Mechanisms of Mitral Isthmus Reconnection After Ablation With and Without Vein of Marshall Ethanol Infusion.

Background: Reconnection of the mitral isthmus (MI) is common after radiofrequency ablation (RFA). Vein of Marshall ethanol infusion (VOMEI) expedites MI ablation, but long-term results are unclear.

Objectives: This study sought to determine anatomic substrates of failed MI ablation, with and without VOMEI.

Experimental drugs for supraventricular tachycardia: an analysis of early phase clinical trials.

Introduction: Supraventricular tachycardias (SVT) are a diverse group of commonly encountered arrhythmias arising at or above the atrioventricular (AV) node. Conventional anti-arrhythmic medications are restricted by extensive side-effect profiles and limited efficacy. Catheter ablation has emerged as a first-line therapy for many arrhythmias but is not a suitable option for all patients.

PET-Driven, Voltage-Guided Atrial Endomyocardial Biopsy Clinches the Diagnosis of Cardiac Sarcoidosis.

Endomyocardial biopsy (EMB) is used in diagnosing infiltrative and other suspected cardiomyopathies. We present a case in which positron emission tomography- and electroanatomic mapping-guided EMB of the atrial septum confirmed the diagnosis of cardiac sarcoidosis in a patient with negative findings on ventricular and lymph node biopsy. ().

Alcohol Ablation for Ventricular Tachycardia.

Catheter-based radiofrequency (RF) ablation is an effective, well-established therapy for ventricular tachycardia (VT). However, a large number of patients still have recurrences, particularly those with substrates arising from intramural locations that are inaccessible through endo- or epicardial catheter approaches. Several unconventional ablation techniques have been proposed to treat RF-refractory VT, including transarterial coronary ethanol ablation and retrograde coronary venous ethanol ablation.

Venous anatomy of the left ventricular summit: Therapeutic implications for ethanol infusion.

Background: Venous ethanol ablation (VEA) is effective for treatment of left ventricular (LV) summit (LVS) arrhythmias. The LVS venous anatomy is poorly understood and has inconsistent nomenclature.

Objective: The purpose of this study was to delineate the LVS venous anatomy by selective venography and 3-dimensional (3D) mapping during VEA and by venous-phase coronary computed tomographic angiography (vCTA).

Intramural Venous Ethanol Infusion for Refractory Ventricular Arrhythmias: Outcomes of a Multicenter Experience.

Objectives: The aim of this study was to assess the long-term efficacy and outcomes of retrograde venous ethanol ablation in treating ventricular arrhythmias (VAs).

Background: Retrograde coronary venous ethanol ablation (RCVEA) can be effective for radiofrequency ablation (RFA)-refractory VAs, particularly those arising in the LV summit (LVS).

Methods: Patients with drug and RFA-refractory VAs were considered for RCVEA after RF failure attempts.

Double-balloon technique for retrograde venous ethanol ablation of ventricular arrhythmias in the absence of suitable intramural veins.

Background: Venous ethanol infusion via an occlusive balloon has been used as a bailout approach to treat ablation-refractory ventricular arrhythmias (VAs). Unfavorable venous anatomy (lack of intramural veins at the targeted site or collateral vein-ethanol shunting) limits its efficacy. Blocking collateral flow with a second balloon may optimize myocardial ethanol delivery.

The SYNTAX II Score Predicts Mortality at 4 Years in Patients Undergoing Percutaneous Coronary Intervention.

Background: Short-term outcome after percutaneous coronary intervention (PCI) has improved dramatically, but the association between clinical or angiographic characteristics and long-term outcome remains less well described. The SYNTAX (Synergy Between PCI With TAXUS and Cardiac Surgery) II score has been designed to overcome the limitations of the purely angiographic SYNTAX I score by including clinical parameters and comorbidities. It has not been tested extensively in "real-world" PCI patients, outside of randomized clinical studies.

Transcatheter Aortic Valve Replacement in Type B Aortic Dissection.

Transcatheter aortic valve replacement (TAVR) has become an acceptable alternative to surgical aortic valve replacement in high-risk and inoperable patients. Several technical and anatomical considerations can increase the complexity and risk of the procedure, and therefore are considered as contraindications to TAVR. Patients with significant aortic disease such as aortic dissection are not usually considered for TAVR due to risk of aortic rupture or retrograde extension of the dissection.