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OBJECTIVES The aim of this study was to describe a mapping approach for ablation of complex atrial re-entrant tachycardias (ARTS) in which high-density activation maps are transformed into low-density activation maps displaying only the active part of the tachycardia circuit. BACKGROUND High-density activation maps during complex ARTs are challenging to interpret because they include the activation patterns of active and passive circuits. Entrainment mapping provides the identification of the active tachycardia circuit. However, current etectroanatomic mapping systems are not capable of color-coding the information obtained from entrainment maneuvers. METHODS Seventeen consecutive patients with atypical atrial flutter were included. A high-density activation map was acquired during index tachycardia. Subsequently, entrainment maneuvers were performed to generate a low-density activation map in which only the activation of the atria directly involved in the flutter circuit was displayed. RESULTS Of all patients included, 82% were men, and their mean age was 62 +/- 7 years. Structural heart disease was present in 59%, and 53% had undergone prior left atrial ablation procedures. Low-density activation maps were successfully generated from an average of 14 3 entrainment points. Twenty circuits (95%) were identified in the left atrium and 1 (5%) in the right atrium. Ablation guided by tow-density mapping successfully terminated all ARTs in 267 +/- 353 s of radiofrequency application. CONCLUSIONS Low-density mapping based on entrainment maneuvers provides a precise delineation of the active circuit during complex ARTs and resulted in successful arrhythmia termination. This approach can be easily incorporated into clinical practice. (C) 2020 by the American College of Cardiology Foundation.

Background Remote monitoring of cardiac implantable electronic devices (CIEDs) has demonstrated substantial benefits. Treatment guidelines have therefore endorsed its use and is being increasingly adopted in the clinical setting, but the level of satisfaction they convey remains still unknown. We developed and validated a questionnaire to measure patient satisfaction with remote monitoring using Medtronic CareLink (R) Network and assessed its internal reliability and dimensional validity. Methods After a thorough literature review, cognitive debriefing of 18 patients, and an expert panel discussion, a 30-item instrument was proposed and grouped into 5 dimensions (items): 1- Information on cardiac condition (3), 2- Device convenience (3), 3- Transmission process (6), 4- Satisfaction with medical monitoring (8), and 5- General opinions (10). Correlation with the visual analog scale (VAS), overall health related quality of life (HRQoL) measured by the EuroQoL-5D accompanied by the VAS as well as with the Medical Outcomes Study (MOS) SF-36 were assessed. Psychometric properties, exploratory factor analysis and a second order confirmatory factor analysis (a hierarchical CFA with a general common factor explaining the relations between the first order common factors, See Figure 1) were estimated. Models were assessed based on item loading size, sign and statistical significance, and goodness-of-fit statistics. Results A total of 186 patients (77% male) with a mean age of 66.03 (SD = 13.94) years were assessed. 48% had implantable cardioverter-defibrillators, 24% had pacemakers, and 29% had cardiac resynchronization therapy devices. An overall Cronbach's alpha = 0.893 was achieved, with acceptable reliabilities for isolated dimensions. Correlations with corresponding VAS scales were meaningful and significant (p < 0.01). The second order factor solution yielded good goodness-of-fit indexes (chi(2)/df = 1.44, CFI = 0.96, TLI = 0.95, RMSEA = 0.05). Satisfaction with remote monitoring was not related to HRQoL (r < 0.05), except for the correlation between the SF-36 mental component and the information on cardiac condition dimension (r = 0.263, p < 0.001). Conclusions The 30-item questionnaire showed good reliability and validity to assess satisfaction with remote monitoring in patients with CIEDs.

BACKGROUND Pulmonary vein electrical isolation is the main goal of atrial fibrillation ablation. To ensure electrical isolation of the pulmonary veins, entrance and exit block should be demonstrated. However, this is sometimes challenging due to the complex anatomy of the pulmonary vein area and the anatomical variations that may preclude the correct position of the commonly used circular multielectrode catheter inside the veins. OBJECTIVE To describe a new pacing maneuver useful to demonstrate complete isolation of ipsilateral veins in cases of difficult catheter placement. METHODS Three representative cases illustrate the usefulness of the maneuver either at the right or left pulmonary veins. RESULTS After the circumferential ablation of ipsilateral veins, the circular catheter is positioned in one vein and the ablation catheter in the other ipsilateral vein. When local capture in one vein can be demonstrated while pacing from the other vein and no conduction to the atria is observed, isolation of both veins can be assured. CONCLUSION This novel maneuver might be of help in assessing complete isolation of the pulmonary veins in cases of difficult circular catheter placement.