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Background and aimsThere is limited data concerning the effect of non-revascularized chronic total occlusions (NR-CTOs) after VT ablation. This study sought to evaluate the impact of NR-CTOs after ablation for electrical storm (ES).MethodsPost-hoc retrospective analysis of data regarding 64 consecutive post-myocardial infarction patients (out of which 12 patients with NR-CTOs and 52 without NR-CTOs) undergoing substrate ablation for ES with an available median follow-up of 37.53 (7.25–64.65) months. Ablation result was assessed by inducibility of sustained monomorphic VT (SMVT) during final programmed ventricular stimulation (PVS). The primary endpoints were all-cause mortality and VT/VF recurrences after ablation, respectively, stratified by the presence of NR-CTOs. The secondary endpoint was to assess the predictive effect of NR-CTOs on all-cause mortality and VT/VF recurrences in relation to other relevant prognostic factors.ResultsAt baseline, the presence of NR-CTOs was associated with higher bipolar BZ-to-total scar ratio (72.4% ± 17.9% vs. 52% ± 37.7%, p = 0.022) and more failure to eliminate the clinical VT (25% (3) vs. 0% (0), p

Atrial fibrillation (AF), the most frequently encountered arrhythmia worldwide, is associated with increased cardiovascular morbidity and mortality. Left atrial (LA) and antral region of the pulmonary veins (PVs) remodeling are risk factors for AF perpetuation. Among the methods of LA fibrosis quantification, bipolar voltage mapping during three-dimensional electro-anatomical mapping is less studied. The main aim of this study was to analyze the relationship between the degree of LA fibrosis quantified in low-voltage areas and the efficacy of AF radiofrequency catheter ablation. All consecutive patients with AF ablation were included, and the degree of LA fibrosis was measured based on the low-voltage areas in the LA and the antral region of PVs (p = 0.018 and p = 0.019, respectively). However, no significant differences were found between the patients with and without AF recurrence in terms of the area and percentage of PVs fibrosis (p = 0.896 and p = 0.888, respectively). Moreover, LA fibrosis parameters proved to be excellent predictors for AF recurrence (areas under the curve of 0.834 and 0.832, respectively, p < 0.001) even after adjustment for LA indexed volume and CHA2DS2-VASc score. In conclusion, LA fibrosis measured on bipolar voltage maps increases the risk of AF recurrence after the RF catheter ablation procedure.

Objective. Radiofrequency catheter ablation is an effective treatment option for cardiac arrhythmias including complex and ventricular arrhythmias. Remote magnetic catheter navigation (RMN) has been developed as a novel way of approach aiming to improve outcome and reduce complication rate, and reduce radiation exposure for both operator and patient. Our aim was to compare success and complication rate in patients with or without severely reduced left ventricular ejection fraction (LVEF). Methods. We retrospectively analyzed all the patients (n = 98) which have undergone RMN in our center between 2015-2021. No selection criteria for RMN procedure have been applied. All clinical and paraclinical, as well as procedural data were collected. Patients were divided into two groups, with or without severely reduced LVEF ≤ 35%. CARTO system was used for 3D electroanatomic mapping. RMN was done using Niobe ES system and an open-irrigated magnetic ablation catheter. Success rate was defi ned by complete elimination of clinical arrhythmia. Non-inducibility following ablation was assessed in all patients presenting with any type of ventricular arrhythmia other than premature ventricular contractions. Testing for inducibility was done by ventricular programmed pacing with up to four extra-stimuli. The statistical analysis was performed using SPSS software. P-value < 0.05 was considered signifi cant. Results. Successful ablation with complete elimination of the clinical arrhythmia was achieved in 92.3% of the patients with severely reduced LVEF and in 88.1% of patients with LVEF > 35% (p = 0.73). Overall minor complication rate was 2.04% with spontaneous resolution. No major complications were reported. Non-inducibility was achieved in 56.4% of the patients with LVEF ≤ 35% and in 79.2% of the patients with LVEF >35% (p = 0.023). Conclusion. Radiofrequency catheter ablation using RMN is effective and safe regardless of the presence or not of a severely reduced LVEF.

Background: Achieving long-term successful outcomes with catheter ablation (CA) of persistent atrial fibrillation (PsAF) remains a challenge. Multiple attempts to determine effective ablation strategies besides the pulmonary veins (PV) were made but, so far, there is no agreed standard approach and no clear consensus as to which is the best one. Among the most frequently used techniques was ablation of complex atrial fractionated electrograms (CFAE) but studies showed contradictory results. The optimal procedural endpoint also needs further refinement. Objectives: We sought to evaluate outcomes in regard to patient characteristics and procedural termination. We also aimed to assess whether continuation of antiarrythmic therapy in the blanking period (1 to 3 months after the procedure) influences long term results. Methods: We enrolled consecutive patients with persistent and long-standing PsAF (LS-PsAF) who underwent one or more radiofrequency catheter ablations (RF CA) - pulmonary vein antral isolation (PVAI), followed by CFAE or resultant atrial tachycardia/flutter elimination, were retrospectively analyzed. Procedural objective was tachyarrhythmia (AF or resultant atrial flutters/tachycardias) termination (TT) to sinus rhythm (SR) during RF delivery. If after extensive substrate based or activation guided ablation sinus rhythm was not restored, conversion was performed with antiarrhythmic drugs (AAD), overdrive pacing or electrical shock. Screening for arrhythmia recurrence was performed via clinical interview and 48 hours Holter monitoring at 1,3 and 6 months and then every 6 months. Results: The cohort included 94 patients (age 54.5±11.4, 67 (71%) males, CHADSVASc 2.3±2, 11 (12%) LS-PsAF) Acute restoration of sinus rhythm (SR) was achieved in 93.4% of the cases, 43% by ablation of CFAE or resultant atrial tachycardia/fl utter(AT/AFL), 36.2% by electric cardioversion, 7.4% by chemical conversion, 3.1 % overdrive pacing, 3.7 % spontaneuous / mechanical. The long term success rate after a mean of 1.7±0.8 procedures was 59% at a mean follow-up period of 80±28 months. Freedom from AF was significantly higher when arrhythmia termination was obtained during RF delivery (p – 0.003). Short-term use of AAD in the blanking period did not lead to improved long term outcomes. Conclusions: In patients with PsAF and LS-PsAF restoration of sinus rhythm during RF delivery for pulmonary vein isolation, ablation of CFAE or resultant atrial tachyarrhythmia predicts long term procedural success. Further research to determine the best strategy to achieve this outcome is necessary.

Hypertrophic cardiomyopathy (HCM) is an inherited primary myocardial disease characterized by asymmetrical/symmetrical left ventricle (LV) hypertrophy, with or without LV outflow tract (LVOT) dynamic obstruction, and poor prognosis. Cardiac resynchronization therapy (CRT) has emerged as a minimally invasive tool for patients with heart failure (HF) with decreased LV ejection fraction (LVEF) and prolonged QRS duration of over 120 ms with or without left bundle branch block (LBBB). Several HCM patients are at risk of developing LBBB because of disease progression or secondary to septal myomectomy, while others might develop HF with decreased LVEF, alleged end-stage/dilated HCM, especially those with thin myofilament mutations. Several studies have shown that patients with myectomy-induced LBBB might benefit from left bundle branch pacing or CRT to relieve symptoms, improve exercise capacity, and increase LVEF. Otherwise, patients with end-stage/dilated HCM and prolonged QRS interval could gain from CRT in terms of NYHA class improvement, LV systolic performance increase and, to some degree, LV reverse remodeling. Moreover, several electrical and imaging parameters might aid proper selection and stratification of HCM patients to benefit from CRT. Nonetheless, current available data are scarce and further studies are still required to accurately clarify the view. This review reassesses the importance of CRT in patients with HCM based on current research by contrasting and contextualizing data from various published studies.

Background: Catheter ablation (CA) for atrial fibrillation (AF) is superior to antiarrhythmic drugs in maintaining sinus rhythm. Novel evidence suggests that increasing the time between the first diagnosis of AF and ablation, or diagnosis-to-ablation time (DAT), is a predictor for AF recurrence post-ablation. Purpose: Our primary objective was to investigate the relationship between DAT and AF recurrence after a first ablation. Methods: Patients with AF who underwent CA in our center were enrolled consecutively, and a retrospective analysis was performed. DAT was treated as a continuous variable and reported as a median for the group with recurrence and the group without recurrence. DAT was also considered as a categorical variable and patients were stratified into three categories: DAT < 1 year, DAT < 2 years, and DAT < 4 years. Results: The cohort included 107 patients, with a mean age of 54.3 ± 11.7 years. Mean DAT was significantly longer in those with AF recurrence: 4.9(3.06) years versus 3.99(3.5) (p = 0.04). The Kaplan–Meier curve revealed a higher likelihood of AF-free status over time for patients with DAT < 2 years compared to those with DAT > 2 years (p = 0.04). Cox multivariate analysis indicated that left atrial volume index (LAVI), obstructive sleep apnoea (OSA), and DAT > 2 years were independently associated with AF recurrence after a single AF ablation procedure (p = 0.007, p = 0.02, and p = 0.03, respectively). Conclusion: A shorter duration between the first AF diagnosis and AF ablation is associated with an increased likelihood of procedural success after a single AF ablation procedure.

Introduction: Catheter ablation (CA) for atrial fibrillation (AF) has been proven to have the highest efficacy in maintaining sinus rhythm. Several studies have proposed different scores for predicting post-procedural success, but most have not been validated in prospective cohorts. Further research is required to determine the optimal formulae. Purpose: This study aimed to identify independent predictors of AF recurrence after CA and develop a composite score. Methods: Consecutive patients with persistent and paroxysmal AF who underwent CA were retrospectively analyzed. The independent predictors of recurrence were used to create a new predictive score. Results: The cohort included 263 patients with a follow-up of 37.6 ± 23.4 months. Persistent AF, f-waves < 0.1 mV, indexed left atrium volume, the presence of type 2 diabetes, and smaller height were independent predictors of recurrence and were used to create a new scoring model, VAT-DHF (V = Volume, AT = AF Type, D = Diabetes, H = Height, F = f waves). The ROC curve for this new score showed an AUC of 0.869, p < 0.0001, 95% CI [0.802–0.936], while those for APPLE and CHA2DS2-VASc showed an AUC of 0.765, 95% CI [0.637–0.893] and an AUC of 0.655, 95% CI [0.580–0.730], respectively. Patients who had a VAT-DHF score between 0 and 3.25, 3.25 and 6, and ≥6, had success rates of 95.7%, 76.3%, and 25% (p < 0.0001), respectively. Conclusions: The novel VAT-DHF score is easy to calculate and may be a useful clinical tool for identifying patients with a low, intermediate, or high risk of AF recurrence after CA.

Background: Electrical storm (ES) is defined by clustering episodes of ventricular tachycardia (VT) and is associated with severe long-term outcomes. We sought to evaluate the prognostic impact of radiofrequency catheter ablation (RFCA) in ES as assessed by aggressive programmed ventricular stimulation (PVS). Methods: Single-center retrospective longitudinal study with 82 consecutive ES patients referred for RFCA with a median follow-up (IQR 25–75%) of 45.43 months (15–69.86). All-cause mortality and VT recurrences were assessed in relation to RFCA outcomes defined by 4-extrastimuli PVS: Class 1—no ventricular arrhythmia; Class 2—no sustained monomorphic VTs (mVT) inducible, but non-sustained mVTs, polymorphic VTs, or VF inducible; Class 3—clinical VT non-inducible, other sustained mVTs inducible; and Class 4—clinical VT inducible. Results: Class 1, Class 2, Class 3, and Class 4 were achieved in 56.1%, 13.4%, 23.2%, and 7.4% of cases, respectively. The combined outcome of Class 1 + Class 2 (no sustained monomorphic VT inducible) led to improved survival (log-rank p < 0.001) and reduced VT recurrence (log-rank p < 0.001). Residual monomorphic VT inducibility (HR 6.262 (95% CI: 2.165–18.108, p = 0.001), NYHA IV heart failure symptoms (HR 20.519 (95% CI: 1.623–259.345), p = 0.02)), and age (HR 1.009 (95% CI: 1.041–1.160), p = 0.001)) independently predicted death during follow-up. LVEF was not predictive of death (HR 1.003 (95% CI: 0.946–1.063) or recurrences (HR 0.988 (95% CI: 0.955–1.021)). Conclusions: Non-inducibility for sustained mVTs after aggressive PVS post-RFCA leads to improved survival in ES, independently of LVEF.