Omega-3 polyunsaturated Fatty Acid supplementation reduced atrial fibrillation recurrence after pulmonary vein antrum isolation.

Objective: To assess if patients treated with omega-3(n-3) polyunsaturated fatty acids (PUFAS) had lower procedural failure rates compared to an untreated population.

Methods And Results: From January 2004 to 2007, 1500 PVAI patients underwent catheter ablation. Two hundred and eighty five (19%) patients were treated with PUFAs.

Incidence of left ventricular function improvement after primary prevention ICD implantation for non-ischaemic dilated cardiomyopathy: a multicentre experience.

Background: The SCD-HeFT study demonstrated a benefit of primary prevention implantable cardioverter-defibrillator (ICD) implantation in patients with non-ischaemic dilated cardiomyopathy (NIDCM). However, NIDCM may improve spontaneously, even after waiting 6-9 months on optimal medical treatment.

Objective: To assess the incidence of left ventricular (LV) function improvement in patients receiving primary prevention ICDs for NIDCM.

Atrial fibrillation ablation strategies for paroxysmal patients: randomized comparison between different techniques.

Background: Whether different ablation strategies affect paroxysmal atrial fibrillation (AF) long-term freedom from AF/atrial tachyarrhythmia is unclear. We sought to compare the effect of 3 different ablation approaches on the long-term success in patients with paroxysmal AF.

Methods And Results: One hundred three consecutive patients with paroxysmal AF scheduled for ablation and presenting in the electrophysiology laboratory in AF were selected for this study.

Esophageal capsule endoscopy after radiofrequency catheter ablation for atrial fibrillation: documented higher risk of luminal esophageal damage with general anesthesia as compared with conscious sedation.

Background: Left atrioesophageal fistula is a rare but devastating complication that may occur after catheter ablation of atrial fibrillation. We used capsule endoscopy to assess esophageal injury after catheter ablation for atrial fibrillation in a population randomized to undergo general anesthesia or conscious sedation.

Methods And Results: Fifty patients undergoing atrial fibrillation ablation for paroxysmal symptomatic atrial fibrillation refractory to antiarrhythmic drugs were enrolled and randomized, including those undergoing the procedure under general anesthesia (25 patients, group 1) and those receiving conscious sedation with fentanyl or midazolam (25 patients, group 2).

Pulmonary vein antrum isolation, atrioventricular junction ablation, and antiarrhythmic drugs combined with direct current cardioversion: survival rates at 7 years follow-up.

Purpose: To report survival rates in patients treated with pulmonary vein antrum isolation (PVAI), atrioventricular junctional ablation (AVJA), and antiarrhythmic and direct current cardioversion (A+DCCV) at 7 years follow-up.

Methods: From February 2002-December 2004, 1,000 consecutive patients underwent PVAI or A+DCCV or AVJA. These patients were matched in a nested casecontrolled methodology.

Right ventricular substrate mapping using the Ensite Navx system: Accuracy of high-density voltage map obtained by automatic point acquisition during geometry reconstruction.

Background: Contact point-to-point electroanatomic mapping (Pt-Map) is a validated tool to evaluate right ventricular (RV) substrate. When using the EnSite NavX system (St. Jude Medical, St Paul, Minnesota), geometry reconstruction by dragging the mapping catheter (Geo-Map) allows for quicker acquisition of a large number of points and better definition of anatomy, but it is not validated for substrate mapping.

Impact of systematic isolation of superior vena cava in addition to pulmonary vein antrum isolation on the outcome of paroxysmal, persistent, and permanent atrial fibrillation ablation: results from a randomized study.

Background: Pulmonary veins (PVs) have been shown to represent the most frequent sites of ectopic beats initiating paroxysmal atrial fibrillation (AF). However, additional non-PV triggers, arising from different areas, have been reported as well. One of the most common non-PV sites described is the superior vena cava.

Impact of type of atrial fibrillation and repeat catheter ablation on long-term freedom from atrial fibrillation: results from a multicenter study.

Background/objective: The purpose of this prospective multicenter study was to compare results of catheter ablation in patients with paroxysmal atrial fibrillation (PAF) and those with nonparoxysmal atrial fibrillation (NPAF). The impact and the role of repeat catheter ablation were assessed in patients with recurrence.

Methods/results: One thousand four hundred four patients underwent catheter ablation for atrial fibrillation (AF) performed by 12 operators at four institutions using a single technique guided by intracardiac echocardiography.

Rational patient selection for catheter ablation of atrial fibrillation.

During the past decade, catheter ablation of atrial fibrillation has been progressively used for the treatment of drug-refractory patients. As experience and technique have evolved, patient selection criteria have been modified to include a wider range of patients. Patients with paroxysmal, persistent, and longstanding persistent atrial fibrillation can be treated with catheter ablation.

Left atrial appendage tip: an unusual site of successful ablation after failed endocardial and epicardial mapping and ablation.

Uncommon sites of ablation for arrhythmias can be the cause of failed ablations. This series includes 4 cases requiring ablation at the tip of the left atrial appendage after both endocardial and epicardial mapping and ablation failed.

Ablation of atrial fibrillation utilizing robotic catheter navigation in comparison to manual navigation and ablation: single-center experience.

Background: Robotic catheter navigation and ablation either with magnetic catheter driving or with electromechanical guidance have emerged in the recent years for the treatment of atrial fibrillation.

Objective: The aim of this study was to compare our center's experience of atrial fibrillation ablation using the Hansen Robotic Medical System with our current manual ablation technique in terms of acute and chronic success, as well as procedure time and radiation exposure to both the patient and the operator.

Methods: A total of 390 consecutive patients with symptomatic and drug-resistant atrial fibrillation (289 males, 62 +/- 11 years) were prospectively enrolled in the study.

Mapping and ablation of ventricular arrhythmias with magnetic navigation: comparison between 4- and 8-mm catheter tips.

Introduction: Remote magnetic navigation (RMN) has been reported as an effective and safe tool to overcome the need for advanced operator skill in the treatment of complex arrhythmias. We report a series of patients undergoing radiofrequency catheter ablation of ventricular arrhythmias (VAs) using RMN with either a 4-mm catheter tip or an 8-mm catheter tip at four different centers.

Methods: Sixty-five patients with clinical and symptomatic history of Vas were included.

Catheter ablation for atrial fibrillation: a promising therapy for congestive heart failure.

Atrial fibrillation (AF) and congestive heart failure (CHF) are cardiovascular epidemics. Catheter ablation of AF is increasingly performed in patients with CHF. Atrioventricular junction ablation (AVJA) and pulmonary vein isolation are the two predominant ablation strategies used to treat AF patients who are refractory to drugs.

Opposing wall mechanics are significantly influenced by longitudinal cardiac rotation in the assessment of ventricular dyssynchrony.

Objectives: This study sought to assess whether longitudinal rotation (LR) affects myocardial systolic velocity profiles and to compare velocity-based measures of dyssynchrony with LR for predicting cardiac resynchronization therapy (CRT) response.

Background: Longitudinal rotation, a rocking motion often seen when the dilated left ventricle (LV) is imaged in its horizontal long-axis plane, is a recently recognized phenomenon and a new predictor of response to CRT.

Methods: One hundred patients with CRT implants and suitable baseline echocardiograms were identified.

Feasibility and safety of using an esophageal protective system to eliminate esophageal thermal injury: implications on atrial-esophageal fistula following AF ablation.

Background: Ablation for atrial fibrillation (AF) requires energy delivery in close proximity to the esophagus (Eso) which has accounted for the LA-Eso fistula, a rare but life-threatening complication.

Purpose: We evaluated an Eso cooling system to protect the Eso during RF ablation.

Methods And Results: An "in vitro" heart-Eso preparation was initially used to test a temperature-controlled fluid-circulating system (EPSac [esophageal protective system]-RossHart Technologies Inc.

Transiliac ICD implantation: defibrillation vector flexibility produces consistent success.

Background: The transiliac approach to implantable cardioverter-defibrillator (ICD) implantation is an alternative in patients for whom pectoral placements are contraindicated. The defibrillation vector is altered from the pectoral configuration because of pulse generator placement in one of the upper abdominal quadrants and separate single-coil, active-fixation defibrillation leads positioned in the high right atrium and right ventricular apex.

Objective: The feasibility, safety, and complications of this approach and the results of defibrillation testing (DFT) with this configuration are described.

Prevention of phrenic nerve injury during epicardial ablation: comparison of methods for separating the phrenic nerve from the epicardial surface.

Background: The proximity of the phrenic nerve (PN) to cardiac tissue relevant to arrhythmias may increase the risk of PN injury. Strategies for preventing PN injury in the pericardial space are limited.

Objective: The purpose of this study was to compare methods for separating the PN from the epicardial surface in order to prevent PN injury.

Evaluation of systolic properties in hypertensive patients with different degrees of diastolic dysfunction and normal ejection fraction.

Background: Left ventricular (LV) diastolic dysfunction (DD) associated with a preserved ejection fraction (EF) is a frequent alteration in hypertensive patients, usually considered an impairment of the diastolic phase alone. However, because systole and diastole are strictly correlated to one another, it is possible that hypertensive patients with isolated DD may also present with initial abnormalities of LV systolic properties, particularly those presenting with a more severe degree of DD. We performed a multiparametric echocardiographic assessment of LV systolic properties in patients without cardiovascular diseases, with preserved EF and different degrees of DD.

Catheter ablation of atrial fibrillation.

Atrial fibrillation is a common arrhythmia associated with significant morbidity, including angina, heart failure, and stroke. Medical therapy remains suboptimal, with significant side effects and toxicities, and a high recurrence rate. Catheter ablation or modification of the atrioventricular node with pacemaker implantation provides rate-control but exposes patients to the hazards associated with implantable devices and does nothing to reduce the risk for stroke.

How to identify and treat patient with pulmonary vein stenosis post atrial fibrillation ablation.

Purpose Of Review: The diagnosis of pulmonary vein stenosis, following catheter ablation of atrial fibrillation, potentially carries significant morbidity for affected patients. It is important that physicians remain aware of the entity and have an understanding of how to treat such patients. There has been controversy in how to assess patients following atrial fibrillation ablation, and how to treat asymptomatic patients with pulmonary vein stenosis.

Ablation for longstanding permanent atrial fibrillation: results from a randomized study comparing three different strategies.

Background: This prospective multicenter randomized study aimed to compare the efficacy of 3 common ablation methods used for longstanding permanent atrial fibrillation (AF).

Methods: A total of 144 patients with longstanding permanent AF (median duration 28 months) were randomly assigned to circumferential pulmonary vein ablation (CPVA, group 1, n = 47), to pulmonary vein antrum isolation (PVAI, group 2, n = 48) or to a hybrid strategy combining ablation of complex fractionated or rapid atrial electrograms (CFAE) in both atria followed by a pulmonary vein antrum isolation (CFAE + PVAI, group 3, n = 49).

Results: Scarring in the left atrium and structural heart disease/hypertension were present in most patients (65%).

Antiarrhythmic effect of reverse ventricular remodeling induced by cardiac resynchronization therapy: the InSync ICD (Implantable Cardioverter-Defibrillator) Italian Registry.

Objectives: We investigated whether the reverse remodeling after cardiac resynchronization therapy (CRT) might reduce the occurrence of ventricular arrhythmias (VAs).

Background: It is currently debated whether CRT has an effect on the burden of VAs.

Methods: The study included 398 patients treated with a CRT defibrillator and with a follow-up of at least 12 months.

Relationship between catheter forces, lesion characteristics, "popping," and char formation: experience with robotic navigation system.

Introduction: Popping, char and perforation are complications that can occur following catheter ablation. We measured the amount of grams (g) applied to the endocardium during ablation using a sensor incorporated in the long sheath of a robotic system. We evaluated the relationship between lesion formation, pressure, and the development of complications.