of treatment options aimed at improving symptoms and quality of life, slowing disease progression, and improving prognosis. However, more research needs to be performed on the role of catheter ablation in this population. Novel pharmacologic and procedural treatment options appear promising and may further improve the treatment options available to this growing population.

Introduction: Antiarrhythmic drugs (AAD) are often prescribed in the blanking period (BP) after catheter ablation of atrial fibrillation (AF) to reduce risk of early recurrence (ER) and late recurrence (LR). There are limited data on which AAD to use during the BP. Hypothesis: We hypothesize that specific AADs may be associated with reduced risk of ER and/or LR after ablation. Methods: A total of 478 consecutive patients (mean age 64.2 years, 67.2% male) undergoing first-time pulmonary vein isolation (PVI) ablation at a single institution were included. Outcomes of interest were: freedom from ER, freedom from LR, initial discontinuation of AAD less than 90 days after ablation, and freedom from second ablation. ER was defined as AF, atrial flutter (AFL), or atrial tachycardia (AT) > 30 seconds within the BP. LR was defined as AF/AFL/AT > 30 seconds occurring after the BP. Results: Of 478 patients, 14.9% (n = 71) were on no AAD, 26.4% (n = 126) were on propafenone/flecainide, 34.5% (n = 165) were on sotalol/dofetilide, 10.7% (n = 51) were on dronedarone, and 13.6% (n = 65) were on amiodarone. Patients on amiodarone were older, had higher BMI, and were more likely to have persistent AF, hypertension, diabetes, heart failure, and coronary artery disease. In unadjusted analyses, there were no differences between groups with regards to the risk of ER (log rank P = 0.171), discontinuation of AAD before ninety days post-ablation (log rank P = 0.235), or freedom from second ablation (log rank P = 0.147). After multivariable adjustment, patients on amiodarone or dronedarone were more likely to experience LR than those on no AAD [Adjusted Hazard Ratio (AHR) 1.83, 95% CI 1.10-3.04, p=0.02 for amiodarone; AHR 1.79, 95% CI 1.05-3.05, p=0.03 for dronedarone]. Conclusions: Following first-time AF catheter ablation, there were no differences between the presence or absence of AAD and risk of ER, while those prescribed amiodarone or dronedarone in the BP were more likely to experience LR than those on no AAD.