Assessment of pericardial adhesions by means of the EpiCO technique: Brighton Adhesion Classification.

Background: Epicardial ablation complications are more frequent in patients with preexisting pericardial adhesions. As opposed to the dry puncture technique, the coronary vein exit and carbon dioxide (CO) insufflation (EpiCO) technique allows diagnosing pericardial adhesions before subxiphoid puncture.

Objective: This study aimed to evaluate the efficacy of the EpiCO technique in diagnosing pericardial adhesions prior to subxiphoid puncture.

Epicardial fat pad within the transverse sinus mimicking a left atrial appendage thrombus.

The presence of left atrial thrombus is a contraindication to cardioversion or catheter ablation in patients with atrial fibrillation, due to the increased risk of systemic thromboembolism. Management of this situation includes changes in the anticoagulation regimen and repeat imaging tests. Accurate diagnosis of left atrial appendage thrombus is therefore essential but can sometimes be challenging.

A New Era in Epicardial Access for the Ablation of Ventricular Arrhythmias: The Epi-Co Registry.

Objectives: This multicenter registry aimed to assess the reproducibility and safety of intentional coronary vein exit and carbon dioxide insufflation to facilitate subxiphoid epicardial access in the setting of ventricular tachycardia ablation.

Background: Epicardial ablation for ventricular tachycardia is not a widespread technique due to the significant potential complications associated with subxiphoid puncture. The first experience in 12 patients showed that intentional coronary vein exit and carbon dioxide insufflation was technically feasible.

Left atrial effective conducting size predicts atrial fibrillation vulnerability in persistent but not paroxysmal atrial fibrillation.

Background: The multiple wavelets and functional re-entry hypotheses are mechanistic theories to explain atrial fibrillation (AF). If valid, a chamber's ability to support AF should depend upon the left atrial size, conduction velocity (CV), and refractoriness. Measurement of these parameters could provide a new therapeutic target for AF.

Super-response to cardiac resynchronization therapy may predict late phrenic nerve stimulation.

Aims: Changes in the anatomical relationship between left phrenic nerve and coronary veins may occur due to the reverse remodelling observed in super-responders to cardiac resynchronization therapy (CRT) and might be the underlying mechanism in patients developing late-onset phrenic nerve stimulation (PNS) without evidence of lead dislodgement (LD). In this study, we sought to evaluate the role of super-response (SR) to CRT as a potential predictor of late-onset PNS.

Methods And Results: Consecutive patients implanted with a left ventricular (LV) lead in a single centre were retrospectively analysed.

Long-term prognosis of drug-induced Brugada syndrome.

Background: Patients with drug-induced Brugada syndrome (BS) are considered at a lower risk than those with a spontaneous type I pattern. Nevertheless, they can present arrhythmic events.

Objective: The purpose of this study was to investigate their clinical characteristics, long-term prognosis and risk factors.

A score model to predict risk of events in patients with Brugada Syndrome.

Aims: Risk stratification in Brugada Syndrome (BS) remains challenging. Arrhythmic events can occur life-long and studies with long follow-ups are sparse. The aim of our study was to investigate long-term prognosis and risk stratification of BS patients.

Phrenic paralysis during cardiac electronic device implantation: incidence, causes and clinical course.

Aims: Phrenic paralysis is a known complication of central venous catheterization, but it is not listed as a complication related to cardiac implantable electronic device (CIED) implants. The aim of this study is to describe the incidence, causes, clinical picture, and management of phrenic paralysis occurring in this scenario.

Methods And Results: We retrospectively analysed data from our CIED implantation database and identified those patients who suffered phrenic paralysis during the implantation procedure.

Clinical characterisation and long-term prognosis of women with Brugada syndrome.

Objectives: Brugada syndrome (BS) in women is considered an infrequent condition with a more favourable prognosis than in men. Nevertheless, arrhythmic events and sudden cardiac death (SCD) also occur in this population. Long-term follow-up data of this group are sparse.

Asymptomatic Brugada Syndrome: Clinical Characterization and Long-Term Prognosis.

Background: Among Brugada syndrome patients, asymptomatic individuals are considered to be at the lowest risk. Nevertheless, arrhythmic events and sudden cardiac death are not negligible. Literature focused on this specific group of patients is sparse.

Prognostic value of programmed electrical stimulation in Brugada syndrome: 20 years experience.

Background: The prognostic value of electrophysiological investigations in individuals with Brugada syndrome remains controversial. Different groups have published contradictory data. Long-term follow-up is needed to clarify this issue.

Implantable cardioverter-defibrillator therapy in Brugada syndrome: a 20-year single-center experience.

Background: Patients with Brugada syndrome and aborted sudden cardiac death or syncope have higher risks for ventricular arrhythmias (VAs) and should undergo implantable cardioverter-defibrillator (ICD) placement. Device-based management of asymptomatic patients is controversial. ICD therapy is associated with high rates of inappropriate shocks and device-related complications.

Regular atrial tachycardias following pulmonary vein isolation for paroxysmal atrial fibrillation: a retrospective comparison between the cryoballoon and conventional focal tip radiofrequency techniques.

Purpose: Occurrence of atrial tachycardias (ATs) following radiofrequency (RF) pulmonary vein (PV) isolation for the treatment of paroxysmal atrial fibrillation (PAF) is a frequent complication. Cryoballoon (CB) ablation might create more homogeneous and demarcated lesions than traditional point by point RF approach, hypothetically leading to a lower incidence of ATs. Our aim is to compare incidence and mechanism of regular ATs occurring after ablation of PAF by means of circumferential point by point RF vs CB ablation.

P-wave indices as predictors of atrial fibrillation recurrence after pulmonary vein isolation in normal left atrial size.

Aims: Prolonged P-wave duration and dispersion are universally accepted noninvasive markers for atrial electrical remodeling. Our aim was to analyze P-wave indices as predictors of atrial fibrillation recurrence after pulmonary vein isolation in patients with normal left atrial size.

Methods: From January 2008 to December 2011, 426 patients with drug-resistant symptomatic paroxysmal atrial fibrillation underwent pulmonary vein isolation as an index procedure by conventional radiofrequency or cryoballoon ablation in our center.

Periprocedural outcomes of prophylactic protamine administration for reversal of heparin after cryoballoon ablation of atrial fibrillation.

Purpose: The aim of this study was to investigate the efficacy and the safety of prophylactic use of protamine in a series of heparinized patients having undergone cryoballoon (CB) ablation for atrial fibrillation (AF).

Methods: From October 2013 to January 2014, 54 consecutive patients received protamine after CB ablation to neutralize unfractionated heparin (UFH) effects. They were prospectively included in this study and compared to a control group of 53 patients who underwent CB ablation without receiving protamine.

Spontaneous and adenosine-induced pulmonary vein reconnection after cryoballoon ablation with the second-generation device.

Introduction: Longer observational time and adenosine challenge have proven to be able to detect pulmonary vein (PV) reconnections. The aim of this study was to assess incidence of spontaneous and adenosine-induced PV reconnection after ablation with second-generation cryoballoon (CB-Adv).

Methods And Results: Fifty consecutive patients (76% male, mean age 60.

One-year follow-up after single procedure Cryoballoon ablation: a comparison between the first and second generation balloon.

Background: With respect to the first generation Cryoballoon (CB), the second generation (Cryoballoon Advance [CB-A], Medtronic, Minneapolis, MN, USA) was designed with technical modifications resulting in a larger and more uniform zone of freezing on the balloon's surface aiming at procedural outcome improvement in the setting of atrial fibrillation (AF) ablation. However, a comparison between both technologies on a midterm follow-up is missing in today's literature.

Methods: A total of 100 patients (the last 50 patients with the first generation CB and the first 50 patients with the second generation CB-A upon its inception in our center) having undergone a single CB ablation for paroxysmal AF (PAF) and having completed a 12-month follow-up, were consecutively included in our study.