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Background: Tachycardia-induced cardiomyopathy refers to changes in cardiac structure and function that result from rapid arrhythmia and can manifest as a continuous or recurrent event. Cardiomyopathy induced by atrial tachycardia is typically reversible if the arrhythmia is effectively controlled. There are few literature reports of atrial tachycardia-induced cardiomyopathy in children, and fewer cases have been effectively treated by radiofrequency catheter ablation in children. Objective: we conducted a clinical summary of 7 cases of atrial tachycardia-induced cardiomyopathy in children in Wuhan Children's Hospital to investigate the effectiveness and safety of radiofrequency catheter ablation for atrial tachycardia-induced cardiomyopathy. Methods: A total of 7 children (4 girls and 3 boys) diagnosed with atrial tachycardia-induced cardiomyopathy and admitted to Wuhan Children's Hospital from January 2017 to April 2024 were selected. An intracardiac electrophysiological study was conducted on all 7 children to verify the origin of the atrial tachycardia and the presence of decreased cardiac function. All children were followed up for a period ranging from 2 to 12 months after RFCA or atrial appendectomy. During this follow-up, left ventricular end-diastolic diameter and left ventricular ejection fraction were monitored. Results: The age range was 3.6 to 13 years and the median age was 11.2 years. The weight range was from 15 to 92 kg, the average weight was 34 kg. The results of the intracardiac electrophysiological study of the 7 cases showed that the origin came from the right pulmonary vein in 2 cases, from the left pulmonary vein in 2 cases, from the left atrial appendage in one case, and from the right atrial appendage in 2 cases. Four cases of tachycardia-induced cardiomyopathy originating in the left and right pulmonary veins were successfully eliminated by radiofrequency catheter ablation (RFCA). The foci of atrial tachycardia were located in the atrial appendages of three children. For two of them, after precise positioning by the atrium three-dimensional electroanatomic mapping system and performing RFCA, the atrial tachycardia briefly stopped for approximately 24 h before reoccurring, and atrial appendectomy was subsequently performed. Nevertheless, in the other child, whose focus of atrial tachycardia was in the right atrial appendage, the lesion was successfully eliminated by RFCA. After RFCA or in combination with atrial appendectomy, 6 children were followed for more than 1 year and 1 child for 2 months. All children had sinus rhythm. At the same time, the left ventricular ejection fraction after RFCA or combined atrial appendectomy was significantly increased in 7 cases, indicating statistical significance (P = 0.018)), but the left ventricular end-diastolic diameter was not statistically significant in the treatment (P = 0.203)). Conclusions: Sustained atrial tachycardia can lead to the occurrence of cardiomyopathy such as cardiac enlargement and heart failure. RFCA and combined atrial appendectomy can effectively stop tachycardia, eliminate the mechanism of tachycardia, and allow complete recovery of cardiac function. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) inducibility with burst pacing (BP) after radiofrequency ablation (RFA) has been reported to be associated with AF recurrence. In contrast, the relevance of inducibility and recurrence after cryoablation (CRA) is unclear. Methods: We investigated 367 patients undergoing initial ablation for paroxysmal AF (RFA: 174, CRA: 193). Propensity score matching was conducted, retaining 134 patients in each group. Following pulmonary vein isolation (PVI), the inducibility by BP was tested. Inductions at 250 ppm were defined as low‐frequency burst pacing (LFBP) positive, and those at 300 ppm were classified as medium‐frequency burst pacing (MFBP) positive. They were followed for 600 days. Results: Forty‐eight patients (18%) had AF recurrence. There was no significant difference in the recurrence rate between RFA and CRA (17% vs. 19%, Log‐rank p = 0.79). In RFA, significant differences were observed for both LFBP (Log‐rank p < 0.001) and MFBP (Log‐rank p < 0.001). In contrast, in CRA, there were no significant differences for either LFBP (Log‐rank p = 0.39) or MFBP (Log‐rank p = 0.19). Multivariable analysis revealed that LFBP‐positive (hazards ratio [HR] = 5.75, 95% confidence interval [CI] 2.41–13.7, p < 0.001) was an independent predictor for recurrence with RFA. Acute reconnection (HR = 2.73, 95% CI 1.13–6.56, p = 0.025) was an independent predictor for recurrence with CRA. Conclusion: The inducibility by BP after RFA predicted recurrence at both low and medium frequencies. LFBP‐positive was an independent predictor of recurrence in multivariable analysis. In contrast, the inducibility by BP after CRA was not a predictor of recurrence. Trail Registration: This study did not require clinical trial registration. [ABSTRACT FROM AUTHOR]

Context: A nomogram model affecting the activated clotting time (ACT) targeting rate during radiofrequency ablation of atrial fibrillation (RFCA) in China. Purpose: The aim of this study is to develop and validate a nomogram model for predicting the activated clotting time targeting rate after the initial bolus heparin dosages during the radiofrequency catheter ablation of atrial fibrillation in China. Methods and Results: A retrospective observational study was conducted on the data of 465 patients with atrial fibrillation who underwent radiofrequency catheter ablation (RFCA) from October 2019 to June 2022. All patients were randomized into a training cohort (70%; n = 325) and a validation cohort (30%; n = 140). Independent risk factors were identified using univariate and multifactorial logistic regression analysis. The predictive nomogram model was established using R software. The nomogram was developed and evaluated based on differentiation, calibration, and clinical efficacy using concordance statistic (C-statistic), calibration plots, and decision curve analysis (DCA), respectively. The nomogram was established using three variables, including sex (OR 1.01, 95% CI 0.29-1.76, P = 0.007), heparin dose (OR 0.04; 95%CI 0.02–0.05, P < 0.001), and the baseline ACT (OR 0.03; 95%CI 0.02–0.04, P < 0.001). The C-statistic of the nomogram was 0.736 (95%CI 0.675–0.732) in the training cohort and 0.700 (95%CI 0.622–0.721) in the validation cohort. The calibration plots showed good agreement between the predictions and observations in the training and validation cohorts. The clinical decision curve also proves that the map is useful in clinical settings. Conclusion: The nomogram model has good discrimination and accuracy, which can screen attainment groups intuitively and individually, and has a certain predictive value for the probability of ACT reaching the target after the adequate dosage of initial heparin in Chinese patients with atrial fibrillation. [ABSTRACT FROM AUTHOR]

Abstract The association between plasma low-density lipoprotein cholesterol (LDL-C) and atrial fibrillation (AF) recurrence after catheter ablation remains unclear. We aimed to assess the relationship between preprocedural LDL-C and the AF recurrence in patients undergoing catheter ablation. The cohort study consecutively included AF patients who underwent de novo catheter ablation between April 2021 and January 2023 in the Second Affiliated Hospital of Nanchang University in Jiangxi Province, China. Patients were divided into quartiles based on their baseline fasting LDL-C level (Q1-Q4). Multivariable Cox proportional hazards models were used to evaluate the relationship between LDL-C and AF recurrence. Our analysis included the use of a generalized additive model and smooth curve fitting (penalized spline method), and two-piecewise Cox proportional hazards models, to address the nonlinearity between preprocedural LDL-C and AF recurrence. A total of 482 AF patients with de novo catheter ablation were enrolled, with a median follow-up period of 15.00 months, AF recurrence occurred in 96 (19.92%) patients. The relationship between preprocedural LDL-C and AF recurrence after ablation presented as an L-shape, and the inflection point for the curve was found at the LDL-C level of 3.20 mmol/L (Log likelihood ratio P = 0.031). The hazard ratios (HR) [(95% confidence intervals (CI)] for AF recurrence were 0.50 (0.33–0.74) and 2.11 (0.76–5.89) to the left and right of the inflection point, respectively. Lower LDL-C level is associated with increased AF recurrence risk after catheter ablation were consistent across all subgroups.

Introduction: The effectiveness and safety of 50 W, high‐power, short‐duration (HPSD) ablation in superior vena cava isolation (SVCI) for patients with atrial fibrillation (AF) have been reported. However, the acute outcomes of SVCI combined with 90 W/4 s, very high‐power, short‐duration (vHPSD) ablation remain unknown. In this study, we aimed to investigate a novel approach that combines 50 W‐HPSD and 90 W/4 s‐vHPSD ablation in SVCI and to elucidate the characteristics, outcomes, and safety of this approach by comparing SVCI with conventional ablation index (AI)‐guided middle‐power, middle‐duration (MPMD) ablation. Methods: Overall, 126 patients who underwent AF ablation with SVCI using the QDOT MICROTM catheter were retrospectively reviewed; one group underwent SVCI with a combined approach of HPSD and vHPSD ablation (50 W/90 W group, n = 73) and another group underwent AI‐guided MPMD ablation (30–40 W group, n = 53). This study compared the procedural details, radiofrequency (RF) ablation profiles, and complications. The RF settings used in the 50 W/90 W group were 50 W/7 s for the lateral segment close to the phrenic nerve and 90 W/4 s for the nonlateral segment. Results: The 50 W/90 W group required a significantly shorter procedural time (3.2 vs. 5.9 min, p <.001), shorter RF duration (42.0 vs. 162.0 s, p <.001), and lower RF energy (2834 vs. 5480 J, p <.001) than the 30–40 W group. Procedural success, first‐pass SVCI, number of RF applications, and SVC reconnection after isoproterenol loading were comparable between the groups. The maximum tip‐electrode temperature of the multi‐thermocouple system was significantly higher in the 50 W/90 W group than in the 30–40 W group (50.0°C vs. 47.0°C, p <.001). No complications, such as phrenic nerve injury or bleeding requiring transfusion, were observed in either group. Conclusions: The combined approach of 50 W/7 s‐HPSD and 90 W/4 s‐vHPSD ablation resulted in successful and safe SVCI with shorter procedural time, shorter RF duration, and lower RF energy. [ABSTRACT FROM AUTHOR]

Background: Safety data of the latest radiofrequency (RF) technologies during atrial fibrillation (AF) ablation in real‐world clinical practice are limited. Objectives: We sought to evaluate the acute procedural safety of the four latest ablation catheters commonly used for AF ablation. Methods: A total of 3957 AF ablation procedures performed between January 2022 and December 2023 at 20 centers with either the THERMOCOOL SMARTTOUCH SF (STSF), TactiCath (TC), QDOT Micro (QDM), or TactiFlex (TF) were retrospectively analyzed. Results: In total, QDM, STSF, TF, and TC were used in 343 (8.7%), 1793 (45.3%), 1121 (28.4%), and 700(17.7%) procedures. Among 2406 index procedures, electrical pulmonary vein isolations were successfully achieved in 99.5%. Despite similar total procedure times in the four groups, the total fluoroscopic time was significantly shorter for QDM/STSF with CARTO than TF/TC with EnSite (18.7 ± 14 vs. 27.6 ± 20.6 min, p <.001) and longest in the TF group. The incidence of cardiac tamponade was 0.7% (0.5% and 0.9% during index and redo procedures, 0.8% and 0.3% for paroxysmal and non‐paroxysmal AF) and was significantly lower for QDM/STSF than TF/TC (0.2% vs. 1.1%, p =.008) and highest in the TF group. The incidence of cardiac tamponade was higher for TF than TC and STSF than QDM. In the multivariate analysis, TF/TC with EnSite was a significant independent predictor of cardiac tamponade during both the index (odds ratio [OR] = 4.8, 95% confidence interval [CI] = 1.3–17.5, p =.02) and all procedures (OR = 3.0, 95% CI = 1.3–7.2, p =.01). Conclusions: The incidence of cardiac tamponade and the fluoroscopic time during AF ablation significantly differed among the latest RF catheters and mapping systems in real‐world clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To investigate the correlation between persistent atrial fibrillation (AF) recurrence and alterations in cystatin C levels pre‐ and post‐radiofrequency catheter ablation (RFCA). Methods: This study encompassed 114 patients diagnosed with persistent AF. Their serum cystatin C levels were assessed both prior to and 3 months after undergoing an RFCA procedure. The variance in cystatin C levels before and after RFCA is represented as ΔCystatin C. Subsequently, we compared these values between two groups: patients who did not experience a recurrence of AF (n = 79) and those who did experience a recurrence (n = 35). Results: A significant reduction in cystatin C levels post‐RFCA in both groups, with a more pronounced decrease observed in the non‐recurrence group. Moreover, the recurrence group exhibited larger left atrial diameter and volume before RFCA compared to the non‐recurrence group. Cox regression analysis indicated that smaller reductions in serum cystatin C levels and greater left atrial volumes before RFCA were associated with an increased risk of recurrence, after adjusting for covariates. The receiver operating characteristic curve indicated an elevated probability of clinical recurrence of AF post‐RFCA in patients with a cystatin C decline < 0.08 mg/L (AUC 0.64). The Kaplan–Meier survival analysis revealed that patients with a cystatin C decline > 0.08 mg/L exhibited significantly higher rates of remaining free from recurrence following RFCA across a 24‐month follow‐up period (Log‐rank test p = 0.003). Conclusions: Alterations in ΔCystatin C levels pre and post‐RFCA in the initial phase could independently predict the recurrence of AF. [ABSTRACT FROM AUTHOR]

Background: Radiofrequency catheter ablation (RFA) targets the left atrial appendage isthmus (LAA isthmus) and mitral isthmus for treatment of atrial fibrillation. However, proximity of left circumflex artery (LCxA) and great cardiac vein (GCV) in the isthmuses poses fatal risks during ablation. Methods: This study investigated relationships of LCxA and GCV across three lines in the LAA and mitral isthmus, using 15 human cadaveric hearts. Distances between the vessels and the endocardium, myocardium, and perivascular fat thickness were measured. Results: The results showed that LCxA was mostly consistently located in lower atrial segments and GCV was in lower/upper atrial segments, with change of course mainly observed in the middle of the LAA. The LCxA was found as close as 3–5 mm from the lower border of the LAA isthmus in 80% of specimens, at a depth of 2–3 mm within the LAA isthmus, where 1 mm consisted of myocardium and the remainder was fat, which may not provide adequate protection due to the possibility of liquefaction of fat with heat application. The effective myocardial thickness was consistently 1 mm across all cases in both isthmuses. LCxA was 2 mm in second and third sections of LAA isthmus ("careful segment"). LCxA distances from left inferior pulmonary vein opening was 5 to 12 mm, occasionally dangerously close as <1 mm in 16% of cases. Conclusion: This study measured LCxA and GCV in the LAA and mitral isthmus across three lines for the first time in the Indian population, aiding surgeons in RFA planning. [ABSTRACT FROM AUTHOR]

Objective To investigate the predictive value of ECG P-wave parameters on the prognosis of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA). Methods A total of 70 AF patients who had undergone RFCA were selected. The P-wave dispersion (Pd) and the maximum P-wave duration (P max) of their ECGs before operation were recorded. According to the postoperative prognosis (the presence or absence of AF recurrence), they were divided into good prognosis group and poor prognosis group. Logistic regression analysis was used to explore the correlation between P-wave parameters of ECG and prognosis of AF patients after RFCA. ROC curve analysis was utilized to evaluate the predictive value of P-wave parameters on the prognosis of AF patients after RFCA. Results Among the 70 AF patients, 30 cases had poor prognosis while 40 cases had good prognosis after RFCA. Pd and P max in the poor prognosis group were both higher than those in the good prognosis group (both P<0. 05). There were no statistically significant differences in other parameters between the two groups (all P> 0. 05). The results of Logistic regression analysis revealed that Pd and P max were risk factors influencing the prognosis of AF patients after RFCA (OR>1, P<0. 05). The ROC curve analysis showed that the AUC values of Pd, P max and the combined indicators in assessing the risk factors of poor prognosis among AF patients after RFCA were 0. 751, 0. 760 and 0. 900, respectively. Conclusion The P-wave parameters of ECG are related to the prognosis of AF patients after RFCA; the combined detection of Pd and Pmax could improve the prognostic prediction efficiency. [ABSTRACT FROM AUTHOR]

Objective To investigate the value of body surface MVP ECG risk score before radiofrequency catheter ablation on predicting postoperative recurrence in patients with paroxysmal atrial fibrillation (PAF). Methods We selected 299 inpatients with PAF who had been treated by radiofreqency catheter ablation as study objects. According to the presence or absence of the recurrence of atrial fibrillation (AF), they were divided into AF recurrence group (n = 40) and sinus rhythm maintenance group (n = 259). The preoperative MVP risk scores were compared between the two groups. By using ROC curve analysis, we determined the optimal cut-off value of MVP risk score on predicting postoperative recurrence after AF ablation, while the critical value of MVP risk score was utilized in the survival curve analysis of postoperative recurrence after AF ablation. Results (ⅰ) The followup time of patients with PAF after ablation was 22. 0 (11. 0,35. 0) months, and the overall non-recurrence rate was 86. 6%. (ⅱ) Compared with the sinus rhythm maintenance group, patients in the AF recurrence group had longer course of disease [12. 0 (3. 0, 48. 0) months vs. 36. 0 (11. 5, 72. 0) months, P<0. 05], and increased preoperative MVP risk score [(2. 20 ± 0. 94) points vs. (3. 40 ± 1. 12) points, P < 0. 01)]. There were no statistically significant differences in the remaining preoperative indexes between the two groups. (ⅲ) Univariate Cox regression analysis suggested that preoperative MVP risk score and course of disease were risk factors for postoperative recurrence after ablation. Multivariate Cox regression analysis showed that high preoperative MVP risk score (OR = 2. 261, 95%CI 1. 700-3. 007, P<0. 01) was an independent risk factor for postoperative recurrence after PAF ablation. (ⅳ) The area under curve (AUC) of preoperative MVP risk score was 0. 76 (95%CI 0. 674- 0. 843, P<0. 05) for predicting postoperative recurrence after ablation in PAF patients; the optimal cut-off value was 3 points, the sensitivity was 63. 0%, and the specificity was 85. 0%. Conclusion Preoperative MVP ECG risk score is valuable for predicting postoperative recurrence of PAF after radiofrequency catheter ablation. [ABSTRACT FROM AUTHOR]

Pulmonary vein (PV) stenosis is a rare complication following PV isolation (PVI) for atrial fibrillation. Despite the benefit of early intervention, screening is not conducted, emphasizing the importance of maintaining a high index of suspicion. Standardized management approaches are unavailable for this serious complication. This report presents the case of a 56-year-old male with PV stenosis following PVI. During an annual follow up, the patient was asymptomatic, however a left pleural effusion was noted. Subsequent investigations, including a cardiac computed tomography (CT), confirmed the presence of left superior and inferior PV stenosis. Balloon angioplasty (BA) of both PVs was performed, followed by stenting of the left inferior PV with a balloon-expandable bare metal stent (BMS). The stent slipped shortly after deployment requiring snaring and removal. Re -stenosis was confirmed on repeat CT and successful stenting with self-expandable BMSs was performed. Dual anti-platelet treatment was prescribed post-procedure, with lifelong single anti-platelet therapy after 3 months. Patent PVs with stents in-situ were noted on CT three months post-stenting. A recognized consensus among the literature favors stenting over BA, however, no prospective studies have demonstrated the superiority of drug-eluting stents versus BMSs, or balloon-expandable against self-expandable stents. Effective management requires a tailored, multidisciplinary approach. Pulmonary vein (PV) stenosis is a rare complication of PV isolation ablation for atrial fibrillation with no guideline-directed treatment protocols. Maintaining a high index of suspicion for PV stenosis is essential to ensure timely intervention to improve lung perfusion and alleviate symptoms. Our case demonstrates the superiority of stenting over balloon angioplasty in maintaining PV patency following stenosis, as well as the successful application of self-expandable stents following slippage of a balloon-expandable stent. [ABSTRACT FROM AUTHOR]

Background: Pulmonary vein isolation (PVI) employing cryoballoon (CB) or contact force-guided radiofrequency (CF-RF) catheter ablation has been established as an effective strategy for managing atrial fibrillation (AF). However, its efficacy in hypertrophic cardiomyopathy (HCM) remains to be further explored. Methods: This retrospective study analyzed 60 consecutive AF patients with HCM (average age 67 ± 10 years; 41 men) who were consecutively admitted to our hospital from January 2014 to December 2022 and underwent initial PVI. Results: The patients were treated with CB (26 patients) or CF-RF (34 patients). Successful PVI was achieved in both groups without significant complications. In the CF-RF group, additional ablations were performed on the cavotricuspid isthmus (14.7% of patients) and the anterior line (2.9%). The CB group benefited from reduced procedural times (93 ± 31 vs. 165 ± 60 min, p < 0.05) and decreased saline irrigation requirements (77.5 ± 31.4 vs. 870 ± 281.9 mL, p < 0.0001). Using a contrast medium was exclusive to the CB group (33.8 ± 4.2 mL). In a 12-month follow-up, the atrial tachyarrhythmia recurrence-free rates in the CB and CF-RF groups were comparable (77% and 76%, respectively; p = 0.63 according to the log-rank test). Notably, pulmonary vein reconnection was prevalent in most (7 out of 8) patients requiring a secondary ablation procedure. Conclusion: PVI is feasible as a strategy for AF in patients with HCM employing either CB or CF-RF techniques. While the recurrence-free rates were comparable in both groups, differences were noted in procedure duration, saline usage, and the need for a contrast medium. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between serum long non-coding RNA metastasis-associated lung adenocarcinoma transcript 1 (LncRNA MALAT1), microRNA (miRNA)-150-5p and recurrence after radiofrequency catheter ablation (RFCA) in patients with atrial fibrillation. Methods: 117 AF patients who underwent RFCA in Wuhan Asia Heart Hospital and Liyuan Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2021 to June 2022 were selected as AF group, and 76 healthy volunteers were selected as control group. AF patients were divided into recurrence group and non-recurrence group according to whether they relapsed after 1 year of follow-up. The expression of serum LncRNA MALAT1 and miR-150-5p was detected by real-time fluorescence quantitative polymerase chain reaction. The correlation between LncRNA MALATI and miR-150-5p expression in AF serum were analyzed by Pearson correlation analysis. The factors affecting the recurrence of AF patients after RFCA were analyzed by multivariate Logistic regression analysis. The predictive value of serum LncRNA MALATI and miR-150-5p on the recurrence of AF patients after RFCA were analyzed by receiver operating characteristic (ROC) curve. Results: Compared with control group, the expression of serum LncRNA MALATI in AF group was increased, and the expression of miR-150-5p was decreased (P<0.05). Serum LncRNA MALATI was negatively correlated with miR-150-5p expression in AF patients (r=-0.737, P<0. 001). After 1 year of follow-up, the recurrence rate of RFCA in 117 AF patients was 35.04% (41/117). Compared with non-recurrence group, the expression of serum LncRNA MALATI in recurrence group was increased, and the expression of miR-150-5p was decreased (P<0.05). Multivariate Logistic regression analysis showed that prolonged course of disease, persistent AF, increased CHA2DS2-VASc score, and increased LncRNA MALAT1 were independent risk factors for recurrence after RFCA in AF patients, and increased miR-150-5p was an independent protective factor (P<0.05). The area under the curve predicted by serum LncRNA MALAT1 combined with miR-150-5p was 0.893, which was greater than 0.785 and 0.786 predicted by serum LncRNA MALAT1 and miR-150-5p alone. Conclusion: High expression of serum LncRNA MALAT1 and low expression of miR-150-5p in AF patients, which are closely relate to recurrence after RFCA. Serum LncRNA MALAT1 combine with miR-150-5p has a high predictive value for recurrence in AF patients after RFCA. [ABSTRACT FROM AUTHOR]

Background: Global longitudinal strain (GLS) and atrial voltage are acknowledged markers for worse rhythm outcome after ablation of persistent atrial fibrillation (PeAF). The majority of research efforts have been directed towards the left atrium (LA), with relatively fewer studies focusing on the right atrium (RA). The aim of this study was to investigate the effect of the biatrial substrate on the outcome following radiofrequency catheter ablation (RFCA). Methods: All patients underwent two‐dimensional speckle tracking echocardiography (2D‐STE) and high‐density mapping (HDM) on LA and RA in preoperative and postoperative stages of RFCA. Atrial substrate was assessed by GLS, average voltage, and low voltage zone (LVZ). Results: This retrospective study enrolled 48 patients. With a follow‐up of 385.98 ± 161.78 days, 22.92% (11/48) of all patients had AF recurrence and 63.64% in low strain group. Left atrial‐low voltage zone (LA‐LVZ) prior to RFCA was 67.52 ± 15.27% and 54.21 ± 20.07%, respectively, in the recurrence group and non‐recurrence group. Multivariate regression analysis showed that preoperative LA‐GLS (OR 0.047, 95%CI 0.002–0.941, p =.046) was independent predictors of AF recurrence. Biatrial average voltage in preoperative and postoperative stages were positively correlated (preoperative: r = 0.563 p <.001; postoperative: r = 0.464 p =.002). There was no significant difference in the proportion of RA in the recurrence group except the septum in preoperative and postoperative stages. Conclusions: Low LA‐GLS and high LA‐LVZ may be predictors of RFCA recurrence in PeAF patients. Biatrial average voltage were positively correlated in preoperative and postoperative stages. [ABSTRACT FROM AUTHOR]

A 60‐year‐old male patient suffered from frequent episodes of atrial tachycardia (AT), after the index procedure of catheter ablation for paroxysmal atrial fibrillation. During the repeat procedure, the activation map showed that the earliest activation site was located at the roof of left atrium. Multiple ablations at the earliest activation site on the roof failed to terminate the AT; however, ablation within the pulmonary artery at an adjacent anatomical site successfully eliminated the AT, even without recording distinct near‐field potential. [ABSTRACT FROM AUTHOR]

• Personal mastery was significantly associated with quality of life in patients with atrial fibrillation after radiofrequency ablation. • Health promoting behavior mediated the relationship between personal mastery and quality of life. • Targeted interventions for improving personal mastery and health promoting behavior are important ways to enhance the quality of life. Improving quality of life is vital for patients with atrial fibrillation (AF) after radiofrequency ablation. Quality of life can be affected not only by personal mastery but also by health promoting behavior as previously studied. However, it remains unclear whether health promoting behavior mediates the relationship between personal mastery and quality of life. To explore whether health promoting behavior mediates the relationship between personal mastery and quality of life in patients with AF after radiofrequency ablation. A cross-sectional design and convenience sampling were conducted at a tertiary hospital in China. Self-reported questionnaires were used to assess personal mastery, health promoting behavior and quality of life. SPSS and AMOS software were used for statistical analysis. A total of 202 patients with AF after radiofrequency ablation were enrolled (mean age 58.28 ± 12.70 years). The scores for personal mastery and quality of life were 22.52 ± 2.53 points and 62.58 ± 8.59 points, respectively, indicating a limited level. The health promoting behavior exhibited a moderate level, with scores averaging 103.82 ± 8.47 points. There was a positive correlation between the three variables (all P < 0.05). Health promoting behavior played a partial mediating role in the relationship between personal mastery and quality of life in patients with AF after radiofrequency ablation, accounting for 44.79 % of the total effect. In order to improve quality of life and prognosis, it is necessary to consider enhancing personal mastery and increasing patient compliance with health promoting behavior, which are important ways to improve their quality of life. [ABSTRACT FROM AUTHOR]

Radiofrequency catheter ablation (RFCA) is the preferred technique for the treatment of atrial fibrillation, but the recovery of electrical conduction after ablation seriously endangers the health of patients. This study aimed to develop reactive oxygen species (ROS) responsive double-locked liposome collaborative photodynamic therapy (PDT) to target the ablation area and reduce the recovery of electrical conduction after ablation. The successful synthesis of β-cyclodextrin modified with phenylboronic acid pinacol ester (OCD) was confirmed by 1H NMR and FT-IR. Furthermore, the successful synthesis of octadecylamine-modified indocyanine green (ICG-ODA) was confirmed by 1H NMR and mass spectrometry. The ICG-ODA was encapsulated in liposomes to generate a double-locked hybrid liposome (ICG-ODA@rNP), which was subsequently characterized. Several properties of ICG-ODA@rNP were evaluated, including the drug release, targeting ability and ability to inhibit electrical conduction recurrence. Moreover, a model was constructed for the blockage of electrical conduction after RFCA in rabbits to further evaluate ICG-ODA@rNP. The preliminary safety evaluation of ICG-ODA@rNP was also performed. The ICG-ODA@rNP with a uniform particle size showed excellent storage stability. The nanoparticle can sensitively release drugs under ROS environment, and exhibits excellent photothermal effects. Furthermore, ICG-ODA@rNP can circulate for a long time in vivo and accumulate significantly in the ablation area. In a pacing test with a left atrial appendage (LAA), these nanoparticles, combined with PDT, reduced the ratio of electrical conduction recovery, which was confirmed by a hematoxylin and eosin (H&E) test. Further molecular analysis revealed that ICG-ODA@rNP could increase RFCA-induced apoptosis and ROS levels. Specifically, ICG-ODA@rNP significantly increased the expression of Bax and cleaved caspase-3, and decreased the expression of Bcl-2. In addition, the excellent biosafety of the double-locked nanoparticle was verified. This study provides evidence that ICG-ODA@rNP, with the double lock characteristic and biosafety, which exhibits a targeting effect on RFCA-induced cardiac injury areas, which further reduce electrical conduction recovery in RFCA areas by collaborativing PDT.

We described a premature ventricular contraction arising from the left coronary sinus cusp, in which we discussed about the interpretations of the signals recorded there. Our case provided further insights into the interpretation of signals recorded at the coronary sinus cusp during premature ventricular contraction ablation.

Abstract Objective Previous studies have shown a clear link between insulin resistance (IR) and an elevated risk of atrial fibrillation (AF). However, the relationship between the estimated glucose disposal rate (eGDR), which serves as a marker for IR, and the risk of AF recurrence after radiofrequency catheter ablation (RFCA) remains uncertain. Therefore, this study aimed to examine the potential association between the eGDR and the risk of AF recurrence following RFCA. Methods This retrospective study was conducted at Nanchang University Affiliated Second Hospital. The study enrolled 899 patients with AF who underwent RFCA between January 2015 and January 2022. The formula used to calculate the eGDR was as follows: 19.02 − (0.22 * body mass index) − (3.26 * hypertension) − (0.61 * HbA1c). Cox proportional hazard regression models and exposure–effect curves were used to explore the correlation between the baseline eGDR and AF recurrence. The ability of the eGDR to predict AF recurrence was evaluated using the area under the receiver operating characteristic curve (AUROC). Results The study observed a median follow-up period of 11.63 months, during which 296 patients experienced AF recurrence. K‒M analyses revealed that the cumulative incidence AF recurrence rate was significantly greater in the group with the lowest eGDR (log-rank p

Background: Despite the progressive course of atrial fibrillation (AF), the optimal timing of radiofrequency catheter ablation (RFCA) during disease course is still unknown. We aimed to investigate the impact of early RFCA within a year after AF diagnosis on procedural outcomes. Methods: A single-center retrospective study was conducted on symptomatic AF patients (n = 130) referred for RFCA with a 16-month median follow-up. Patients were stratified based on the diagnosis-to-ablation time (DAT) into early (≤1 year) and late (>1 year) RFCA groups. Atrial arrhythmia recurrence after single RFCA was the primary outcome. Secondary outcomes included cardiovascular hospitalizations, AF progression, and antiarrhythmic drug (AAD) use. Results: Within a year of AF diagnosis, 33 patients (25.4%) underwent RFCA. In the early-RFCA group, 84.4% of patients did not have recurrent atrial arrhythmia, in contrast to 60.8% in the late-RFCA group (p = 0.039). Late RFCA (HR = 2.74, 95% CI = 1.062–7.052, p = 0.037) and AF recurrence during the blanking period (HR = 4.57, 95% CI = 2.38–8.57, p < 0.0001) were independent predictors of atrial arrhythmia recurrence on multivariate analysis. Compared to the late-RFCA group, the early-RFCA group had significantly lower rates of cardiovascular hospitalizations (18% vs. 42%, p = 0.023), AF progression (0.0% vs. 11.3%, p = 0.044), and AAD use (45.4% vs. 81.4%, p < 0.001). Conclusions: Early RFCA within a year of AF diagnosis is associated with less atrial arrhythmia recurrence, fewer cardiovascular hospitalizations, less AF progression, and less AAD use. DAT of more than one year and AF recurrence during the blanking period are independent predictors of atrial arrhythmia recurrence after single RFCA. [ABSTRACT FROM AUTHOR]

Background and Objectives: Radiofrequency catheter ablation (RFCA) is a highly successful intervention. By comparing the lesion changes in prostate parenchymal and striated muscle tissues after RFCA with and without cooling, it was possible to assess the correlation between the shape regularity, area, and perimeter of the thermal lesion, and to predict the geometric shape changes of the lesions. Materials and Methods: A standard prostate and striated muscle RFCA procedure was performed on 13 non-purebred dogs in two sessions: no cooling and cooling with 0.1% NaCl solution. Microtome-cut 2–3 µm sections of tissue samples were stained with haematoxylin and eosin and further examined. The quotient formula was employed to evaluate the geometric shape of the damage zones at the ablation site. Results: The extent of injury following RFCA in striated muscle tissue was comparable to that in prostate parenchymal tissue. Regression analysis indicated a strong and positive relationship between area and perimeter in all experimental groups. In the experimental groups of parenchymal tissues with and without cooling, an increase in the area or perimeter of the damage zone corresponded to an increase in the quotient value. A similar tendency was observed in the striated muscle group with cooling. However, in the striated muscle group without cooling, an increase in lesion area or perimeter lowered the quotient value. Standardised regression coefficients demonstrated that in the striated muscle with cooling, the damage zone shape was more determined by area than perimeter. However, in the parenchymal tissue, the perimeter had a more substantial impact on the damage zone shape than the area. Conclusions: The damage area and perimeter have predictive power on the overall shape regularity of damage zone geometry in both striated muscles and parenchymal tissue. This approach is employed to achieve a balance between the need for tumour eradication and the minimisation of ablation-induced complications to healthy tissue. [ABSTRACT FROM AUTHOR]

Objective: Previous studies have shown a clear link between insulin resistance (IR) and an elevated risk of atrial fibrillation (AF). However, the relationship between the estimated glucose disposal rate (eGDR), which serves as a marker for IR, and the risk of AF recurrence after radiofrequency catheter ablation (RFCA) remains uncertain. Therefore, this study aimed to examine the potential association between the eGDR and the risk of AF recurrence following RFCA. Methods: This retrospective study was conducted at Nanchang University Affiliated Second Hospital. The study enrolled 899 patients with AF who underwent RFCA between January 2015 and January 2022. The formula used to calculate the eGDR was as follows: 19.02 − (0.22 * body mass index) − (3.26 * hypertension) − (0.61 * HbA1c). Cox proportional hazard regression models and exposure–effect curves were used to explore the correlation between the baseline eGDR and AF recurrence. The ability of the eGDR to predict AF recurrence was evaluated using the area under the receiver operating characteristic curve (AUROC). Results: The study observed a median follow-up period of 11.63 months, during which 296 patients experienced AF recurrence. K‒M analyses revealed that the cumulative incidence AF recurrence rate was significantly greater in the group with the lowest eGDR (log-rank p < 0.01). Participants with an eGDR ≥ 8 mg/kg/min had a lower risk of AF recurrence than those with an eGDR < 4 mg/kg/min, with a hazard ratio (HR) of 0.28 [95% confidence interval (CI) 0.18, 0.42]. Additionally, restricted cubic spline analyses demonstrated a linear association between the eGDR and AF recurrence (p nonlinear = 0.70). The area under the curve (AUC) for predicting AF recurrence using the eGDR was 0.75. Conclusions: The study revealed that a decrease in the eGDR is associated with a greater AF recurrence risk after RFCA. Hence, the eGDR could be used as a novel biomarker for assessing AF recurrence risk. [ABSTRACT FROM AUTHOR]

Introduction: The left ventricular summit (LVS) is the highest point on the epicardial surface of the left ventricle. A part of the LVS that is located between the left coronary arteries (lateral‐LVS) is one of the major sites of idiopathic ventricular arrhythmia (VA) origins. Some idiopathic epicardial VAs can be ablated at endocardial sites adjacent to the epicardial area septal to the lateral‐LVS (septal‐LVS). This study examined the prevalence and electrocardiographic and electrophysiological characteristics of septal‐LVS VAs. Methods: We studied consecutive patients with idiopathic VAs originating from the LVS (67 patients) and aortic root (93 patients). Results: Based on the ablation results, among 67 LVS VAs, 54 were classified as lateral and 13 as septal‐LVS VAs. As compared with the lateral‐LVS VAs, the septal‐LVS VAs were characterized by a greater prevalence of left bundle branch block with left inferior‐axis QRS pattern, later precordial transition, lower R‐wave amplitude ratio in leads III to II, lower Q‐wave amplitude ratio in leads aVL to aVR, and later local ventricular activation time relative to the QRS onset during VAs (V‐QRS) in the great cardiac vein. The electrocardiographic and electrophysiological characteristics of the septal‐LVS VAs were similar to those of the aortic root VAs. However, the V‐QRS at the successful ablation site was significantly later during the septal‐LVS VAs than aortic root VAs (p <.0001). The precordial transition was significantly later during the septal‐LVS VAs than aortic root VAs (p <.05). Conclusions: Septal‐LVS VAs are considered a distinct subgroup of idiopathic VAs originating from the left ventricular outflow tract. [ABSTRACT FROM AUTHOR]

A 70-year-old man with recurrent atrial fibrillation (AF) underwent transcatheter radiofrequency ablation after an earlier unsuccessful attempt. Although typical AF triggers were ablated, the patient's condition persisted, leading to the identification of the interatrial septum (IAS) as the probable source of the tachycardia trigger. Given the depth and thickness of the IAS, traditional radiofrequency ablation proved ineffective. However, using the alternative method of bipolar radiofrequency catheter ablation (B-RFCA), the atrial tachycardia was successfully terminated. B-RFCA demonstrates potential for effectively terminating tachycardias originating from deep intramural locations, suggesting its potential as a pivotal technique for complex cases with septal atrial tachycardia. [ABSTRACT FROM AUTHOR]

Assess pre and postinterventional anxiety levels in radiofrequency catheter ablation recipients (RFCA) for atrioventricular nodal reentry tachycardia (AVNRT) and investigate whether changes are associated with demographic and clinical characteristics and AVNRT subtypes. This was a single-centre prospective study conducted from September 2019 to March 2020. A total of 51 patients who were to undergo RFCA due to newly diagnosed symptomatic AVNRT were included. Electrophysiological studies were performed on all patients, the AVNRT subtype was determined, and the RFCA procedure was applied. The severity of anxiety before RFCA and 3 months after the procedure was determined by the state-trait anxiety inventory. The mean age was 50.1±17.3 years and 70.6% (n=36) were women. The median STAI-State score after ablation (37 [33–42]) was significantly lower than before (63 [52–72]) (p<0.001). Similarly, median STAI-Trait scores after ablation (45 [39–49]) were found to be significantly lower than before the procedure (59 [46–69]) (p<0.001). There were no significant relationships between the decrease in STAI-State or STAI-Trait scores and analyzed parameters such as age, sex, AVNRT type and other laboratory values. Administration of RFCA in AVNRT can improve AVNRT-induced anxiety and could eliminate the potential need for antiarrhythmic or anxiolytic therapy. Therefore, RFCA may also positively impact quality of life, and reduce unnecessary treatments, and healthcare costs associated with AVNRT. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To investigate the correlation between persistent atrial fibrillation (AF) recurrence and alterations in cystatin C levels pre‐ and post‐radiofrequency catheter ablation (RFCA). Methods This study encompassed 114 patients diagnosed with persistent AF. Their serum cystatin C levels were assessed both prior to and 3 months after undergoing an RFCA procedure. The variance in cystatin C levels before and after RFCA is represented as ΔCystatin C. Subsequently, we compared these values between two groups: patients who did not experience a recurrence of AF (n = 79) and those who did experience a recurrence (n = 35). Results A significant reduction in cystatin C levels post‐RFCA in both groups, with a more pronounced decrease observed in the non‐recurrence group. Moreover, the recurrence group exhibited larger left atrial diameter and volume before RFCA compared to the non‐recurrence group. Cox regression analysis indicated that smaller reductions in serum cystatin C levels and greater left atrial volumes before RFCA were associated with an increased risk of recurrence, after adjusting for covariates. The receiver operating characteristic curve indicated an elevated probability of clinical recurrence of AF post‐RFCA in patients with a cystatin C decline 0.08 mg/L exhibited significantly higher rates of remaining free from recurrence following RFCA across a 24‐month follow‐up period (Log‐rank test p = 0.003). Conclusions Alterations in ΔCystatin C levels pre and post‐RFCA in the initial phase could independently predict the recurrence of AF.

PurposeAtrial tachycardia is an uncommon supraventricular tachycardia in children. It is often drug-resistant and likely to occur concomitantly with tachycardia-induced cardiomyopathy, making radiofrequency catheter ablation the preferred treatment. The aim of this study was to assess the feasibility, safety, and effectiveness of radiofrequency catheter ablation for the treatment of different types of atrial tachycardia in children, particularly in those with drug-resistant and tachycardia-induced cardiomyopathy.MethodsA total of 28 children with atrial tachycardia (including focal atrial tachycardia and atrial flutter) who underwent atrial radiofrequency ablation at the Children's Hospital Affiliated to Chongqing Medical University from May 2018 to December 2023 were included. The baseline characteristics, preoperative medication, surgical information, and postoperative follow-up data of these children were analyzed statistically.ResultsThe mean age patients at ablation was 10.24 ± 3.40 years. A total of 78.6% of the patients (22/28) who received preoperative pharmacological treatment had intermittent or persistent atrial tachycardia. Of the 28 children who underwent radiofrequency ablation, 24 (85.7%) were diagnosed with focal atrial tachycardia, three (10.7%) with atrial flutter, and one (3.6%) with both. No postoperative complications occurred in any patient. The immediate ablation success rate in the 25 patients with focal atrial tachycardia was 96.0% (24/25). After 26.89 ± 18.17 months of follow-up, only three patients had recurrence. The ablation difficulty of focal atrial tachycardia originating in the appendage was higher than that originating in the non-atrial appendage (44.4% vs. 6.3%, p = 0.01). The success rate of ablation for atrial flutter was 100%, except in one child with underlying cardiomyopathy who experienced recurrence. Final success was achieved in 25 of the 28 patients (89.2%) at the end of the follow-up period. In addition, eight children (28.6%) in this study were diagnosed with tachycardia-induced cardiomyopathy, with significantly increased ejection fraction and shortening rate after radiofrequency ablation (p 0.05).ConclusionRadiofrequency catheter ablation is safe and effective for the treatment of atrial tachycardia in children in the short- and long-term.It can be used as the first treatment option for children with medically refractory atrial tachycardia and tachycardia-induced cardiomyopathy.

BackgroundA previous investigation reported that an abnormal P-wave terminal force in lead V1 (PTFV1) is a marker for electrical remodeling of the left atrium (LA). We aimed to assess the relationship of PTFV1 with LA tachyarrhythmia (LATA) recurrence after radiofrequency catheter ablation (RFCA) in patients with paroxysmal atrial fibrillation (PAF) and normal LA size.MethodsPatients with PAF and normal LA size (LA volume index 4,000 μV*ms were 1.22 (1.13–1.32, p

Junwei Zhan,1 Chengfei Peng,2 Yuxin Liu,1 Zhanhua Bi,1 Guoxiu Lu,1 Shanhu Hao,1 Yanan Tong,1 Guoxu Zhang1 1Department of Nuclear Medicine, General Hospital of Northern Theater Command, Shenyang, 110016, People’s Republic of China; 2Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, 110016, People’s Republic of ChinaCorrespondence: Guoxu Zhang; Yanan Tong, Department of Nuclear Medicine, General Hospital of Northern Theater Command, No. 83, Wenhua Road, Shenyang, 110016, People’s Republic of China, Email zhangguoxu_502@163.com; tongyn1119@foxmail.comObjective: Atrial fibrillation (AF) is a common arrhythmia. This study explored serum miR-29b-3p expression in AF patients and its value in predicting AF recurrence after radiofrequency catheter ablation (RFCA).Methods: Totally 100 AF patients who underwent RFCA were enrolled, with 100 individuals without AF as controls. Serum miR-29b-3p expression in participants was determined using RT-qPCR. The correlation between miR-29b-3p and atrial fibrosis markers (FGF-21/FGF-23) was assessed by Pearson analysis. The diagnostic efficacy of serum miR-29b-3p and FGF-21/FGF-23 in predicting AF recurrence after RFCA was analyzed by the receiver operating characteristic (ROC) curves. The Kaplan-Meier method was adopted to evaluate the effect of miR-29b-3p expression on the incidence of AF recurrence after RFCA. The independent risk factors for AF recurrence after RFCA were analyzed by logistic regression analysis.Results: Serum miR-29b-3p was poorly expressed in AF patients. After RFCA, AF patients showed elevated serum miR-29b-3p expression. Serum miR-29b-3p expression in AF patients negatively correlated with serum FGF-21 and FGF-23 concentrations. The cut-off values of serum miR-29b-3p, FGF-21, and FGF-23 in identifying AF recurrence were 0.860 (sensitivity: 100.00%, specificity: 39.71%), 222.2 pg/mL (sensitivity: 96.88%, specificity: 32.35%) and 216.3 ng/mL (sensitivity: 53.13%, specificity: 70.59%), respectively. Patients with low miR-29b-3p expression had a significantly higher incidence of AF recurrence than patients with high miR-29b-3p expression. Serum miR-29b-3p expression was one of the independent risk factors for AF recurrence after RFCA.Conclusion: Low miR-29b-3p expression in AF patients has certain predictive values and is one of the independent risk factors for AF recurrence after RFCA.Keywords: miR-29b-3p, atrial fibrillation, radiofrequency catheter ablation, recurrence, fibrosis marker, logistic regression analysis

Abstract Aims We aimed to evaluate the effects of radiofrequency catheter ablation (RFCA) and the factors influencing mortality after RFCA in patients with pulmonary hypertension (PH) and atrial flutter (AFL). Methods and results Fifty‐eight consecutive PH patients with AFL who underwent an electrophysiological study and RFCA between April 2013 and August 2021 were selected for this study. In the study population, pulmonary arterial hypertension associated with congenital heart disease (PAH‐CHD) was the most common type of PH (n = 34, 59%), followed by idiopathic pulmonary arterial hypertension (IPAH) (n = 19, 33%). Typical atrial flutter was the most common type of atrial flutter (n = 50, 86.2%). Sinus rhythm was restored in 53 (91.4%) patients during RFCA. After a mean follow‐up of 33.8 months, AFL recurred in a total of 22 patients. Nine of them underwent repeat RFCA, and the site of the repeat ablation was not exactly the same as the first. At a median follow‐up of 34.6 months after the last ablation, none of the patients who underwent repeat RFCA experienced AFL recurrence, and all of these patients survived. There were no procedure‐related complications during hospitalization or follow‐up. Univariate Cox regression analysis suggested that AFL recurrence after the last ablation was not associated with all‐cause mortality. NT‐proBNP (HR: 1.00024, 95% CI: 1.00008–1.00041, P = 0.004), pulmonary artery systolic pressure (PASP) (HR: 1.048, 95% CI: 1.020–1.076, P = 0.001), and IPAH (vs. PAH‐CHD, HR: 7.720, 95% CI: 1.437–41.483, P = 0.017) were independent predictors of all‐cause mortality in PH patients with AFL after RFCA. Receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) of PASP for predicting all‐cause mortality was 0.708. There was no significant difference in the Kaplan–Meier curves for all‐cause mortality between patients with AFL recurrence after the last ablation and those without recurrence (P = 0.851). Patients with higher PASP (≥110 mmHg) and IPAH showed the lower survival rate in Kaplan–Meier curves. Conclusion Repeat ablation was safe and feasible in patients with recurrent AFL and can maintain sinus rhythm. AFL recurrence was not associated with all‐cause mortality, and patients with high PASP or IPAH were at higher risk for adverse outcomes.

Abstract Background This study investigates the relationship between triglyceride-glucose (TyG) index trajectories and the results of ablation in patients with stage 3D atrial fibrillation (AF). Methods A retrospective cohort study was carried out on patients who underwent AF Radiofrequency Catheter Ablation (RFCA) at the Cardiology Department of the Fourth Affiliated Hospital of Zhejiang University and Taizhou Hospital of Zhejiang Province from January 2016 to December 2022. The main clinical endpoint was determined as the occurrence of atrial arrhythmia for at least 30 s following a 3-month period after ablation. Using a latent class trajectory model, different trajectory groups were identified based on TyG levels. The relationship between TyG trajectory and the outcome of AF recurrence in patients was assessed through Kaplan-Meier survival curve analysis and multivariable Cox proportional hazards regression model. Results The study included 997 participants, with an average age of 63.21 ± 9.84 years, of whom 630 were males (63.19%). The mean follow-up period for the participants was 30.43 ± 17.75 months, during which 200 individuals experienced AF recurrence. Utilizing the minimum Bayesian Information Criterion (BIC) and the maximum Entropy principle, TyG levels post-AF RFCA were divided into three groups: Locus 1 low-low group (n = 791), Locus 2 low-high-low group (n = 14), and Locus 3 high-high group (n = 192). Significant differences in survival rates among the different trajectories were observed through the Kaplan-Meier curve (P

Abstract Background Atrial tachycardia (AT) originating from the left atrial appendage (LAA) is uncommon and the most difficult arrhythmia to eliminate. Therefore, we present the case of a 5-year-old girl with tachycardia-induced cardiomyopathy (TIC) caused by AT originating from the LAA and successfully treated with RFCA associated to left atrial appendectomy. With resolution of AT, we observed a progressive improvement of LV function. The effectiveness and safety of this combination therapy were evaluated over a one-month follow-up period. Case presentation A 5 -year-old female was evaluated for three days of incessant cough and a syncopal episode. Surface echocardiography and 24-hour monitoring showed that the infant had persistent atrial tachycardia. Echocardiography revealed an enlarged tele diastolic diameter (46.1 mm) and malfunctioning (EF 28.53%) left ventricle. The location of the lesion at the apex of the LAA was further confirmed by electrophysiological study and RFCA. After RFCA, the infant’s ECG monitor showed that sinus rhythm was maintained for up to 22 h. Subsequently, atrial tachycardia recurred and sinus rhythm disappeared. Finally, atrial appendectomy was performed and sinus rhythm returned to normal. Conclusions The heart function of the infant improved and sinus rhythm was maintained, further demonstrating the safety and effectiveness of combined treatment with RFCA and atrial appendectomy after electrophysiological localization of AT from LAA to TIC.

Abstract Aims The current management of patients with atrial fibrillation (AF) and concomitant heart failure (HF) remains a significant challenge. Catheter ablation (CA) has been shown to improve left ventricular ejection fraction (LVEF) in these patients, but which patients can benefit from CA is still poorly understood. The aim of our study was to determine the predictors of improved ejection fraction in patients with persistent atrial fibrillation (PeAF) complicated with HF undergoing CA. Methods and results A total of 435 patients with persistent AF underwent an initial CA between January 2019 and March 2023 in our hospital. We investigated consecutive patients with left ventricular systolic dysfunction (LVEF

Supraventricular macro re-entry tachyarrhythmias occupy the leading places among all types of tachyarrhythmias. The most common in this category is typical atrial flutter (AFL). This heart rhythm disorder has a negative impact on the patients’ quality of life. Its complications can lead to disability and death due to possible thromboembolism. Therapeutic treatment is limited in effectiveness. The main method of intervention is catheter radiofrequency ablation (RFA). The standard approach of RFA of AFL is performed without the use of navigation systems under fluoroscopy guidance. However, this results in an increased radiation exposure to the patient and the medical personnel. Modern technologies in the field of invasive electrophysiology make it possible to create anatomical models of heart and reproduce the spread of electrical excitation. However, the routine use of additional navigation methods remains controversial. The aim. To compare the duration of RFA of typical AFL and radiation exposure with the use of anatomical and propagation mapping. Materials and methods. This study is based on the analysis of the treatment results obtained for 53 patients at the National Amosov Institute of Cardiovascular Surgery in the period from 2014 to 2023. Depending on imaging methods, the patients were divided into two groups. The first group included 27 patients with an anatomical mapping of the right atrium. The second group included 26 patients with propagation mapping. Results. In all the patients we have achieved a bidirectional conduction block through cavotricuspid isthmus. In the first group, the total duration of confirming the diagnosis and creating the anatomical model was 312 ± 26 seconds. The mean time to the moment of AFL termination and restoration of sinus rhythm was 230 ± 19 seconds. The average duration of the procedure was 41.5 ± 3.5 minutes, the average fluoroscopy time was 120 ± 10 seconds, the average dose area product (DAP) was 15 ± 1.3 Gy·cm2. In the second group, the average time for creating a 3D propagation model of right atrium and verifying the diagnosis was 748 ± 65 seconds. The average time from the first application to the termination of tachycardia was 227 ± 20 seconds. The average duration of the procedure was 55 ± 4.7 minutes, X-ray time was 93 ± 8 seconds, average DAP was 13 ± 1.1 Gy·cm2. The duration of the procedure in the second group was significantly longer (p = 0.03), however, the radiation exposure and DAP were not statistically different (p = 0.31) between the observation groups. Conclusions. The use of propagation mapping increases the time of the procedure by 24.5% and does not give a significant advantage in reducing the radiation exposure. The use of a navigation system during cavotricuspid isthmus RFA is recommended for concomitant radical treatment of complex supraventricular arrhythmias, such as atrial fibrillation.

Premature ventricular complexes (PVC) is one of the most common arrhythmias in daily clinical practice. In the vast majority of cases, PVC has a good prognosis, but in some cases it can cause serious, including lifethreatening complications. On the other hand, asymptomatic, frequent PVC can lead to the development of left ventricular (LV) systolic dysfunction, which can be reversible with effective therapy. Medications remain the mainstay of therapy for PVC. However, the effectiveness of some drugs is quite low, while other drugs have significant side and proarrhythmic effects. Technological advances in the field of radiofrequency (RF) catheter ablation in recent years have opened up tremendous prospects in the radical correction of PVC and put forward this approach in selective cases as the method of choice. However, this invasive technology may at the same time carry the risks of serious complications, which can occur in up to 5% of individuals undergoing this procedure. The potential risks of RF catheter ablation largely depend on the accessibility of the ectopic focus. In this regard, differential diagnosis of the source of ectopia is of great importance for a balanced assessment of the possible risks and effectiveness of this invasive method. Standard diagnostic methods, such as 12-lead electrocardiography, Holter monitoring and echocardiography, allow in many cases to make the best decision regarding further management tactics. Frequent, asymptomatic PVC needs in annual monitoring to prevent LV systolic dysfunction development in cases high potential RF catheter ablation risks and drugs ineffectiveness. Traditional echocardiography and novel ultrasound technologies can help in this difficult of choice cases.

Left atrial calcification (LAC) has been reported in 13.8 % of patients after atrial fibrillation (AF) ablation, which is related with stiff LA physiology and increased cardiovascular events. We describe a case in which long-term persistence of atrial inflammation caused by radiofrequency catheter ablation (RFCA) resulted in LAC. A 73-year-old man who underwent three previous AF ablations presented to our institution with a chief complaint of shortness of breath upon exertion. Electrocardiography showed a normal sinus rhythm, and transthoracic echocardiography revealed mild pulmonary hypertension. A marked decrease was observed in the mitral Doppler A-wave. Right heart catheterization showed marked V-wave augmentation in the pulmonary artery wedge pressure waveform despite the absence of mitral regurgitation, leading to a diagnosis of stiff LA syndrome. Computed tomography images revealed atrial wall thickening consistent with the ablation sites 6 months after the first ablation, which reflected inflammation-induced edema. LAC occurred at the site of atrial wall edema and expanded over several years. Mitral Doppler tracing showed a decrease in the A-wave two years and nine months after the first detection of LAC. This case demonstrates inflammation-induced atrial edema can persist for months after RFCA and may adversely affect atrial function years later. This case demonstrates inflammation-induced atrial edema can persist for months after radiofrequency catheter ablation and may adversely affect atrial function years later. Considering that left atrial calcification (LAC) was detected two years and nine months before atrial function declined in this case, early detection of LAC may be a predictor of future atrial function deterioration. Careful follow-up is recommended for patients with LAC. [ABSTRACT FROM AUTHOR]

For left-sided radiofrequency catheter ablation (LCA) in pediatrics, significant practice variability exists regarding anticoagulation and discharge practices. Given the lack of data in pediatric patients, the risks and benefits of these practices are not well defined. The purpose of this study was to evaluate the safety of same-day discharge and use of aspirin (ASA) in pediatric patients following LCA. We performed a retrospective cohort study of pediatric patients who underwent LCA from 2010 to 2020 at our institution. Discharge timing and ASA usage were based on operator preference. The primary outcome was incidence of postablation anticoagulation complications reported within 1 month of the procedure. Three hundred seventy-six patients underwent LCA and met inclusion criteria. Median [25th, 75th percentiles] age was 13.9 [10.5, 16.2] years; 18 (4.7%) had a history of structural heart disease. The most common substrates for ablation were Wolff-Parkinson-White syndrome (183 patients [48.7%]), concealed accessory pathway (159 patients [42.3%]), and ectopic atrial tachycardia (10 patients [2.7%]). Three hundred thirty-eight patients (89.9%) were discharged on the day of LCA. Seventy-six patients (20.2%) were prescribed ASA at discharge. Of those who underwent follow-up (273 patients [72.6%]), 7 (2.7%) reported an anticoagulation complication (5 with hematoma, 2 with headache). One of these patients was prescribed ASA; none required readmission. There was no correlation between anticoagulation complications and same-day discharge or with ASA usage. Given the rare incidence of anticoagulation complications in pediatric patients undergoing LCAs, same-day discharge from the electrophysiology laboratory without anticoagulation should be considered. [ABSTRACT FROM AUTHOR]