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Background: The present study aimed to elucidate the safety and effectiveness of a noble and unique airway management technique in which a pediatric intubation tube is used in adult patients with atrial fibrillation (AF) undergoing catheter ablation (CA) under continuous deep sedation. Methods: In total, 246 consecutive patients with AF (mean age, 65±10 years; 60 women) underwent CA under dexmedetomidine-based continuous deep sedation. A 4-mm pediatric intubation tube guided by a 10-French intratracheal suction tube was inserted smoothly, and the tip of the tube was located at the base of the epiglottis. The maximum shifting distance of the heart (MSDH) was measured with the 3D mapping system (Ensite NavX system) before and after inserting the pediatric intubation tube. Results: At baseline, the MSDH of patients under continuous deep sedation was 23±14 mm. The pediatric intubation tube reduced the MSDH to 13±6 mm (mean reduction from baseline, 38.4±21.7%; P

Background: The safety and efficacy of radiofrequency hot balloon catheter (Toray-Satake balloon [TSB]) ablation for the treatment of atrial fibrillation (AF) was evaluated in a 3-center pilot study. Methods: Thirty patients (24 men; age, 61±8 years) with drug-resistant AF (paroxysmal, n=24; persistent, n=6) were evaluated in this study. The pulmonary veins (PVs) and PV antrum were isolated using the TSB under general anesthesia (n=12) or deep sedation (n=18). Results: Complete PV isolation was achieved in 110 (92%) of 120 PVs, and decreased PV potentials were observed in the right superior PV in 4 patients (13%), left superior PV in 4 patients (13%), and left inferior PV in 2 patients (7%). The mean total procedure time was 104±27 min. The mean total fluoroscopic and total application times were 32±14 min and 12±2 min, respectively. After a single session, 22 (73%) and 20 (67%) of the 30 patients were free from AF after 6 and 11.4±2.2 months of follow-up, respectively. There were no device-related severe complications such as stroke, esophageal fistula, symptomatic PV stenosis, phrenic nerve palsy, or pyloric spasm. Conclusion: TSB catheter ablation might be a promising approach for the treatment of drug-resistant AF.

Background: There is limited data regarding the outcomes after stepwise ablation for persistent atrial fibrillation (AF) in patients with heart failure (HF). Methods and results: Patients without structural heart disease undergoing stepwise ablation for persistent AF (continuous AF≤1 year) were studied (n=108; age, 61±10 years) and 32 patients had a history of HF. The HF patients were further grouped on the basis of left ventricular ejection fraction (LVEF)≤45% (n=15) and >45% (n=17). During a median follow-up period of 2.2 years, repeated ablations were necessary in 65 patients. The proportion of patients that were arrhythmia free 1 year after the last ablation was 67% in patients with LVEF≤45%, 86% in LVEF>45%, and 91% in no HF (p=0.0009). In patients with LVEF≤45%, the AF burden was reduced to less than one paroxysmal episode per month, and patients with and without recurrences both showed significant increases in LVEF over the follow-up period (38±7% to 60±10% and 37±6% to 53±10%, respectively). Conclusions: HF patients with LVEF≤45% had lower chances to remain free from arrhythmias after stepwise ablation for persistent AF than those with LVEF>45%. Nevertheless, LVEF also improved in patients with recurrences, reflecting the observed reduction in AF burden and emphasizing the benefits of ablation.

A 39-year-old man with a seemingly non-remodeled, small heart suffered persistent atrial fibrillation (AF). Extensive isolation of the pulmonary vein, superior vena cava, and posterior left atrium, in conjunction with right atrium focal ablation, was performed to ablate multiple AF foci during two catheter ablation sessions. Sinus arrest occurred suddenly during follow-up, despite the absence of recurrent AF, ultimately necessitating pacemaker implantation. This case underscores the necessity of careful follow-up after catheter ablation, highlighting the risk of sudden, severe sinus node dysfunction, even in young AF patients with small hearts.