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Introduction: To report a series of patients with osteoid osteoma treated by radiofrequency ablation in whom no complications or recurrences occurred.Methods: Over a 13-year period, 32 consecutive patients with osteoid osteoma were treated by radiofrequency ablation in an Australasian teaching centre.Results: All patients had resolution of symptoms with no complication or recurrence.Conclusions: This series is further evidence for the use of radiofrequency ablation as the primary treatment for osteoid osteoma. [ABSTRACT FROM AUTHOR]

Double ventricular response in dual atrioventricular (AV) nodal pathways can result in nonreentrant supraventricular tachycardia. Since this condition was first described in 1979, around 20 cases have been reported. Here, we present the case of a patient with a confirmed diagnosis of double ventricular response in dual AV nodal pathways resembling an interpolated premature beat who underwent successful radiofrequency ablation of the slow pathway. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the feasibility of performing comprehensive Cardiac Magnetic resonance (CMR) guided electrophysiological (EP) interventions in a porcine model encompassing left atrial access.Methods: After introduction of two femoral sheaths 14 swine (41 ± 3.6 kg) were transferred to a 1.5 T MR scanner. A three-dimensional whole-heart sequence was acquired followed by segmentation and the visualization of all heart chambers using an image-guidance platform. Two MR conditional catheters were inserted. The interventional protocol consisted of intubation of the coronary sinus, activation mapping, transseptal left atrial access (n = 4), generation of ablation lesions and eventually ablation of the atrioventricular (AV) node. For visualization of the catheter tip active tracking was used. Catheter positions were confirmed by passive real-time imaging.Results: Total procedure time was 169 ± 51 minutes. The protocol could be completed in 12 swine. Two swine died from AV-ablation induced ventricular fibrillation. Catheters could be visualized and navigated under active tracking almost exclusively. The position of the catheter tips as visualized by active tracking could reliably be confirmed with passive catheter imaging.Conclusions: Comprehensive CMR-guided EP interventions including left atrial access are feasible in swine using active catheter tracking.Key Points: • Comprehensive CMR-guided electrophysiological interventions including LA access were conducted in swine. • Active catheter-tracking allows efficient catheter navigation also in a transseptal approach. • More MR-conditional tools are needed to facilitate left atrial interventions in humans. [ABSTRACT FROM AUTHOR]

OBJETIVO: A operação de "Cox-Maze III" apresenta alta efetividade para o tratamento da fibrilação atrial (FA) crônica, porém, devido a sua alta complexidade, não é amplamente utilizada. Novas alternativas, que envolvem o uso de fontes de energia, como a radiofreqüência, para criação de lesões transmurais, que substituem as linhas de secção e sutura da técnica de Cox, foram desenvolvidas visando simplificar o procedimento. O objetivo deste estudo é avaliar os resultados do emprego da radiofreqüência intra-operatória para tratamento da FA crônica em pacientes com cardiopatias associadas com indicação de tratamento cirúrgico. MÉTODO: Entre fevereiro de 2002 e março de 2003, 35 pacientes consecutivos portadores de FA crônica foram submetidos à ablação com radiofreqüência intra-operatória, associada a outros procedimentos cirúrgicos. A idade variou de 16 a 69 anos (média = 55,4 anos), sendo 23 (65,7%) pacientes do sexo feminino. RESULTADOS: A ablação foi associada ao tratamento cirúrgico da valva mitral em 29 (82,9%) pacientes e à atriosseptoplastia em seis (17,1%) pacientes. A mortalidade hospitalar foi de 2,8%; vinte e seis (76,4%) pacientes apresentavam-se em ritmo sinusal no momento da alta hospitalar. Após seguimento médio de 11,7 ± 2,8 meses, a sobrevida foi de 94,2% e 24 (72,7%) pacientes apresentavam-se em ritmo sinusal. CONCLUSÃO: A ablação por radiofreqüência intra-operatória demonstrou ser uma técnica segura e eficiente para o tratamento da FA crônica, apresentando índices satisfatórios de reversão para o ritmo sinusal em médio prazo.OBJECTIVE: The "Cox-Maze III" operation is very effective in the treatment of chronic atrial fibrillation, but many surgeons do not use this technique because of its high complexity. In order to simplify the procedure, new alternatives that involve the use of different energy sources, such as radiofrequency, to create transmural lesions that substitute the atrial incisions of the Cox technique have been developed. The purpose of this study is to evaluate the results of intraoperative radiofrequency ablation in the treatment of chronic atrial fibrillation in patients with associated cardiac diseases. METHOD: Between February 2002 and March 2003, 35 consecutive patients with chronic atrial fibrillation were submitted to intraoperative radiofrequency ablation, associated with other surgical procedures. The ages of the patients ranged from 16 to 69 years old (mean 55.4 years old); there were 23 (65.7%) female patients. RESULTS: Radiofrequency ablation was associated with surgical treatment of the mitral valve in 29 (82.9%) patients and with treatment of atrial septal defect in six (17.1%). There was 1 (2.8%) in-hospital death; at the time of hospital discharge 26 patients (76.4%) were in sinus rhythm. After a mean follow-up of 11.7 ± 2.8 months, the overall survival rate was 94.2 % and 24 (72.7%) patients were in sinus rhythm. CONCLUSION: Intraoperative radiofrequency ablation is a safe and effective technique for the treatment of chronic atrial fibrillation, with satisfactory midterm results in terms of conversion to sinus rhythm.

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The efficacy and safety of catheter ablation for the management of atrial fibrillation (AF) has been improved in recent years. Radiofrequency (RF) catheter ablation for maintaining sinus rhythm is superior to the current antiarrhythmic drug therapy in selected patients. Pulmonary vein isolation (PVI) is the cornerstone of various catheter ablation strategies. It is well recognized that pulmonary vein (PV) antrum contributes to the AF initiation and/or perpetuation. Since PV stenosis is a complication of ablation within a PV, the ablation site for PVI has shifted to the junction between the left atrium and the PV rather than the ostium of the PV. However, PV reconnection after ablation is the major cause of recurrence of AF. The recovery of PV conduction could be caused by anatomical variations such as the failure to produce complete transmural lesion or gaps at the ablation line due to the transient electrophysiologic effects from the RF ablation. In this review, we discussed several factors to be considered for the achievement of the best PVI, including clinical aspects and technical aspects.

Background: Periprocedural thromboembolic and hemorrhagic events are worrisome complications of catheter ablation for atrial fibrillation (AF). The periprocedural anticoagulation management could play a role in the incidence of these complications. Although ablation procedures performed without warfarin discontinuation seem to be associated with lower thromboembolic risk, no randomized study exists., Methods and Results: This was a prospective, open-label, randomized, parallel-group, multicenter study assessing the role of continuous warfarin therapy in preventing periprocedural thromboembolic and hemorrhagic events after radiofrequency catheter ablation. Patients with CHADS2 score ≥1 were included. Patients were randomly assigned in a 1:1 ratio to the off-warfarin or on-warfarin arm. The incidence of thromboembolic events in the 48 hours after ablation was the primary end point of the study. The study enrolled 1584 patients: 790 assigned to discontinue warfarin (group 1) and 794 assigned to continuous warfarin (group 2). No statistical difference in baseline characteristics was observed. There were 39 thromboembolic events (3.7% strokes [n=29] and 1.3% transient ischemic attacks [n=10]) in group 1: two events (0.87%) in patients with paroxysmal AF, 4 (2.3%) in patients with persistent AF, and 33 (8.5%) in patients with long-standing persistent AF. Only 2 strokes (0.25%) in patients with long-standing persistent AF were observed in group 2 (P<0.001). Warfarin discontinuation emerged as a strong predictor of periprocedural thromboembolism (odds ratio, 13; 95% confidence interval, 3.1-55.6; P<0.001)., Conclusion: This is the first randomized study showing that performing catheter ablation of AF without warfarin discontinuation reduces the occurrence of periprocedural stroke and minor bleeding complications compared with bridging with low-molecular-weight heparin., Clinical Trial Registration Url: http://www.clinicaltrials.gov. Unique identifier: NCT01006876., (© 2014 American Heart Association, Inc.)

We report in a 65-year-old man hepatocellular carcinoma adjacent to a transjugular intrahepatic portosystemic shunt stent-graft which was successfully treated with irreversible electroporation (IRE). IRE is a new non-thermal tissue ablation technique which uses electrical pulses to induce cell necrosis by irreversible membrane poration. IRE proved to be more advantageous in the ablation of perivascular tumor with little injury to the surrounding structures.