Simplified method for esophagus protection during radiofrequency catheter ablation of atrial fibrillation--prospective study of 704 cases.

Introduction: Although rare, the atrioesophageal fistula is one of the most feared complications in radiofrequency catheter ablation of atrial fibrillation due to the high risk of mortality.

Objective: This is a prospective controlled study, performed during regular radiofrequency catheter ablation of atrial fibrillation, to test whether esophageal displacement by handling the transesophageal echocardiography transducer could be used for esophageal protection.

Methods: Seven hundred and four patients (158 F/546M [22.

Right ventricular apical pacing: the unwanted model of cardiac stimulation?

Despite having a huge benefit in enabling heart rate control, cardiac pacing by stimulating the right ventricular apex causes an artificial iatrogenic left bundle-branch block-like syndrome. As a result, QRS widening and cardiac wall desynchronization occurs. The problems caused by this undesirable pacemaker side effect have been ignored, as they are counteracted by the great benefit of cardiac rate correction.

Radiofrequency catheter ablation of atrial fibrillation guided by spectral mapping of atrial fibrillation nests in sinus rhythm.

Background: Two types of myocardia can be observed through the endocardial spectral mapping (SM) in sinus rhythm: the compact type with a smooth spectrum and the fibrillar type with a segmented spectrum (atrial fibrillation nests). During the atrial fibrillation (AF), the compact type has an organized activation and low frequency (passive), whereas the fibrillar type has a rather disorganized activation and high frequency (active/resonant), with both being activated by high-frequency sustained tachycardia--the background tachycardia (BT).

Objective: To describe the treatment of AF by the ablation of the AF nests and BT.