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Deviation of the esophagus during atrial fibrillation (AF) ablation can reduce esophageal injury. This study reports upon a novel esophageal retractor that utilizes vacuum suction and mechanical deflection to deviate the esophagus. The device was used in seven patients undergoing cryoballoon AF ablation. The esophagus was deviated 31.9 ± 4.4 mm to the right and 28.2 ± 5.9 mm to the left. Endoscopy at 4.4 ± 1.5 days postablation showed no esophageal injury. This study demonstrates the safe and effective deviation of the esophagus without a trailing edge with an esophageal retractor utilizing vacuum suction and mechanical deflection.

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias. Electronic supplementary material The online version of this article (10.1007/s10840-019-00664-2) contains supplementary material, which is available to authorized users.

Numbers, numbers, they endessly fill out our life… weight, height and many other more hidden body attributes, too, like chronobiological parameters! Fat and thin woman, by Lyudmyla Kharlamova

© 2021 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/., The World Heart Federation (WHF) commenced a Roadmap initiative in 2015 to reduce the global burden of cardiovascular disease and resultant burgeoning of healthcare costs. Roadmaps provide a blueprint for implementation of priority solutions for the principal cardiovascular diseases leading to death and disability. Atrial fibrillation (AF) is one of these conditions and is an increasing problem due to ageing of the world's population and an increase in cardiovascular risk factors that predispose to AF. The goal of the AF roadmap was to provide guidance on priority interventions that are feasible in multiple countries, and to identify roadblocks and potential strategies to overcome them. Since publication of the AF Roadmap in 2017, there have been many technological advances including devices and artificial intelligence for identification and prediction of unknown AF, better methods to achieve rhythm control, and widespread uptake of smartphones and apps that could facilitate new approaches to healthcare delivery and increasing community AF awareness. In addition, the World Health Organisation added the non-vitamin K antagonist oral anticoagulants (NOACs) to the Essential Medicines List, making it possible to increase advocacy for their widespread adoption as therapy to prevent stroke. These advances motivated the WHF to commission a 2020 AF Roadmap update. Three years after the original Roadmap publication, the identified barriers and solutions were judged still relevant, and progress has been slow. This 2020 Roadmap update reviews the significant changes since 2017 and identifies priority areas for achieving the goals of reducing death and disability related to AF, particularly targeted at low-middle income countries. These include advocacy to increase appreciation of the scope of the problem; plugging gaps in guideline management and prevention through physician education, increasing patient health literacy, and novel ways to increase access to integrated healthcare including mHealth and digital transformations; and greater emphasis on achieving practical solutions to national and regional entrenched barriers. Despite the advances reviewed in this update, the task will not be easy, but the health rewards of implementing solutions that are both innovative and practical will be great.

BACKGROUND Frequent premature ventricular complexes (PVCs) are common after a myocardial infarction (MI), but data on PVC ablation in this population are limited. OBJECTIVE The purpose of this study was to analyze data on PVC ablation in post-MI patients. METHODS Three hundred thirty-two patients with frequent PVCs and left ventricular (LV) dysfunction were prospectively studied. Data from 67 patients (20%; age 63 +/- 10 years; 65 men [93%]) with previous MI were compared with the remaining 265 patients. RESULTS PVCs in post-MI patients originate predominantly from the LV (92% LV vs 6% right ventricle [RV]; P

Aims Frequent premature ventricular complexes (PVCs) can induce or worsen left ventricular systolic dysfunction. We aimed to investigate the influence of the baseline QRS in the response after PVC ablation in patients with depressed left ventricular ejection fraction (LVEF). Methods and results Two hundred and fifteen [59 ± 13 years old, 152 (71%) men] consecutive patients with left ventricular (LV) systolic dysfunction and frequent PVCs referred for ablation were included and followed-up for 12 months. Echocardiographic response was defined as an improvement of at least five absolute points in LVEF. Clinical, electrocardiogram, and electrophysiological characteristics were analysed. Mean baseline QRS duration was 110 ms [97–140]. Premature ventricular complex burden significantly decreased after ablation from 23% [16–33] at baseline to 1% [0–8] at 12 months, P 130 ms. Conclusions In patients with LV systolic dysfunction, intrinsic QRS duration is inversely related to the probability and the degree of echocardiographic response after frequent PVC ablation. Patients with a QRS duration >130 ms at baseline have the poorer response after ablation.

Background: GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic t...

European Heart Rhythm Association (EHRA) consensus document on management of arrhythmias and cardiac electronic devices in the critically ill and post-surgery patient, endorsed by endorsed by Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Cardiac Arrhythmia Society of Southern Africa (CASSA), and Latin American Heart Rhythm Society (LAHRS).

Aims Ablation of frequent premature ventricular complexes (PVCs) improves left ventricular ejection fraction in patients with left ventricular (LV) systolic dysfunction. This study aims to evaluate the long-term hard outcomes and potential prognostic variables in this population. Methods and results Prospective multicentre study including 101 consecutive patients [56 ± 12 years old, 62 (61%) men] with LV systolic dysfunction and frequent PVCs who underwent PVC ablation before November 2015. The last evaluation performed was considered the long-term follow-up (LTFUP) evaluation. Mean follow-up was 34 ± 16 months (range 24–84 months). Ablation was successful in 95 (94%) patients. There was a significant reduction in the PVC burden from 21 ± 12% at baseline to 3.8 ± 6% at LTFUP, P Conclusion In patients with LV systolic dysfunction, ablation of frequent PVCs induces a significant improvement in functional, structural, and neurohormonal status, which persists at LTFUP. A sustained reduction in the baseline PVC burden is associated with a lower risk of cardiac mortality, cardiac transplantation, or hospitalization for heart failure during follow-up.

Premature ventricular complex (PVC) ablation has been shown to improve left ventricular ejection fraction (LVEF) and New York Heart Association functional class in patients with left ventricular dysfunction. Both are considered key variables in predicting risk of sudden cardiac death.The objective of this study was to assess whether ablation might remove the primary prevention (PP) implantable cardioverter-defibrillator (ICD) indication in patients with frequent PVC.Sixty-six consecutive patients with PP-ICD indication and frequent PVC [33 (50%) men; mean age 53 ± 13 years; 11 (17%) with ischemic heart disease] underwent PVC ablation. The ICD was withheld and the indication was reevaluated at 6 and 12 months.LVEF progressively improved from 28% ± 4% at baseline to 42% ± 12% at 12 months (P.001). New York Heart Association functional class improved from 2 patients with NYHA functional class I (3%) at baseline to 35 (53%) at 12 months (P.001). The brain natriuretic peptide level decreased from 246 ± 187 to 176 ± 380 pg/mL (P = .004). The PP-ICD indication was removed in 42 patients (64%) during follow-up, from 38 (92%) of them at 6 months, showing an independent association with baseline PVC burden and successful sustained ablation. In patients with successful sustained ablation, a cutoff value of 13% PVC burden had a sensitivity of 100% and a specificity of 93% (area under the curve 99%) for removing ICD indication postablation. No sudden cardiac deaths or malignant ventricular arrhythmias were observed.In patients with frequent PVC and PP-ICD indication, ablation improves LVEF and, in most cases, allows removal of the indication. Withholding the ICD and reevaluating within 6 months of ablation seems to be a safe and appropriate strategy.

Aims To assess the results of transcatheter ablation of cardiac arrhythmias in Latin America and establish the first Latin American transcatheter ablation registry. Methods and results All ablation procedures performed between 1 January and 31 December 2012 were analysed retrospectively. Data were obtained on the characteristics and resources of participating centres (public or private institution, number of beds, cardiac surgery availability, type of room for the procedures, days per week assigned to electrophysiology procedures, type of fluoroscopy equipment, availability and type of electroanatomical mapping system, intracardiac echo, cryoablation, and number of electrophysiologists) and the results of 17 different ablation substrates: atrio-ventricular node reentrant tachycardia, typical atrial flutter, atypical atrial flutter, left free wall accessory pathway, right free wall accessory pathway, septal accessory pathway, right-sided focal atrial tachycardia, left-sided focal atrial tachycardia, paroxysmal atrial fibrillation, non-paroxysmal atrial fibrillation, atrio-ventricular node, premature ventricular complex, idiopathic ventricular tachycardia, post-myocardial infarction ventricular tachycardia, ventricular tachycardia in chronic chagasic cardiomyopathy, ventricular tachycardia in congenital heart disease, and ventricular tachycardias in other structural heart diseases. Data of 15 099 procedures were received from 120 centres in 13 participating countries (Argentina, Bolivia, Brazil, Chile, Colombia, Cuba, El Salvador, Guatemala, Mexico, Peru, Dominican Republic, Uruguay, and Venezuela). Accessory pathway was the group of arrhythmias most frequently ablated (31%), followed by atrio-ventricular node reentrant tachycardia (29%), typical atrial flutter (14%), and atrial fibrillation (11%). Overall success was 92% with the rate of global complications at 4% and mortality 0.05%. Conclusion Catheter ablation in Latin America can be considered effective and safe.

During the past three decades, catheter and surgical ablation of atrial fibrillation (AF) have evolved from investigational procedures to their current role as effective treatment options for patients with AF. Surgical ablation of AF, using either standard, minimally invasive, or hybrid techniques, is available in most major hospitals throughout the world. Catheter ablation of AF is even more widely available, and is now the most commonly performed catheter ablation procedure. In 2007, an initial Consensus Statement on Catheter and Surgical AF Ablation was developed as a joint effort of the Heart Rhythm Society (HRS), the European Heart Rhythm Association (EHRA), and the European Cardiac Arrhythmia Society (ECAS).1 The 2007 document was also developed in collaboration with the Society of Thoracic Surgeons (STS) and the American College of Cardiology (ACC). This Consensus Statement on Catheter and Surgical AF Ablation was rewritten in 2012 to reflect the many advances in AF ablation that had occurred in the interim.2 The rate of advancement in the tools, techniques, and outcomes of AF ablation continue to increase as enormous research efforts are focused on the mechanisms, outcomes, and treatment of AF. For this reason, the HRS initiated an effort to rewrite and update this Consensus Statement. Reflecting both the worldwide importance of AF, as well as the worldwide performance of AF ablation, this document is the result of a joint partnership between the HRS, EHRA, ECAS, the Asia Pacific Heart Rhythm Society (APHRS), and the Latin American Society of Cardiac Stimulation and Electrophysiology (Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia [SOLAECE]). The purpose of this 2017 Consensus Statement is to provide a state-of-the-art review of the field of catheter and surgical ablation of AF and to report the findings of a writing group, convened by these five international societies. The writing group is charged with defining the indications, techniques, and outcomes of AF ablation procedures. Included within this document are recommendations pertinent to the design of clinical trials in the field of AF ablation and the reporting of outcomes, including definitions relevant to this topic. The writing group is composed of 60 experts representing 11 organizations: HRS, EHRA, ECAS, APHRS, SOLAECE, STS, ACC, American Heart Association (AHA), Canadian Heart Rhythm Society (CHRS), Japanese Heart Rhythm Society (JHRS), and Brazilian Society of Cardiac Arrhythmias (Sociedade Brasileira de Arritmias Cardiacas [SOBRAC]). All the members of the writing group, as well as peer reviewers of the document, have provided disclosure statements for all relationships that might be perceived as real or potential conflicts of interest. All author and peer reviewer disclosure information is provided in Appendix A and Appendix B. In writing a consensus document, it is recognized that consensus does not mean that there was complete agreement among all the writing group members. Surveys of the entire writing group were used to identify areas of consensus concerning performance of AF ablation procedures and to develop recommendations concerning the indications for catheter and surgical AF ablation. These recommendations were systematically balloted by the 60 writing group members and were approved by a minimum of 80% of these members. The recommendations were also subject to a 1-month public comment period. Each partnering and collaborating organization then officially reviewed, commented on, edited, and endorsed the final document and recommendations. The grading system for indication of class of evidence level was adapted based on that used by the ACC and the AHA.3,4 It is important to state, however, that this document is not a guideline. The indications for catheter and surgical ablation of AF, as well as recommendations for procedure performance, are presented with a Class and Level of Evidence (LOE) to be consistent with what the reader is familiar with seeing in guideline statements. A Class I recommendation means that the benefits of the AF ablation procedure markedly exceed the risks, and that AF ablation should be performed; a Class IIa recommendation means that the benefits of an AF ablation procedure exceed the risks, and that it is reasonable to perform AF ablation; a Class IIb recommendation means that the benefit of AF ablation is greater or equal to the risks, and that AF ablation may be considered; and a Class III recommendation means that AF ablation is of no proven benefit and is not recommended. The writing group reviewed and ranked evidence supporting current recommendations with the weight of evidence ranked as Level A if the data were derived from high-quality evidence from more than one randomized clinical trial, meta-analyses of high-quality randomized clinical trials, or one or more randomized clinical trials corroborated by high-quality registry studies. The writing group ranked available evidence as Level B-R when there was moderate-quality evidence from one or more randomized clinical trials, or meta-analyses of moderate-quality randomized clinical trials. Level B-NR was used to denote moderate-quality evidence from one or more well-designed, well-executed nonrandomized studies, observational studies, or registry studies. This designation was also used to denote moderate-quality evidence from meta-analyses of such studies. Evidence was ranked as Level C-LD when the primary source of the recommendation was randomized or nonrandomized observational or registry studies with limitations of design or execution, meta-analyses of such studies, or physiological or mechanistic studies of human subjects. Level C-EO was defined as expert opinion based on the clinical experience of the writing group. Despite a large number of authors, the participation of several societies and professional organizations, and the attempts of the group to reflect the current knowledge in the field adequately, this document is not intended as a guideline. Rather, the group would like to refer to the current guidelines on AF management for the purpose of guiding overall AF management strategies.5,6 This consensus document is specifically focused on catheter and surgical ablation of AF, and summarizes the opinion of the writing group members based on an extensive literature review as well as their own experience. It is directed to all health care professionals who are involved in the care of patients with AF, particularly those who are caring for patients who are undergoing, or are being considered for, catheter or surgical ablation procedures for AF, and those involved in research in the field of AF ablation. This statement is not intended to recommend or promote catheter or surgical ablation of AF. Rather, the ultimate judgment regarding care of a particular patient must be made by the health care provider and the patient in light of all the circumstances presented by that patient. The main objective of this document is to improve patient care by providing a foundation of knowledge for those involved with catheter ablation of AF. A second major objective is to provide recommendations for designing clinical trials and reporting outcomes of clinical trials of AF ablation. It is recognized that this field continues to evolve rapidly. As this document was being prepared, further clinical trials of catheter and surgical ablation of AF were under way.

BACKGROUND Frequent premature ventricular complexes (PVCs) can induce or worsen left ventricular (LV) systolic dysfunction. OBJECTIVE The purpose of this study was to identify the clinical pattern of patients having a "pure PVC-induced" cardiomyopathy at presentation. METHODS This prospective multicenter study included 155 consecutive patients (age 55612 years, 96 men [62%], 23% +/- 12% mean PVC burden) with LV dysfunction and frequent PVCs submitted for ablation and followed up for at least 12 months. Patients with a previously diagnosed structural heart disease (50 [32%]) and those without complete PVC abolition during follow-up who did not normalize LV ejection fraction (LVEF) (24 [15%]) were excluded from the analysis. RESULTS Of the remaining 81 patients, 41 (51%) had a successful sustained ablation, did not have normalized LVEF, and were classified as having PVC-worsened nonischemic cardiomyopathy, and 40 (49%) who had normalized LVEF were considered as having pure PVC-induced cardiomyopathy. The latter group had higher baseline PVC burden (27% +/- 12% vs 12% +/- 8%; P < .001), smaller LV end-diastolic diameter (58 +/- 5 mmvs 60 +/- 6 mm; P=.05), and shorter Kintrinsic QRS (105 +/- 12 vs 129 +/- 24 ms; P130 ms, baseline PVC burden 63 mm. CONCLUSION Almost half of patients with frequent PVCs and low LVEF of unknown origin normalize LVEF after sustained PVC abolition, and these patients can be identified before ablation.

During the past three decades, catheter and surgical ablation of atrial fibrillation (AF) have evolved from investigational procedures to their current role as effective treatment options for patients with AF. Surgical ablation of AF, using either standard, minimally invasive, or hybrid techniques, is available in most major hospitals throughout the world. Catheter ablation of AF is even more widely available, and is now the most commonly performed catheter ablation procedure. In 2007, an initial Consensus Statement on Catheter and Surgical AF Ablation was developed as a joint effort of the Heart Rhythm Society (HRS), the European Heart Rhythm Association (EHRA), and the European Cardiac Arrhythmia Society (ECAS).1 The 2007 document was also developed in collaboration with the Society of Thoracic Surgeons (STS) and the American College of Cardiology (ACC). This Consensus Statement on Catheter and Surgical AF Ablation was rewritten in 2012 to reflect the many advances in AF ablation that had occurred in the interim.2 The rate of advancement in the tools, techniques, and outcomes of AF ablation continue to increase as enormous research efforts are focused on the mechanisms, outcomes, and treatment of AF. For this reason, the HRS initiated an effort to rewrite and update this Consensus Statement. Reflecting both the worldwide importance of AF, as well as the worldwide performance of AF ablation, this document is the result of a joint partnership between the HRS, EHRA, ECAS, the Asia Pacific Heart Rhythm Society (APHRS), and the Latin American Society of Cardiac Stimulation and Electrophysiology (Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia [SOLAECE]). The purpose of this 2017 Consensus Statement is to provide a state-of-the-art review of the field of catheter and surgical ablation of AF and to report the findings of a writing group, convened by these five international societies. The writing group is charged with defining the indications, techniques, and outcomes of AF ablation procedures. Included within this document are recommendations pertinent to the design of clinical trials in the field of AF ablation and the reporting of outcomes, including definitions relevant to this topic. The writing group is composed of 60 experts representing 11 organizations: HRS, EHRA, ECAS, APHRS, SOLAECE, STS, ACC, American Heart Association (AHA), Canadian Heart Rhythm Society (CHRS), Japanese Heart Rhythm Society (JHRS), and Brazilian Society of Cardiac Arrhythmias (Sociedade Brasileira de Arritmias Cardiacas [SOBRAC]). All the members of the writing group, as well as peer reviewers of the document, have provided disclosure statements for all relationships that might be perceived as real or potential conflicts of interest. All author and peer reviewer disclosure information is provided in Appendix A and Appendix B. In writing a consensus document, it is recognized that consensus does not mean that there was complete agreement among all the writing group members. Surveys of the entire writing group were used to identify areas of consensus concerning performance of AF ablation procedures and to develop recommendations concerning the indications for catheter and surgical AF ablation. These recommendations were systematically balloted by the 60 writing group members and were approved by a minimum of 80% of these members. The recommendations were also subject to a 1-month public comment period. Each partnering and collaborating organization then officially reviewed, commented on, edited, and endorsed the final document and recommendations. The grading system for indication of class of evidence level was adapted based on that used by the ACC and the AHA.3,4 It is important to state, however, that this document is not a guideline. The indications for catheter and surgical ablation of AF, as well as recommendations for procedure performance, are presented with a Class and Level of Evidence (LOE) to be consistent with what the reader is familiar with seeing in guideline statements. A Class I recommendation means that the benefits of the AF ablation procedure markedly exceed the risks, and that AF ablation should be performed; a Class IIa recommendation means that the benefits of an AF ablation procedure exceed the risks, and that it is reasonable to perform AF ablation; a Class IIb recommendation means that the benefit of AF ablation is greater or equal to the risks, and that AF ablation may be considered; and a Class III recommendation means that AF ablation is of no proven benefit and is not recommended. The writing group reviewed and ranked evidence supporting current recommendations with the weight of evidence ranked as Level A if the data were derived from high-quality evidence from more than one randomized clinical trial, meta-analyses of high-quality randomized clinical trials, or one or more randomized clinical trials corroborated by high-quality registry studies. The writing group ranked available evidence as Level B-R when there was moderate-quality evidence from one or more randomized clinical trials, or meta-analyses of moderate-quality randomized clinical trials. Level B-NR was used to denote moderate-quality evidence from one or more well-designed, well-executed nonrandomized studies, observational studies, or registry studies. This designation was also used to denote moderate-quality evidence from meta-analyses of such studies. Evidence was ranked as Level C-LD when the primary source of the recommendation was randomized or nonrandomized observational or registry studies with limitations of design or execution, meta-analyses of such studies, or physiological or mechanistic studies of human subjects. Level C-EO was defined as expert opinion based on the clinical experience of the writing group. Despite a large number of authors, the participation of several societies and professional organizations, and the attempts of the group to reflect the current knowledge in the field adequately, this document is not intended as a guideline. Rather, the group would like to refer to the current guidelines on AF management for the purpose of guiding overall AF management strategies.5,6 This consensus document is specifically focused on catheter and surgical ablation of AF, and summarizes the opinion of the writing group members based on an extensive literature review as well as their own experience. It is directed to all health care professionals who are involved in the care of patients with AF, particularly those who are caring for patients who are undergoing, or are being considered for, catheter or surgical ablation procedures for AF, and those involved in research in the field of AF ablation. This statement is not intended to recommend or promote catheter or surgical ablation of AF. Rather, the ultimate judgment regarding care of a particular patient must be made by the health care provider and the patient in light of all the circumstances presented by that patient. The main objective of this document is to improve patient care by providing a foundation of knowledge for those involved with catheter ablation of AF. A second major objective is to provide recommendations for designing clinical trials and reporting outcomes of clinical trials of AF ablation. It is recognized that this field continues to evolve rapidly. As this document was being prepared, further clinical trials of catheter and surgical ablation of AF were under way.

Objectives This study aimed to assess the benefit after ablation of premature ventricular complexes (PVC) in patients with frequent PVC and left ventricular (LV) dysfunction, regardless of previous structural heart disease (SHD) diagnosis, PVC morphology, or estimated site of origin. Background Ablation of PVC in patients with LV dysfunction is usually restricted to patients with suspected PVC-induced cardiomyopathy. Methods Consecutive patients with frequent PVC and LV dysfunction accepted for ablation at 4 centers were prospectively included. Of the 80 patients included, 27 (34%) had a diagnosis of SHD. Results Successful sustained ablation (SSA) was achieved in 53 (66%) patients, and LVEF improved in these patients from 33.7 ± 8% to 43.8 ± 9.4% and 45.8 ± 10.9% at 6 and 12 months, respectively (p 13% PVC and SSA had class I indication for cardioverter defibrillator implantation, these indications were absent at 6 months post-ablation. Conclusions Independently of the presence of SHD, the SSA of frequent PVC in patients with depressed LVEF induced a progressive clinical and functional improvement. Improvement in heart failure parameters was related to baseline PVC burden and persistence of ablation success.

Background: Implantable cardioverter defibrillators (ICDs) have been used in the treatment of either sustained ventricular tachycardia or ventricular fibrillation in patients with Chagas’ cardiomyopathy. This study aimed at determining mortality rate and risk factors of all-cause 1-year mortality in primary and secondary ICD patients with Chagas’ cardiomyopathy. Methods: One hundred and forty-eight Chagas’ patients with ICDs were included from the Medtronic ICD Registry Latin America. All patients were followed for 1 year. Results: At implant, mean age was 60.1 ± 9.4 years and 72.9% were male. Mean left ventricular ejection fraction(LVEF)was 40.1 ±11%. Meanfollow-upwas12 ±7months. Duringthefollow-up,15patientsdied (10.2%). Patients who died were older (64 ±10.8 years vs 59 ± 9.1; P = 0.04), had more atrial fibrillation (13.3% vs 3.8%; P = 0.02), had lower LVEF (33.4% ± 9.8 vs 40.9% ± 11.3; P = 0.01), and worse functional class (III/IV 40% vs 21.8%; P = 0.03). The multivariate analysis showed that two independent predictors of all-cause 1-year mortality remained statistically significant: age more than 65 (hazard ratio [HR] = 2.85, 95% confidence interval [CI] 1.77‐3.92; P = 0.03) and LVEF less than 30% (HR = 2.68, 95% CI 1.57‐3.79; P = 0.04). Conclusion: This analysis showed that patients older than 65 years of age and with LVEF less than 30% were independent predictors of all-cause 1-year mortality in patients with chronic Chagas’ cardiomyopathy. (PACE 2011; 1‐7)

ObjectiveThis study aims to evaluate the influence of myocardial scar after premature ventricular complexes (PVC) ablation in patients with left ventricular (LV) dysfunction.Methods70 consecutive patients (58±11 years, 58 (83%) men, 23% (18–32) mean PVC burden) with LV dysfunction and frequent PVCs submitted for ablation were included. A late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) was performed prior to the ablation and a quantitative and qualitative analysis of the scar was done.ResultsLeft ventricular ejection fraction progressively improved from 34.3%±9% at baseline to 44.4%±12% at 12 months (pConclusionsPresence of myocardial scar modulates, but does not preclude, the probability of response to PVC ablation in patients with LV dysfunction.

Cardiac tachyarrhythmias are recurrent or chronic and in some cases life-threatening conditions. Heart rhythm disturbances are often highly symptomatic and the psychological impact of the disease can be significant. Patients' beliefs and knowledge about their health (and illness), medications, and healthcare they receive are important determinants of whether or not they accept recommended treatments; influence their coping responses to their illness and treatment; adherence to recommended therapy; and ultimately affects health outcomes. Incorporation of patients' values and preferences for therapy should now be considered as an integral part of the decision-making process and treatment strategy. It is important to acknowledge and understand the impact of cardiac tachyarrhythmias on the patient. To address this issue, a Task Force was convened by the European Heart Rhythm Association (EHRA), and endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLEACE), with the remit to comprehensively review the published evidence available, to publish a joint consensus document on patient values and preferences for the management of cardiac tachyarrhythmias, and to provide up-to-date consensus recommendations for use in clinical practice. Hence this unique consensus document focuses on patients, summarizing the available literature on patients' experiences of living with various cardiac tachyarrhythmias and their treatment preferences, and identifies gaps in knowledge which will help to inform clinical practice and future research. The document will also summarize key points for discussions with patients during consultations regarding their condition, treatment options, disease trajectory, treatment goals, and outcomes. Finally, this document provides links to useful resources and patient advocacy groups and organizations and professional societies relevant to each group of cardiac tachyarrhythmias. ### Patients' experiences of living with atrial fibrillation The experience of living with atrial fibrillation (AF) has been investigated from several perspectives. Quantitative studies reveal that patients with AF generally report lower health-related quality …

There was an error on the above article. The sentence “Even if a dual-chamber ICD is implanted, dual-chamber discrimination should be programmed only if the atrial lead becomes chronic or if atrial sensing is unreliable” is not correct. It should read: “Even if a dual- chamber ICD is implanted, dual-chamber discrimination should be programmed only if the atrial lead becomes chronic or if atrial sensing is reliable”.

Introduccion y objetivos La ablacion con radio-frecuencia de vias accesorias izquierdas requiere ocasionalmente multiples aplicaciones debido a cartografia inadecuada, mal contacto electrodo-cateter y factores anatomicos particulares; sin embargo, dichas caracteristicas no han sido especificamente analizadas. Metodos En una serie prospectiva de 65 pacientes con ablacion de vias izquierdas se analizaron las caracteristicas de los electrogramas en cada punto de aplicacion, el numero de aplicaciones, la impedancia, potencia y temperatura de las mismas. Resultados Cincuenta y dos pacientes (80%) requirieron menos de 5 aplicaciones (grupo A), y 13 (20%) requirieron ≥ 5 aplicaciones (grupo B). La presencia de un potencial indicativo de via accesoria en el electrograma local fue similar en ambos grupos y no hubo diferencias en los intervalos A-V o V-A locales. Sin embargo en pacientes con preexcitacion, el intervalo Delta-V fue menor en el grupo A que en el B (8 frente a 15 ms; p Conclusiones Los pacientes que requirieron mas de 5 aplicaciones tenian electrogramas y contacto tisular iguales o mejores que los que requirieron menos de 5 aplicaciones, lo que sugiere que la dificultad en estos procedimientos pueda ser debida mas a factores anatomicos que a deficiente cartografia o inadecuado contacto con el tejido.

This study sought to determine the long-term follow-up, safety, and efficacy of radiofrequency catheter ablation of patients with the permanent form of junctional reciprocating tachycardia (PJRT). We assessed the reversibility of tachycardia induced LV dysfunction and we detailed the location and electrophysiological characteristics of these retrograde atrioventricular decremental pathways. PJRT is an infrequent form of reciprocating tachycardia, commonly incessant, and usually drug refractory. The ECG hallmarks include an RP interval > PR with inverted P waves in leads II, III, a VF, and V3-V6. During tachycardia, retrograde VA conduction occurs over an accessory pathway with slow and decremental conduction properties, located predominantly in the posteroseptal zone. It is known that long-lasting and incessant tachycardia may result in tachycardia induced severe ventricular dysfunction. We included 36 patients (13 men, 23 women, mean +/- SD, aged 44 +/- 22 years) with the diagnosis of PJRT. Seven patients had tachycardia induced left ventricular dysfunction. Radiofrequency energy was delivered at the site of earliest retrograde atrial activation during ventricular pacing or during reciprocating tachycardia. All patients were followed at the outpatient clinic and serial echocardiograms were performed in those who presented with depressed LV function. Radiofrequency ablation was performed in 36 decremental accessory pathways. Earliest retrograde atrial activation was right posteroseptal in 32 patients (88%), right mid-septal in 2 (6%), right posterolateral in 1 (3%), and left anterolateral in 1 (3%). Thirty-five accessory pathways were successfully ablated with a mean of 5 +/- 3 applications. A mid-septal accessory pathway could not be ablated. After a mean follow-up of 21 +/- 16 months (range 1-64) 34 patients are asymptomatic. There were recurrences in 8 patients after the initial successful ablation (mean of 1.2 months), 5 were ablated in a second ablation procedure, 2 patients required a third procedure, and 1 patient required four ablation sessions. All patients with LV dysfunction experienced a remarkable improvement after ablation. Mean preablation LV ejection fraction in patients with tachycardiomyopathy was 28% +/- 6% and rose to 51% +/- 16% after ablation (P < 0.02). Our study supports the concept that radiofrequency catheter ablation is a safe and effective treatment for patients with PJRT. Radiofrequency ablation should be the treatment of choice in these patients because this arrhythmia is usually drug refractory. The majority of accessory pathways are located in the posteroseptal zone. Cessation of the arrhythmia after successful ablation results in recovery of LV dysfunction.

Introduccion La ablacion con radiofrecuencia del nodo auriculoventricular ha emergido como una alternativa valida en el tratamiento de la fibrilacion auricular refractaria al tratamiento antiarritmico, habiendose demostrado ampliamente sus efectos beneficiosos. Hemos tratado a un subgrupo de pacientes que presentaron un deterioro hemodinamico despues de la ablacion, en relacion con un aumento del grado de insuficiencia mitral. Pacientes y metodos Hemos evaluado a 256 pacientes consecutivos remitidos para ablacion del nodo auriculoventricular e implantacion de marcapasos definitivo por fibrilacion auricular refractaria. Dado que observamos que el deterioro hemodinamico se dio solamente en pacientes con insuficiencia mitral previa a la ablacion comparamos retrospectivamente las caracteristicas clinicas, electrofisiologicas y ecocardiograficas de los pacientes con insuficiencia mitral previa y deterioro hemodinamico (grupo A, n = 14) y los pacientes sin deterioro hemodinamico (grupo B, n = 11). Resultados La duracion del procedimiento, la tecnica y el numero de aplicaciones durante la ablacion fueron similares en ambos grupos. El grado de insuficiencia mitral valorado de 1 (minima) a 4 (severa) era similar en ambos grupos antes de la ablacion (1,15 ± 1,05 frente a 1,11 ± 0,97). Los pacientes del grupo A presentaron un deterioro hemodinamico en forma de edema agudo de pulmon (3 pacientes) o insuficiencia cardiaca congestiva (11 pacientes) una media de 6 semanas despues de la ablacion. En todos ellos se aprecio un empeoramiento del grado de insuficiencia mitral (1,15 ± 1,05 frente a 2,90 ± 1,15; p Conclusion La ablacion con radiofrecuencia del nodo auriculoventricular junto a la implantacion de un marcapasos se acompana generalmente de una mejoria clinica notable; sin embargo, en un subgrupo de pacientes esta provoca un deterioro hemodinamico con empeoramiento de una insuficiencia mitral previa.

Multiple accessory pathways in patients with the Wolff-Parkinson-White syndrome are infrequent and are associated with a higher risk of ventricular fibrillation. We present an exceptional case of a patient with four accessory pathways with anterograde conduction and a fasciculo-ventricular fiber in whom we performed a radiofrequency ablation. A 20 year old healthy male patient was seen at the emergency room after suffering syncope. The electrocardiogram showed atrial fibrillation with wide QRS complex suggestive of preexcitation. The electrophysiologic study demonstrated the presence of four atrio-ventricular accessory pathways with antegrade conduction (left lateral, right posteroseptal, right midseptal and right posterolateral). After ablation of the fourth accessory pathway, the electrocardiogram showed a persistent delta wave with a short HV interval. Atrial stimulation demonstrated decremental conduction, progressive lengthening of the AH interval and no modification in the HV interval nor in the preexcitation pattern, suggestive of the presence of a fasciculo-ventricular fiber. This exceptional case report is demonstrative of the complexity of the Wolff-Parkinson-White syndrome, and the feasibility and efficacy of radiofrequency catheter ablation in a single procedure.

Objetivos. Este estudio evalua la hipotesis que en pacientes con sincope de origen no conocido y anomalias cardiacas, las arritmias ventriculares inducibles son arritmias especificas y, por tanto, podrian ser tratadas apropiadamente. Antecedentes. El sincope es una entidad clinica frecuente. La evolucion y tratamiento de pacientes con sincope y anomalias cardiacas sin una clara etiologia no han sido bien definidos. Muchos pacientes tienen en su evaluacion un estudio electrofisiologico. En estas evaluaciones se encuentran anormalidades del nodo sinusal, prolongacion de los tiempos de conduccion o arritmias inducibles y, usualmente, se asume que esta es la causa del sincope y, segun ello, estos pacientes son tratados. Sin embargo, que las taquiarritmias sean la verdadera causa del sincope y que el tratamiento de estas taquiarritmias puede prevenir la recurrencia del sin

Objetivos En este estudio evaluamos la eficacia y la seguridad de la ablacion con radiofrecuencia en pacientes con la forma permanente de taquicardia reciproca de la union utilizando una via de conduccion lenta o de tipo Coumel, en un seguimiento a largo plazo y determinamos la probable recuperacion de la funcion ventricular despues del procedimiento. Antecedentes La taquicardia reciproca de la union es una forma poco comun de taquicardia reciproca, muchas veces incesante y usualmente refractaria a la terapia farmacologica. Se caracteriza por tener un intervalo RP > PR y por ondas «p» de polaridad negativa en las derivaciones II-III y aVF y V4-V6. La conduccion retrograda se realiza a traves de una via accesoria con conduccion lenta y decremental. La localizacion de esta via accesoria es en general posteroseptal derecha, aunque tambien se han comunicado otras localizaciones de la via accesoria. Se ha descrito que la presencia de taquicardia incesante puede desencadenar la denominada taquicardiomiopatia con severa disfuncion ventricular izquierda. Pacientes y metodos Este estudio incluyo a 24 pacientes (9 varones y 15 mujeres), con una edad media de 44 ± 22 anos, con un diagnostico de la forma permanente de taquicardia reciproca de la union confirmada por el estudio electrofisiologico. Seis pacientes tenian deterioro de su funcion ventricular. La radiofrecuencia fue aplicada en el lugar de activacion auricular retrograda mas precoz durante la taquicardia (n = 22) o durante la estimulacion ventricular (n = 2). A todos los pacientes se le hizo seguimiento clinico y electrocardiografico, ademas de ecocardiograma bidimensional en los que presentaron disfuncion ventricular. Resultados Se realizaron ablaciones en 24 vias accesorias con estas caracteristicas. El sitio de activacion auricular retrograda mas precoz fue posteroseptal derecho en 22 pacientes (92%), medioseptal derecho en 1 (4%) y posterolateral derecho en 1 (4%). Se realizaron ablaciones con exito en 23 vias accesorias con una media de 5 ± 3 (mediana, 4) aplicaciones de radiofrecuencia, de 48 ± 13 s de duracion. En la unica via de localizacion medioseptal no se logro realizar la ablacion. En un seguimiento medio de 21 ± 16 meses (mediana, 15; rango, 2-64 meses), 22 pacientes permanecen asintomaticos. Se observo recurrencia en 4 pacientes (durante el primer mes en tres y al segundo mes en uno), a dos de ellos se realizo la ablacion de forma efectiva en un segundo procedimiento, un paciente necesito un tercer procedimiento y el cuarto paciente necesito 4 sesiones de ablacion. Todos los pacientes con funcion ventricular deteriorada tuvieron una clara mejoria en el seguimiento postablacion. La funcion ventricular media preablacion de los 6 pacientes con taquicardiomiopatia fue del 28 ± 6% (mediana, 27) y postablacion del 51 ± 16% (mediana, 47; p Conclusiones Este estudio confirma que la ablacion mediante cateter con radiofrecuencia es una terapia util y segura en los pacientes con taquicardia reciproca de la union. Debido a la usual refractariedad de esta arritmia a los farmacos antiarritmicos, el procedimiento deberia ser considerado como la primera opcion en el tratamiento de estos pacientes. La mayoria de las vias accesorias en este grupo de pacientes con taquicardia reciproca de la union estan localizadas en la zona posteroseptal derecha. La mejoria en la disfuncion ventricular es la regla despues de la ablacion efectiva de la via accesoria.

Introduccion El proposito de este estudio es describir los resultados del seguimiento a largo plazo (minimo 3 anos) de pacientes con taquicardia por reentrada nodal del tipo comun, a los que realizamos una ablacion por radiofrecuencia. Pacientes y metodos Incluimos a 60 pacientes consecutivos con una edad media de 56 ± 16 anos (rango, 14-83 anos), de los cuales 16 eran varones y 44 mujeres, a quienes se les realizo una ablacion por radiofrecuencia de la via lenta nodal (n = 51,grupo A) y de la via rapida nodal (n = 9, grupo B), entre enero de 1992 y marzo de 1994. A todos se les realizo un seguimiento clinico y electrocardiografico al termino de 1, 3, 6 y 12 meses de la ablacion y en el momento de concluir el seguimiento enabril de 1997. Resultados Durante un periodo de seguimiento medio de 48 ± 7 meses (rango, 38-63 meses), el total de los pacientes evaluados permanecen asintomaticos. Hubo 8 recurrencias que se presentaron en un tiempo medio de 1 ± 2 meses (rango, 0,5- 7 meses) despues del primer procedimiento de ablacion. En todas ellas se realizo una segunda ablacion efectiva. El intervalo PR preablacion, a los 12 meses y en abril de 1997, fue de 122 ± 11, de 124 ± 13 y de 124 ± 15 ms, respectivamente, en el grupo A. El intervalo PR preablacion, a los 12 meses y en abril de 1997, fue de 130 ± 24, de 200 ± 12 y 200 ± 24 ms, respectivamente, en el grupo B. No se observaron trastornos graves de la conduccion auriculoventricular en ningun paciente. En un paciente se produjo un nuevo bloqueo completo de la rama izquierda y 4 pacientes fallecieron por causas extracardiacas. Conclusiones En los pacientes con taquicardia por reentrada nodal, la ablacion por radiofrecuencia es una terapia segura y eficaz, con buenos resultados iniciales que se mantienen en el seguimiento, con un bajo indice de recurrencias y sin complicaciones agudas y a largo plazo.

This study aimed to assess the benefit after ablation of premature ventricular complexes (PVC) in patients with frequent PVC and left ventricular (LV) dysfunction, regardless of previous structural heart disease (SHD) diagnosis, PVC morphology, or estimated site of origin.Ablation of PVC in patients with LV dysfunction is usually restricted to patients with suspected PVC-induced cardiomyopathy.Consecutive patients with frequent PVC and LV dysfunction accepted for ablation at 4 centers were prospectively included. Of the 80 patients included, 27 (34%) had a diagnosis of SHD.Successful sustained ablation (SSA) was achieved in 53 (66%) patients, and LVEF improved in these patients from 33.7 ± 8% to 43.8 ± 9.4% and 45.8 ± 10.9% at 6 and 12 months, respectively (p0.05), without differences related to previous diagnosis of SHD (p = 0.69). BNP decreased from 109 [64 to 242] pg/ml to 60 [25 to 170] pg/ml, 50 [14 to 130] pg/ml, and 60 [19 to 81] pg/ml at 1, 6, and 12 months (p0.05). Patients in NYHA class I increased from 12 (23%) to 42 (79%) at 12 months (p0.05). A 13% baseline PVC burden had 100% sensitivity and 85% specificity to predict an absolute increase ≥ 5% in LVEF after SSA. Although 20 patients with13% PVC and SSA had class I indication for cardioverter defibrillator implantation, these indications were absent at 6 months post-ablation.Independently of the presence of SHD, the SSA of frequent PVC in patients with depressed LVEF induced a progressive clinical and functional improvement. Improvement in heart failure parameters was related to baseline PVC burden and persistence of ablation success.

Implantable cardioverter defibrillators (ICDs) have been used in the treatment of either sustained ventricular tachycardia or ventricular fibrillation in patients with Chagas' cardiomyopathy. This study aimed at determining mortality rate and risk factors of all-cause 1-year mortality in primary and secondary ICD patients with Chagas' cardiomyopathy.One hundred and forty-eight Chagas' patients with ICDs were included from the Medtronic ICD Registry Latin America. All patients were followed for 1 year.At implant, mean age was 60.1 ± 9.4 years and 72.9% were male. Mean left ventricular ejection fraction (LVEF) was 40.1 ± 11%. Mean follow-up was 12 ± 7 months. During the follow-up, 15 patients died (10.2%). Patients who died were older (64 ±10.8 years vs 59 ± 9.1; P = 0.04), had more atrial fibrillation (13.3% vs 3.8%; P = 0.02), had lower LVEF (33.4%± 9.8 vs 40.9%± 11.3; P = 0.01), and worse functional class (III/IV 40% vs 21.8%; P = 0.03). The multivariate analysis showed that two independent predictors of all-cause 1-year mortality remained statistically significant: age more than 65 (hazard ratio [HR] = 2.85, 95% confidence interval [CI] 1.77-3.92; P = 0.03) and LVEF less than 30% (HR = 2.68, 95% CI 1.57-3.79; P = 0.04).This analysis showed that patients older than 65 years of age and with LVEF less than 30% were independent predictors of all-cause 1-year mortality in patients with chronic Chagas' cardiomyopathy.

OBJECTIVESThe objective of this study was to analyze the influence of coronary artery revascularization in patients with ventricular arrhythmias.BACKGROUNDCoronary artery revascularization is an effective treatment for myocardial ischemia; however, its effect on ventricular arrhythmias not related to an acute ischemic event has not been carefully studied.METHODSSixty-four patients (58 men, mean age 65 ± 8 years old) with prior myocardial infarction, spontaneous ventricular arrhythmias not related to an acute ischemic event (55 ventricular tachycardia, 9 ventricular fibrillation) and coronary lesions requiring revascularization were studied prospectively. Electrophysiological study was performed before and after revascularization, and events during follow-up were analyzed.RESULTSAt initial study 61 patients were inducible into sustained ventricular arrhythmias. After revascularization, in 62 survivors, 52 out of 59 patients previously inducible were still inducible (group A), and 10 patients were noninducible (group B). No differences were found in clinical, hemodynamic, therapeutic and electrophysiological characteristics between both groups. During 32 ± 26 months follow-up, 28/52 patients in group A (54%) and 4/10 patients in group B (40%) had arrhythmic events (p = 0.46). An ejection fraction