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Remote magnetic navigation (RMN) presents a promising approach for catheter ablation in complex arrhythmias. This study aims to offer additional insights into the feasibility, safety, and efficacy of RMN for catheter ablation of epicardial atrial and ventricular arrhythmias in patients without structural heart disease. We present a case series of three patients (39-year-old female, 28-year-old female, and 17-year-old male) referred to our institute for epicardial ablation following unsuccessful endocardial procedures. The first patient exhibited approximately 40,000 monomorphic premature ventricular complexes (PVCs) in a 24-hour Holter recording, while the second patient experienced incessant left ventricular tachycardia (VT). In both cases, the QRS morphology indicated an epicardial origin of the arrhythmia. The third patient suffered from incessant atrial tachycardia (AT) originating from the distal portion of the vein of Marshall (VOM). Epicardial 3D electroanatomic mapping and ablation with RMN were performed with ease and minimal fluoroscopy usage. Coronary angiogram visualization on the RMN screen provided real-time information on the catheter tip's position relative to the coronary arteries. In all cases, the earliest signals were recorded epicardially, and unipolar recordings displayed sharp negative deflections at the sites of successful ablation. In the first patient, pace mapping was superior in the epicardium compared to the endocardium, and PVCs were eradicated by epicardial ablation. In the second patient, epicardial ablation immediately terminated the VT. In the third patient, epicardial ablation at the site exhibiting a distinct VOM potential promptly terminated the AT. No perioperative complications were observed, and all patients remained asymptomatic and free of arrhythmias during long-term follow-up. Our findings suggest that RMN is a feasible, effective, and safe approach for epicardial ablation of left ventricular outflow tract PVCs and VT, as well as atrial tachycardia originating from the VOM. [ABSTRACT FROM AUTHOR]

We investigated whether posterior left atrial (LA) box isolation (BOXI) improved the rhythm outcome of catheter ablation in persistent atrial fibrillation (AF) when compared with complex fractionated atrial electrograms (CFAE) ablation. A total of 183 patients with persistent AF who underwent catheter ablation were recruited from the AF ablation registry database at Mie University Hospital; 68 patients underwent CFAE ablation, and 115 patients underwent BOXI. All patients underwent clinical review and 24-hour ambulatory ECG monitoring to detect asymptomatic arrhythmias at 1, 3, 6, and 12 months post-initial ablation. Patients in the BOXI group had a significantly higher freedom from AF rate than those in the CFAE group (81.5% vs 63.9%, p=0.014), with a similar trend in propensity score-matched patients (p=0.003). The BOXI procedure emerged as the only independent prognostic factor for freedom from AF recurrence. BOXI led to greater reduction in left atrial diameter from baseline to 3-6 months post-catheter ablation compared to CFAE ablation. Thus, BOXI may offer superiority over CFAE ablation in maintaining sinus rhythm in patients with persistent AF, in addition to pulmonary vein isolation. [ABSTRACT FROM AUTHOR]

Left atrial posterior wall (LAPW) isolation is associated with favorable outcomes for catheter ablation of persistent atrial fibrillation (PEAF); however, the optimal technique remains unclear. We hypothesized that LAPW isolations, which included higher internal ablation lesion densities with larger proportions of left atrium (LA) surface area electrical isolation, would result in increased rates of freedom from arrhythmia recurrence two years following the initial procedure. LAPW lesion density and surface area relative to total LA surface area were calculated using electroanatomic maps of 110 consecutive patients not on antiarrhythmic medications undergoing LAPW isolation for PEAF (CARTO 3, Biosense Webster, Inc.). LAPW isolation was performed at the discretion of 5 experienced operators after voltage mapping. LAPW pulmonary vein entrance and exit block were confirmed. Freedom from arrhythmia recurrence at two years was compared by Kaplan-Meier analysis. LAPW lesion density ranged from 0% to 99%. The proportion of LA surface area isolated ranged from 35% to 75%. There was no significant difference in arrhythmia-free survival stratified by median LAPW ablation density (31% vs 27%, P=0.8) or median proportion of electrically isolated LA surface area (31% vs 27%, P=0.8). Voltage map-guided LAPW isolation did not significantly increase freedom from arrhythmia recurrence (29% vs 28%, P=1). Neither the density of ablation within nor the dimensions of the LAPW isolated region predicted arrhythmia-free survival for catheter ablation of PEAF. Voltage map-guided LAPW isolation resulted in similar ablation efficacy regardless of LA scar burden. [ABSTRACT FROM AUTHOR]

Catheter ablation, a widely used treatment option for patients with AF who are symptomatic despite medical therapy, carries inherent risks and may lead to adverse events. This systematic review aims to evaluate the current evidence on the use of prophylactic colchicine after catheter ablation for AF in reducing the risk of AF recurrence and inflammatory biomarkers. Digital databases were searched systematically to identify studies reporting the outcomes of prophylactic use of colchicine after AF ablation. A total of four studies, recruiting 503 patients, were included in the final analysis. Overall, AF recurrence was higher in the placebo group compared to the colchicine group. However, side effects of colchicine were more frequently observed after colchicine treatment. Colchicine dosing ranged from 0.5 mg to 1.2 mg daily, and the duration of treatment ranged from 14 to 90 days. Gastrointestinal side effects were predominantly reported in the studies investigating initiation of colchicine. In conclusion, the use of prophylactic colchicine after catheter ablation for atrial fibrillation may be a promising strategy for reducing the risk of AF recurrence. [ABSTRACT FROM AUTHOR]

Background: Patients with both atrial fibrillation (AF) and heart failure (HF) with reduced left ventricular ejection fraction (LVEF<55%) have a significantly higher risk of stroke and mortality. Improvement of LVEF has been reported in patients with AF and HF after endocardial ablation, but endocardial ablation in patients with persistent (PersAF) and longstanding persistent AF (LSPAF) has had low success in long-term freedom from atrial arrhythmias without repeat procedures. In this population, we sought to determine if a hybrid approach combining endocardial catheter ablation and epicardial surgical ablation would improve LVEF. Objective: To determine the effect of Hybrid Convergent ablation on LVEF in patients with AF. Methods: A multicenter, retrospective analysis of LVEF pre- and post- Hybrid Convergent was performed in consecutive patients with AF. LVEF was measured through 2D echocardiography. Mean baseline and post-procedure LVEF were compared by one sample t-test or Wilcoxon signed rank test. Results: Data from 158 patients, of whom 98% had PersAF/LSPAF, were included. At baseline, patients were a mean 65.7 ± 8.6 years of age, 74% male, BMI of 33 ± 5.7 kg/m2, and had a mean 6.4 ± 6.5 years history of continuous AF and approximately 27% had failed previous endocardial ablation. Patients with reduced baseline LVEF (<55%) experienced a significant improvement in LVEF versus baseline (+6.84% improved; p < 0.0001) at a mean follow up of 7.8 ± 8.7 months. The observed improvement was greatest in patients with severely reduced LVEF (<40% at baseline, +10.9% improved with mean follow-up of 9.3 ± 10.9 months, p = 0.0002). No change in LVEF was observed in patients with a normal baseline LVEF (p = 0.776). Conclusion: A significant improvement in LVEF was observed in patients with non-paroxysmal AF and reduced EF at baseline, particularly in those with severely reduced LVEF, after Hybrid Convergent ablation. [ABSTRACT FROM AUTHOR]

Cor triatriatum is a rare yet important anomaly. We want to highlight the importance of ICE for realtime assessment of the cardiac anatomy during interventional electrophysiology procedures especially when ancillary imaging modalities have failed to detect abnormalities. In these cases, ICE with color flow Doppler imaging guidance was essential for prompt diagnosis of cor triatriatum including definition of the membrane structure with fenestrations or identifying modest atrial obstruction, and guiding proper and uneventful catheter manipulation around the membrane, especially when manipulating near the pulmonary vein orifices. The development of symptoms in patients with cor triatriatum may be insidious and may be delayed even until late adult life. In our patients the cor triatriatum was an incidental ICE finding without significant hemodynamic consequences, because of the sizable defect in the membrane allowing communication. The incidence of cor triatriatum in our adult patients population is 0.09% (4 of 4269) using ICE during radio frequency ablation procedures for tachyarrhythmias. [ABSTRACT FROM AUTHOR]

Background: Despite rapid improvement in 3-demensional (3D) mapping technology, fluoroscopy-guided radiofrequency ablation remains the standard of practice in ventricular tachycardia (VT) and premature ventricular contraction (PVC) ablations. This study aimed to demonstrate the safety and efficacy of fluoroless VT/PVC ablation compared with conventional fluoroscopy-guided ablation in a real-world clinical setting. Methods: This was a nonrandomized, single-arm, retrospective study. The primary outcome was the termination of VT/PVC, as determined by noninducible VT/PVC postablation on and off isoproterenol. Safety outcomes included early onset adverse events. Results: Procedural data for 37 fluoroless cases and 39 fluoroscopy-guided cases were included in the analysis. Mean procedure time was significantly lower in the fluoroless group (P = 0.029). Fluoroscopy time was significantly lower in the fluoroless group (P <0.001). Acute success rate and recurrence were not significantly different between both groups (P = 0.675 and P = 0.453, respectively). Complication rates were low and similar between both groups (P = 0.999). Conclusions: Fluoroless VT/PVC ablation with CARTO 3D mapping system guidance showed acceptable procedure time, success in ablation, and adverse event rates. Fluoroscopy and procedure times were better than conventional fluoroscopy-guided VT/PVC ablation. [ABSTRACT FROM AUTHOR]

Background: The study focused to identify markers of success in patients submitted to high-power short-duration (HPSD) atrial fibrillation (AF) ablation with contact force (CF) catheter. Methods: Prospective, observational study with 227 patients with first AF ablation in sinus rhythm using 50W of power and divided in two groups; success and failure according to absence or presence of AF related arrhythmias, respectively. Results: Success observed in 188 and failure in 39 patients, respectively. Median follow-up was 31±21.1 months. Left atrial time was shorter in success than in recurrence group (69.6±23.1 vs 83.2±21.2 min, p=0.008) as in total procedure time (80.1±30.2 vs 98.5±23.3min, (p=0.01). Radiofrequency time was 1,478±321.2 vs 1,888.4±584.1sec (p=0.001) in success and failure groups, respectively. Esophageal warming observed in 58 (30.9%) success and 14 (53.8%) recurrence patients (p=0.01). Higher rate of first-pass isolation observed in success than recurrence, 118 (77.6%) and 15 (50%) (p=0.039), respectively. After ablation heart rate increased from 53.8±9.7 to 66.8±11.6bpm in success and 57±7.7 to 64.4±10.4bpm in recurrence groups (p= 0.001), respectively. Conclusion: HPSD ablation identified that shorter left atrial time, lower luminal esophageal temperature heating, shorter radiofrequency time, higher heart rate increase and first-pass isolation effect were associated with better arrhythmia free-survival rates during follow-up. [ABSTRACT FROM AUTHOR]

Background: Hybrid / Convergent (HA) ablation using surgical epicardial and catheter endocardial RF ablation improves freedom from AF in patients with persistent AF. Triggers in the left atrial appendage may contribute to recurrence of AF following catheter ablation. Objective: Assess the impact on AF recurrence following HA with LAA closure (LAAC) with the AtriClip device. Methods: Consecutive patients from 2014-2019 with persistent AF without prior ablation were treated with HA. In 2016 LAAC was added to further reduce both arrhythmia substrate and stroke risk. We assessed one-year outcomes. Recurrence was defined as clinical episode of atrial arrhythmia (AA) after a 90-day blanking period. Results: 139 patients with persistent AF without prior ablation underwent HA. 59 (48%) had HA alone, and 64 (52%) had HA with LAAC. Baseline characteristics were similar in both groups with longer AF chronicity in patients with HA plus LAAC (6.4 vs 4.6 years p=0.15). Complete LAAC was noted in 61 (95%) patients treated with LAAC. There was a trend to improved freedom from any AA in the HA with LAAC group (88% vs 76%; p=0.15). Freedom from any AA off antiarrhythmic drug was significantly improved with HA and LAAC compared to HA alone (77% vs 58%; p=0.04). LAAC patients required fewer repeat catheter ablations at 1 year (p<0.05). No strokes, or deaths were noted in either group. Conclusion: Patients with persistent AF treated with HA and LAAC using the AtriClip device had a significant reduction in AF recurrence off antiarrhythmic drug at one year. [ABSTRACT FROM AUTHOR]

Introduction: The limited success rate of conventional ablation approach including isolation of pulmonary veins (PVI) in non-paroxysmal AF has led to the search for alternative ablation strategies. In this study, we evaluated the outcome of three different ablation approaches for non-paroxysmal AF. Methods: Patients were randomly assigned to Group 1: PVI+ isolation of LA posterior wall (PWI), Group 2: PVI+ scar homogenization and Group 3: PVI+PWI+ ablation of sustained non-PV triggers. LA scar (<0.5 mV) was identified by 3-D voltage mapping in sinus rhythm. Freedom from arrhythmia recurrence at 1 year and acute procedure-success, defined as AF termination (organization to AT or conversion to sinus rhythm), were compared across the groups Results: A total of 62 patients were randomized to group 1: 22, group 2: 19 and group 3: 21. Eight (36.3%) in group 1 and 9 (47.3%) in group 2 failed to achieve acute procedural success and underwent PVI+PWI+NPV trigger ablation. Acute success was achieved in all (100%) group 3 patients. Acute procedure failure or recurrence of arrhythmia at 1 year was reported in 54.5% (12/22) in group 1, 68.4% (13/19) group 2 and 28.6% (6/21) in group 3. Compared to group 3, the combined failure rate was significantly higher in group 2 (Chi-Square p= 0.011, Odds ratio 5.42 (95% CI 1.40 to 20.97), p=0.014). Conclusion: In patients with non-paroxysmal AF, PVI+ scar homogenization was associated with significantly lower success rate compared to the ablation strategy targeting PV+ posterior wall +non-PV triggers. [ABSTRACT FROM AUTHOR]

Remote Magnetic Navigation (RMN) is an evolving technology, allowing operators to reduce radiation exposure in addition to providing precise catheter positioning. While many studies are available to characterize the utility of RMN in different arrhythmia subtypes, there is a paucity of literature evaluating RMN in SVT ablations. In this review, we summarize available literature, caveats and benefits of RMN in SVT ablation. [ABSTRACT FROM AUTHOR]

Premature ventricular complexes (PVCs) are widely common in the general population. In patients with recurrent symptoms and structural heart diseases, catheter ablation is highly effective in treating PVCs. Robotic magnetic navigation (RMN) was developed and applied in PVC ablation in the past two decades. RMN has exhibited inherent advantages over manual ablation since its creation, namely drastically decreased fluoroscopy time, improved catheter maneuverability and stability, and better safety profile. Despite earlier reports of lower efficacy and longer procedure times, technological advances and accumulated user experience have significantly decreased procedure time and improved ablation efficacy while retaining its merits. This review provides a summary of the current evidence in the applications, procedural characteristics, efficacy and safety of RMN in PVC ablations. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia for which catheter ablation (CA) is considered a first-choice treatment option. Because of the expanding AF pandemic, there is need for highly efficient and effective CA strategies. Pulmonary vein isolation (PVI) is a pivotal part of any AF ablative strategy. Currently, multiple ablation techniques are being utilized to realize PVI, including Remote Magnetic Navigation (RMN) guided radiofrequency (RF) ablation. This study aimed to systematically describe and evaluate a novel, minimally-invasive RMN-guided PVI strategy. Methods: This study retrospectively included a series of consecutive patients diagnosed with AF who were treated with a novel minimallyinvasive RMN-guided PVI strategy between September 2020 and March 2021. Primary outcomes were both procedural efficiency (i.e. LA access time, mapping time, procedure time) and efficacy (first-pass isolation (FPI) and acute success rates). Results: This case series included 14 patients. Efficiency outcomes: The mean total procedure time was 63.1 ± 13.5 minutes. LA access time was 6.5±1.9 minutes. Mapping was completed in 7.1±1.4 minutes. Efficacy outcomes: We observed a 100% FPI rate in right-sided and a 57% FPI rate in left-sided PVs. In all cases there was successful PV isolation at the end of procedure. There were no adverse events. Conclusion: In conclusion, a novel, minimally-invasive RMN guided PVI strategy yields high efficiency, with short procedure and fluoroscopy times, in addition to efficacious PVI. [ABSTRACT FROM AUTHOR]

Ablation of atrial tachycardias arising from the superior portion of Crista Terminalis may be risky because of the possibility to injure the right phrenic nerve. Although few techniques for phrenic nerve displacement have been reported, their execution can be difficult, timeconsuming and expose the patient to further complications related to epicardial puncture. In our case, radiofrequency catheter ablation from the right superior pulmonary vein allowed us to successfully treat the arrhythmia without hampering the phrenic nerve integrity. [ABSTRACT FROM AUTHOR]

Cardiac involvement in the rare monogenic autosomal recessive Alström syndrome (ALMS) may manifest as infantile, juvenile or adult dilated or restrictive cardiomyopathy. Case reports have described ventricular arrhythmias and conduction system disease, though little is known about atrial arrhythmia burden and management in these patients. This case presents a possible underreported atrial phenotype of the ALMS with exceptionally advanced structural remodelling with atrial scar encompassing nearly the entire left atrium in a young patient. It highlights the difficulties in managing these patient with medical rate and rhythm control due to frequent multi-organ involvement and concomitant conduction system disease, as well as the challenges faced during invasive activation mapping in an exceptionally disease atrial myocardium with ubiquitous complex low amplitude EGMs undermining the value of high density mapping with automated annotation algorithms. [ABSTRACT FROM AUTHOR]

Background: Radiofrequency ablation (RFA)is an important treatment option for patients with atrial fibrillation (AF). During RFA, a significant amount of energy is delivered into the left atrium (LA), resulting in considerable LA-injury. The impact of this damage on mechanical and endocrine LA-function, however, is often disregarded. We therefore aimed to evaluate the endocrine- and mechanical function of the heart 4-months after RFA of AF. Methods: In total 189 patients eligible for RFA of AF were studied. The levels of the N-terminal pro-B-natriuretic peptide (NT-proBNP) and the mid-regional fragment of the N-terminal pro-atrial natriuretic peptide (MR-proANP) were measured. The maximum LAvolume (LAVmax),the LA ejection fraction (LAEF) and the LA peak longitudinal strain (PALS), were measured using transthoracic echocardiography. The measurements were performed before and 4-months after the intervention. Results: 87 patients had a recurrence during a mean follow-up of 143±36 days. NT-proBNP and MR-proANP decreased significantly at follow-up. This reduction was greater in patients who did not suffer any recurrence after RFA. The LAVmax decreased significantly, whereas the PALS only improved in patients who did not suffer from any recurrence. On the other hand, LAEF did not change significantly after RFA of AF. Conclusions: Despite extensive ablation during RFA of AF, the endocrine function of the heart improved 4-months after the index procedure. Patients with no arrhythmia recurrence showed a more pronounced improvement in their endocrinal function. Mechanically, the LAVmax was reduced, and the LA strain improved significantly. [ABSTRACT FROM AUTHOR]

Background: Radio frequency ablation (RFA)is an important treatment option for patients with atrial fibrillation (AF). During RFA, a significant amount of energy is delivered into the left atrium (LA), resulting in considerable LA-injury. The impact of this damage on mechanical and endocrine LA-function, however, is often disregarded. We therefore aimed to evaluate the endocrine- and mechanical function of the heart 4-months after RFA of AF. Methods: In total, 189 patients eligible for RFA of AF were studied. The levels of the N-terminal pro-B-natriuretic peptide (NT-proBNP) and the mid-regional fragment of the N-terminal pro-atrial natriuretic peptide (MR-proANP) were measured. The maximum LAvolume (LAVmax), the LAejection fraction (LAEF) and the LA peak longitudinal strain (PALS), were measured using transthoracic echocardiography. The measurements were performed before and 4-months after the intervention. Results:87 patients had a recurrence during a mean follow-up of 143±36 days. NT-proBNP and MR-proANP decreased significantly at follow-up. This reduction was greater in patients who did not suffer any recurrence after RFA. The LAVmax decreased significantly, where as the PALS only improved in patients who did not suffer from any recurrence. On the other hand, LAEF did not change significantly after RFA of AF. Conclusions: Despite extensive ablation during RFA of AF, the endocrine function of the heart improved 4-months after the index procedure. Patients with no arrhythmia recurrence showed a more pronounced improvement in their endocrinal function. Mechanically, the LAV max was reduced, and the LA strain improved significantly. [ABSTRACT FROM AUTHOR]

Background: A novel QDOT MICRO (Biosense Webster, Inc., Irvine, CA) catheter with optimized temperature control and microelectrodes was designed to incorporate real-time temperature sensing with contact force detection and microelectrodes to streamline ablation workflow. The QDOT-MICRO feasibility study evaluated the workflow, performance, and safety of temperature-controlled catheter ablation in patients with symptomatic paroxysmal atrial fibrillation with conventional ablation setting. Methods: This was a non-randomized, single-arm, first-in-human study. The primary outcome was pulmonary vein isolation (PVI), confirmed by entrance block after adenosine and/or isoproterenol challenge. Safety outcomes included incidences of early-onset primary adverse events (AEs) and serious adverse device effects (SADEs). Device performance was evaluated via physician survey. Results: All evaluated patients (n = 42) displayed 100% PVI. Two primary AEs (4.8%) were reported: 1 pericarditis and 1 vascular pseudoaneurysm. An additional SADE of localized infection was reported in 1 patient. No stroke, patient deaths, or other unanticipated AEs were reported. Average power delivered was 32.1±4.1 W, with a mean temperature of 40.8°C±1.6°C. Mean procedure (including 20-minute wait), fluoroscopy, and radiofrequency application times were 129.8, 6.7, and 34.0 minutes, respectively. On device performance, physicians reported overall satisfactory performance with the new catheter, with highest scores for satisfaction and usefulness of the temperature indicator. Conclusions: Initial clinical experience with the novel catheter showed 100% acute PVI success and acceptable safety and device performance in temperature-controlled ablation mode. There were no deaths, stroke, or unanticipated AEs. Fluoroscopy and procedural times were short and similar or better than reported for prior generation catheters. [ABSTRACT FROM AUTHOR]

Coronary artery spasm during catheter ablation for arrhythmias is a rare but previously reported complication. Timing of presentation, manifestations of vasospasm, and purported mechanisms vary somewhat in the prior literature. We present a case of chest pain, inferior lead ST elevation, and complete AV block with angiographically confirmed right coronary artery (RCA) vasospasm that occurred immediately after catheter ablation for atrial fibrillation. [ABSTRACT FROM AUTHOR]

Cardiac electrophysiology study (EPS) and catheter ablation procedure are established diagnostic and therapeutic procedures for cardiac arrhythmias. Pulmonary embolism (PE) is a relatively rare but potentially fatal complication of cardiac electrophysiology study (EPS). The paradoxical embolism (PDE) occurs due to an intracardiac defect with a right to left shunt with patent foramen ovale (PFO) being the most common cause. The simultaneous occurrence of PE and PDE is rare. Here we present a case of PE and PDE after EPS and radiofrequency catheter ablation (RFCA) of the slow pathway in a patient with recurrent supraventricular tachycardia (SVT) due to atrioventricular nodal reentry tachycardia (AVNRT). To our knowledge, such a case of PE and PDE has not been reported after SVT ablation. [ABSTRACT FROM AUTHOR]

Background: The long-term results of endocardial and percutaneous epicardial catheter ablation of ventricular tachycardia (VT) in patients with structural heart disease are disappointing. Arrhythmia recurrence after ablation, and VTs with an epicardial substrate remain a clinical challenge. The purpose of this manuscript is to elaborate on feasibility and potential advantages of a surgical hybrid ablation (i.e., combined endocardial and surgical epicardial ablation) based on our initial experience consisting of five cases. Methods: Endocardial electro-anatomical voltage and activation maps were created (Carto, Biosense Webster, California, USA), and endocardial radiofrequency applications were applied at exit sites, low voltage areas and isthmi. Next, after surgical access, epicardial voltage and activation maps were produced in combination with visual assessment of the epicardial substrate. Epicardial low voltage areas, isthmi and exit sites were identified and ablated using radiofrequency energy. Results: After the procedure, VT was non-inducible in 80% of the cases (4/5, in one case no induction was performed). No peri-procedural complications occurred. After a mean follow-up of 18 months, one patient remained in sinus rhythm without, and 2 with use of antiarrhythmic drugs. One patient needed a redo procedure after 21 months, and in one patient the amiodarone dose was raised because of 2 sustained VTs. After this additional treatment, both kept sinus rhythm. Conclusions: Hybrid VT ablation is a safe and effective patient tailored procedure that comprises the major advantage of combining direct anatomical visualization and enhanced catheter stability with high-density 3D mapping. As a consequence, this procedure should be considered as a valid treatment option in complex VT management. [ABSTRACT FROM AUTHOR]

Atrial fibrillation is the most common cardiac rhythm disorder observed in clinical practice. It carries high morbidity and mortality rates, primarily related to heart failure, stroke and death. Validation of noninvasive markers in the diagnosis of heart failure with preserved ejection fraction and risk stratification is relevant in this clinical setting. The spectral tissue Dopplerderived E/e' ratio is a simple and reproducible index, which has been validated in noninvasive assessment of left ventricular diastolic pressures, regardless of rhythm. Septal E/e' >11 is a good predictor of invasively determined left ventricular diastolic pressure >15 mmHg in patients with atrial fibrillation. Several studies have validated the clinical relevance of abnormal values for E/e' at rest and during exercise in the diagnosis and risk stratification of heart failure with preserved ejection fraction in patients with atrial fibrillation. Increased E/e' value is associated with adverse outcome (death, left atrial appendage thrombus, stroke and heart failure) in patients with atrial fibrillation and predicts arrhythmia recurrence after cardioversion and catheter ablation. In conclusion, E/e' by spectral tissue Doppler is clinically relevant in the clinical management of any patients with atrial fibrillation referred for transthoracic Doppler echocardiography. [ABSTRACT FROM AUTHOR]

A case is presented demonstrating the value of intracardiac echocardiography during ablation of tricuspid ring premature ventricular complexes. [ABSTRACT FROM AUTHOR]

Background: Catheter ablation of long-standing persistent AF (LSAF) remains challenging. Since AF-Nest (AFN) description, we have observed that a stable, protected, fast source firing, namely "Background Tachycardia"(BT), could be hidden beneath the chaotic AF. Following pulmonary vein isolation (PVI)+AFN ablation one or more BT may arise or be induced in 30-40% of patients, which could be the culprit forAF maintenance and ablation recurrences. Methods and Results: We studied 114 patients, from 322 sequential LSAF regular ablations, having spontaneous or induced residual BT after EGM-guided PVI+AFN ablation of LSAF; 55.6±11y/o, 97males (85.1%), EF=65.5±8%, LA=42.8±6.7mm. Macroreentrant tachycardias were excluded. Pre-ablationAF 12-leads ECG Digital processing(DP) and spectral analysis(SA) was performed searching for BT before AF ablation and its correlation with BT during ablation. After PVI, 38.1±9 AFN sites/patient and 135 sustained BTs (1-3, 1.2±0.5/patient) were ablated. BT cycle length(CL) was 246.3±37.3ms. In 79 patients presenting suitable DP for SA, the BT-CL was 241.6±34.3ms with intra procedure BT-CL correlation r=0.83/p<0.01. Following BT ablation, AF could not be induced. During FU of 13→60 months(22.8±12m), AF freedom for BT RF(+) vs. BT RF(-) groups were 77.9% vs. 56.4% (p=0.009), respectively. There was no significant complication. Conclusions: BT ablation following PVI and AFN ablation improved long-term outcomes ofLSAF ablation. BT is likely due to sustained microreentry, protected during AF by entry block. BT can be suspected by spectral analysis of the pre-ablation ECG and is likely one important AF perpetuator by causing electrical resonance of the AFN. This ablation strategy warrants randomized, multicenter investigation. [ABSTRACT FROM AUTHOR]

Moderate to heavy alcohol use has been shown to be associated with increased atrial fibrillation (AF) incidence. However, the relationship between alcohol use and AF recurrence after pulmonary vein isolation (PVI) is not well known. We sought to study the impact of different alcohol consumption levels on outcomes after AF ablation.A retrospective analysis was performed of 226 consecutive patients undergoing first time PVI for AF. Clinical data were collected including alcohol intake classified into 3 groups: none-rare (< 1 drink/week), moderate (1-7 drinks/week), and heavy (> 7 drinks/week). Patients were followed for recurrences within the first 3 months (blanking period; early recurrence) and after 3 months up to 1 year (late recurrence) after the ablation. Paroxysmal and persistent AF had early recurrence rates of 29.1% and 32.2%, and late recurrence rates of 30.2% and 44.1%, respectively. The none-rare alcohol group had a higher frequency of diabetes mellitus (p=0.007). Neither moderate or heavy alcohol consumption, in reference to the none-rare group, was significantly predictive of early or late AF recurrence on adjusted multivariate logistic regression analysis (p>0.05).Despite known associations between alcohol and incidence of AF, alcohol consumption is not associated with early or late AF recurrence after PVI in this cohort. [ABSTRACT FROM AUTHOR]

Premature ventricular complexes (PVCs) and ventricular tachycardia (VT) in patients with structurally normal hearts originate from the right ventricular outflow tract (RVOT) in the majority of cases. In the last few decades catheter ablation of these arrhythmias has been proven to be effective. RVOT VT/PVCs may cause disabling symptoms or arrhythmia induced cardiomyopathy. However, the PVC burden at which catheter ablation should be recommended is still controversial. What adds to the controversy is why some patients with only a low number of PVCs can be highly symptomatic and may even develop arrhythmia induced cardiomyopathy, whilst others may have a higher PVC/VT burden and remain asymptomatic and do not develop cardiomyopathy for a long period of time. Therefore, although catheter ablation of RVOT PVCs has high success and low complication rates, the time point of when ablation should be recommended is currently still under debate. This review discusses the treatment strategies and prognosis for RVOT tachycardias and focuses on the question of which arrhythmia burden is appropriate to offer RF ablation. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most common arrhythmia and is a major cardiovascular challenge due to its close association with increased morbidity and mortality. Although the incidence and prevalence of AF is slightly lower in developing countries than in developed countries, the AF-associated risk of stroke is similar. Treatment of AF is far from satisfactory in developing countries, which may be due to limited health-care resources and social and racial characteristics that differ from Western populations. Chronic rate control is still the main treatment strategy of persistent AF because anti-arrhythmic drugs have only a modest long-term effect on maintenance of sinus rhythm, and no superior impact in terms of cardiovascular outcomes. With the development of ablation techniques and strategies, more AF patients received catheter ablation, although the benefit, complications, and high recurrence rate associated with AF ablation remain under investigation. Improvement in antithrombotic therapy of AF has been observed, although still fewer patients receive oral anticoagulants in developing countries than in Western countries. Novel treatment for the prevention of thromboembolism, such as new oral anticoagulants with different mechanisms of action or the percutaneous transcatheter closure of the left atrial appendage, has recently been introduced in developing countries as an alternative option for the prevention of AF-associated strokes. More data are needed regarding upstream therapy. [ABSTRACT FROM AUTHOR]

Catheter ablation is widely used to treat drug-refractory, symptomatic atrial fibrillation (AF). However, beyond pulmonary vein isolation, there remains little consensus on the recommended approach to ablation both in paroxysmal or persistent AF patients. Although ancillary ablation strategies are often used, the lack of a clear endpoint for AF ablation makes it challenging to evaluate their importance. Noninducibility and termination of AF during AF ablation have been advocated as potential endpoints. Several studies have attempted to assess their role in an AF ablation protocol. However, the data for non-inducibility and termination as endpoints are mixed. Moreover, there are a number of limitations in the studies reported and limitations of the endpoints themselves. It is likely that non-inducibility or termination of AF during AF ablation may be markers of less structural remodeling rather than true endpoints for ablation. Herein, we review the relevant literature on the topic of inducibility and termination with respect to AF ablation and attempt to draw conclusions with guidance to further investigation. [ABSTRACT FROM AUTHOR]

Pediatric patients present unique anatomic challenges for catheter ablation. Small patient size requires special adaptation and understanding to perform safe procedures when clinically indicated. The anatomic variations of congenital heart disease also create problems that require pre-procedural preparation for each case in addition to a specialized understanding of a vast anatomic variation and surgical repairs. This understanding coupled with the knowledge of the pathophysiology of arrhythmia disorders and the biophysics of catheter ablation technology are required to perform successful and safe ablation procedures in this special population. [ABSTRACT FROM AUTHOR]

This case report highlights the variety of wide complex tachycardias, and the need for their prompt management, in the growing population of patients with circulatory support devices. We present a case that demonstrates how a wide complex supraventricular tachycardia in a patient with a biventricular assist device can be safely and effectively targeted for treatment using percutaneous radiofrequency catheter ablation, allowing for clinical improvement, weaning of RVAD treatment, and discharge home with LVAD alone. [ABSTRACT FROM AUTHOR]