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Aims: The previous literature has suggested that the iatrogenic atrial septal defects (IASDs) may follow left atrial (LA) access by transseptal (TS) puncture, especially in the case of a single TS for more than one catheter. The aim of the present study is to describe the prevalence of patent foramen ovale (PFO) and IASDs in a cohort of atrial fibrillation (AF) patients undergoing redo catheter ablation (CA) procedures in a high-volume centre accessing LA by a standardized single TS puncture., Methods and Results: Patients (n = 197) who underwent at least one redo AFCA, between 2004 and 2012, were retrospectively enroled. Transoesophageal echocardiography was performed before each procedure during which LA was accessed via a PFO, if present, or by single TS for both the mapping and ablation catheters. At baseline, PFO was detected in 43 (21.8%) patients. Clinical and echocardiographic parameters recorded did not differ within patients presenting with or without PFO. Left atrium was accessed via PFO in 39 (90.7% of those with PFO) patients during the first procedure. New-onset IASD occurred in 11 (5.6%) patients following the first procedure and in 1 (2.2%) patient following the second procedure. The clinical and echocardiographic parameters did not differ within the patients irrespective of whether IASD was reported or not. No TS-related complications occurred., Conclusion: In the present cohort, LA access by PFO or single TS for both the mapping and ablation catheters lead to a small risk of asymptomatic IASD, not increased by redo procedures, confirming that it represents a safe approach. No clinical and/or echocardiographic parameters seemed to predict IASD occurrence., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.)

Background: The natural history of atrial fibrillation (AF) is characterized by gradual increase in duration and frequency of relapses until a definitive shift to permanent AF. Heart disease and comorbidities modulate AF progression. However, to date the influence of catheter ablation on AF evolution has rarely been investigated., Objective: The purpose of this study was to identify long-term predictors of AF progression in a large cohort of patients undergoing AF transcatheter ablation (AFTCA)., Methods: A total of 889 patients (mean age 57 ± 11 years; 53.3% paroxysmal AF, 40.5% persistent AF, 6.2% long-standing AF) underwent AFTCA. All patients underwent pulmonary vein isolation, with linear lesions and complex fractionated atrial electrogram ablation reserved for patients with persistent/long-standing AF and/or confirmed structural heart disease., Results: After median follow-up of 64 months (range 41-84 years), AF progression despite AFTCA occurred in 57 cases (6.4%). However, AF progression was much more pronounced in patients with persistent (10%) or long-standing persistent AF (14.6%) than in those with paroxysmal AF (2.7%, P <.001). Furthermore, AF progression was more frequently reported in patients who presented with underlying comorbidities/cardiomyopathies (9.1%) than in those who presented with lone AF (29.9%, P <.001). At multivariate analysis, comorbidities/cardiomyopathies and baseline persistent/long-standing AF proved to be independent predictors of progression (odds ratio 11.3, 95% confidence interval 2.6-48.0, P <.001, and odds ratio 1.6, 95% confidence interval 1.2-2.1, P <.001, respectively)., Conclusion: The presence of comorbidities/cardiomyopathies and persistent/long-standing AF seem to predict AF progression in patients undergoing AFTCA. Performing AFTCA in the paroxysmal phase of the arrhythmia may reduce progression of AF to its permanent form., (Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Background: We prospectively compared the efficacy, safety, and quality of life (QoL) impact of catheter ablation versus antiarrhythmic drugs (AAD) in elderly patients with persistent atrial fibrillation (AF)., Methods and Results: Four hundred and twelve consecutive patients, aged ≥ 70 years, underwent ablation (Group A, 153 patients) or AAD (Group B, 259 patients). Study endpoints: treatment failure (any AF/AT lasting >30 seconds) and treatment-related adverse events (acute when ≤1 month of procedure and long term when >1 month). At a follow-up of 60 ± 17 months, 43% and 46% patients in Group B versus 58% and 76% in Group A were in sinus rhythm (SR), respectively, after one (P = 0.003) and 2 procedures (P < 0.001). Fifteen acute adverse events occurred (6.7% in Group A vs 1% in Group B, P < 0.001), mainly periprocedural cerebral thromboembolism (3.3% in Group A vs 0.7% in Group B, P = 0.058). Previous TIA/stroke resulted the only independent predictor of periprocedural cerebrovascular accidents (OR 1.2, 95%IC 1.1-1.3). At follow-up, 74 long-term adverse events occurred (7.7% in Group A vs 23.9% in Group B, P < 0.001) with Group B patients more often experiencing AAD-related adverse events (12.7% vs 2.6%, P < 0.001). Group A and absence of AF/AT recurrences significantly improved QoL scores (P < 0.001)., Conclusions: In elderly persistent AF patients, catheter ablation is more effective in maintaining SR and in improving QoL than AAD but is affected by a higher risk of embolic complications, particularly in patients with previous TIA/stroke. Over time, Group A patients more likely discontinued AAD with a reduction of long-term adverse events., (© 2013 Wiley Periodicals, Inc.)