Automatic identification of ablation targets in persistent atrial fibrillation: Initial experience with a new mapping tool.

Introduction: Strategies beyond pulmonary vein isolation (PVI) in persistent atrial fibrillation (persAF) are debated. A novel mapping tool provides algorithmic detection of ablation targets based on electrogram (EGM) properties specific to stable localized rotational activations.

Methods: The mapping tool was used on 31 patients (20 de novo).

Distinct Substrates of Idiopathic Ventricular Fibrillation Revealed by Arrhythmia Characteristics on Implantable Cardioverter-Defibrillator.

Background: Idiopathic ventricular fibrillation (IVF) can be associated with undetected distinct conditions such as microstructural cardiomyopathic alterations (MiCM) or Purkinje (Purk) activities with structurally normal hearts.

Objectives: This study sought to evaluate the characteristics of recurrent VF recorded on implantable defibrillator electrograms, associated with these substrates.

Methods: This was a multicenter collaboration study.

Slow Conduction Corridors and Pivot Sites Characterize the Electrical Remodeling in Atrial Fibrillation.

Objectives: This study aimed to evaluate the progression of electrophysiological phenomena in a cohort of patients with paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PsAF).

Background: Electrical remodeling has been conjectured to determine atrial fibrillation (AF) progression.

Methods: High-density electroanatomic maps during sinus rhythm of 20 patients with AF (10 PAF, 10 PsAF) were compared with 5 healthy control subjects (subjects undergoing ablation of a left-sided accessory pathway).

Sequential ultrahigh-density contact mapping of persistent atrial fibrillation: An efficient technique for driver identification.

Introduction: Literature supports the existence of drivers as maintainers of atrial fibrillation (AF). Whether ultrahigh density (UHD) contact mapping may detect them is unknown.

Methods: We sequentially mapped the left atrial (LA) activation during spontaneous persistent AF and performed circumferential pulmonary vein isolation (CPVI), followed by remapping and ablation of potential drivers (rotational and focal propagation sites) with Rhythmia™ in 90 patients.

Mobile health applications for the detection of atrial fibrillation: a systematic review.

Aims: Atrial fibrillation (AF) is the most common sustained arrhythmia and an important risk factor for stroke and heart failure. We aimed to conduct a systematic review of the literature and summarize the performance of mobile health (mHealth) devices in diagnosing and screening for AF.

Methods And Results: We conducted a systematic search of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials.

Electrophysiologic evidence of epicardial connections between low right atrium and remote right atrial region or coronary sinus musculature: Relevance for catheter ablation of typical atrial flutter.

Background: The coronary sinus (CS) is surrounded by a myocardial coat with extensive connections to the left and right atria that contributes to the interatrial electrical connection. Whereas epicardial connections between CS musculature and the left atrium have largely been demonstrated, clinically relevant epicardial connections from the CS musculature toward the low right atrium (LRA) and epicardial connections between two regions of the right atrium remain questionable.

Methods: Five patients underwent electrophysiology (EP) study for typical atrial flutter (AFl) using either conventional multipolar catheters (four patients) or three-dimensional high-density mapping system (one patient).

Corrigendum.

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Ultrasound-guided axillary vein puncture for cardiac devices implantation in patients under antithrombotic therapy.

Background: Ultrasound-guided axillary venous puncture (UGAVP) for cardiac devices implantation has been developed because of its rapidity, safety and potential long-term lead protection. Early work excluded defibrillators (ICD), cardiac resynchronization therapy (CRT) and upgrade procedures. Compared to the cephalic approach, in previous studies, there was a greater use of pressure dressings with this technique, suggesting a higher risk of bleeding.

Cavotricuspid isthmus is constantly a zone of slow conduction: Data from ultra-high-resolution mapping.

Background: Whether cavotricuspid isthmus (CTI) is a region of conduction slowing during typical flutter has been discussed with conflicting results in the literature. We aimed to evaluate conduction velocity (CV) along the different portions of the typical flutter circuit with a recently proposed method by means of ultra-high-resolution (UHR) mapping.

Methods: Consecutive patients referred for typical atrial flutter (AFL) ablation underwent UHR mapping (Rhythmia, Boston Scientific).

High-resolution/Density Mapping in Patients with Atrial and Ventricular Arrhythmias.

High-definition/ultra-high-definition mapping, owing to an impressive increase of the point density of electroanatomic maps, provides improved substrate characterization, better understanding of the arrhythmia mechanism, and a better selection of the ablation target in patients with atrial and ventricular arrhythmias. Despite the scarce comparative data on ablation results versus standard mapping, ultra-high-definition mapping is increasingly used by the electrophysiology community.

How is Contact Force implemented in routine clinical practice? Results from a French National and Monaco Survey.

Background: Combination of elementary parameters (force, time, power, impedance drop) has been proposed to optimize radiofrequency (RF) delivery. They have been partially validated in clinical studies.

Aims: The aim of this study was to assess contact-force (CF) implementation into clinical practice.

Electrocardiographic modifications induced by breast implants.

Background: Echocardiography realization can be challenging in the presence of breasts implants (BI). It is less known if electrocardiograms (ECG) may be modified in the presence of BI.

Methods: ECG from women with BI (and without any known cardiac structural disease) were sent and analyzed by two experienced electrophysiologists (EP1 and EP2) who were blinded and completely unaware of the context of the patients (Group 1).

Scar identification, quantification, and characterization in complex atrial tachycardia: a path to targeted ablation?

Successful catheter ablation of scar-related atrial tachycardia depends on correct identification of the critical isthmus. Often, this is a represented by a small bundle of viable conducting tissue within a low-voltage area. It's identification depends on the magnitude of the signal/noise ratio.

Electrophysiological Basis for Early Repolarization Syndrome.

During last centuries, Early Repolarization pattern has been interpreted as an ECG manifestation not linked to serious cardiovascular events. This view has been challenged on the basis of sporadic clinical observations that linked the J-wave with ventricular arrhythmias and sudden cardiac death. The particular role of this characteristic pattern in initiating ventricular fibrillation has been sustained by clinical descriptions of a marked and consistent J-wave elevation preceding the onset of the ventricular arrhythmia.

Coronary Sinus Activation and ECG Characteristics of Roof-Dependent Left Atrial Flutter After Pulmonary Vein Isolation.

Background: The electrocardiographic and intracardiac activation features of left atrial roof-dependent macroreentrant flutter have been incompletely characterized.

Methods: Patients post-pulmonary vein (PV) isolation with roof-dependent atrial flutter based on activation and entrainment mapping were included. ECG and coronary sinus activation were compared with mitral annular (MA) flutter.

A comparison between multipolar mapping and conventional mapping of atrial tachycardias in the context of atrial fibrillation ablation.

Background: Activation mapping can be challenging and time-consuming in patients with multiple atrial tachycardias (ATs).

Aims: To compare multielectrode mapping using a dedicated mapping catheter - PentaRay (Biosense Webster Inc.) - and the conventional technique for mapping ATs in the context of atrial fibrillation (AF) ablation.

Spectral and spatiotemporal variability ECG parameters linked to catheter ablation outcome in persistent atrial fibrillation.

With the increasing prevalence of atrial fibrillation (AF), there is a strong clinical interest in determining whether a patient suffering from persistent AF will benefit from catheter ablation (CA) therapy at long term. This work presents several regression models based on noninvasive measures automatically computed from the standard 12-lead electrocardiogram (ECG) such as AF dominant frequency (DF), spectral concentration and spatiotemporal variability (STV). Sixty-two AF patients referred to CA were enrolled in this study.