Baseline NT-Pro-BNP levels and arrhythmia recurrence in outpatients undergoing elective cardioversion of persistent atrial fibrillation: a survival analysis.

Background: Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Elective electrical cardioversion is often performed in patients with persistent AF to attempt sinus rhythm (SR) restoration. However, AF recurrences are frequent after successful cardioversion and several predictors have been identified.

Ablation for longstanding permanent atrial fibrillation: results from a randomized study comparing three different strategies.

Background: This prospective multicenter randomized study aimed to compare the efficacy of 3 common ablation methods used for longstanding permanent atrial fibrillation (AF).

Methods: A total of 144 patients with longstanding permanent AF (median duration 28 months) were randomly assigned to circumferential pulmonary vein ablation (CPVA, group 1, n = 47), to pulmonary vein antrum isolation (PVAI, group 2, n = 48) or to a hybrid strategy combining ablation of complex fractionated or rapid atrial electrograms (CFAE) in both atria followed by a pulmonary vein antrum isolation (CFAE + PVAI, group 3, n = 49).

Results: Scarring in the left atrium and structural heart disease/hypertension were present in most patients (65%).

Lead extraction: a new effective tool to overcome fibrous binding sites.

We report the case of a 50 year-old woman referred for extraction of an infected biventricular implantable cardioverter defibrillator (ICD) who underwent device and leads extraction. Due to adhesions at the level of the subclavian-innominate vein angle, manual traction with locking stylet was ineffective. A new mechanical sheath provided with a stainless steel bladed tip, the Evolution Mechanical Dilator Sheath (Cook Medical), was successfully used to complete lead extraction.

Pulmonary-vein isolation for atrial fibrillation in patients with heart failure.

Background: Pulmonary-vein isolation is increasingly being used to treat atrial fibrillation in patients with heart failure.

Methods: In this prospective, multicenter clinical trial, we randomly assigned patients with symptomatic, drug-resistant atrial fibrillation, an ejection fraction of 40% or less, and New York Heart Association class II or III heart failure to undergo either pulmonary-vein isolation or atrioventricular-node ablation with biventricular pacing. All patients completed the Minnesota Living with Heart Failure questionnaire (scores range from 0 to 105, with a higher score indicating a worse quality of life) and underwent echocardiography and a 6-minute walk test (the composite primary end point).

Catheter ablation of atrial fibrillation in patients with diabetes mellitus type 2: results from a randomized study comparing pulmonary vein isolation versus antiarrhythmic drug therapy.

Introduction: Atrial fibrillation (AF) and diabetes mellitus type 2 (DM2) often coexist; however, a small number of patients with DM2 undergoing catheter ablation (CA) of AF have been included in previous studies. The aim of this study was to evaluate safety and efficacy of ablation therapy in DM2 patients with drug refractory AF.

Methods And Results: From January 2005 to September 2006, 70 patients with a diagnosis of DM2 and paroxysmal (n = 29) or persistent (n = 41) AF were randomized to receive either pulmonary vein isolation or a new antiarrhythmic drug treatment (ADT) with a 1-year follow-up.

Cardiac pacemaker battery discharge after external electrical cardioversion for broad QRS Complex Tachycardia.

External electrical cardioversion or defibrillation may be necessary in patients with implanted cardiac pacemaker (PM) or implantable cardioverter defibrillator (ICD). Sudden discharge of high electrical energy employed in direct current (DC) transthoracic countershock may damage the PM/ICD system resulting in a series of possible device malfunctions. For this reason, when defibrillation or cardioversion must be attempted in a patient with a PM or ICD, some precautions should be taken, particularly in PM dependent patients, in order to prevent damage to the device.

Impact of pre-existent areas of complex fractionated atrial electrograms on outcome after pulmonary vein isolation.

Background: Atrial fibrillation (AF) drivers outside pulmonary veins (PV) may account for failure after PV isolation. The aim of this study was to characterize pre-existent areas of complex fractionated atrial electrograms (CFAEs) recorded in right atrium (RA) and in coronary sinus (CS) during catheter-based PV isolation and to assess their relation to outcome.

Methods And Results: With a tricuspid annulus and CS mapping, CFAEs were retrospectively identified in consecutive patients who underwent PV isolation.

Fossa ovalis radiofrequency perforation in a difficult case of conventional transseptal puncture for atrial fibrillation ablation.

A 65-year-old man was referred for atrial fibrillation ablation to our center. Routine pre-procedure transthoracic and transoesophageal echocardiography and cardiac computed tomography examinations showed a normal interatrial septum and fossa ovalis anatomy. Access to left atrium was initially planned using a conventional transseptal needle puncture.

Safety of single transseptal puncture for ablation of atrial fibrillation: retrospective study from a large cohort of patients.

Introduction: Transseptal puncture (TSP) is the conventional approach to assess the left atrial chamber. This technique has been widely used in interventional cardiology and, in the last years, this approach is mostly applied to electrophysiologic procedures. For atrial fibrillation (AF) ablation, two or more transseptal sheaths are often positioned in the left atrium in the majority of centers, therefore requiring two or more transseptal punctures.

Cardiopulmonary resuscitation alone vs. cardiopulmonary resuscitation plus automated external defibrillator use by non-healthcare professionals: a meta-analysis on 1583 cases of out-of-hospital cardiac arrest.

Background: Out-of-hospital cardiac arrest (OHCA) accounts for 250.000-350.000 sudden cardiac deaths per year in the United States.

Gender-related differences in catheter ablation of atrial fibrillation.

Aims: Women have an increased risk for atrial fibrillation (AF)-related complications and there is evidence towards a reduced efficacy of the rhythm control strategy than men. A catheter-based strategy is therefore widely attractive, but the impact of gender on catheter ablation (CA) of AF remains undefined.

Methods And Results: We included 221 consecutive patients (150 men) who underwent CA of drug-refractory AF.

Residual fibrous tissue floating in the right atrium after percutaneous pacemaker lead extraction: an unusual complication early detected by intracardiac echocardiography.

Extraction of pacemaker leads represents the optimal therapy in patients with endocarditis involving the pacemaker leads. The percutaneous approach is becoming popular. However, complications of percutaneous extraction are not rare and incomplete removal of the vegetations with embolization in the pulmonary arteries has been described.

Pulmonary vein antral isolation using an open irrigation ablation catheter for the treatment of atrial fibrillation: a randomized pilot study.

Objectives: We sought to test how catheter ablation using an open irrigation catheter (OIC) compares with standard catheters for pulmonary vein antrum isolation.

Background: Open irrigation catheters have the advantage of delivering greater power without increasing the temperature of the catheter tip, which enables deeper and wider lesions without the formation of coagulum on catheters.

Methods: Catheter ablation was performed using an 8-mm catheter (8MC) or an OIC.

Sustained right ventricular tachycardia originating close to defibrillator lead tip in hypertrophic cardiomyopathy.

The case of a 57-year-old woman with a longstanding history of obstructive hypertrophic cardiomyopathy in dilatative phase and incessant monomorphic ventricular tachycardia is reported. Endocardial recordings and electroanatomic mapping suggested local reentry involving right ventricular apical septum, close to a pacing/defibrillation lead tip. Radiofrequency pulses delivered at this site resulted in definite cure of the arrhythmia.

Use of video capsule endoscopy in a patient with an implantable cardiac defibrillator.

Video capsule endoscopy (VCE) is a useful diagnostic tool in patients with unknown blood loss, particularly when there is a high suspicion of small bowel disease, but because of its use of radio frequency, it is relatively contraindicated in patients with a cardiac device. We report the case of a patient with an implantable cardiac defibrillator (ICD) who underwent VCE because of anaemia and previous surgery for colorectal cancer. Device interrogations were performed before and after the procedure.

Heart rate turbulence as a noninvasive risk predictor of ventricular tachyarrhythmias in myotonic dystrophy type 1.

Introduction: Myotonic dystrophy type 1 (MD1) is the most common muscular dystrophy of adult life. Cardiac involvement is characterized by disorders of atrioventricular conduction, ventricular arrhythmias, and sudden death. Heart rate turbulence (HRT) is a noninvasive risk predictor in patients affected by ischemic heart disease.

Widespread electroanatomic alterations of right cardiac chambers in patients with myotonic dystrophy type 1.

Introduction: Conduction disturbances and arrhythmias characterize the cardiac feature of myotonic dystrophy type 1 (MD1); a myocardial involvement has been suggested as part of the cardiac disease. The aim of our study was to investigate the underlying myocardial alterations using electroanatomic mapping (CARTO) and their possible correlation with genetic and neurological findings.

Methods And Results: Right atrial and ventricular CARTO maps were obtained in 13 MD1 patients.

Long-term follow-up after radiofrequency catheter ablation of atrial fibrillation: role of the acute procedure outcome and of the clinical presentation.

Aims: This study is a single centre long-term experience on a consecutive cohort of patients with paroxysmal or persistent atrial fibrillation (AF) undergoing electrical disconnection of pulmonary veins (PVs) by means of catheter ablation. Long-term outcome was analyzed in relation to acute procedure success and to the clinical presentation.

Methods And Results: Two hundred and thirty-four patients (182 males, mean age 55.