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Background: Published data concerning risk factors of VF in WPW patients are inconsistent or contradictory., Methods and Results: We included 1007 patient (pts) (mean age 35 years; 45% female) with an accessory pathway (AP) referred for non pharmacological treatment. Group 1 consisted of 56 pts (42M, aged 34 ± 15 yrs) with an AP and documented VF and Group 2-951 pts (513M, aged 35 ± 15 yrs) with an AP and without VF. Univariate predictors of VF were: overt pre-excitation, male gender, multiple AP, large AP. Multivariate predictors were: overt pre-excitation, male gender and MAP. The mean shortest pre-excited RR interval during AF was significantly shorter in Group 1: 205 ± 27 vs. 243 ± 64, P=0.019. VF as an end point of the first arrhythmia episode (AVRT or AF) was observed in 20 pts (15M, 5F). Primary VF (no documented arrhythmia prior to aborted SCD) occurred in 16 pts (13M, 3F). The mean age of primary VF pts was significantly lower than of pts with history of AVRT or AVRT and/or AF (24.5 vs. 36.5 vs. 38 yrs., P<0.005 and P=0.002, respectively). Age at VF occurrence shows a bi-modal distribution with peak occurrences in the 2-nd/3-rd and 5-th decades., Conclusion: In patients with an accessory pathway, overt pre-excitation, male gender and multiple AP constitute independent risk factors of VF episodes. Young patients in the 2-nd/3-rd and older patients in the 5-th decade might be at higher risk of VF occurrence., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

We present a case of a 14 year-old boy with a incessant fascicular tachycardia with retrograde conduction and tachycardiomyopathy. Verapamil, adenosine, lignocaine and repeated cardioversions were unsuccessful in termination of tachycardia. Amiodarone however caused sinus node dysfunction and temporary electrode pacing had to be used. The patient underwent successful radiofrequency catheter ablation in the area of the left posterior fascicle. Because of ventricular extrasystoles (with QRS morphology resembling that of fascicular VT) the patient underwent second ablation which significantly reduced the number of ventricular beats. The course of subsequent 12-year follow-up was uneventful.

Background: There is some disagreement concerning the minimal value of the interval between components of double potentials (DPs interval) that allows distinguishing complete and incomplete block in the cavotricuspid isthmus (CTI)., Objectives: To assess clinical utility of the relationship between atrial flutter cycle length (AFL CL) and the DPs interval., Methods: Ablation of the CTI was performed in 87 patients during AFL (245 ± 40 ms). Subsequently, DPs were recorded during proximal coronary sinus pacing at sites close to a gap in the ablation line and after achievement of complete isthmus block., Results: We noted strong correlation between AFL CL and the DPs interval after achievement of isthmus block (r = 0.73). The mean DPs interval was 95.3 ± 18.3 ms (range 60-136 ms) and 123.3 ± 24.3 ms (range 87-211 ms) during incomplete and complete isthmus block, respectively (P < 0.001). When expressed as a percentage of AFL CL, this interval was 35.7 ± 3.5% AFL CL (range 28-40.2%) and 50.4 ± 6.9% AFL CL (range 39-72%) during incomplete and complete isthmus block, respectively (P < 0.001). A cutoff value of 40% of AFL CL identified CTI block with 96.7% sensitivity and 100% specificity., Conclusions: The interval between DPs after achievement of block in the CTI correlates with AFL CL. The DPs interval expressed as a percentage of AFL CL allows better distinguishing between complete and incomplete isthmus block compared to standard method based on milliseconds. The DPs interval below 40% of AFL CL indicates sites close to a gap in the ablation line., (©2010, The Authors. Journal compilation ©2010 Wiley Periodicals, Inc.)

Aims: The goal of this study was to describe mapping and ablation of severe arrhythmias during pregnancy, with minimum or no X-ray exposure. Treatment of tachyarrhythmia in pregnancy is a clinical problem. Pharmacotherapy entails a risk of adverse effects and is unsuccessful in some patients. Radiofrequency ablation has been performed rarely, because of fetal X-ray exposure and potential maternal and fetus complications. GROUP AND METHOD: Mapping and ablation was performed in 9 women (age 24-34 years) at 12-38th week of pregnancy. Three had permanent junctional reciprocating tachycardia, and 2 had incessant atrial tachycardia. Four of them had left ventricular ejection fraction < or =45%. One patient had atrioventricular nodal reciprocating tachycardia requiring cardioversion. Three patients had Wolff-Parkinson-White syndrome. Two of them had atrial fibrillation with ventricular rate 300 bpm and 1 had atrioventricular tachycardia 300 bpm. Fetal echocardiography was performed before and after the procedure., Results: Three women had an electroanatomic map and ablation done without X-ray exposure. The mean fluoroscopy time in the whole group was 42 +/- 37 seconds. The mean procedure time was 56 +/- 18 minutes. After the procedure, all women and fetuses were in good condition. After a mean period of 43 +/- 23 months follow up (FU), all patients were free of arrhythmia without complications related to ablation either in the mothers or children., Conclusion: Ablation can be performed safely with no or minimal radiation exposure during pregnancy. In the setting of malignant, drug-resistant arrhythmia, ablation may be considered a therapeutic option in selected cases.

We describe a 23-year-old man with drug refractory, left atrial arrhythmias (paroxysmal atrial tachycardia, runs, pairs and single extra beats) in the area of remnant of left upper pulmonary vein ostium (in fact, this vein). The superior drained into vena innominata/vena cava superior. The patient underwent three unsuccessful catheter ablations in another center. Computed tomography scan of left atrium and pulmonary veins revealed this rare congenital anomaly. This information was crucial to perform successful ablation in the area of remnant and distinguish left atrial appendage from the remnant area. During 6 month follow-up the patient remained free of arrhythmia.

Background: Atrial fibrillation (AF) in WPW syndrome occurs earlier and is more common than in the general population., Aim: To evaluate the predisposing factors for the first episode of AF in patients with WPW., Methods: We analysed data on 930 patients (510 males, 420 females) with WPW treated in our centre during 1988-2007. AF was diagnosed in 236 patients (25% - 161 males, 75 females, aged 36 +/- 15 years). The AF group was divided into two subgroups - patients with AF and atrio-ventricular reentrant tachycardia (AVRT), and patients with AF only. The analysis included subjects' age and gender, the presence of AVRT, the number and properties of accessory pathways, left ventricular ejection fraction (LVEF) and concomitant cardiovascular diseases., Results: The groups did not differ in terms of concomitant diseases and LVEF. In the whole group of patients with AF, arrhythmia occurred earlier in men than in women (34 +/- 14 vs. 40 +/- 15 years of age, p = 0.013). In the subgroup with AF and AVRT, AF was documented earlier compared to patients with AF only (34 +/- 15 vs. 41 +/- 15 years of age, p = 0.0072). AVRT was more common in patients with AF compared to those without AF (69 vs. 53%, p < 0.001). In the whole group of 930 patients, AF was observed more often in patients with overt pre-excitation compared to concealed WPW (29 vs. 12%, p < 0.001)., Conclusions: In patients with WPW syndrome, AF occurs earlier in patients with AVRT compared to patients with AF and without documented AVRT, earlier in men compared to women, and is more common in patients with overt WPW.

Introduction: Measuring the postpacing interval (PPI) and correcting for the tachycardia cycle length (TCL) is an important entrainment response (ER). However, it may be impossible to measure PPI due to electrical noise on the mapping catheter. To overcome this problem, 2 alternative methods for the assessment of ER have been proposed: N+1 difference (N+1 DIFF) and PPIR method. PPI-TCL difference (PPI-TCL) correlates very well with ER assessed by new methods, but the agreement with PPI-TCL was established only in relation to PPIR method. Moreover, it is not known which of these methods is superior in the assessment of ER., Methods: We analyzed 155 episodes of ER in 21 patients with heterogeneous reentrant arrhythmias. ER was estimated by PPI-TCL and by both alternative methods. Agreement between methods was assessed by means of the Bland-Altman test, kappa coefficient (kappa), and correlation coefficient (r). Finally, a mathematical comparison of the alternative methods was performed., Results: The agreement between PPI-TCL and alternative methods was very good. For N+1 DIFF the mean difference was -1.86 +/- 7.31 ms; kappa = 0.9; r = 0.98; for PPIR method the mean difference was -1.46 +/- 7.65 ms; kappa = 0.92; r = 0.99. Agreement between both alternative methods was also very high: the mean difference of 0.5 +/- 6.6 ms; kappa = 0.89; r = 0.99. The analysis of the equations used for calculation of ER by these methods revealed that essentially they were mathematically equivalent., Conclusion: Each of the alternative methods may be used for evaluation of ER when PPI-TCL cannot be assessed directly. Results obtained by both alternative methods are comparable.

We describe a 42-year-old professional driver with hypertension, obesity and recurrent episodes of highly symptomatic typical atrial flutter. Despite chronic sotalol treatment, 1:1 AV conduction with RBBB-morphology was observed. After excluding of thrombus in the heart chambers, the 'urgent' and successful RF ablation was performed.

Background and Aim: Reduction of ICD interventions improves the quality of life and possibly reduces mortality. Ablation reduces ICD interventions in patients with ablatable arrhythmia, but its effectiveness needs to be proven for patients with coronary artery disease (CAD) regardless of the type of arrhythmia. Our study was designed to address this issue, but it had to be terminated due to recruitment problems. The reasons for early termination are described in this paper., Methods: Patients with CAD and implanted ICD, who within the past three months survived an episode of VT/VF, were selected for this study. Patients were to be randomised for ablation or pharmacotherapy. A group of 209 patients was screened between June and December of 2007., Results: Out of 209 patients, 39 (18.7%) had appropriate ICD therapy during the last three months and were potentially eligible for the trial. Out of 39 patients, 34 could not be randomised, due to the presence of exclusion criteria (n-25) or consent refusal (n-9). Previous ablation (n-10), left ventricular thrombus (n-3) or presence of mitral or aortic artificial valve (n-3) were the most frequent exclusion criteria. During follow-up of 12 months one patient required ablation due to frequent ICD discharges. From the five randomised patients, two were randomised to ablation and three to the pharmacotherapy arm., Conclusions: 1. Ablation might not be suitable as a routine treatment for all patients with ICD interventions, as a significant group prefers not to undergo RF ablation as a routine treatment or there are contraindications for the ablation. 2. There are obstacles in prospective and randomised evaluation of the role of ablation in patients with CAD and ICD interventions, which are related both to patients' medical conditions and to patients' will. These limitations should be taken into account when designing further studies.

We present a case of a 29-year-old woman who suffered from incessant atrial tachycardia (AT) leading to tachycardia-induced cardiomyopathy. Based on classical mapping of the right and left atria the focus of AT was localised in the inter-atrial septum area. The RF applications from the right atrium stopped AT for some seconds. Applications from the left atrium terminated AT definitively. The patient has been free from symptoms of arrhythmia and heart failure for seven years.

We describe a case of persistent atrial tachycardia/flutter in a 19-year old female with corrected transposition of great arteries (ccTGA) and dual inlet left ventricle (DILV), treated with surgical palliative operations. The arrhythmia became persistent and symptomatic with dyspnea and severe cyanosis. During the EP study, the right atrial isthmus-dependent reentry was identified. In electroanatomical maps large areas of low voltage and electrical silence were localised. Due to these areas of slow conduction the isthmus dependent arrhythmia had long CL. Linear RF applications closed the isthmus, resulting in flutter termination. During 3 months of follow-up the patient remained free of arrhythmia.

We present a case of a 54 year old male with a long-standing atrial fibrillation (AF) who was scheduled for cardiac transplantation due to the progression of heart failure. Previous treatment included pacemaker implantation, mitral valvuloplasty, a-v node modification using RF ablation, and pharmacological therapy. This time the patient underwent complex AF ablation which consisted of pulmonary vein isolation, mitral and left atrial roof line creation, cavo-tricuspid isthmus ablation and ablation of complex fractionated atrial electrograms, which resulted in restoration of sinus rhythm. Because of the right atrial post-incisional tachycardia the patient underwent second ablation session. This complex invasive approach occurred successful. The patient remains in sinus rhythm with improved left ventricular function and better NYHA class over a 12-month follow-up.

We present a case of 23-year-old male with the Marfan syndrome multiple accessory pathways and atrio-ventricular reentry ant tachycardia (AVRT) as well as atrial fibrillation (AF). Sotalol was partially effective for AVRT, however, it did not prevent AF, RF ablation cured all arrythmias. This case shows that sotalol can attenuate AVRT recurrences, however, it does not prevent rapid conduction via accessory pathways during AF.

A vicious circle of interactions between dilated cardiomyopathy and longstanding persistent AF/AFL may cause symptoms of advanced congestive heart failure. In a 31-year-old patient with diagnosis of familial dilated cardiomyopathy and permanent AF lasting for five years, gradually decreased left ventricular ejection fraction (LVEF) and increased diameter of heart chambers - left ventricular diastolic dimension (LVdD) 7.7 cm, left atrium (LA) 5.4 cm, and LVEF 15% were noted. Pharmacological treatment was ineffective Successful RF ablation of AF/AFL substrate (CTI block, PVs isolation, CFAE ablation, roof and MIG line, CS applications) reversed symptoms of significant heart remodeling (LVdD 5.9 cm, LA 4.3 cm, LVEF 50%).

Background: Pseudo-Mahaim (AP-M) fibers are a rare variant of atrioventricular (AV) accessory pathways. Atriofascicular and atrioventricular accessory connections are characterized by slow conduction and decremental properties. Dual physiological AV node pathways, slow and fast, are observed in a large number of patients with AP-M. Therefore, there is substrate for AV nodal reentrant tachycardia (AVNRT) in addition to antidromic AV reentrant tachycardia (AVRT) with left bundle branch block (LBBB)-like morphology. Other arrhythmia such as atrial fibrillation (AF) or atrial flutter (AFL) and ventricular fibrillation (VF) are also observed. We analysed the occurrence of arrhythmias in a group of patients with AP-M treated in our department., Methods: We evaluated 27 patients (12 women) aged 14-53 years (mean age 25.6 years) with AP-M. The clinical course in these patients, in particular with regard to the occurrence of arrhythmias, was analysed. Patients with dual AV node properties were compared to patients without such findings., Results: We found dual AV node properties in 18 patients (Group 1), while 9 patients had fast pathway only (Group 2). Twenty-six patients presented with AVRT, 2 patients with AVNRT, 3 patients with AF, 1 patient with AT, 2 patients with AFL, and 3 patients with VF. In 2 patients, AP-M were seen in an atypical area. In one patient, the pathway connected the right atrium with the left ventricle (septal region), and in the other patient it connected the left atrium with the left ventricle (left anterior region)., Conclusions: The majority of AP-M was right-sided. Two thirds of patients with AP-M had anatomical substrate for AVNRT (fast/slow pathway AV node). VF or asystole occurred in 10% of patients.

We describe a case of a 44-year old man with recurrent atrial arrhythmias (atrial ectopy, atrial tachycardia and fibrillation) originating from the vein of Marshall (VoM). Stress, exertion and isoproterenol increased frequency and duration of highly symptomatic arrhythmia paroxysms. In 2002 he underwent two sessions of RF ablation. In the area of the left inferior pulmonary vein ostium (LIPV) and along the course the VoM, spiky, firing potentials were recorded. Ablation of the VoM region induced high frequency focal firing (CL approximately 200 ms) with 1: 1 VoM-->LA conduction. Before sinus rhythm return, a gradual increase of conduction of VoM-->LA block was observed. During the second session residual breakthroughs were recorded. During 5 years of follow-up the patient remained free from arrhythmia without antiarrhythmic drugs.

We present a case of 53-year-old patient who experienced paroxysms of wide QRS complex tachycardia at a rate of 150 bpm and LBBB morphology 6 years after inferior myocardial infarction and CABG. Anamnesis and morphology of tachycardia could suggest ventricular tachycardia. However during electrophysiological study we observed AVRT with LBBB and "regularly irregular" AVRT with normal QRS complex and changing entrance to the AV node (through slow and fast pathway). In this paper we present our approach and try to explain why the tachycardia using concealed bypass tract appeared so late in life.

We describe a case of a 25-year-old woman suffering from recurrent adrenergic polymorphic ventricular tachycardia (PVT). As a 14-year-old the patient suffered from recurrent episodes of syncope during exercise or emotion. On Holter monitoring unsustained runs of PVT were observed. The patient survived SCD (VF) which occurred near the hospital. An ICD was implanted and during the first year over 150 adequate discharges were present. During 9 year follow-up the patient had to have 4 ICDs replaced. She suffered from post-traumatic stress disorder syndrome due to frequent ICD shocks. After age of 23 she was admitted to our hospital and an ablation using the CARTO system was performed. No low voltage areas were observed. During the study ventricular premature beats and VT/PVT runs were observed originating from the Purkinje fibres. RF applications were delivered at those sites, during which abrupt PVT runs were present. After the ablation no ventricular arrhythmia was registered in the ICD memory during 2-year follow-up.

We present a case of a 19-year-old patient with incessant arrhythmias originating from the right upper pulmonary vein (RUPV) presenting as frequent premature beats, automatic rhythms mimicking sinus rhythm (SR) and pulmonary vein tachycardias. Morphology of P' wave resembled sinus P wave due to relatively short distance of the ectopic focus from the sinus node. Occasionally, when discharges from the focus were relatively slow (800-500 ms) and regular it was mimicking sinus rhythm. Activation preceding P' wave during arrhythmia was recorded in RUPV as well as in superior vena cava. In this paper we discuss our approach that allowed localising the arrhythmogenic focus in the RUPV. After isolation of the RUPV sinus rhythm was restored with tachycardia at a cycle length of 320 ms continuing in the isolated vein.

Introduction: As assessed by patients, paroxysmal atrial fibrillation (AF) is very bothersome and significantly decreases quality of life (QoL)., Aim: To learn the circumstances that patients attribute to the onset of episodes of paroxysmal AF and attempt to characterise the psychological importance of these situations and their influence on patients' QoL., Methods: The study involved 76 patients (54 males, aged 17-74 years, mean 53.2), referred for ablation of paroxysmal AF. Disease duration ranged from 1 to 30 years, mean 8.3 years. Physical examination included searching for comorbidities and maximum ventricular rate during AF. Patients underwent psychological evaluation prior to ablation. The QoL was assessed with the SF-36v2 questionnaire. Questionnaire detailing the symptoms was also used., Results: Fifty-five (72%) patients were able to indicate situations accompanying onset of paroxysmal AF. From depicted situations cluster analysis distinguished three clusters: I--heavy meals, alcohol and coffee intake, exercise or stress; II--single sudden movement and rest following stressful events; III--sleep. Significant difference in QoL assessment was observed between these 3 groups. Patients in whom paroxysmal AF occurred after a single sudden movement and at rest find their QoL definitely the worst. The best QoL was in subjects with AF starting at night. Maximum ventricular rate during AF did not correlate with QoL in the whole study group; however, gender-matched analysis revealed significant correlation in females (r=-0.58; p=0.03). There was no significant correlation between other analysed variables and QoL., Conclusions: Objective indicators between patient health, such as disease duration or comorbidities, do not affect patients' subjective assessment of QoL. Maximum ventricular rate during AF correlated with QoL only in females. Circumstances of AF event onsets, their relationship with disorganisation of activities and psychological value significantly influence QoL of the patients.

We describe a case of a 34-year-old woman with atrial fibrillation induced by focal frequent tachycardias from superior vena cava and atypical atrioventricular nodal reentrant tachycardia. Selective isolation of SVC and slow pathway RF ablation cured all types of atrial arrhythmias. The slow pathway was localised in the postero-septal mitral anulus and ablated from the left atrium.

Recent studies have demonstrated spatio-temporal organisation in atrial fibrillation (AF), with a highest dominant frequencies (DF) at pulmonary veins ostia (PVo). We present a case of 58-year-old woman with AF evaluated by spectral frequency analysis. Simultaneous recordings at each veno-atrial junction and coronary sinus were obtained. Sequential fast Fourier transforms (FFT) of digitalized signals were performed. FFT profiles were analysed to determine DF. Low DF recorded at right inferior PVo suggested no contribution to AF process. Ablation of high DF PVo and low DF SVC with nonuniform anisotropic conduction resulted in AF termination and good clinical outcome in 1-year follow-up.

In patients with frequent ICD discharges an acute stress disorder (ASD), and afterwards a post-traumatic stress disorder (PTSD) is commonly observed. We present a case of a 53-year-old patient with ASD and PTSD in whom RF ablation of VT was performed. After the successful procedure the symptoms of PTSD were significantly diminished. We conclude that in patients with PTSD after ICD discharges RF ablation should be performed as soon as possible.

We present a case of a 19-year old man with minor Ebstein's anomaly, intermittent long QT interval and WPW syndrome in whom atrial fibrillation, degenerating into ventricular fibrillation was the first symptom. QRS complex morphologies during atrial fibrillation revealed the presence of three accessory pathways (septal, right inferior paraseptal and antero-inferior). Immediately after resuscitation the patient was treated with amiodarone, which resulted in a significant prolongation of QT interval to 700 ms. After RF ablation of accessory pathways patient remains asymptomatic during 6-month follow up, however QTc interval is about 500 ms.

We describe a case of a 24-year-old pregnant woman (35 hbd) who was admitted because of fast (240 bpm) supraventricular tachycardia which required electrical external cardioversion (transesophageal atrial pacing and drugs were ineffective). She underwent RF ablation during which a single RF application effectively cured atypical atrio-ventricular nodal tachycardia. The duration of fluoroscopy was 53 seconds. The child was delivered on time and with no complications.

Introduction: Targeted treatment of atrial fibrillation (AF) involves circumferential isolation of all pulmonary veins (PV) or isolation of electrical connections within their ostia. Only in some cases are the real localisation and number of triggering foci, the anatomy of venous ostia as well as the form of AF (paroxysmal, persistent, chronic, primary or secondary) taken into consideration., Aim: To compare the results of selective electrical isolation (1-3 PV ostia or ablation of a single focus in other veins or atrium) versus isolation of all pulmonary veins., Methods: RF ablation was performed in eighty patients (51 men, 29 women) with symptomatic, drug-refractory AF. Fifty-nine patients had paroxysmal AF (PAF), 16 persistent (AFpers), and 5 chronic AF (AFchro). Selective ablation was carried out in those patients who had detectable AF triggers during sinus rhythm -- supraventricular extrasystolic beats (SVEB) of 1 to 3 morphologies (group I). Extended ablation -- isolation of all 4-5 PV -- was performed in patients with multiple SVEB morphologies and heterogeneous electrical connections within all PV (group II). Group I consisted of 60 patients (22 females) aged 46+/-14 years, whereas group II comprised 20 patients (7 females) aged 52+/-13 years. In 24 patients (18 from group I and 6 from group II) with concomitant typical atrial flutter, an ablation line in the cavo-tricuspid isthmus was also performed. Long-term results were assessed 17+/-15.6 (4-105) months after the procedure based on routine ECG, ambulatory 24-hour ECG monitoring, clinical evaluation and regular phone calls. In patients with PAF, left atrial diameter <4.2 cm and evidence of successful ablation, antiarrhythmic agents were withheld. In patients with AFpers and AFchro, antiarrhythmic drugs were discontinued 3 to 6 months after successful ablation., Results: Complete procedural success was achieved in 61 (76%) patients, and significant clinical improvement was observed in another 9 (11%) patients. Effective ablation significantly improved quality of life. In group I the procedure was entirely successful or a marked improvement was reported (single, transient palpitation episodes and/or atrial tachyarrhythmias lasting up to 30 seconds) in 54 (90%) patients. Among 48 (80%) patients with complete success, 25 (42%) did not receive any antiarrhythmic drugs during follow-up, 12 (20%) with arterial hypertension received beta-blockers, and 11 (18%) continued beta-blocker + class I antiarrhythmic drug. In another 6 (10%) patients a significant clinical improvement in arrhythmia control was observed. In Group II the procedure was fully effective or a significant improvement was observed in 16 (80%) patients. Among 13 (65%) patients with complete success, 5 (25%) did not require any antiarrhythmic drugs, 4 (20%) who had hypertension continued beta-blockers, and another 4 (20%) continued beta-blocker + I class antiarrhythmic drug. A significant clinical improvement of arrhythmia control was observed in another 3 (15%) patients., Conclusions: In patients with a limited number of triggering foci and limited AF substrate, selective ablation effectively eliminates AF with a low risk of complications. Detailed electrophysiological assessment (standard ECG, 12-lead Holter ECG monitoring and endocardial mapping) allows precise identification of this group of patients. In patients with chronic and persistent AF benefits occur with some delay which is associated with a delayed reversal of atrial remodelling.

In a 14 year old boy with corrected transposition of great arteries after correction of Fallot-like pentalogy, Ebstein-like tricuspid valve anomaly and WPW syndrome that was treated surgically, atrial tachycardia (AT) 260-280 ms was diagnosed and ablated. Due to earlier therapy it was impossible to insert catheters through femoral veins, and a subclavian and carotid veins access was used. The arrhythmia was a peri-incisional right AT. The isthmus was diagnosed with the use of entrainment pacing between a scar near VCI and the surgical incision along crista terminalis. Application in that region terminated AT and it was not inducible after the procedure.

We present a case of a 15-year old girl in whom supraventricular tachycardia (SVT) with rSr' pattern in lead V1 and the QRS width of less than 110 ms, suggesting typical slow-fast AVNRT, was the presenting arrhythmia. During sinus rhythm no preexcitation was observed. Considerable variability of the tachycardia cycle length (240-370 ms), attributable to the presence of the fast and slow nodal pathways, was also observed. However, during the electrophysiological study only orthodromic atrio-ventricular reciprocating tachycardia with the left-sided superior accessory pathway as the retrograde limb was documented. Thus, rSr' pattern was due to incomplete right bundle branch block. We describe how the correct diagnosis and the site of the atrial insertion of the accessory pathway could be inferred from the careful analysis of the P' wave morphology during the tachycardia.

Lef atrial thrombus formation during ablation of atrial fibrillation carries the risk of thrombo-embolic complications. We describe a case of a 55 year old male in whom thrombus formation was detected by intracardiac echocardiography. Thrombus was safely removed by aspiration into transseptal sheath.

Background: Primary amyloid light-chain (AL) amyloidosis results from plasma cell dyscrasia. Fibrillar deposits of monoclonal immunoglobulin light chains are present in various organs, especially in the heart. The patients suffer from fatal cardiac dysfunction., Case Report: We report the case of a 54-year-old man with symptoms of cardiac arrhythmia which was refractory to conventional treatment and ablations. At a later stage of his disease, the diagnosis of AL amyloidosis associated with monoclonal gammapathy of uncertain significance was established. Echocardiography, electrocardiography, serum immunofixation studies, abdominal fat aspirate biopsy, and bone marrow biopsy indirectly confirmed the diagnosis of cardiac amyloidosis. The patient died., Conclusions: The diagnosis of AL cardiac amyloidosis is difficult, the prognosis always serious, the available therapy limited, and the mortality high.

Objectives: The goal of this study was to describe the mapping and ablation of polymorphic ventricular tachycardia (VT) after myocardial infarction (MI)., Background: The initiating mechanisms of polymorphic VT after MI have not been reported., Methods: Five patients (four males; age 61 +/- 7 years) with recurrent episodes of polymorphic VT after anterior MI (left ventricular ejection fraction 32 +/- 7%) despite revascularization and antiarrhythmic drugs were studied. All patients demonstrated frequent ventricular premature beats (PBs) initiating polymorphic VT. Pace mapping and activation mapping were used to identify the earliest site of PB activity. The presence of a Purkinje potential preceding PB defined its origin from the Purkinje network. Electroanatomic voltage mapping was performed to delineate the extent of MI., Results: The PBs were observed in all cases to arise from the Purkinje arborization in the MI border zone. These PBs were right bundle-branch block in all five patients, with morphologic variations in the limb leads in four; one also had a left bundle-branch block morphology. The coupling interval of the PB to the preceding QRS complex demonstrated significant variations (320 to 600 ms). During PB, the Purkinje potential at the same site preceded the QRS complex by 20 to 160 ms and was associated with different morphologies. Repetitive Purkinje activity was documented during polymorphic VT. Splitting of Purkinje activity and Purkinje to muscle conduction block were also observed. Ablation at these sites eliminated all PBs. At 16 +/- 5 months follow-up using defibrillator memory interrogation, no patient has had recurrence of arrhythmia., Conclusions: The Purkinje arborization along the border-zone of scar has an important role in the mechanism of polymorphic VT in patients after MI. Ablation of the local Purkinje network allows suppression of polymorphic VT.

Background: Atrial fibrillation (AF) in patients with WPW syndrome may be a life-threatening arrhythmia., Aim: To identify risk factors of AF and their prognostic significance in patients with WPW syndrome., Methods: Clinical and electrophysiological parameters of 239 patients with WPW syndrome, who underwent successful RF ablation, were analysed using logistic regression and multivariate analysis. One hundred eight patients had no history of AF whereas the remaining 81 patients had previous spontaneous AF episodes. Long-term follow-up data (mean 29+/-23 months, range 1-99 months) were available in 136 patients (87 without AF and 49 with AF)., Results: Patients with AF were significantly older, more frequently of male gender and had more often a history of syncope than patients without AF. There were two peaks of AF occurrence - in the third and in the fifth decade of life. Fourteen patients had a history of ventricular fibrillation - 11 patients with AF vs 3 patients without AF (p=0.0016). Patients with a history of AF were more prone to AF induced during electrophysiological study and had less frequently concealed accessory pathways., Conclusions: Age, gender and a history of syncope are the independent risk factors of AF in patients with WPW syndrome. Anterograde conduction via accessory pathway is of major importance in the development of AF. RF ablation of an accessory pathway should be performed early because the risk of the procedure is small and there is an increasing risk of AF with ageing.

The laser Doppler flowmetry offers a new noninvasive, real-time technique for monitoring of the blood perfusion in living tissue. In spite of some instrumental problems, e.g. relative calibration and unknown sampling measurement depth, this method has already been used in clinical examination. The purpose of presented study was the application of the laser Doppler method in evaluation of the vasovagal syncope induced in the tilt-table test. Twelve patients with the history of syncopal episodes were examined using the head-up tilt-table test. In the some condition three normal subjects were also examined as the reference. Results of examination have showed that the changes measured by laser Doppler method are clearly visible during the pre-syncope and syncope period. These changes in perfusion precede the subjective clinical symptoms as well as decrease in the blood pressure, blood oxygen saturation and heart rate.