Targeting non-pulmonary vein triggers in persistent atrial fibrillation: results from a prospective, multicentre, observational registry.

Aims: We evaluated the efficacy of an ablation strategy empirically targeting pulmonary veins (PVs) and posterior wall (PW) and the prevalence and clinical impact of extrapulmonary trigger inducibility and ablation in a large cohort of patients with persistent atrial fibrillation (PerAF).

Methods And Results: A total of 1803 PerAF patients were prospectively enrolled. All patients underwent pulmonary vein antrum isolation (PVAI) extended to the entire PW.

Arrhythmia profile and ablation-outcome in elderly women with atrial fibrillation undergoing first catheter ablation.

Background: This study evaluated the arrhythmia profile and ablation outcome in women with atrial fibrillation (AF) aged ≥75 years.

Methods: A total of 573 consecutive female patients undergoing first AF ablation were classified into group 1: ≥75 years (n = 221) and group 2: < 75 years (n = 352). Isolation of PVs, posterior wall and superior vena cava was performed in all.

Periprocedural and long-term safety and feasibility of direct oral anticoagulants in patients with biological valve undergoing radiofrequency catheter ablation for atrial fibrillation: a prospective multicenter study.

Background: Direct oral anticoagulants (DOACs) are contraindicated in patients with atrial fibrillation (AF) and mechanical cardiac valves. However, safety and efficacy are controversial in patients with biological cardiac valves.

Objective: We report the safety and feasibility of periprocedural and long-term treatment with DOACs in patients with biological valves undergoing ablation for AF.

Long-term Outcome of Pulmonary Vein Isolation Versus Amiodarone Therapy in Patients with Coexistent Persistent AF and Congestive Heart Failure.

Although pharmacological rhythm control of AF in patients with heart failure with reduced ejection fraction (HFrEF) does not seem to provide any benefit over rate control, catheter ablation of AF has been shown to improve clinical outcomes. These results can be explained with higher success rates of catheter ablation in restoring and maintaining sinus rhythm compared with antiarrhythmic drugs. In addition, pharmacotherapy is not void of side-effects, which are thought to offset its potential antiarrhythmic benefits.

Toward a Uniform Ablation Protocol for Paroxysmal, Persistent, and Permanent Atrial Fibrillation.

Atrial fibrillation catheter ablation has emerged as the most effective strategy to restore and maintain sinus rhythm. The cornerstone of atrial fibrillation ablation is elimination of triggers from the pulmonary veins by pulmonary vein isolation. Nevertheless, some patients may experience atrial tachyarrhythmia recurrences even with permanent pulmonary vein antral isolation.

Stroke Risk in Patients With Atrial Fibrillation Undergoing Electrical Isolation of the Left Atrial Appendage.

Background: Loss of contractility leading to stasis of blood flow following left atrial appendage electrical isolation (LAAEI) could lead to thrombus formation.

Objectives: This study evaluated the incidence of thromboembolic events (TE) in post-LAAEI cases "on" and "off" oral anticoagulation (OAC).

Methods: A total of 1,854 consecutive post-LAAEI patients with follow-up transesophageal echocardiography (TEE) performed in sinus rhythm at 6 months to assess left atrial appendage (LAA) function were included in this analysis.

Association between prolonged P wave duration and left atrial scarring in patients with paroxysmal atrial fibrillation.

Background: We evaluated the association of P wave duration (PWD) with left atrial scar (LAS) in patients with paroxysmal atrial fibrillation (PAF).

Methods: Consecutive patients with PAF undergoing their first catheter ablation were screened and only those in sinus rhythm at baseline were included in the analysis. A standard 12-lead electrocardiogram (ECG) was performed in all and three-dimensional voltage mapping of the left atrium was generated for identification of low-voltage areas (≤0.

Impact of rotor ablation in non-paroxysmal AF patients: Findings from the per-protocol population of the OASIS trial at long-term follow-up.

The objective of this study was to evaluate the long-term efficacy of FIRM ablation with PVAI vs PVAI plus posterior wall isolation (PWI) and non-PV trigger ablation in persistent (PeAF) and long-standing persistent AF (LSPAF) patients. The procedure time was recorded to be 180.6 ± 35.

Prevalence of right atrial non-pulmonary vein triggers in atrial fibrillation patients treated with thyroid hormone replacement therapy.

Background: Thyroid hormone (TH) is known to enhance arrhythmogenicity, and high-normal thyroid function is related with an increased recurrence of atrial fibrillation (AF) after catheter ablation. However, the impact of thyroid hormone replacement (THR) on AF ablation is not well known.

Methods: This study evaluated 1163 consecutive paroxysmal AF patients [160 (14%) on THR and 1003 (86%) without THR] undergoing their first catheter ablation.

Impact of Rotor Ablation in Nonparoxysmal Atrial Fibrillation Patients: Results From the Randomized OASIS Trial.

Background: Nonrandomized studies have reported focal impulse and rotor modulation (FIRM)-guided ablation to be superior to pulmonary vein antrum isolation (PVAI) for persistent atrial fibrillation and long-standing persistent atrial fibrillation.

Objectives: This study sought to compare efficacy of FIRM ablation with or without PVAI versus PVAI plus non-PV trigger ablation in randomized persistent atrial fibrillation and long-standing persistent atrial fibrillation patients.

Methods: Nonparoxysmal atrial fibrillation (AF) patients undergoing first ablation were randomized to FIRM only (group 1), FIRM + PVAI (group 2) or PVAI + posterior wall + non-PV trigger ablation (group 3).

Association of pretreatment with angiotensin-converting enzyme inhibitors with improvement in ablation outcome in atrial fibrillation patients with low left ventricular ejection fraction.

Background: Angiotensin-converting enzyme inhibitors (ACEIs) reduce the incidence of atrial fibrillation (AF).

Objective: The purpose of this study was to assess the impact of upstream ACEI therapy on postablation AF recurrence and hospitalization in patients with low left ventricular ejection fraction (LVEF).

Methods: Three hundred forty-five consecutive patients undergoing first AF ablation with low LVEF (≤45%) were classified into group 1 (ACEI+, n = 187 [54%], of whom 44 patients [23.

Impact of Uncontrolled Hypertension on Atrial Fibrillation Ablation Outcome.

Objectives: The goal of this study was to evaluate the impact of hypertension on the outcome of atrial fibrillation (AF) ablation.

Background: Hypertension is a well-known independent risk factor for incident AF.

Methods: A total of 531 consecutive patients undergoing AF ablation were enrolled in this study and divided into 3 groups: patients with uncontrolled hypertension despite medical treatment (group I, n = 160), patients with controlled hypertension (group II, n = 192), and patients without hypertension (group III, n = 179).

Effect of periprocedural amiodarone on procedure outcome in patients with longstanding persistent atrial fibrillation undergoing extended pulmonary vein antrum isolation: results from a randomized study (SPECULATE).

Background: The impact of amiodarone on ablation outcome in longstanding persistent atrial fibrillation (LSPAF) patients is not known yet.

Objective: The purpose of this study was to assess the effect of amiodarone on procedural-outcomes in LSPAF patients undergoing catheter ablation.

Methods: We enrolled 112 LSPAF patients on amiodarone and scheduled to undergo atrial fibrillation (AF) ablation.

Ventricular tachycardia originating from the septal papillary muscle of the right ventricle: electrocardiographic and electrophysiological characteristics.

Introduction: Premature ventricular complexes (PVCs) and ventricular tachycardia (VT) arising from papillary muscles of both ventricles have recently been described. There is a lack of data on VT originating from the right ventricular papillary (RV PAP) muscles. There have been no prior studies focused on the electrocardiogram (ECG) features and ablation of PVC/VT arising from the septal papillary muscle of the right ventricle.

Ventricular fibrillation triggered by PVCs from papillary muscles: clinical features and ablation.

Background: Animal studies showed that papillary muscles can be sources of ventricular fibrillation (VF) in both the left and right ventricle, but this occurrence in humans has been described only in patients with ischemic heart disease.

Objective: To investigate the role of papillary muscle premature ventricular contractions (PVCs) as triggers for VF and the safety and feasibility of catheter ablation in these patients.

Methods: Six patients (2 male; age, 40 ± 11 years; 5 with a normal structural heart and 1 with nonischemic cardiomyopathy) with history of VF resulting in repetitive implantable cardioverter defibrillator shocks, despite antiarrhythmic drug therapy, and a papillary muscle focus of PVCs triggering VF were included and underwent mapping and ablation of PVCs.

Safety and effectiveness of transvenous lead extraction in octogenarians.

Introduction: As the population ages, the number of elderly patients with implantable cardiac devices referred for transvenous lead extraction will dramatically increase in Western countries. The safety and effectiveness of lead extraction in elderly patients has not been well evaluated. We report the safety and effectiveness of transvenous lead extraction in octogenarians.

Examining the safety of amiodarone.

Introduction: Amiodarone is the most widely used antiarrhythmic agent, with demonstrated effectiveness against all the spectrum of cardiac tachyarrhythmias. The risk of adverse effects acts as a limiting factor to its utilization especially in the long term. This article systematically reviews the published evidence on amiodarone versus placebo to examine its safety as an antiarrhythmic drug.