The use of Intracardiac Echocardiography in Catheter Ablation of Atrial Fibrillation.

Purpose Of The Review: Intracardiac echocardiography (ICE) provides real-time, fluoroless imaging of cardiac structures, allowing optimal catheter positioning and energy delivery during ablation procedures. This review summarizes the use of ICE in catheter ablation of atrial fibrillation (AF).

Recent Findings: Growing evidence suggests that the use of ICE improves procedural safety and facilitates radiofrequency and cryoballoon AF ablation.

Association of beat-to-beat P-wave analysis index to the extent of left atrial low-voltage areas in patients with paroxysmal atrial fibrillation.

Background: Left atrial (LA) fibrosis has been shown to be associated with atrial fibrillation (AF) recurrence. Beat-to-beat (B2B) index is a non-invasive classifier, based on B2B P-wave morphological and wavelet analysis, shown to be associated with AF incidence and recurrence. In this study, we tested the hypothesis that the B2B index is associated with the extent of LA low-voltage areas (LVAs) on electroanatomical mapping.

Ablation of residual potentials along the circumferential line reduces acute pulmonary vein reconnection.

Introduction: Acute pulmonary vein (PV) reconnection is frequently encountered in patients undergoing PV isolation (PVI) procedure for the treatment of atrial fibrillation. In this study, we investigated whether the identification and ablation of residual potentials (RPs), after the initial achievement of PVI, reduces acute PV reconnection rate.

Methods: Following PVI in 160 patients, mapping along the ablation line was performed to identify RPs, defined as bipolar amplitude ≥0.

P-Wave Beat-to-Beat Analysis to Predict Atrial Fibrillation Recurrence after Catheter Ablation.

The identification of patients prone to atrial fibrillation (AF) relapse after catheter ablation is essential for better patient selection and risk stratification. The current prospective cohort study aims to validate a novel P-wave index based on beat-to-beat (B2B) P-wave morphological and wavelet analysis designed to detect patients with low burden AF as a predictor of AF recurrence within a year after successful catheter ablation. From a total of 138 consecutive patients scheduled for AF ablation, 12-lead ECG and 10 min vectorcardiogram (VCG) recordings were obtained.

Cavotricuspid isthmus ablation guided by force-time integral - A randomized study.

Background: Force-time integral (FTI) is an ablation marker of lesion quality and transmurality. A target FTI of 400 gram-seconds (gs) has been shown to improve durability of pulmonary vein isolation, following atrial fibrillation ablation. However, relevant targets for cavotricuspid isthmus (CTI) ablation are lacking.

Remote Cardiac Rhythm Monitoring in the Era of Smart Wearables: Present Assets and Future Perspectives.

Remote monitoring and control of heart function are of primary importance for patient evaluation and management, especially in the modern era of precision medicine and personalized approach. Breaking technological developments have brought to the frontline a variety of smart wearable devices, such as smartwatches, chest patches/straps, or sensors integrated into clothing and footwear, which allow continuous and real-time recording of heart rate, facilitating the detection of cardiac arrhythmias. However, there is great diversity and significant differences in the type and quality of the information they provide, thus impairing their integration into daily clinical practice and the relevant familiarization of practicing physicians.

Intra-atrial Conduction Block During Radiofrequency Ablation of Left-sided Accessory Pathways.

Catheter ablation is currently the therapeutic approach of choice for many patients with accessory pathways. Despite the high success rate of radiofrequency ablation of the left lateral accessory pathways, a rather uncommon manifestation is intra-atrial conduction block at the level of the mitral isthmus. We report 2 cases of orthodromic atrioventricular reentrant tachycardia using a concealed left-sided accessory pathway with an abrupt change in the activation of the coronary sinus from an eccentric to concentric sequence after ablation delivery.

The contribution of intracardiac echocardiography in catheter ablation of ventricular arrhythmias.

Catheter ablation is a well-established treatment option for patients with ventricular arrhythmias. Recent advances in various imaging modalities, including three-dimensional electroanatomic mapping systems, magnetic resonance imaging, transesophageal and intracardiac echocardiography (ICE) have been adopted in catheter ablation of ventricular arrhythmias improving procedural outcome and safety. ICE is an imaging tool which provides real-time visualization of anatomical structures of the heart, facilitating catheter manipulation and navigation during ablation procedures.

Atrial substrate characterization in patients with atrial fibrillation and hypertrophic cardiomyopathy: Evidence for an extensive fibrotic disease.

Introduction: Data regarding the left atrial (LA) electroanatomical substrate in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF) are missing. In this electroanatomical mapping (EAM) study, we evaluated the extent of LA fibrosis and its impact on catheter ablation outcomes in patients with HCM and AF.

Materials And Methods: High-density LA EAM was performed during AF in 28 consecutive patients with obstructive HCM and AF (42.

Safety of smartwatches and their chargers in patients with cardiac implantable electronic devices.

Aims: Cardiac implantable electronic devices (CIEDs) are susceptible to electromagnetic interference (EMI). Smartwatches and their chargers could be a possible source of EMI. We sought to assess whether the latest generation smartwatches and their chargers interfere with proper CIED function.

High-density mapping of de novo focal atrial tachycardias using a new software: Protected low-voltage areas by zones of conduction delay.

Background: The pathophysiological mechanism of focal atrial tachycardias (AT) remains obscure.

Methods: Fifteen patients (6 males, age 45 ± 18) with focal AT underwent high-density activation mapping using a new software called extended early-meets-late (EEML).

Results: Irrespective of the arrhythmia mechanism, low bipolar voltage fractionated signals (0.

The aortic cusps are the predominant successful ablation site of idiopathic outflow-tract ventricular arrhythmias.

Background: Data regarding the successful ablation site of idiopathic outflow tract (OT) ventricular arrhythmias (VAs) in the modern era of mapping and ablation are limited.

Methods And Results: Over a 4-year period, a total of 309 patients underwent detailed activation mapping of OT VAs including the right ventricular outflow tract (RVOT), the left ventricular outflow tract (LVOT) and the aortic cusps (AC), and the coronary venous system. 244 cases were successfully ablated at the index procedure (78.

Fasciculoventricular bypass tracts: Electrocardiographic and electrophysiologic features.

Fasciculoventricular accessory pathways are rare variants of preexcitation. The differential diagnosis of fasciculoventricular accessory pathways from other preexcitation variants can be challenging. Based on two cases, we discuss the specific electrocardiographic and electrophysiologic features of fasciculoventricular bypass tracts.

Beneficial Effect of Flecainide Controlled Release on the Quality of Life of Patients with Atrial Fibrillation-the REFLEC-CR Study.

Purpose: Atrial fibrillation (AF) is the most common cardiac arrhythmia with a considerable impact on patients' quality of life (QoL).

Methods: This prospective, multicenter, observational study aimed to evaluate the effect of oral treatment with controlled-release (CR) flecainide on AF patients' QoL and treatment compliance during a 12-week period. A total of 70 sites enrolled consecutive patients with paroxysmal (PAF) or persistent AF (PerAF), treated with flecainide CR in the context of a rhythm control strategy.

Reel syndrome-An uncommon etiology of ICD dysfunction.

Reel syndrome occurs due to the rotation of the implantable device on its transverse axis with subsequent coiling of the leads around the pulse generator. Device interrogation and chest X-ray should be performed in any case of device malfunction.

Atrial fibrosis as a dominant factor for the development of atrial fibrillation: facts and gaps.

Atrial fibrillation (AF), the most commonly diagnosed arrhythmia, affects a notable percentage of the population and constitutes a major risk factor for thromboembolic events and other heart-related conditions. Fibrosis plays an important role in the onset and perpetuation of AF through structural and electrical remodelling processes. Multiple molecular pathways are involved in atrial substrate modification and the subsequent maintenance of AF.

Correction to: Restitution metrics in Brugada syndrome: a systematic review and meta-analysis.

The original version of this article unfortunately has a typo error. The name of the author "Kamalan Jeeveratnam" should be presented as "Kamalan Jeevaratnam" as shown above.

Restitution metrics in Brugada syndrome: a systematic review and meta-analysis.

Background: Brugada syndrome (BrS) is an ion channelopathy that predisposes affected subjects to ventricular tachycardia/fibrillation (VT/VF) and sudden cardiac death. Restitution analysis has been examined in BrS patients but not all studies have reported significant differences between BrS patients and controls. Therefore, we conducted a systematic review and meta-analysis to investigate the different restitution indices used in BrS.

Simple hematological predictors of AF recurrence in patients undergoing atrial fibrillation ablation.

Backgound: Red cell distribution width (RDW) and neutrophil-to-lymphocyte ratio (NLR) are simple hematologic indices that have been used to predict adverse outcomes in different clinical settings. The aim of our study is to determine whether RDW and NLR can predict atrial fibrillation (AF) recurrence in patients undergoing AF ablation.

Methods: Consecutive patients, without known hematological disorders, who underwent AF catheter ablation between January 2014 and April 2017 were enrolled into this study.

Clinical characteristics and long-term clinical course of patients with Brugada syndrome without previous cardiac arrest: a multiparametric risk stratification approach.

Aims: Risk stratification in Brugada syndrome (BrS) still represents an unsettled issue. In this multicentre study, we aimed to evaluate the clinical characteristics and the long-term clinical course of patients with BrS.

Methods And Results: A total of 111 consecutive patients (86 males; aged 45.