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Previous clinical studies on pulmonary vein isolation (PVI) with radiofrequency balloons (RFB) reported safe and effective procedures for a 20 s RF delivery via posterior electrodes. Recent recommendations from the manufacturer suggest reducing the application time to 15 s on the posterior wall (PW) when facing the esophagus region. Here, we retrospectively assess whether 15 s of RF delivery time on posterior electrodes is safe while still ensuring lesion metrics of sufficient quality. This retrospective study included 133 patients with paroxysmal and persistent atrial fibrillation who underwent PVI using an RFB (Heliostar, Biosense Webster, Inc., Irvine, CA, USA) at two European centers. The ablation protocol was set for an RF duration of 20 s/60 s for the posterior/anterior electrodes. A multielectrode temperature probe was systematically used. In the case of an esophageal temperature rise (ETR) above 42 °C (ETR+), an endoscopic evaluation was performed. All posterior electrode lesion metric dynamics (temperature (T) and impedance (Z)) were collected from the RFB generator and analyzed offline. In total, 2435 posterior electrode applications were analyzed. With an RF delivery of 19.8 (19.7–19.8) s, the median impedance drop was 18.4 (12.2–25.2) Ω, while the temperature rise was 11.1 (7.1–14.9) °C. Accordingly, impedance (84.6 (79.3–90.2) Ω) and temperature plateaus (38 (35.3–41.1) °C) were reached at 13.9 (10.6–16) s and 16.4 (12.6–18.5) s, respectively. Overall, 99.6% and 95.8% of electrodes reached 90% (16.6 Ω) and 95% (17.5 Ω) of their impedance drops within 15 s of RF delivery, while 97.2% and 92.8% achieved 90% (34.2 °C) and 95% (36.1 °C) of their temperature rise to reach the plateaus within 15 s of RF delivery. An ETR >42 °C occurred in 37 (30.1%) patients after 17.7 ± 2.3 s of RF delivery. In the ETR+ group, the impedance drop and temperature rise on the posterior electrodes were higher compared to patients where ETR was

BackgroundCoronavirus disease 2019 (COVID-19) is a systemic disease caused by severe acute respiratory syndrome coronavirus 2. Arrhythmias are frequently associated with COVID-19 and could be the result of inflammation or hypoxia. This study aimed to define the incidence of arrhythmias in patients with COVID-19 and to correlate arrhythmias with pulmonary damage assessed by computed tomography (CT).MethodsAll consecutive patients with a COVID-19 diagnosis hospitalized at Universitair Ziekenhuis Brussel, Belgium, between March 2020 and May 2020, were screened. All included patients underwent a thorax CT scan and a CT severity score, a semiquantitative scoring system of pulmonary damage, was calculated. The primary endpoint was the arrhythmia occurrence during follow-up.ResultsIn this study, 100 patients were prospectively included. At a mean follow-up of 19.6 months, 25 patients with COVID-19 (25%) experienced 26 arrhythmic episodes, including atrial fibrillation in 17 patients, inappropriate sinus tachycardia in 7 patients, atrial flutter in 1 patient, and third-degree atrioventricular block in 1 patient. No ventricular arrhythmias were documented. Patients with COVID-19 with arrhythmias showed more often need for oxygen, higher oxygen maximum flow, longer QTc at admission, and worse damage at CT severity score. In univariate logistic regression analysis, significant predictors of the primary endpoint were: the need for oxygen therapy (odds ratio [OR] 4.59, 95% CI 1.44–14.67, p = 0.01) and CT severity score of pulmonary damage (OR per 1 point increase 1.25, 95% CI 1.11–1.4, p < 0.001).ConclusionsIn a consecutive cohort of patients with COVID-19 the incidence of cardiac arrhythmias was 25%. The need for oxygen therapy and CT severity score were predictors of arrhythmia occurrence during follow-up.

Electrical isolation of pulmonary veins (PVI) is the cornerstone of invasive treatment of atrial fibrillation (AF). However, arrhythmia-free survival of a PVI only approach is suboptimal in patients with persistent and long-term persistent AF. Hybrid AF ablation has been developed with the aim of combining the advantages of a thoracoscopic surgical ablation (direct visualization of anatomical structures to be spared and the possibility to perform epicardial lesions) and endocardial ablation (possibility to check line block, confirm PVI, and possibility to perform cavotricuspid isthmus ablation). Patient selection is of utmost importance. In persistent and long-term persistent AF, hybrid AF ablation demonstrated promising results in terms of AF free survival. It has been associated with a relatively low complication rate if performed in centers with expertise in hybrid procedures and experience with both surgical and endocardial ablation. Different techniques have been described, with different approaches and lesion sets. The aim of this review is to provide a state-of-the-art overview of hybrid AF ablation.

Le bloc auriculo-ventriculaire (BAV) représente une complication non négligeable de la chirurgie cardiaque. Il est responsable de séquelles lourdes et graves compromettant le pronostic de la maladie et conduisant à la mise en place d'un stimulateur cardiaque définitif. Il est primordial d'étudier et de déterminer les différents facteurs prédictifs de BAV post opératoire, son histoire naturelle, son incidence ainsi que le délai exact de la mise en place d'un pacemaker. Notre étude est une étude rétrospective descriptive à propos de 23 patients opérés pour chirurgie cardiaque sous circulation extracorporelle entre octobre 1989 et août 2010 ayant présentés des troubles conductifs auriculo-ventriculaires en post opératoire..Plusieurs facteurs de risque ont été étudiés dans notre série, liés surtout à l'atteinte directe du noeud auriculo-ventriculaire ou à l'ischémie myocardique. Le délai d'apparition du trouble conductif ainsi que le délai d'implantation on été également étudié. Plusieurs facteurs favorisants de survenue de BAV ont été identifiés liés essentiellement au type de la cardiopathie opérée avec une prédominance de la cardiopathie congénitale, d'autres facteurs ont été rapportés notamment la présence d'hypertrophie ventriculaire gauche (HVG) de troubles conductifs en préopératoire, une durée du clampage aortique et de CEC prolongée. La moitié des patients ont présenté un BAV immédiat. Le délai d'implantation par rapport à la date de la découverte du BAV varie dans notre série d'une implantation immédiate après le diagnostic positif (J0) à un délai d'implantation allant jusqu'à 57 jours. Plusieurs facteurs de risques déterminent la survenue de BAV post chirurgie cardiaque, leur connaissance est primordial ainsi que le délai exact de l'implantation du stimulateur cardiaque définitif.

Le syndrome CHARGE est caractérisé par un large polymorphisme clinique associant colobome, anomalies cardiaques, atrésie de choanes, retard staturo-pondéral et de développement, anomalies génitales, anomalies des oreilles ainsi que d'autres anomalies. Les auteurs rapportent le cas d'un syndrome CHARGE diagnostiqué lors du bilan d'une tétralogie de Fallot chez un nourrisson de 22 mois. Les différentes manifestations cliniques de ce syndrome sont rapportées ainsi que les critères diagnostiques.