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The article discusses a study which investigated the hypothesis that acute pulmonary vein isolation (PVI) results from a combination of irreversible and reversible atrial injury. The study used cardiac magnetic resonance imaging (CMRI) after radiofrequency ablation and involved 25 paroxysmal atrial fibrillation (AF) patients. The study found the higher T2 signal on acute scans. Greater decline in delayed enhancement (DE) on chronic imaging in patients with recurrences is also observed.

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]

Aims: To prospectively compare cardiac magnetic resonance late gadolinium enhancement (LGE) findings created by standard vs. robotically assisted catheter ablation lesions and correlate these with clinical outcomes., Methods and Results: Forty paroxysmal atrial fibrillation patients (mean age 54 ± 13.8 years) undergoing first left atrial ablation were randomized to either robotic-assisted navigation (Hansen Sensei(®) X) or standard navigation. Pre-procedural, acute (24 h post-procedure) and late (beyond 3 months) scans were performed with LGE and T2W imaging sequences and percentage circumferential enhancement around the pulmonary vein (PV) antra were quantified. Baseline pre-procedural enhancements were similar in both groups. On acute imaging, mean % encirclements by LGE and T2W signal were 72% and 80% in the robotic group vs. 60% (P = 0.002) and 76%(P = 0.45) for standard ablation. On late imaging, the T2W signal resolved to baseline in both groups. Late gadolinium enhancement remained the predominant signal with 56% encirclement in the robotic group vs. 45% in the standard group (P = 0.04). At 6 months follow-up, arrhythmia-free patients had an almost similar mean LGE encirclement (robotic 64%, standard 60%, P = 0.45) but in recurrences, LGE was higher in the robotic group (43% vs. 30%, P = 0.001). At mean 3 years follow-up, 1.3 procedures were performed in the robotic group compared with 1.9 (P < 0.001) in the standard to achieve a success rate of 80% vs. 75%., Conclusion: Robotically assisted ablation results in greater LGE around the PV antrum. Effective lesions created through improved catheter stability and contact force during initial treatment may have a role in reducing subsequent re-do procedures., (© The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.)