Optimizing cryoballoon pulmonary vein isolation: lessons from >1000 procedures- the Frankfurt approach.

Aims: Cryoballoon (CB) pulmonary vein isolation (PVI) is an accepted ablation strategy for rhythm control in atrial fibrillation (AF). We describe efficacy and safety in a high volume centre with a long experience in the use of the second-generation CB (CB2).

Methods And Results: Consecutive paroxysmal AF (PAF) or persistent AF (persAF) patients undergoing CB2-PVI were enrolled.

Durability of cryoballoon left atrial appendage isolation: Acute and invasive remapping electrophysiological findings.

Background: The left atrial appendage (LAA) has been identified as a potential source of atrial fibrillation (AF) and has been described as the "fifth" pulmonary vein (PV). We report our initial experience in LAA isolation (LAAI) using the cryoballoon (CB) and data on durability of CB-LAAI.

Methods: Patients treated with a CB-LAAI were retrospectively identified.

Electrical isolation of the left atrial appendage by Maze-like catheter substrate modification: A reproducible strategy for pulmonary vein isolation nonresponders?

Introduction: The ablation strategy for atrial fibrillation (AF) despite pulmonary vein isolation (PVI) is controversial. Left atrial appendage isolation (LAAI) may contribute to improve outcome. We describe an ablation approach ("Maze-like"-LAAI) that (1) modifies the underlying LA substrate by linear ablation (2) eliminates the LAA as a putative AF trigger site and (3) incorporates an unambiguous procedural endpoint.

What Is the Acute Antral Lesion Size After Pulmonary Vein Isolation Using Different Balloon Ablation Technologies?

Background: Clinical outcome after pulmonary vein isolation (PVI) may be linked to both durability of PVI and the antral lesion size. Data on balloon-guided technologies are scarce. We investigated the size of the isolated surface area (ISA) acutely after PVI achieved by cryoballoon (CB) or laser balloon (LB), both using voltage mapping.

Visually guided pulmonary vein isolation in patients with persistent atrial fibrillation.

Aims: The role of balloon catheters in patients with persistent forms of atrial fibrillation (AF) remains ill defined. We therefore sought to assess the safety and efficacy of a laser balloon (LB)-guided pulmonary vein isolation (PVI) in consecutive all-comers with persistent AF.

Methods And Results: All patients undergoing an LB-guided PVI procedure for persistent AF between January 2011 and December 2012 were matched to patients undergoing circumferential PVI using irrigated radiofrequency (RF) current ablation for date of procedure, age, gender, AF duration, left atrial (LA) size, and left ventricular ejection fraction.

Decennial Analysis of Interventional Left Atrial Appendage Closure.

Introduction: Data on long-term follow-up (LTFU) after interventional closure of the left atrial appendage (LAAC) in patients with nonvalvular atrial fibrillation (AF) are scarce. We sought to determine the outcome of patients after LAAC with the first generation device.

Methods And Results: The Cardioangiologisches Centrum Bethanien (CCB) LAAC registry database was analyzed.

Comparison of balloon catheter ablation technologies for pulmonary vein isolation: the laser versus cryo study.

Introduction: Balloon catheters have been developed to facilitate pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (PAF). We sought to compare the safety and efficacy of the cryoballoon (CB) and the laserballoon (LB) in a pilot study.

Methods And Results: One hundred and forty patients with drug-refractory PAF were prospectively allocated in a 1:1 fashion to undergo a PVI procedure with the 28 mm CB or the LB and were followed for 12 months using 3-day Holter ECG recording.

Endoscopic ablation systems.

Pulmonary vein (PV) isolation for ablation of atrial fibrillation is a well-accepted therapy option for high symptomatic patients refractory to antiarrhythmic drugs. Radiofrequency point-by-point ablation is the gold-standard technique; however, in the last two decades, many new technologies have been developed. The endoscopic ablation system makes direct PV ostium visualization possible, despite the large anatomy variation thanks to its compliant balloon.

Long-term outcome after catheter ablation for left posterior fascicular ventricular tachycardia without development of left posterior fascicular block.

Background: Catheter ablation of left posterior fascicular (LPF) ventricular tachycardia (VT) is commonly performed during tachycardia. This study reports on the long-term outcome of patients undergoing ablation of LPF VT targeting the earliest retrograde activation within the posterior Purkinje fiber network during sinus rhythm (SR).

Methods: This study retrospectively analyzed 24 consecutive patients (8 female; mean age 26 ± 11 years) referred for catheter ablation of electrocardiographically documented LPF VT.

Correlation between substrate location and ablation strategy in patients with ventricular tachycardia late after myocardial infarction.

Background: The requirement for epicardial radiofrequency ablation (RFA) is still undefined in ventricular tachycardia (VT) late after myocardial infarction (MI).

Objective: The purpose of this study was to evaluate the correlation between the need for epicardial RFA and the clinical and electrophysiologic characteristics of VT late after MI.

Methods: Endocardial mapping and RFA were performed for VT late after MI, followed by epicardial mapping and RFA if no endocardial substrate was present or endocardial RFA failed.

Impact of pulmonary vein anatomy assessed by cardiac magnetic resonance imaging on endoscopic pulmonary vein isolation in consecutive patients.

Aims: Recently, the novel endoscopic ablation system (EAS) was introduced and proved its potential for successful pulmonary vein isolation (PVI) in patients suffering from paroxysmal atrial fibrillation (PAF). The current study will investigate the impact of pulmonary vein (PV) anatomy assessed by pre-interventional cardiac magnetic resonance imaging (CMRI) on endoscopic PVI.

Methods And Results: Fifty-one patients (23 females, age 57 ± 9 years) with a long history (5 ± 5 years) of drug-refractory PAF were included into our analysis.

Luminal esophageal temperature rise and esophageal lesion formation following remote-controlled magnetic pulmonary vein isolation.

Background: Remote magnetic pulmonary vein isolation (PVI) demonstrates comparable success rate to manual ablation, but thermal effects on esophageal tissue remain undefined.

Objective: The purpose of this study was to evaluate the potential thermal effects on esophageal tissue during remote magnetic wide-area circumferential pulmonary vein isolation (CPVI).

Methods: Twenty-five patients (23 men, age 57 ± 10 years) in the magnetic navigation system (MNS) group and 25 control subjects (15 men, age 61 ± 12 years) with drug-refractory paroxysmal or persistent atrial fibrillation underwent CPVI.

One-year clinical outcome after pulmonary vein isolation using the novel endoscopic ablation system in patients with paroxysmal atrial fibrillation.

Background: Pulmonary vein isolation (PVI) is an established treatment option for atrial fibrillation (AF). Recently the novel endoscopic ablation system (EAS) was introduced and proved potential for successful acute PVI.

Objective: This study sought to investigate the 1-year follow-up results after EAS-based PVI.

Esophageal temperature change and esophageal thermal lesions after pulmonary vein isolation using the novel endoscopic ablation system.

Background: Pulmonary vein isolation (PVI) is an established treatment option for paroxysmal atrial fibrillation. Recently, a novel endoscopic ablation system (EAS) was introduced. The incidence and severity of ablation-induced esophageal thermal lesions (ETLs) are unknown.

Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow-up.

Background: Paroxysmal atrial fibrillation (AF) naturally progresses toward chronic AF at an estimated rate of 15% to 30% over a 1- to 3-year period. Pulmonary vein (PV) isolation is increasingly performed for the treatment of drug-refractory paroxysmal AF. The long-term data on clinical outcome after circumferential PV isolation are limited.

Feasibility of circumferential pulmonary vein isolation using a novel endoscopic ablation system.

Background: Pulmonary vein isolation (PVI) is an established treatment option for patients with drug refractory paroxysmal atrial fibrillation. A novel compliant endoscopic ablation system housing a 980-nm-diode laser allows for discrete point-by-point ablation enabling a true circumferential ablation line design. We sought to determine the feasibility and safety of a circumferential ablation using endoscopic ablation system.

Remote-controlled magnetic pulmonary vein isolation using a new irrigated-tip catheter in patients with atrial fibrillation.

Background: Lack of an irrigated-tip magnetic catheter has limited the role of remote-controlled magnetic navigation (Niobe II, Stereotaxis) for catheter ablation of atrial fibrillation (AF).

Methods And Results: A novel 3.5-mm-tip irrigated magnetic catheter (group 1, Thermocool Navistar RMT, Biosense Webster) was used for 3D left atrial reconstruction (CARTO RMT) and remote-controlled magnetic pulmonary vein isolation.

Catheter ablation of long-standing persistent atrial fibrillation: a lesson from circumferential pulmonary vein isolation.

Introduction: Circumferential pulmonary vein isolation (CPVI) is associated with a high success rate in patients with paroxysmal and persistent atrial fibrillation (AF). However, in patients with long-standing persistent AF, the ideal ablation strategy still remains a matter of debate.

Methods And Results: Two-hundred and five patients underwent catheter ablation for long-standing persistent AF defined as continuous AF of more than 1-year duration.

Long-term clinical outcome following pulmonary vein isolation with high-intensity focused ultrasound balloon catheters in patients with paroxysmal atrial fibrillation.

Aims: High-intensity focused ultrasound (HIFU) applied via a balloon catheter is a novel technology for pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (PAF). The long-term success rate is unknown.

Methods And Results: Thirty-two patients (22 male, age 60 +/- 9 years) with a long history [5 (4;9) years] of drug refractory [3 +/- 1 anti-arrhythmic drugs (AADs)], symptomatic PAF were included into the analysis.

Pulmonary vein isolation with high-intensity focused ultrasound: results from the HIFU 12F study.

Aims: High-intensity focused ultrasound (HIFU) applied via a balloon catheter (BC) is a novel technology for simplified pulmonary vein isolation (PVI). Safety and efficacy of the third generation HIFU-BC were assessed.

Methods And Results: In 22 patients (10 male, mean age 65 +/- 6 years) with paroxysmal atrial fibrillation (PAF), a PVI during real-time PV spike registration and oesophageal temperature measurement was attempted.

Are Balloon Based Strategies Better Than Conventional Radiofrequency Catheter Ablation: Exploring New Frontiers In The Treatment Of Atrial Fibrillation.

Paroxysmal atrial fibrillation can be eliminated with continuous circular linear lesions around the pulmonary veins using radiofrequency ablation. Due to the technical complexity of this procedure balloon-based devices have been developed to simplify pulmonary vein isolation. Cryoballoon ablation provides excellent safety and is technically less demanding when compared to radiofrequency catheter ablation in selected patients.

Glycoprotein 130 ligand oncostatin-M induces expression of vascular endothelial growth factor in human adult cardiac myocytes.

Objective: In murine and rat cardiac myocytes the gp130 system transduces survival as well as hypertrophic signals and via induction of the expression of the potent angiogenic factor VEGF in these cells also indirectly contributes to cardiac repair processes through the development of new blood vessels. There are, however, species differences in receptor specificity and receptor crossreactivity in the gp130-gp130 ligand system. We asked whether gp130 signaling is also involved in the regulation of VEGF in human cardiac myocytes and if so which gp130 ligands are critical for such an effect.