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Introduction: Pulmonary vein isolation (PVI) is a recommended strategy for rhythm control in atrial fibrillation (AF), but its success rate remains unsatisfactory. Continuous research is being conducted to explore new technologies and modifications to the existing ablation workflow in order to reduce the arrhythmia recurrence rate., Objectives: This study aimed to determine the influence of the distance between ablation lines (DBL) on AF recurrence rate in patients undergoing their first PVI; and thus to optimize the procedure outcomes., Patients and Methods: This is a retrospective cohort study conducted at a tertiary care center in Poland. A total of 146 patients (median age, 62 years; women, 34.3%) referred for a first PVI for either paroxysmal (n = 103) or persistent (n = 43) AF were evaluated. The procedures were performed with the use of a very‑high‑power, short‑duration catheter (QDot MicroTM, Biosense Webster, Inc., Irvine, California, United States) or a conventional, ablation index-guided ThermoCool Smarttouch SF catheter (Biosense Webster, Inc.). Freedom from AF recurrence was used as a primary end point. The impact of DBL on the outcome of PVI, accounting for conventional risk factors, was evaluated., Results: Greater distance between opposite circumferential PVI lines and its ratio to the transverse diameter of the left atrium (DLB/TD) were associated with a lower risk of AF recurrence (hazard ratio [HR], 0.966; 95% CI, 0.935-0.998 [per 1 mm]; P = 0.04 and HR, 0.968; 95% CI, 0.944-0.993 [per 1%]; P = 0.01, respectively). There was no correlation between DBL or DBL/TD ratio and the impedance level., Conclusions: Close distance between PVI lines contributes to AF recurrence; thus, increasing the DBL and ensuring a higher DBL/TD ratio may be an advantageous ablation strategy.

Background: Pulmonary vein isolation (PVI) is at the forefront of rhythm control strategies in patients with atrial fibrillation (AF). A very-high-power, short-duration (vHPSD) catheter, QDot MicroTM (Biosense Webster) was designed to improve the effectiveness of AF ablation within a shorter procedure time. The aim of this study was to compare the effectiveness and safety of PVI ablation between this vHPSD ablation mode and conventional ablation-index-guided ablation (ThermoCool Smarttouch SF catheter)., Methods: This single-center, retrospective, observational study enrolled 108 patients with AF, referred for catheter ablation between December 16, 2019 and December 3, 2021. In 54 procedures (mean age: 58.0 ± 12.3; 66.67% male), a QDot MicroTM catheter was used (vHPSD-group), and 54 patients (mean age: 57.2 ± 11.8; 70.37% male) were treated with a ThermoCool SmarttouchTM SF catheter (AI-group). The primary endpoint was freedom from AF 3 months after ablation., Results: Atrial fibrillation was found to recur in 14.81% of patients in the vHPSD-group and in 31.48% of patients in the AI-group (p = 0.07). There was no difference in treatment-emergent adverse events between the two groups (6.3% vs. 0%; p = 0.10). One severe adverse event (a cerebral vascular accident) was observed in the vHPSD-group. The mean dose of remifentanil was reported to be lower during QDot MicroTM catheter-based PVI (p < 0.01). The vHPSD-based PVI was associated with shorter radiofrequency application time (p < 0.001), fluoroscopy time (p < 0.0001), and total procedure time (p < 0.0001)., Conclusions: This study suggests vHPSD ablation is safe, can reduce the dosage of analgesics during significantly shorter procedures and may enhance the success rate of catheter-based PVI.

Purpose: Pulmonary vein isolation is a well established method of definite treatment of atrial fibrillation (AF). Periprocedural onset of AF usually terminates spontaneously within minutes, but not in all cases. Antazoline is an antihistaminic agent with antiarrhythmic properties. The aim of our retrospective study was to evaluate the efficacy of antazoline in termination of AF in patients undergoing pulmonary vein isolation., Materials and Methods: Consecutive 141 patients who received antazoline to terminate AF during pulmonary vein isolation were analyzed. The antazoline was administered at the rate of 30-50mg/min (max. 500mg) after the circumferential ablation in the ostia of pulmonary veins and before confirmation of isolation. Success was defined as restoration of sinus rhythm within 20min after antazoline infusion., Results: The efficacy of antazoline was 83.6% in paroxysmal and 31.1% in persistent AF patients. Clinical variables that were independently predictive of antazoline ineffectiveness were female (odds ratio [OR]: 4.35; 95% confidence interval [CI]: 1.26-14.3; p=0.018) and AF at the beginning of procedure (OR 28.4; 95% CI 3.89-208.0; p=0.001). Due to antazoline related side effects infusion was discontinued in 7 patients (5%)., Conclusions: Antazoline seems to be safe agent in termination of AF in patients undergoing pulmonary vein isolation. We also observed satisfying efficacy, which needs to be proved in a randomized clinical trial., (Copyright © 2015 Medical University of Bialystok. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)

Background: Atrial fibrillation (AF) is the most frequent sustained supraventricular tachyarrhythmia. Radiofrequency (RF) ablation is one of the options used to prevent the recurrence of AF. Despite thorough studies, the relation between left atrial (LA) size and the results of RF ablation remains controversial., Aim: To estimate the relation between LA size assessed by echocardiography and the AF recurrence rate after pulmonary vein isolation (PVI)., Methods: Our analysis comprised 175 AF patients subjected to PVI between June 2011 and March 2012. Inclusion criteria comprised: symptomatic AF with no reversible cause, and age < 70, LA < 5.5 cm (anteroposterior). PVI was performed with a 4-mm non-irrigated catheter or irrigated catheter and circular mapping catheter (electroanatomic mapping with LocaLisa or CARTO systems). Recurrence was defined as any atrial tachyarrhythmia episode that lasted more than 30 s after three months of blanking period. Standard echocardiographic post-ablation anteroposterior LA measurements were performed with additional parameters such as systolic and diastolic LA area and volume (on sinus rhythm)., Results: The analysis included 198 procedures performed in 175 patients. Median follow-up time was 17 months. Median age was 56 years. After the first procedure, AF recurred in 88 (52.4%) patients. Efficacy after the last procedure was 55.2% (43.5% for persistent AF and 59.7% for paroxysmal AF). No significant relation between any of the LA parameters and the recurrence rate was found. Cox univariate and multivariate analysis revealed only very early AF recurrence as a prognostic factor for AF recurrence in the long term., Conclusions: In patients with AF, no relation could be observed between the recurrence rate after PVI and the echocardiographic LA measurement parameters.

Background: Radiofrequency (RF) catheter ablation is a first-line therapy for patients withdrug-refractory atrial fibrillation (AF). Complete isolation of electrical potentials at the ostium of pulmonary vein (PV) is a challenging procedure. There are different techniques and devicesused for PV isolation (PVI). The objective of this study was to evaluate the efficacy and safety of PV ablation catheter (PVAC)., Methods: A total of 67 consecutive patients with paroxysmal and persistent AF were treated with the PVAC. The patients' information were obtained from clinical charts. Follow-up was obtained by one day Holter monitoring at 2, 4, 6, 8, 10 and 12 months after ablation and ECG registration if any symptoms or arrhythmia occurred., Results: The median follow-up duration was 16 months (IQR: 12-20 months). In the population which was available at follow-up (n = 60), 22 (36.7%) patients were in sustained sinus rhythm (SR) without anti-arrhythmic drugs (AAD). Overall 26 (43.3%) patients were in sustained SR with and without AAD. In the paroxysmal AF group, after a single PVAC ablation procedure (n = 39), 19 (48.7%) patients had sustained SR without AAD. In the persistent AF group (n = 15), after the single PVAC ablation, 2 (13.3%) patients had sustained SR without AAD., Conclusions: PVI with PVAC is a safe procedure with 48.7% efficacy in patients with paroxysmal AF. The efficacy of PVAC in patients with persistent or long-standing persistent AF is not acceptable.

Background: Increased resting heart rate (RHR) after pulmonary vein isolation (PVI) for treatment of atrial fibrillation (AF) is a common observation, possibly resulting from ganglionated plexus modification during ablation. Previous trials have suggested that an increase in RHR after ablation might be related to higher efficacy of the procedure. The aim of this study was to determine whether or not higher increase in RHR after radiofrequency (RF) PVI might predict better long-term outcome of the procedure in a real-life cohort of patients in whom index ablation for paroxysmal AF was performed. Material and methods: The health records of patients who underwent index point-by-point or drag lesion RF PVI for paroxysmal AF in our department between January 2014 and November 2018 were analyzed. Resting heart rate (RHR) was determined from 12-lead ECG recorded prior to the ablation and before discharge to evaluate changes in RHR after PVI. Only patients in sinus rhythm before the procedure and at discharge were included in the analysis. Telephone follow-up was collected for evaluation of arrhythmia recurrence status. Results: A total of 146 patients who underwent PVI for paroxysmal AF were included. Mean follow-up time was 3.5 years. RHR increased from 64 [58.5–70], prior to procedure, to 72 [64.25–80] bpm at discharge (p < 0.001). Higher increase in RHR was not protective from arrhythmia recurrence in long-term observation in both univariable HR = 1.001 (CI 0.99–1.017, p = 0.857) and multivariable analyses HR = 1.001 (CI 0.99–1.02, p = 0.84). Conclusions: RHR after PVI increased in comparison to baseline in our cohort. However, we did not observe higher increase in RHR to be associated with more favorable long-term effectiveness of the procedure. [ABSTRACT FROM AUTHOR]

Introduction: Our aim was to compare in a prospective randomized study the safety, direct results and periprocedural data of ablation using an nMARQ catheter, a PVAC catheter used with the EnSite system, or a PVAC catheter only under fluoroscopy control.Material and Methods: One hundred two patients (70 male, 57 ±11 years) with atrial fibrillation (AF) were prospectively randomized to: group 1 - ablation performed with an nMARQ catheter and the CARTO 3 system; group 2 - a PVAC catheter used with the EnSite system; group 3 - ablation with a PVAC catheter without a 3D system.Results: Complete isolation of 400/402 pulmonary veins (PV) (99.5%). Linear ablation was performed in 23 patients in group 1 (small distance between lines isolating PV), in 3 patients in group 2, in 1 patient in group 3. The superior vena cava was isolated in 1 patient, 9 patients, and 9 patients respectively. Duration of fluoroscopy and dose area product were significantly smaller in group 1 (6.5 ±2.9 min/808.8 ±393.9 cGy/cm2 vs. 13.6 ±5.6 min/1662.6 ±677.8 cGy/cm2 and 18.8 ±7.6 min/2327.9 ±975.5 cGy/cm2; p < 0.001). Procedure duration was shorter in group 1 (82.9 ±18.8 min vs. 101.2 ±19.6 min, p < 0.001 and 99.8 ±20.8 min, NS). Contrast injection was necessary in 2 patients in group 1, in 8 patients in group 2 and in all patients in group 3. Because nMARQ is a thermocool catheter, the volume of fluid injection was significantly greater (2348.5 ±543.5 ml vs. 1077.9 ±280.5 ml and 1076.5 ±375.6 ml, p < 0.001). There were no periprocedural deaths. We observed no cardiac tamponade, neurological complications and no atrioesophageal fistula during follow-up.Conclusions: The lowest radiological exposure was observed during ablation performed with an nMARQ catheter. 3D systems reduced fluoroscopy duration and the necessity of contrast injection. The nMARQ catheter requires injection of a large volume of fluid. [ABSTRACT FROM AUTHOR]

Background. Atrial fibrillation (AF) is associated with endothelial dysfunctions. Objectives. The aim of the study was to assess the influence of the duration of an AF episode on the endothelial function. Material and methods. The study included 65 patients with persistent AF qualified for the percutaneous pulmonary veins isolation. Patients were divided into three subgroups with increasing time of the duration of AF episode, as follow: ≥ 7 months (n = 24 patients), from 7 to 14 months (n = 18 patients) and ≤ 14 months (n = 23 patients). Concentrations of endothelin-1 (ET-1), thrombomodulin (TM) and VEGF in serum were measured. Results. Median age in the whole study group was 56 years with 84.6% of males. Patients with longer lasting AF episode had a higher body mass index and less incidence of heart failure. Median values of ET- 1, TM and VEGF were 3.1 (2.5-3.5) pg/mL, 3126.0 (2827.2-3594.1) pg/mL and 464.6 (323.6-630.1), respectively. Among increasing tertiles of AF episode duration, median ET-1 serum concentrations were as follows: 3.3 (2.8-3.7) pg/mL, 3.06 (2.6-3.4) pg/mL, 2.7 (2.3-3.2) pg/mL, p = 0.019, respectively. There was also a trend towards negative association of serum VEGF level with AF episode duration. Serum biomarkers' levels were not associated with total AF duration. Conclusions. AF episode duration may be associated with the endothelial function, assessed by serum biomarkers. ET-1 serum concentrations are significantly lower in patients with longer AF. ET-1, TM and VEGF have no correlation with total AF duration. [ABSTRACT FROM AUTHOR]