Cardiac radiotherapy transiently alters left ventricular electrical properties and induces cardiomyocyte-specific ventricular substrate changes in heart failure.

Aims: Ongoing clinical trials investigate the therapeutic value of stereotactic cardiac radioablation (cRA) in heart failure patients with ventricular tachycardia. Animal data indicate an effect on local cardiac conduction properties. However, the exact mechanism of cRA in patients remains elusive.

Left atrial conduction times and regional velocities in persistent atrial fibrillation patients with and without fibrotic atrial cardiomyopathy.

Despite the progress in understanding left atrial substrate and arrhythmogenesis, only little is known about conduction characteristics in atrial fibrillation patients with various stages of fibrotic atrial cardiomyopathy (FACM). This study evaluates left atrial conduction times and conduction velocities based on high-density voltage and activation maps in sinus rhythm (CARTO3 V7) of 53 patients with persistent atrial fibrillation (LVEF 60% (55-60 IQR), LAVI 39 ml/m (31-47 IQR), LApa 24 ± 6 cm). Measurements were made in low voltage areas (LVA ≤ 0.

Mechanistic assessment and ablation of left ventricular assist device related ventricular tachycardia in patients with severe heart failure.

Left-ventricular-assist-devices (lvad) are an established treatment for patients with severe heart failure with reduced ejection fraction (HF) and reduce mortality. However, HF patients have significant substrate for ventricular tachycardia (VT) and the lvad itself might be pro-arrhythmogenic. We investigated the mechanism of VT in lvad-patients in relation to the underlying etiology and provide and data for ablation in these HF patients.

Open Ablation of the Left Ventricle During Implantation of a Left Ventricular Assist Device.

This report describes the successful treatment of persistent ventricular tachycardia in a 66-year-old patient with ischemic cardiomyopathy during left ventricular assist device (LVAD) implantation. Recurrent episodes of ventricular tachycardia led to cardiac decompensation necessitating LVAD implantation. After opening the left ventricle, an AtriCure Isolator Synergy OLL2 radiofrequency clamp was used to perform 4 sets of transmural lesions.

Minimally invasive approach to the treatment of atrial fibrillation: Concomitant Convergent and LARIAT procedure.

The Convergent procedure comprises epi- and endocardial ablation of the left atrium and represents an effective alternative to conventional endocardial ablation in patients with therapy-resistant atrial fibrillation. The LARIAT approach allows the epi- and endocardial closure of the left atrial appendage and effectively reduces the risk of stroke in patients with atrial fibrillation. In this video tutorial, we provide step-by-step guidance through the concomitant Convergent and LARIAT procedures.

Clinical outcomes of cryoballoon ablation for pulmonary vein isolation: Impact of intraprocedural heart rhythm.

Background: The current study sought to assess the impact of the intraprocedural heart rhythm (sinus rhythm [SR] vs. atrial fibrillation [AF]) on acute procedural characteristics, durability of pulmonary vein isolation (PVI) and long-term clinical outcomes of cryoballoon (CB) ablation.

Methods: A total of 195 patients with symptomatic paroxysmal (n = 136) or persistent AF (n = 59) underwent CB-based PVI.

Isolated atrial amyloidosis suspected by electrophysiological voltage mapping and diagnosed by Tc-DPD scintigraphy.

We present not-yet-seen multimodal images of a 55-year-old female patient with isolated atrial amyloidosis (IAA) who clinically suffered from multiple atrial arrhythmias and heart failure symptoms with preserved left ventricular ejection fraction. We aim to show structural and functional abnormalities detected by electrophysiological voltage mapping, cardiac magnetic resonance imaging (MRI) [cMRI; atrial strain measurements, late gadolinium enhancement (LGE) visualization], and Tc-DPD scintigraphy. Bipolar voltage mapping performed during two electrophysiological procedures showed diffuse left atrial low-voltage areas (bipolar < 0.

Long-term left atrial remodeling after ablation of persistent atrial fibrillation: 7-year follow-up by cardiovascular magnetic resonance imaging.

Purpose: Restoration of sinus rhythm in patients with persistent atrial fibrillation (ps. AF) induces reverse atrial remodeling and improvement of left ventricular function. We evaluated the effect of ablative treatment on cardiac remodeling after a long follow-up period of 7 years by cardiovascular magnetic resonance (CMR).

Atrial fibrillation ablation strategies and outcome in patients with heart failure: insights from the German ablation registry.

Background: Heart failure (HF) and atrial fibrillation (AF) often coexist, but data on the prognostic value of differing ablation strategies according to left ventricular ejection fraction (LVEF) are rare.

Methods And Results: From January 2007 until January 2010, 728 patients with HF were enrolled in the multi-center German ablation registry prior to AF catheter ablation. Patients were divided into three groups according to LVEF: HF with preserved LVEF (≥ 50%, HFpEF, n = 333), mid-range LVEF (40-49%, HFmrEF, n = 207), and reduced LVEF (< 40%, HFrEF, n = 188).

Clinical impact of repolarization changes in supine versus upright body position.

Background: The impact of postural changes on various electrocardiography (ECG) characteristics has only been assessed in a few small studies. This large prospective trial was conducted to confirm or refute preliminary data and add important results with immediate impact on daily clinical practice.

Methods: ECGs in supine and upright position from 1028 patients were analyzed.

German ablation registry: Cryoballoon vs. radiofrequency ablation in paroxysmal atrial fibrillation--One-year outcome data.

Background: Although radiofrequency (RF) ablation has long been the standard of care for atrial fibrillation (AF) ablation, cryoballoon technology has emerged as a feasible approach with promising results. Prospective multicenter registry data referring to both ablation technologies in AF ablation are lacking so far.

Objective: The purpose of this study was to report data from the German ablation registry with respect to efficacy and safety in pulmonary vein ablation with different energy sources for paroxysmal AF after 1-year follow-up.

Three-dimensional rotational venography of the coronary sinus tree facilitates left ventricular lead implantation for CRT.

Background: Precise knowledge of the coronary sinus (CS) tree anatomy facilitates catheter-based intubation of the CS, target vein and lead selection and reduces the need for fluoroscopy, contrast medium and overall procedure time in cardiac resynchronization therapy (CRT). Three-dimensional rotational angiography (3DRA) provides a new means of multiangle imaging of the CS tree that can be applied preoperatively.

Purpose And Methods: Our study aims to investigate the feasibility of preoperative rotational CS venography and its implications for CRT device implantation procedures.

Fast atrial activity predicts recurrence of atrial fibrillation after pulmonary vein isolation: results from a prospective randomized study.

Background: Recurrence of atrial fibrillation (AF) after ablative treatment is common. We hypothesized that AF recurrence is heralded by fast ectopic atrial activity occurring after electrical reconnection of previously isolated pulmonary veins.

Methods: Patients with paroxysmal or persistent AF undergoing pulmonary vein isolation (PVI) were followed up by 24-h Holter monitoring every 3 months for the first year and every 6 months thereafter.

Second generation of cryoballoons can improve efficiency of cryoablation for atrial fibrillation.

Background: We investigated whether the new second generation of cryoballoons can improve the efficiency and safety of cryoablation for atrial fibrillation (AF) during ablation and in terms of outcome.

Methods: Data of AF patients consecutively treated with a single 28-mm cryoballoon were analyzed. Patients were divided into two groups: the G1 group was treated with the first-generation cryoballoons (ArcticFront) and G2 with the second generation (ArcticFront Advance).

Prolonged ablation on critical segments of pulmonary vein ostia in paroxysmal atrial fibrillation: a prospective randomized controlled study.

Introduction: Electrical reconnection of the pulmonary veins (PVs) plays a key role in the recurrence of atrial fibrillation (AF) after ablative treatment. This randomized controlled study tested the hypothesis that prolonged ablations, on areas that may be critical for left atrial (LA)-PV conduction, can significantly reduce the rate of acute PV reconnection and AF recurrence.

Methods: Patients with paroxysmal AF were randomly assigned to either a control or an add-on group.

Precordial electrode placement for optimal ECG monitoring: implications for ambulatory monitor devices and event recorders.

Introduction: Detection of QRS complexes, P-waves and atrial fibrillation f-waves in electrocardiographic (ECG) signals is critical for the correct diagnosis of arrhythmias. We aimed to find the best bipolar lead (BL) with the highest signal amplitude and shortest inter-electrode spacing.

Methods: ECG signals (120 seconds) were recorded in 36 patients with 16 precordial electrodes placed in a standardized pattern.

Combined use of three-dimensional rotational angiogram of left atrium and circular multi-electrode ablation catheter for pulmonary vein isolation.

Background: A novel circular pulmonary vein ablation catheter (PVAC) has been introduced for pulmonary vein isolation (PVI). Accurate delineation of left atrium-pulmonary vein (LA-PV) anatomy is important for this technique. The aim of this study was to test whether the 3-dimensional rotational angiography (3D RTA) of the left atrium can facilitate PVI using PVAC technique.

Predictive value of left atrial volume measured by non-invasive cardiac imaging in the treatment of paroxysmal atrial fibrillation.

Purpose: We investigate the role of left atrial volume (LAV) as a predictor of outcome following pulmonary vein isolation (PVI) in patients with exclusive paroxysmal atrial fibrillation (AF).

Methods: PVI was performed in 213 patients (80 females, aged 60 ± 10 years) with paroxysmal AF using either the pulmonary vein ablation catheter (PVAC, n = 78) or conventional single-tip ablation (n = 135). LAV was assessed by multi-detector computed tomography (n = 39) or cardiac magnetic resonance imaging (n = 174) prior to ablation.

Characteristic changes of volume and three-dimensional structure of the left atrium in different forms of atrial fibrillation: predictive value after ablative treatment.

Introduction: Atrial fibrillation (AF) is associated with electroanatomical remodelling of the left atrium (LA), especially with LA dilatation. However, little is known about the changes of the three-dimensional structure of the LA, regarding the type of atrial fibrillation and their prognostic value after an ablative treatment.

Methods: One hundred fifteen patients (72 males, 59 ± 11 years) with an indication for AF ablation were prospectively included.

Cardiovascular magnetic resonance imaging for accurate sizing of the left atrium: predictability of pulmonary vein isolation success in patients with atrial fibrillation.

Purpose: To prospectively determine the most reproducible approach for left-atrial size assessment using cardiovascular magnetic resonance (CMR) imaging in patients with atrial fibrillation and its value for prediction of pulmonary vein isolation (PVI) treatment success.

Materials And Methods: Eighty patients underwent CMR imaging prior to PVI; the CMR examination included standard cine sequences, a multislice cine sequence in 4-chamber orientation with full left-atrial coverage, and a contrast-enhanced MR angiography of the left atrium. Left-atrial size was determined as: diameter, area, volume segmented from angiography, and diastolic/systolic volumes from cine imaging (Simpson's rule).

Intraprocedural imaging of left atrium and pulmonary veins: a comparison study between rotational angiography and cardiac computed tomography.

Background: Atrial fibrillation (AF) ablation is facilitated by anatomical visualization of the left atrium (LA) and the pulmonary veins (PVs). The purpose of this study was to compare accuracy, radiation exposure, and costs between three-dimensional atriography (3D-ATG) and cardiac computed tomography (CCT).

Methods: Seventy patients with an indication for AF ablation were included.

Serial monitoring of reverse left-atrial remodeling after pulmonary vein isolation in patients with atrial fibrillation: a magnetic resonance imaging study.

Purpose: To prospectively determine the impact of sinus rhythm restoration on left-atrial (LA) volumes and function assessed by cardiac magnetic resonance (CMR) imaging within the first year after pulmonary vein isolation (PVI).

Methods: Forty-one patients (28 men; age: 57 ± 10 years) with paroxysmal or non-paroxysmal atrial fibrillation were studied serially using CMR at baseline and at 1-, 3-, 6- and 12-month intervals following PVI. LA diastolic and systolic volumes were determined by cine imaging with full gapless LA coverage applying Simpson's rule.

A novel cryoballoon technique for mapping and isolating pulmonary veins: a feasibility and efficacy study.

Introduction: The study was designed to evaluate the feasibility and efficacy of a simplified cryoballoon technique in which a microcircular catheter was introduced into the central lumen of a cryoballoon catheter for the purpose of recording pulmonary vein (PV) potentials during ablation procedures and without interchanging catheters.

Methods And Results: A total of 23 consecutive patients with paroxysmal atrial fibrillation (AF) were enrolled. A single transseptal puncture was made and a cryoballoon catheter was inserted into the left atrium.