Search

Cure of typical atrial flutter (AFL) by catheter ablation to produce bidirectional block across the tricuspid annulus-inferior vena cava isthmus (IS) is highly effective, but failures may occur. We describe a technique that may allow creation of bidirectional block where a conventional strategy has failed. AFL ablation was performed using the conventional approach with a mapping/ablation (ablation) catheter introduced via the right femoral vein (RFV) to create a line of bidirectional block across the IS. If this was not achieved after five passes of the ablation catheter from the tricuspid annulus to the inferior vena cava (IVC) a catheter inversion technique was used. This allowed stable positioning of the ablation catheter at the IVC end of the isthmus. In 11 patients, a mean of 17 (range 3 to 45) radiofrequency (RF) applications was given before the catheter inversion technique was applied. Following catheter inversion a mean of 4 (1 to 14) further RF applications achieved bidirectional isthmus block in every patient. No complications occurred. Catheter inversion provides a simple, safe, and effective means of achieving bidirectional isthmus conduction block in cases where a conventional ablation strategy might have failed. [ABSTRACT FROM AUTHOR]

A 63-year-old man presented with cachexia and confusion. He was found to have culture-negative endocarditis affecting his aortic valve. Despite treatment with broad-spectrum antibiotics and extensive investigation for an underlying cause, he suffered a large cerebral infarct and died. At post-mortem he was found to have non-bacterial thrombotic endocarditis and a metastatic signet-ring carcinoma. [ABSTRACT FROM AUTHOR]

Introduction: Recent evidence supports left atrial appendage closure (LAAC) as a cost-effective alternative to warfarin. However these findings, based on clinical trial populations, may not be generalisable to clinical practice. The cost-impact of a real world experience of LAAC compared with warfarin, dabigatran, rivaroxaban, apixaban, aspirin and no therapy in patients with nonvalvular atrial fibrillation (NVAF) is unknown.Methods: Cost minimisation analysis using a cost impact model incorporating data from a network meta-analysis was used to systematically assess the costs of LAAC device implantation over a 10 year time horizon to determine the costs of LAAC in relation to all other treatment strategies in patients with nonvalvular AF at risk of stroke, with and without contraindications to anticoagulation. Complications and subsequent stroke rates were determined from our experience of 112 implants in 110 patients (Age 70.8±9.7, CHA2DS2-VASc 4.6±1.7, HAS-BLED 3.9±1.2). Device implantation and complication costs were obtained from UK NHS 2014 tariffs, while those for stroke were sourced from peer-reviewed literature. Overall cost-impact of LAAC was quantified as time to achieve cost parity with other strategies and cost saved over 10 years.Results: Cost parity was achieved between 4.8 (vs Dabigatran 110mg) to 7.3 (vs Warfarin) years. Cost saving over 10 years ranged between 26.4% against PROTECT AF data (£9,933.82 vs £13,504.16) and 46.7% against Dabigatran 110mg (£9,933.82 vs £18,633.71).Conclusion: LAAC in real world practice can substantially reduce costs relative to all other treatment strategies, including clinical trial data of LAAC, over a relatively short time horizon for patients at risk with NVAF. [ABSTRACT FROM PUBLISHER]

Introduction: The impact of triaging patients with selected arrhythmia emergencies diagnosed by ambulance paramedics directly to centres capable of delivering specialist care 24 hrs a day (24/7) has not been measured. Triage of patients diagnosed by the London Ambulance Service (LAS) with ventricular tachycardia (VT) directly to arrhythmia centres was evaluated and compared to standard care.Methods: Seven hospitals across London were accredited as arrhythmia centres, capable of delivering consultant led specialist care 24/7. ECG criteria for the diagnosis of VT were developed and reinforced at an education event for paramedics. A pilot study evaluated outcome for patients triaged with VT to four arrhythmia centres. Comparison groups comprised patients across London not triaged, and received by arrhythmia and non-arrhythmia centres.Results: During six months in 2013, 47 patients were triaged with VT. The diagnosis was confirmed in 30 patients (64%). The commonest misdiagnosis was atrial fibrillation (8 patients, 17%). For the 17 patients incorrectly triaged, one patient underwent emergency coronary intervention, and one patient ablation for supraventricular tachycardia. The median length of stay for this group was one day. 76 patients were admitted with VT but not triaged. The table below gives information on outcome for the triaged and non-triaged patients with VT.Conclusions: LAS paramedics diagnosed VT accurately. Where atrial arrhythmias were triaged as VT, specialist are was received and patients discharged rapidly. A sigificant minority of triaged patients required urgent coronary intervention. Many patients received by arrhythmia centres with VT underwent specialist arrhythmia interventions, and nearly half the patients received by non-arrhythmia centres required transfer for specialist care. These findings support ongoing triage for patients diagnosed by LAS paramedics with VT. The co-location of arrhythmia and coronary intervention services is supported. Ongoing LAS paramedic education, review and refinement of ECG criteria for VT should be undertaken.VT triaged to arrhythmia centreVT received by arrhythmia centre (not triaged)VT received by non-arrhythmia centreNo303739Acute coronary syndrome (%)3 (10)00 (5 urgent angiograms)Pts transferred (%)0018 (46)Time to transferN/AN/A3 daysICD implant/VT ablation (%)12/5 (53)13/7 (57)6 local ICD implant (15)Major complications (%)2 (12)1 (5)0Length of stay (days, median)597**patients not transferred (incomplete data) [ABSTRACT FROM PUBLISHER]

This article focuses on a study that explores effects of the gap-junction uncoupler carbenoxolone (CARB) on human myocardial conduction and arrhythmogenicity. All commercially available antiarrhythmic drugs modify action potential (AP) and are potentially pro-arrhythmic. CARB, an anti-ulcer drug, has been shown to reduce gap-junctional coupling without affecting cellular ion channels. The ability to terminate VT with pacing was effected by CARB in one patient due to slowing of conduction and apparent enlargement of the excitable gap.

Background: Long-term clinical outcomes of catheter ablation (CA) compared to thoracoscopic surgical ablation (SA) to treat patients with long-standing persistent atrial fibrillation (LSPAF) are not known., Objective: The purpose of this study was to compare the long-term (36-month) clinical efficacy, quality of life, and cost-effectiveness of SA and CA in LSPAF., Methods: Participants were followed up for 3 years using implantable loop recorders and questionnaires to assess the change in quality of life. Intention-to-treat analyses were used to report the findings., Results: Of the 115 patients with LSPAF treated, 104 (90.4%) completed 36-month follow-up [CA: n = 57 (95%); SA: n = 47 (85%)]. After a single procedure without antiarrhythmic drugs, 7 patients (12%) in the CA arm and 5 (11%) in the SA arm [hazard ratio 1.22; 95% confidence interval (CI) 0.81-1.83; P = .41] were free from atrial fibrillation/tachycardia (AF/AT) ≥30 seconds at 36 months. Thirty-three patients (58%) in the CA arm and 26 (55%) in the SA arm (hazard ratio 1.04; 95% CI 0.57-1.88; P = .91) had their AF/AT burden reduced by ≥75%. The overall impact on health-related quality of life was similar, with mean quality-adjusted life year estimates of 2.45 (95% CI 2.31-2.59) for CA and 2.32 (95% CI 2.13-2.52) for SA. Estimated costs were higher for SA (mean £24,682; 95% CI £21,746-£27,618) than for CA (mean £18,002; 95% CI £15,422-£20,581)., Conclusion: In symptomatic LSPAF, CA and SA were equally effective at achieving arrhythmia outcomes (freedom from AF/AT ≥30 seconds and ≥75% burden reduction) after a single procedure without antiarrhythmic drugs. However, SA is significantly more costly than CA., Competing Interests: Disclosures The authors have no conflicts of interest to disclose., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)

Background: In nonvalvular atrial fibrillation (NVAF), the left atrial appendage (LAA) is the source of thrombus in up to 90% of patients. LAA pseudothrombus (LAAPT), defined as a filling defect on the initial but not the 60-second delayed acquisition on cardiovascular computed tomography scan (CCT), is a recognized phenomenon in NVAF, with unknown clinical relevance. We aimed to determine the relationship between LAAPT and history of stroke in patients with NVAF., Methods and Results: The study included 213 consecutive patients with NVAF undergoing CCT who were assessed for LAAPT. LA and LAA dimensions and LAA morphology correlated with clinical demographics including cardiovascular risk factors, history of stroke, thromboembolic stroke, and transient ischemic attack. Mean age (±SD) was 65.1±10.5 years (range 31-89) and 150 of 213 (70.4%) were men. LAAPT was present in 59 of 213 (27.7%) patients. Greater mean LAA ostium area (5.7 versus 4.5, P <0.001), greater mean LAA ostium area:curved length (0.11 versus 0.08, P <0.001), increased LAA volume (14.0 versus 10.2, P <0.001), and lower mean LAA tortuosity index (1.17 versus 1.38, P <0.001) were all associated with the presence of LAAPT. On multivariable analysis, LAAPT on CCT (odds ratio [OR], 3.20 [95% CI, 1.40-7.20]; P <0.006) and higher CHA 2 DS 2 -VASc score (OR, 1.65 [95% CI, 1.16-2.35]; P =0.01) were associated with all strokes, with LAAPT remaining a statistically significant risk factor even after adjustment for CHA 2 DS 2 -VASc score., Conclusions: LAAPT on CCT is common in patients with NVAF. It has a strong positive association with stroke prevalence, even after adjustment for CHA 2 DS 2 -VASc score. LAAPT on CCT may potentially allow further stratification for stroke risk, additive to the CHA 2 DS 2 -VASc score.

Aims: This proof-of-concept study sought to evaluate changes in heart rate (HR) obtained from a consumer wearable device and compare against implantable loop recorder (ILR)-detected recurrence of atrial fibrillation (AF) and atrial tachycardia (AT) after AF ablation., Methods and Results: REMOTE-AF (NCT05037136) was a prospectively designed sub-study of the CASA-AF randomized controlled trial (NCT04280042). Participants without a permanent pacemaker had an ILR implanted at their index ablation procedure for longstanding persistent AF. Heart rate and step count were continuously monitored using photoplethysmography (PPG) from a commercially available wrist-worn wearable. Photoplethysmography-recorded HR data were pre-processed with noise filtration and episodes at 1-min interval over 30 min of HR elevations ( Z -score = 2) were compared with corresponding ILR data. Thirty-five patients were enrolled, with mean age 70.3 ± 6.8 years and median follow-up 10 months (interquartile range 8-12 months). Implantable loop recorder analysis revealed 17 out of 35 patients (49%) had recurrence of AF/AT. Compared with ILR recurrence, wearable-derived elevations in HR ≥ 110 beats per minute had a sensitivity of 95.3%, specificity 54.1%, positive predictive value (PPV) 15.8%, negative predictive value (NPV) 99.2%, and overall accuracy 57.4%. With PPG-recorded HR elevation spikes (non-exercise related), the sensitivity was 87.5%, specificity 62.2%, PPV 39.2%, NPV 92.3%, and overall accuracy 64.0% in the entire patient cohort. In the AF/AT recurrence only group, sensitivity was 87.6%, specificity 68.3%, PPV 53.6%, NPV 93.0%, and overall accuracy 75.0%., Conclusion: Consumer wearable devices have the potential to contribute to arrhythmia detection after AF ablation., Study Registration: ClinicalTrials.gov Identifier: NCT05037136 https://clinicaltrials.gov/ct2/show/NCT05037136., Competing Interests: Conflict of interest: S.G. reports funding through the BigData@Heart Innovative Medicines Initiative [grant no. 116074]. A.B. reports funding from the BigData@Heart Innovative Medicines Initiative [grant no. 116074] during the conduct of the study. D.K. reports grants from the National Institute for Health Research (NIHR CDF-2015-08-074 RATE-AF; NIHR130280 DaRe2THINK; NIHR132974 D2T-NeuroVascular; and NIHR203326 BRC), the British Heart Foundation (PG/17/55/33087, AA/18/2/34218, and FS/CDRF/21/21032), the EU/EFPIA Innovative Medicines Initiative (BigData@Heart 116074), EU Horizon (HYPERMARKER 101095480), UK National Health Service—Data for R&D—Subnational Secure Data Environment programme, and the ESC supported by educational grants from Boehringer Ingelheim/BMS-Pfizer Alliance/Bayer/Daiichi Sankyo/Boston Scientific, the NIHR/University of Oxford Biomedical Research Centre, and British Heart Foundation/University of Birmingham Accelerator Award (STEEER-AF). In addition, he has received research grants and advisory board fees from Bayer, Amomed, and Protherics Medicines Development; all outside the submitted work. G.G. reports support from the NIHR Birmingham Experimental Cancer Medicine Centre, NIHR Birmingham Surgical Reconstruction and Microbiology Research Centre, Nanocommons H2020-EU (731032), and the MRC Heath Data Research UK (HDRUK/CFC/01). S.H. reports speaker fees from Alivercor, consultancy fees from BMS, a research grant from Abbott, and the NIHR grants (CASA and LOTO). G.A., I.K.H., Z.C., J.J., D.J., V.M., W.H., and T.W. have no relevant disclosures., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: Leadless pacemakers (LPs) may mitigate the risk of lead failure and pocket infection related to conventional transvenous pacemakers. Atrial LPs are currently being investigated. However, the optimal and safest implant site is not known., Objectives: We aimed to evaluate the right atrial (RA) anatomy and the adjacent structures using complementary analytic models [gross anatomy, cardiac magnetic resonance imaging (MRI), and computer simulation], to identify the optimal safest location to implant an atrial LP human., Methods and Results: Wall thickness and anatomic relationships of the RA were studied in 45 formalin-preserved human hearts. In vivo RA anatomy was assessed in 100 cardiac MRI scans. Finally, 3D collision modelling was undertaken assessing for mechanical device interaction. Three potential locations for an atrial LP were identified; the right atrial appendage (RAA) base, apex, and RA lateral wall. The RAA base had a wall thickness of 2.7 ± 1.6 mm, with a low incidence of collision in virtual implants. The anteromedial recess of the RAA apex had a wall thickness of only 1.3 ± 0.4 mm and minimal interaction in the collision modelling. The RA lateral wall thickness was 2.6 ± 0.9 mm but is in close proximity to the phrenic nerve and sinoatrial artery., Conclusions: Based on anatomical review and 3D modelling, the best compromise for an atrial LP implantation may be the RAA base (low incidence of collision, relatively thick myocardial tissue, and without proximity to relevant epicardial structures); the anteromedial recess of the RAA apex and lateral wall are alternate sites. The mid-RAA, RA/superior vena cava junction, and septum appear to be sub-optimal fixation locations., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Introduction: It is not known whether the optimal atrioventricular (AV opt ) delay varies between left ventricular (LV) pacing site during endocardial biventricular pacing (BiVP) and may therefore needs consideration., Methods: We assessed the hemodynamic AV opt in patients with chronic heart failure undergoing endocardial LV lead implantation. AV opt was assessed during atrio-BiVP with a "roving LV lead." Up to four locations were studied: mid-lateral wall, mid-septum (or a close alternative), site of greatest hemodynamic improvement, and LV lead implant site. The AV opt was compared to a fixed AV delay of 180 ms., Results: Seventeen patients were included (12 male, aged 66.5 ± 12.8 years, ejection fraction 26 ± 7%, 16 left bundle branch block or high percentage of right ventricular pacing [RVP], QRS duration 167 ± 27 ms). In most locations (62/63), AV opt increased systolic blood pressure during BiVP compared with RVP (relative improvement 6 mmHg, interquartile range [IQR] 4-9 mmHg). Compared to a fixed AV delay, the hemodynamic improvement at AV opt was higher (1 mmHg, IQR 0.2-2.6 mmHg, p < .001). Within most patients (16/17), we observed a difference in AV opt between pacing sites (median paced AV opt 209 ms, IQR 117-250). Within this range, the hemodynamic impact of these differences was small (median loss 0.6 mmHg, IQR 0.1-2.6 mmHg)., Conclusion: Within a patient, different endocardial LV lead locations have slightly different hemodynamic AV opt which are superior to a fixed AV delay. The hemodynamic consequence of applying an optimum from a different lead location is small., (© 2023 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.)

Background: Left atrial (LA) function following catheter or surgical ablation of de-novo long-standing persistent atrial fibrillation (AF) and its impact on AF recurrence was studied in patients participating in the CASA-AF trial (Catheter Ablation vs. Thoracoscopic Surgical Ablation in Long Standing Persistent Atrial Fibrillation)., Methods: All patients underwent echocardiography preablation, 3 and 12 months post-ablation. LA structure and function were assessed by 2-dimensional volume and speckle tracking strain measurements of LA reservoir, conduit, and contractile strain. Left ventricular diastolic function was measured using transmitral Doppler filling velocities and myocardial tissue Doppler velocities to derive the e', E/e', and E/A ratios. Continuous rhythm monitoring was achieved using an implantable loop recorder., Results: Eighty-three patients had echocardiographic data suitable for analysis. Their mean age was 63.6±9.7 years, 73.5% were male, had AF for 22.8±11.6 months, and had a mean LA maximum volume of 48.8±13.8 mL/m 2 . Thirty patients maintained sinus rhythm, and 53 developed AF recurrence. Ablation led to similar reductions in LA volumes at follow-up in both rhythm groups. However, higher LA emptying fraction (36.3±10.6% versus 27.9±9.9%; P <0.001), reservoir strain (22.6±8.5% versus 16.7±5.7%; P =0.001), and contractile strain (9.2±3.4% versus 5.6±2.5%; P <0.001) were noted in the sinus rhythm compared with AF recurrence group following ablation at 3 months. Diastolic function was better in the sinus rhythm compared with the AF recurrence group with an E/A ratio of 1.5±0.5 versus 2.2±1.2 ( P <0.001) and left ventricular E/e' ratio of 8.0±2.1 versus 10.3±4.1 ( P <0.001), respectively. LA contractile strain at 3 months was the only independent predictor of AF recurrence., Conclusions: Following ablation for long-standing persistent AF, improvement in LA function was greater in those who maintained sinus rhythm. LA contractile strain at 3 months was the most important determinant of AF recurrence following ablation., Registration: URL: https://www., Clinicaltrials: gov; Unique identifier: NCT02755688., Competing Interests: Disclosures Dr Khan received presentation fees from CHRS and NIHR grant (EME 12/127/127); Dr Haldar received a grant from NIHR (EME 12/127/127), Abbott, presentation fees from Alivecor and Zurich Heart House; Dr Bahrami received honoraria fees from Medtronic and meeting support from Edwards Lifesciences; Dr De Souza received presentation/support fees from Medtronic and Atricure. Dr De Souza is serving as BISICS President; Dr Markides received educational grants, consultancy fees, and honoraria from Biosense Webster; Dr Jones receives institutional research grants from Biosense Webster, Boston Scientific, and Medtronic; the rest of the authors disclose no conflicts of interest.

Aims: Left bundle branch area pacing (LBBAP) has been shown to be effective and safe. Limited data are available on LBBAP in the congenital heart disease (CHD) population. This study aims to describe the feasibility and safety of LBBAP in CHD patients compared with non-CHD patients., Methods and Results: This is a single-centre, non-randomized observational study recruiting consecutive patients with bradycardia indication. Demographic data, ECGs, imaging, and procedural data including lead parameters were recorded. A total of 39 patients were included: CHD group (n = 13) and non-CHD group (n = 26). Congenital heart disease patients were younger (55 ± 14.5 years vs. 73.2 ± 13.1, P < 0.001). Acute success was achieved in all CHD patients and 96% (25/26) of non-CHD patients. No complications were encountered in either group. The procedural time for CHD patients was comparable (96.4 ± 54 vs. 82.1 ± 37.9 min, P = 0.356). Sheath reshaping was required in 7 of 13 CHD patients but only in 1 of 26 non-CHD patients, reflecting the complex and distorted anatomy of the patients in this group. Lead parameters were similar in both groups; R wave (11 ± 7 mV vs. 11.5 ± 7.5, P = 0.881) and pacing threshold (0.6 ± 0.3 V vs. 0.7 ± 0.3, P = 0.392). Baseline QRS duration was longer in the CHD group (150 ± 28.2 vs. 118.6 ± 26.6 ms, P = 0.002). Despite a numerically greater reduction in QRS and a similar left ventricular activation time (65.9 ± 6.2 vs. 67 ± 16.8 ms, P = 0.840), the QRS remained longer in the CHD group (135.5 ± 22.4 vs. 106.9 ± 24.7 ms, P = 0.005)., Conclusion: Left bundle branch area pacing is feasible and safe in CHD patients as compared to that in non-CHD patients. Procedural and fluoroscopy times did not differ between both groups. Lead parameters were satisfactory and stable over a short-term follow-up., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Introduction: Conduction system pacing (CSP), consisting of His bundle pacing (HBP) or left bundle branch area pacing (LBBAP) is a rapidly developing field. These pacing techniques result in single lead left ventricular resynchronisation. Understanding of the associated learning curve of the two techniques is an important consideration for new implanters/implanting centres., Methods: We conducted a review of the first 30 cases of both HBP and LBBAP at The Royal Brompton Hospital. The procedural duration and fluoroscopy time were used as surrogates for the learning curve of each technique., Results: Patient characteristics were similar in HBP and LBBAP groups; LV ejection fraction (46% vs 54%, p = 0.08), pre-procedural QRS duration (119 ms vs 128 ms, p = 0.32).Mean procedural duration was shorter for LBBAP than for HBP (87 vs 107mins, p = 0.04) and the drop in procedural duration was more marked in LBBAP, plateauing and remaining low at 80mins after the initial 10 cases. Fluoroscopic screening time mirrored procedural duration (8 min vs 16 min, p < 0.01)., Discussion/conclusion: Our data suggest that the CSP learning curve was shorter for LBBAP than for HBP and appears to plateaux after the first 10 cases, however the HBP learning curve is longer with continued improvement over the first 30 cases. The shorter learning curve of LBBAP in conjunction with the superior electrical parameters and simplified programming mean the establishment of a CSP program is potentially easier with LBBAP compared to with HBP., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 Published by Elsevier B.V.)

Aims: The ARC-HF and CAMTAF trials randomized patients with persistent atrial fibrillation (AF) and heart failure (HF) to early routine catheter ablation (ER-CA) versus pharmacological rate control (RC). After trial completion, delayed selective catheter ablation (DS-CA) was performed where clinically indicated in the RC group. We hypothesized that ER-CA would result in a lower risk of cardiovascular hospitalization and death versus DS-CA in this population., Methods and Results: Overall, 102 patients were randomized (age 60 ± 11 years, left ventricular ejection fraction [LVEF] 31 ± 11%): 52 to ER-CA and 50 to RC. After 12 months, patients undergoing ER-CA had improved self-reported symptom scores, lower New York Heart Association class (i.e. better functional capacity), and higher LVEF compared to patients receiving RC alone. During a median follow-up of 7.8 (interquartile range 3.9-9.9) years, 27 (54%) patients in the RC group underwent DS-CA and 34 (33.3%) patients died, including 17 (32.7%) randomized to ER-CA and 17 (34.0%) randomized to RC. Compared with DS-CA, a strategy of ER-CA exhibited similar risk of all-cause mortality (adjusted hazard ratio [aHR] 0.89, 95% confidence interval [CI] 0.44-1.77, p = 0.731) and combined all-cause mortality or cardiovascular hospitalization (aHR 0.80, 95% CI 0.43-1.47, p = 0.467). However, analyses according to treatment received suggested an association between CA and improved outcomes versus RC (all-cause mortality: aHR 0.43, 95% CI 0.20-0.91, p = 0.028; all-cause mortality/cardiovascular hospitalization: aHR 0.48, 95% CI 0.24-0.94, p = 0.031)., Conclusions: In patients with persistent AF and HF, ER-CA produces similar long-term outcomes to a DS-CA strategy. The association between CA as a treatment received and improved outcomes means there is still a lack of clarity regarding the role of early CA in selected patients. Randomized trials are needed to clarify this question., (© 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Purpose: We aimed to evaluate whether outcomes with ablation in persistent (PsAF) and long-standing persistent (LsPsAF) AF can be improved beyond what can be achieved with pulmonary vein isolation (PVI) alone, using individualized mapping to guide ablation., Methods: We studied 20 pts (15 M, 68 ± 11y) with PsAF (14) or LsPsAF (6) referred for first-time AF ablation. Following antral PVI, individualized mapping (IM) was performed using a high-density mapping catheter stably and fully deployed for 30 s at each of 23 ± 9 sites per patient. Activation data were reviewed, and an ablation strategy designed to intersect areas of focal and rotational activity. Mean follow-up was 429 ± 131 days. The study population was compared to a matched contemporary control cohort (CC) of 20 consecutive patients undergoing conventional ablation., Results: Despite the IM group having a higher median comorbidities score, 3.5 vs. 2.5 in the CC group, indicating potentially more complex patients and more advanced substrate, cumulative freedom from AF after a single procedure was achieved in 94% of patients in the IM group vs. 75% in the CC group at 1 year and remained the same in both groups at the conclusion of the study (p = 0.02). There was a similar trend in atrial arrhythmia-free survival between both groups (84% vs. 67% at 1 year) that did not reach statistical significance. The procedure duration was longer in the IM group by a median of 31.5 min (p = 0.004)., Conclusions: Individualized mapping to guide AF ablation appears to achieve significantly greater AF-free survival compared to conventional PVI when applied as a primary ablation treatment. The results of this pilot study need to be confirmed in a larger, randomized trial., (© 2022. The Author(s).)

Background: Patients with adult congenital heart disease (ACHD) are a rapidly growing cardiovascular population with increasing health needs and co-morbidities. Furthermore, their management requires frequent and ongoing hospital visits which can be burdensome. Digital health and remote monitoring have been shown to have a vast potential to enhance delivery of healthcare for patients, reducing their need for travel to clinic appointments therefore reducing costs to the patient and the healthcare service., Methods: Patients over the age of 16 with a diagnosis of ACHD were invited to use the tailored digital application too. They were monitored for a period of 6 months. Information on patient demographics, time using the application, flagged events that prompted clinical reviews and their feedback through patient surveys were collected., Results: A total of 103 patients were enrolled and registered to use the digital application tool. There were 57 (56%) males, median age at the time of enrolment was 39 (16-73) years. The majority (96%) had a moderate or complex ACHD according to the ACC/AHA classification. There was a total of 7 modules that were completed on a weekly basis. The median length of a participant session was 2.2 min and the mean time to complete a module was 21 s. In total, 35 (67%) felt that the application helped them better manage their cardiac condition. Almost all (94%) of patients expressed that they would like to continue using the application beyond the pilot. There were 18 flagged events during the 6 month observation period, and 50% of received early clinical intervention., Conclusion: Application based remote monitoring in this select group was well received and potentially holds large benefit to patients both clinically and economically. There were no safety concerns in our pilot feasibility study. Our data may inform much needed and timely investment in digital health., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Purpose: We aimed to assess the feasibility, safety, and operator feedback of a novel star-shaped high-density mapping catheter containing 48 platinum-iridium mapping electrodes distributed across eight spines., Methods: This prospective, single-arm, first-in-human study was conducted at five European sites. Primary endpoints were completion of pre-ablation mapping requirements, obtaining clinically indicated mapping with the new catheter without resorting to non-study mapping catheters, and incidence of serious adverse events (SAEs). Physician feedback survey assessed catheter performance, including deployment, ease of use, and mapping results. The subjects were followed for 7 days post-procedure., Results: Of 31 patients enrolled (11 ventricular tachycardia [VT], 10 scar-related atrial tachycardia [AT]/atypical atrial flutter [AFL], and 10 persistent atrial fibrillation [PsAF]), 28 had study catheter inserted for mapping purposes. Pre-ablation mapping was achieved in 23/28 patients (82.1%). Median of total pre-ablation mapping times were 121.0, 72.5, and 31.5 min for the VT, scar-related AT/atypical AFL, and PsAF subgroups, respectively. More than two-thirds of mapping points acquired were used to generate CARTO maps relevant for ablation. All 16 patients who had conduction channel(s), gaps(s), or critical isthmus identified had the areas successfully mapped. The ability to deploy, maneuver, and reach the atria and ventricles using the catheter was rated positively for most procedures. Only one SAE (heart failure) was reported, unrelated to the device., Conclusion: The study results demonstrate the feasibility of the OCTARAY catheter to successfully map complex arrhythmias with good safety profile. Operator feedback indicates satisfaction with ease of use and maneuverability of the catheter., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)