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Introduction: Ablation of anteroseptal (parahisian) pathways may be difficult using conventional catheters.Methods and Results: Two patients (51 and 20 years old) underwent ablation of a parahisian accessory pathway using the magnetic navigation system Niobe (Stereotaxis, Inc.), which consists of two external permanent magnets (0.08 Tesla) that steer a small magnet embedded in the tip of the ablation catheter. A motor drive allows the advancement or retraction of the catheter. From the control room, the ablation was performed using a single radiofrequency current application (fluoroscopy 3.2 and 6.0 minutes, respectively).Conclusions: The Niobe magnetic navigation system was successfully used to perform completely remote controlled mapping and ablation of parahisian accessory pathways. [ABSTRACT FROM AUTHOR]

Introduction: The magnetic navigation system (MNS) allows remote-controlled navigation of an ablation catheter from the control room. We tested the hypothesis, whether the MNS and a single additional diagnostic nonsteerable catheter would have the potential to identify the tachycardia substrate and allow subsequent ablation in patients with documented supraventricular tachycardia (SVT). Methods and Results: A total of 41 patients (24 females, age 45 ± 16 years) underwent an invasive electrophysiologic (EP) study using the MNS. Together with a conventional diagnostic catheter in the right ventricle, the magnetic catheter (MC) was used to investigate the underlying EP substrate in a sequential fashion and subsequently to perform radiofrequency (RF) ablation. A custom-made device allowed the separate assessment of fluoroscopy deployed from the control and examination room. Using conventional EP criteria, identification of the underlying substrate was possible in all but 4 noninducible patients (no accessory pathway [AP], no dual atrioventricular [AV] node): APs were present in 10 patients, AV node re-entrant tachycardia in 26 patients, and ectopic atrial tachycardia in 1 patient. Despite 3 patients, in which switching to conventional ablation was necessary (8%), all others were successfully treated using the MNS. Overall fluoroscopy amounted to a median of 3.4 minutes (interquartile range, 2.4-5.3) with only a median of 1.0 minute exposure for the investigator. Conclusions: Remote catheter ablation of SVT using the new MNS Niobe and a single conventional diagnostic catheter is feasible. Compared to conventional EP studies, a reduction of radiation exposure for both patients and investigators was demonstrated. [ABSTRACT FROM AUTHOR]

Background: Management of atrial fibrillation (AF) in very severe obese patients is challenging. Cryoballoon ablation (CBA) represents an effective rhythm control strategy. However, data in this patient group were limited., Methods: Highly symptomatic AF patients with body mass index (BMI) ≥ 40 kg/m 2 who had failed antiarrhythmic drug therapy and electrocardioversion and failure to achieve targeted body-weight-reduction underwent CBA., Results: Data of 72 very severe obese AF patients (Group A) and 129 AF patients with normal BMI (Group B, BMI < 25 kg/m 2 ) were consecutively collected. Group A had significantly younger age (60.6 ± 10.4 vs. 69.2 ± 11.2 years), higher BMI (44.3 ± 4.3 vs. 22.5 ± 1.6 kg/m 2 ). Procedural pulmonary vein isolation (PVI) was successful in all patients (2 touch-up ablation in Group A). Compared to Group B, Group A had similar procedural (61.3 ± 22.6 vs. 57.5 ± 19 min), similar fluoroscopy time (10.1 ± 5.5 vs. 9.2 ± 4.8 min) but significantly higher radiation dose (2852 ± 2095 vs. 884 ± 732 µGym 2 ). We observed similar rates of real-time-isolation (78.6% vs. 78.5%), single-shot-isolation (86.5% vs. 88.8%), but significantly longer time-to-sustained-isolation (53.5 ± 33 vs. 43.2 ± 25 s). There was significantly higher rate of puncture-site-complication (6.9% vs. 1.6%) in Group A. One-year clinical success in paroxysmal AF was (Group A: 69.4% vs. Group B: 80.2%; p < .001), in persistent AF was (Group A: 58.1% vs. Group B: 62.8%; p = .889). In Re-Do procedures Group A had a numerically lower PVI durability (75.0% vs. 83.6%, p = .089)., Conclusion: For very severe obese AF patients, CBA appears feasible, leads to relatively good clinical outcome., (© 2024 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.)

Background: The second-generation cryoballoon (CB2) has recently been introduced featuring improved surface cooling. Increased procedural efficacy of pulmonary vein isolation (PVI) when compared to the first-generation balloon (CB1) has been reported. The aim of the study was to investigate the clinical outcome of cryoballoon PVI after 1 year using the CB2 as compared to the CB1., Methods and Results: A total of 105 consecutive patients with paroxysmal atrial fibrillation (AF) were studied. Cryoballoon PVI (28 mm) was performed in 50 patients using the CB1, and in 55 patients using the CB2. Patients were scheduled for 72-hour Holter ECG recording at 3, 6, 9, and 12 months and every 6 months thereafter. The study endpoint was defined as recurrent AF or atrial tachycardia >30 seconds documented after a blanking period of 90 days after the procedure. Complete PVI was achieved in 49/50 (98%) and 55/55 (100%) patients in the CB1 and CB2 group, respectively. After a mean follow-up of 416 ± 75 days, 21 (CB1 group) and 10 (CB2 group) patients reached the study endpoint. Kaplan-Meier estimates of arrhythmia-free survival after a single procedure without AAD therapy after 1 year were 63.9% versus 83.6% (P = 0.008) in the CB1 and CB2 group, respectively. Persistent phrenic nerve palsy with delayed healing occurred in 2 (CB1 group) and 3 (CB2 group) patients., Conclusion: Clinical outcome of PVI using the CB2 was significantly improved when compared to the CB1., (© 2014 Wiley Periodicals, Inc.)