Key characteristics for effective acute pulmonary vein isolation when using a novel cryoballoon technology: insights from the CHARISMA registry.

Purpose: A new cryoballoon (CB) technology (POLARx™; Boston Scientific) for pulmonary vein (PV) isolation in patients with atrial fibrillation (AF) has recently been introduced. The aim of this study was to evaluate procedural and biophysical parameters resulting in acute PV isolation when using this new CB.

Methods: We assessed the first 69 consecutive patients indicated for AF ablation who underwent PV isolation by means of a novel CB system.

Safety and efficacy of atrial fibrillation ablation guided by Ablation Index module.

Purpose: Reconnection of pulmonary veins (PVs) remains common following radiofrequency catheter ablation for atrial fibrillation (AF). Ablation Index (AI) is a novel ablation quality marker that incorporates stability, contact force (CF), time, and power in a weighted formula. Its use seems to improve lesion durability.

High-density mapping to guide ablation of a right bundle branch morphology premature ventricular contraction from the right outflow tract.

The Rhythmia ultrahigh-density mapping system with a specific algorithm seems to be helpful in identifying the target area to successfully treat multiple morphologies by catheter ablation in the right ventricular outflow tract RVOT. Interestingly, the acquisition process seemed to be extremely faster than a standard manual point-by-point premature ventricular contraction (PVC) mapping.

Twelve-year follow-up of catheter ablation for atrial fibrillation: A prospective, multicenter, randomized study.

Background: Randomized and controlled studies have reported the effect of catheter ablation (CA) for atrial fibrillation (AF) over a follow-up of 12-24 months.

Objective: We report on the effect of CA plus antiarrhythmic drugs in comparison with antiarrhythmic drugs alone on the maintenance of sinus rhythm over 12-year follow-up.

Methods: We extended the follow-up duration of the 137 patients who were enrolled in the Catheter Ablation for the Cure of Atrial Fibrillation Study between February 1, 2002, and June 30, 2003, and randomized to antiarrhythmic drugs (control group) or antiarrhythmic drugs plus CA (ablation group).

Hypertonic Saline in Conjunction with High-Dose Furosemide Improves Dose-Response Curves in Worsening Refractory Congestive Heart Failure.

Introduction: Diuretic responsiveness in patients with chronic heart failure (CHF) is better assessed by urine production per unit diuretic dose than by the absolute urine output or diuretic dose. Diuretic resistance arises over time when the plateau rate of sodium and water excretion is reached prior to optimal fluid elimination and may be overcome when hypertonic saline solution (HSS) is added to high doses of furosemide.

Methods: Forty-two consecutively hospitalized patients with refractory CHF were randomized in a 1:1:1 ratio to furosemide doses (125 mg, 250 mg, 500 mg) so that all patients received intravenous furosemide diluted in 150 ml of normal saline (0.

Inducibility of ventricular arrhythmia and tachyarrhythmia recurrences in patients with implantable defibrillator.

Introduction: We evaluated the potential ability of the electrophysiological (EP) inducibility of ventricular arrhythmias to predict the likelihood of appropriate ICD intervention over the long-term in ischemic and nonischemic patients with current primary prevention indications for ICD implantation.

Methods: Between 2006 and 2008, 206 consecutive heart failure patients who were candidates for ICD implantation for the primary prevention of sudden cardiac death according to standard indications underwent EP testing, usually on ICD implantation.

Results: On EP testing, 15 (7%) patients had inducible monomorphic ventricular tachycardia (VT) and 14 (7%) ventricular fibrillation (VF).

Remote monitoring improves outcome after ICD implantation: the clinical efficacy in the management of heart failure (EFFECT) study.

Aims: Internet-based remote interrogation systems have been shown to reduce emergency department and in-office visits in patients with implantable cardioverter defibrillators (ICDs), resulting in increased efficiency for healthcare providers. Nonetheless, studies sized to demonstrate the impact of remote monitoring on patients' outcome have been lacking.

Methods And Results: The EFFECT study was a multicentre clinical trial aimed at measuring and comparing the outcome of ICD patients conventionally followed-up by means of in-clinic visits (Standard arm) or by remote monitoring (Remote arm) in the clinical practice of 25 Italian centres.

Geometrical and electrical predictors of cardiac resynchronization therapy response.

Several studies have demonstrated the beneficial effect of cardiac resynchronization therapy (CRT) in patients with drug-refractory heart failure. A variable proportion, up to 30%, of CRT patients do not benefit from treatment. The lack of response to CRT has a variety of potential causes.

Remote monitoring for implantable defibrillators: a nationwide survey in Italy.

Background: Remote monitoring (RM) permits home interrogation of implantable cardioverter defibrillator (ICD) and provides an alternative option to frequent in-person visits.

Objective: The Italia-RM survey aimed to investigate the current practice of ICD follow-up in Italy and to evaluate the adoption and routine use of RM.

Methods: An ad hoc questionnaire on RM adoption and resource use during in-clinic and remote follow-up sessions was completed in 206 Italian implanting centers.

Antiarrhythmic therapy following ablation of atrial fibrillation.

Antiarrhythmic drugs (AADs) are often used after ablation for atrial fibrillation (AF); the drugs employed vary, but most common are the drugs that were unsuccessful prior to ablation since it seems that the efficacy of AADs might substantially increase after catheter ablation of AF. AADs reduce early recurrences of atrial tachyarrhythmias after AF catheter ablation, whereas they did not prevent arrhythmia recurrences occurring later. Several upstream therapies (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statins, corticosteroids and colchicine) have been tested with conflicting results.

Feasibility and efficacy of electrical cardioversion after cardiac resynchronization implantation in patients with permanent atrial fibrillation.

Purpose: Patients with permanent atrial fibrillation (AF) who undergo cardiac resynchronization therapy (CRT) may spontaneously recover sinus rhythm during follow-up. We tested the feasibility and efficacy of electrical cardioversion attempted after 3 months of CRT in patients with permanent AF and measured the long-term maintenance of sinus rhythm.

Methods: Twenty-eight consecutive patients with permanent AF in whom CRT defibrillators had been implanted were scheduled for internal electrical cardioversion after 3 months (group A) and were compared with a control group of 27 patients (group B).

Does catheter ablation cure atrial fibrillation? Single-procedure outcome of drug-refractory atrial fibrillation ablation: a 6-year multicentre experience.

Aims In the last decade, several approaches to ablating triggers and substrates of atrial fibrillation (AF) have been developed. However, most studies have reported data only on short- or medium-term follow-up. The aim of this study was to investigate whether the 1-year efficacy of catheter ablation for AF is predictive of long-term clinical success.

Clinical and technical determinants of long-term performance of coronary sinus leads.

Objectives: Little is known about coronary sinus lead performance in patients with cardiac resynchronization therapy devices. We evaluated the impact of clinical and technical parameters on coronary sinus lead performance over long-term follow-up.

Methods: From February 1999 to July 2004, 235 patients (181 men; mean age, 68 +/- 9 years; mean left ventricular ejection fraction, 26.

Long-term outcomes of CRT-PM versus CRT-D recipients.

Objective: To compare the rates of all-cause mortality in recipients of cardiac resynchronization therapy devices without (CRT-PM) versus with defibrillator (CRT-D).

Methods: Between February 1999 and July 2004, 233 patients (mean age = 69 +/- 8 years, 180 men) underwent implantation of CRT-PM or CRT-D devices. New York Heart Association (NYHA) heart failure functional class II was present in 11%, class III in 69%, and class IV in 20% of patients; mean left ventricle ejection fraction (LVEF) was 26.

Role of pulmonary veins isolation in persistent atrial fibrillation ablation: the pulmonary vein isolation in persistent atrial fibrillation (PIPA) study.

Background: The role of pulmonary veins (PV) isolation in patients with persistent atrial fibrillation (AF) is still debated. The aim of this study was to evaluate the adjunctive role of PV isolation in patients with persistent AF who underwent circumferential PV ablation (anatomical approach).

Methods: We treated 97 consecutive patients presenting with drug-refractory persistent AF by an anatomical approach (group A, n = 36, mean age = 60 +/- 8 years, 29 males) or an integrated approach (group B, n = 61, mean age 59 +/- 10 years, 48 males).

Radiofrequency circumferential ablation limited to the left atrium showing fibrillatory activity in a patient with paroxysmal atrial fibrillation.

We report a case of a tailored approach to atrial fibrillation based on the substrate. In a patient with paroxysmal atrial fibrillation, electroanatomic mapping showed that atrial fibrillation was limited to a large area around the ostia of right pulmonary veins. The patient was successfully treated by catheter anatomic isolation of this area from the remaining part of the left atrium.

Acute left ventricular dyssynchrony improvement predicts long-term benefit from cardiac resynchronization therapy.

Study Objective: To evaluate the relationship between acute response to cardiac resynchronization therapy (CRT) and long-term clinical outcome in patients with drug refractory heart failure.

Methods And Results: In 28 patients undergoing CRT implant, left ventricular (LV) dyssynchrony was evaluated by tissue Doppler imaging (TDI)-derived longitudinal strain by mean of septum-lateral basal asynchrony index (S-Li) and basal delayed longitudinal contraction (DLC). TDI measurements were made before, and 30 minutes and 1 year after implant.

Long-term performance of coronary sinus leads used for cardiac resynchronization therapy.

Background: Little is known regarding the long-term performance of coronary sinus (CS) leads, which have an effect on the longevity of cardiac resynchronization therapy (CRT) systems.

Methods: This study included 109 patients (79 men) whose mean age was 68 +/- 9 years, New York Heart Association (NYHA) functional class 3.2 +/- 0.

Antiarrhythmic drug therapy after radiofrequency catheter ablation in patients with atrial fibrillation.

Objectives: The use of antiarrhythmic drugs after ablation is a controversial issue when evaluating the efficacy of atrial fibrillation (AF) ablation. This study compares in a prospective and randomized fashion the impact of an antiarrhythmic drug in preventing AF recurrence after AF ablation.

Methods: From February 2004 to May 2005, 107 consecutive patients (mean age 57 +/- 10 years, 69 men), with paroxysmal (60%) or persistent (40%) drug refractory AF, were randomly assigned to ablation alone (Group A, 53 patients) or combined with the best antiarrhythmic therapy, preferably amiodarone (Group B, 54 patients).

Long-term results of hybrid therapy in patients with atrial fibrillation who develop atrial flutter during flecainide infusion.

The flecainide infusion test has been proposed to screen candidates for hybrid pharmacological and ablation therapy. We report the long-term follow-up of 154 consecutive patients with paroxysmal or persistent atrial fibrillation (AF) who developed atrial flutter (AFL) during flecainide infusion (IC AFL), treated with inferior vena cava-tricuspid annulus isthmus catheter ablation and oral flecainide (hybrid therapy). Over a mean of 54.