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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]

Multispline catheters were recently introduced and have led to significant improvements in electrogram acquisition and analysis. Omnipolar mapping is now able to be performed with these multispline catheters. Omnipolar mapping has the advantages of mapping a focal segment without needing the entire chamber of interest to be mapped, does not need a stable reference and is cycle length independent. This article will review the mechanism of omnipolar mapping and show how this technology can be used for multiple arrythmias. [ABSTRACT FROM AUTHOR]

Peripartum cardiomyopathy is an idiopathic cardiomyopathy that most commonly affects women in the third trimester of pregnancy or in the first five months of the postpartum period. It has been associated with a myriad of different findings on electrocardiograms and arrhythmias. This review discusses these electrocardiogram changes and arrhythmias in regards to prevalence, genetic landscape, screening and prognostication implications, and management. [ABSTRACT FROM AUTHOR]

Background: Robotic systems have been used in a diverse spectrum of cardiac interventions, mainly in the field of invasive cardiology, namely interventional cardiology and electrophysiology (EP). The state-of-the-art robotic systems allow mapping and ablation of various arrhythmias without the need for manual conventional catheter steering. The aim of robotic procedures is to achieve the same effectiveness and safety as conventional procedures, whilst reducing the radiation exposure for patients and operators, and to be able to reach targets within the heart that are otherwise unreachable conventionally with greater precision and catheter stability. Purpose: We aimed to demonstrate the feasibility of 3D electroanatomical mapping (EAM) using the remote magnetic navigation (RMN) system (Niobe ES, Stereotaxis Inc) by comparing the mapping performance of 2 operators (one located in the electrophysiology catheter lab control room and the second ~1200 km away via remote online connection). Methods: Two operators were tasked to perform 3D fast anatomical maps (FAM, CARTO 3 RMT, Biosense Webster) of the right and left atrial and ventricular chambers, as well as the aorta of a 3D phantom representing normal cardiac anatomy. All procedures were recorded on the Odyssey Cinema system for further analysis. Parameters compared were duration of FAM, total volume acquired and average distance of surface match to a contrast enhanced computed tomography (CT) of the same phantom. A composite endpoint of map completeness, mapping time and surface match accuracy was calculated to demonstrate if quality of the maps between operators were comparable. Results: A total of 60 maps were created (6 maps for each right atrium (RA), left atrium (LA), right ventricle (RV), left ventricle (LV) and aorta (Ao) per operator) in an alternating fashion. Average mapping time was 16:08±3:36 min for all chambers with shorter mapping times for right atrial chamber 14:28±3:47 min. Total volumes did not significantly differ between operators. Match statistics also revealed no difference between map completeness. Comparing the composite endpoint, both operators achieved the same accuracy. Conclusion: A distant operator located more than 1200 km away from the RMN laboratory connected online to perform 3D electroanatomical maps of all cardiac chambers of a phantom with equal accuracy and procedure parameters as compared to an operator located in the control room. These results support the feasibility of truly remote-controlled procedures which would allow an expert operator to actively support a local team in EP interventions. [ABSTRACT FROM AUTHOR]

Introduction: Symptoms like syncope or palpitations frequently present a diagnostic challenge. An implantable loop recorder (ILR) is an important aid in the management of these patients. Methods: A retrospective study of patients that underwent ILR implantation from November 2007 to 2014. For each patient the indication for implantation, baseline characteristics, previous study, complications, recorded tracing and interventions were evaluated. Results: A total of 62 patients were included, 50% men, with a mean age of 62.5±18.8 years old. Previously to ILR implantation 88.7% of patients had performed Holter, 17.7% external events recorder, 33.9% Tilt test and 29% an electrophysiological study. The implantation indications were recurrent syncope in 90.3%, palpitations 8.1% and ischemic stroke in one patient. Mean follow-up time was 17.1±16.3 months. Symptoms were reported in 66.1% of the patients, 46.8% of those yielding a diagnostic finding. In all cases of palpitation complaints with diagnosis we found atrial fibrillation (AF). In patients with syncope atrioventricular conduction disturbance was demonstrated in 19.6%, sinus node dysfunction in 16.1%, paroxysmal supra-ventricular tachycardia 7.1% and AF in 1.8%. These finding resulted in 19 pacemaker and one CRT-D implantation, introduction of anticoagulation in five patients and one ablation of accessory pathway. There were no major complications. Conclusion: ILR proved to be safe and efficient. It has enabled the identification or exclusion of serious rhythm disturbances in more than half of patients and provided a targeted therapeutic intervention. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is a complex arrhythmia, that has been studied non-invasively assessing atrial refractory period, atrioventricular node (AV) node refractory period, and ventricular response. The AV node plays a fundamental role as it filters many of the numerous irregular atrial impulses bombarding the node. Despite its importance, the electrophysiological (EP) characteristics of the AV node are not routinely evaluated since conventional EP techniques for assessment of refractory period or conduction velocity of the AV node are not applicable in AF. Since rate-control drugs control ventricular response through their effect on the AV node, noninvasive assessment of AV node electrophysiology may be useful. The RR series, though being highly irregular, contains information that can be used for risk stratification and prediction of outcome. In particular, RR irregularity measures during AF have been shown to be related to clinical outcome. This paper reviews the attempts done to noninvasively characterize the AV node and the ventricular response, highlighting clinical applications and limitations of the noninvasive techniques. [ABSTRACT FROM AUTHOR]