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.

Vein of Marshall ethanol infusion for recurrent atrial fibrillation in patients with durably isolated pulmonary veins.

Background: Vein of Marshall (VoM) ethanol ablation has a proven benefit in patients with persistent atrial fibrillation (AF) undergoing index procedure; however, its role in repeat ablation is unknown. We sought to evaluate the benefit of empiric VoM ethanol ablation in addition to posterior wall isolation (PWI) during the repeat procedure in patients with durable pulmonary vein (PV) isolation from prior ablation.

Methods: Twenty-three patients (age 67.

Atrioesophageal Fistula Rates Before and After Adoption of Active Esophageal Cooling During Atrial Fibrillation Ablation.

Background: Active esophageal cooling reduces the incidence of endoscopically identified severe esophageal lesions during radiofrequency (RF) catheter ablation of the left atrium for the treatment of atrial fibrillation. A formal analysis of the atrioesophageal fistula (AEF) rate with active esophageal cooling has not previously been performed.

Objectives: The authors aimed to compare AEF rates before and after the adoption of active esophageal cooling.

Acute and Long-Term Scar Characterization of Venous Ethanol Ablation in the Left Ventricular Summit.

Background: Venous ethanol ablation (VEA) can be effective for ventricular arrhythmias from the left ventricular summit (LVS); however, there are concerns about excessive ablation by VEA.

Objectives: The purpose of this study was to delineate and quantify the location, extent, and evolution of ablated tissue after VEA as an intramural ablation technique in the LVS.

Methods: VEA was performed in 59 patients with LVS ventricular arrhythmias.

Safety and Efficacy of a Novel Approach to Pulmonary Vein Isolation Using Prolonged Apneic Oxygenation.

Background: Improved ablation catheter-tissue contact results in more effective ablation lesions. Respiratory motion causes catheter instability, which impacts durable pulmonary vein isolation (PVI).

Objectives: This study sought to evaluate the safety and efficacy of a novel ablation strategy involving prolonged periods of apneic oxygenation during PVI.

Substrate Ablation by Multivein, Multiballoon Coronary Venous Ethanol for Refractory Ventricular Tachycardia in Structural Heart Disease.

Background: Ablation of ventricular tachycardia (VT) in the setting of structural heart disease often requires extensive substrate elimination that is not always achievable by endocardial radiofrequency ablation. Epicardial ablation is not always feasible. Case reports suggest that venous ethanol ablation (VEA) through a multiballoon, multivein approach can lead to effective substrate ablation, but large data sets are lacking.

Advanced Techniques for Ethanol Ablation of Left Ventricular Summit Region Arrhythmias.

Background: Coronary venous ethanol ablation (VEA) can be used as a strategy to treat ventricular arrhythmias arising from the left ventricular summit, but collateral flow and technical challenges cannulating intramural veins in complex venous anatomies can limit its use. Advanced techniques for VEA can capitalize on collateral vessels between target and nontarget sites to improve success.

Methods: Of 55 patients with left ventricular summit ventricular arrhythmia, advanced techniques were used in 15 after initial left ventricular summit intramural vein mapping failed to show suitable targets for single vein, single-balloon VEA.

Temporal Changes and Clinical Implications of Delayed Peridevice Leak Following Left Atrial Appendage Closure.

Objectives: The aim of this study was to assess temporal changes and clinical implications of peridevice leak (PDL) after left atrial appendage closure.

Background: Endocardial left atrial appendage closure devices are alternatives to long-term oral anticoagulation (OAC) for patients with atrial fibrillation. PDL >5 mm may prohibit discontinuation of OAC.

Role of Intracardiac Echography for Transcatheter Occlusion of Left Atrial Appendage.

Left atrial appendage closure (LAAC) is an increasingly common procedure for patients with nonvalvular atrial fibrillation and contraindications to long-term anticoagulation. Traditionally, LAAC has been performed under transesophageal echocardiography (TEE) guidance. Although most operators have become experienced and comfortable with TEE-guided appendage closure, there has been a growing interest in the use of intracardiac echocardiography (ICE) for LAAC.

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.

Implantation of leadless pacemakers via inferior vena cava filters is feasible and safe: Insights from a multicenter experience.

Background: The leadless Micra transcatheter-pacing system (Micra-TPS) is implanted via a femoral approach using a 27-French introducer sheath. The Micra Transcutaneous Pacing Study excluded patients with inferior vena cava (IVC) filters.

Objective: To examine the feasibility and safety of Micra-TPS implantation through an IVC filter.

Electrocardiographic localization of ventricular arrhythmias successfully ablated from the distal great cardiac vein.

Background: Idiopathic ventricular arrhythmias (IVAs) from the left ventricular (LV) summit may be successfully ablated from the distal great cardiac vein (dGCV). Using a 12-lead electrocardiogram (ECG) to localize IVAs that can be ablated from the dGCV is valuable for ablation planning.

Objective: To determine if a "w" wave, a notch in the Q wave in lead I, and other ECG features can identify IVAs that can be successfully ablated from the dGCV.

Percutaneous approaches for retrieval of an embolized or malpositioned left atrial appendage closure device: A multicenter experience.

Background: Experience with retrieval of a Watchman left atrial (LA) appendage (LAA) closure device (WD) is limited. An embolized or grossly malpositioned WD warrants retrieval to minimize the risk of thromboembolic complications and vascular occlusion.

Objective: The purpose of this study was to report approaches for percutaneous retrieval of a WD from multicenter experience.

Escape mapping to achieve bidirectional block: A case series.

Escape mapping is a novel technique that can be used to locate sites of persistent conduction and achieve exit block during an atrial fibrillation ablation. This method allows for mapping solely with the ablation catheter in the left atrium by annotating to a catheter in the coronary sinus. We illustrate the utility escape mapping during an atrial fibrillation ablation where entrance block is achieved without exit block.

Left atrial thrombus despite continuous direct oral anticoagulant or warfarin therapy in patients with atrial fibrillation: insights into rates and timing of thrombus resolution.

Purpose: Left atrial thrombus (LAT) may be detected by transesophageal echocardiography (TEE) in patients with atrial fibrillation (AF) or flutter (AFL) despite continuous anticoagulation therapy. We sought to examine the rates and timing of LAT resolution in response to changes in anticoagulation regimen.

Methods: A retrospective study of 1517 consecutive patients on ≥ 4 weeks continuous oral anticoagulation (OAC) undergoing TEE prior to either direct current cardioversion or catheter ablation for AF or AFL was performed.

Venous Obstruction in Cardiac Rhythm Device Therapy.

Purpose Of Review: A variety of complex vascular pathologies arise following the implantation of electronic cardiac devices. Pacemaker and defibrillator lead insertion may cause proximal venous obstruction, resulting in symptomatic venous congestion and the compromise of potential future access sites for cardiac rhythm lead management.

Recent Findings: Various innovative techniques to recanalize the vein and establish alternate venous access have been pioneered over the past few years.