Transseptal puncture for left atrial ablation: Risk factors for cardiac tamponade and a proposed causative classification system.

Aims: Cardiac tamponade is a high morbidity complication of transseptal puncture (TSP). We examined the associations of TSP-related cardiac tamponade (TRCT) for all patients undergoing left atrial ablation at our center from 2016 to 2020.

Methods And Results: Patient and procedural variables were extracted retrospectively.

Transvenous lead extraction on uninterrupted anticoagulation: A safe approach?

Introduction: Current guidelines advocate reviewing peri-procedural anticoagulation on individual case basis for transvenous lead extraction (TLE). We investigated the safety of TLE on uninterrupted warfarin with therapeutic INR.

Methods: Retrospective registry of consecutive patients undergoing TLE on uninterrupted warfarin (Warfarin Group) across two centres.

Initial experience of the High-Density Grid catheter in patients undergoing catheter ablation for atrial fibrillation.

Purpose: A significant proportion of patients undergoing catheter ablation for atrial fibrillation (AF) experience arrhythmia recurrence. This is mostly due to pulmonary vein reconnection (PVR). Whether mapping using High-Density Wave (HDW) technology is superior to standard bipolar (SB) configuration at detecting PVR is unknown.

Atrial tachyarrhythmias following percutaneous device closure of secundum atrial septal defects.

Background: Atrial tachyarrhythmias (ATs) are a major source of morbidity in the atrial septal defect (ASD) patient cohort. The optimal timing and approach of anti-arrhythmic intervention is currently unclear. Here, we sought to determine the overall rate of ATs following percutaneous ASD closure and risk factors that may predict this.

Rupture of mitral valve papillary muscle: a rare complication following myocardial infarction.

Here we present a rare clinical presentation of papillary muscle rupture in a 55-year-old man who presented to accident and emergency department with chest pain and was diagnosed as having had a non-ST elevation myocardial infarction. During the admission, he developed papillary muscle rupture due to the myocardial infarction resulting in acute mitral regurgitation. This caused significant haemodynamic compromise needing emergency admission to the intensive care unit and eventually surgery to replace the valve.

Ultra-High-Density Activation Mapping to Aid Isthmus Identification of Atrial Tachycardias in Congenital Heart Disease.

Objectives: A new electroanatomic mapping system (Rhythmia, Boston Scientific, Marlborough, Massachusetts) using a 64-electrode mapping basket is now available; we systematically assessed its use in complex congenital heart disease (CHD).

Background: The incidence of atrial arrhythmias post-surgery for CHD is high. Catheter ablation has emerged as an effective treatment, but is hampered by limitations in the mapping system's ability to accurately define the tachycardia circuit.

Cryoablation for persistent and longstanding persistent atrial fibrillation: results from a multicentre European registry.

Aims: Although cryoballoon pulmonary vein isolation is a well-established treatment for paroxysmal atrial fibrillation (AF), it's role in persistent AF is unclear. We examined procedural success and long-term outcomes of cryoablation in persistent and longstanding persistent AF.

Methods And Results: International multicentre registry from three UK and eight European centres.

A multicentered evaluation of ablation at higher power guided by ablation index: Establishing ablation targets for pulmonary vein isolation.

Background: Pulmonary vein isolation (PVI) using high power delivered by SmartTouch Surround Flow (STSF) catheters guided by ablation index (AI) was evaluated in a multicenter registry.

Methods: Patients with paroxysmal AF underwent PVI with STSF catheters using 30 W on the posterior wall and 40 W elsewhere. AI targets were 350 posterior walls and 450 elsewhere.

A novel technique for performing transseptal puncture guided by a non-fluoroscopic 3D mapping system.

Background: Transseptal puncture (TSP) is commonly performed under fluoroscopic guidance in left atrial ablation procedures. This exposes patients and healthcare professionals to deleterious ionizing radiation. We describe a novel technique for performing TSP non-fluoroscopically using a three-dimensional (3D) mapping system only.

Ventricular tachycardia ablation in structural heart disease: Impact of ablation strategy and non-inducibility as an end-point on long term outcome.

Background: To investigate the long term outcomes after catheter ablation (CA) of ventricular tachycardia (VT) in the context of structural heart disease in a multicenter cohort. The impact of different ablation strategies (substrate ablation versus activation guided versus combined) and non-inducibility as an end-point was evaluated.

Methods: Data was pooled from prospective registries at 5 centres over a 5 year period.

Thrombo-embolic events in left ventricular endocardial pacing: long-term outcomes from a multicentre UK registry.

Aims: Endocardial left ventricular (LV) pacing is a viable alternative in patients with failed coronary sinus (CS) lead implantation. However, long-term thrombo-embolic risk remains unknown. Much of the data have come from a small number of centres.

Catheter ablation for atrial fibrillation on uninterrupted direct oral anticoagulants: A safe approach.

Background: Current consensus guidelines suggest direct oral anticoagulants (DOACs) are interrupted periprocedurally for catheter ablation (CA) of atrial fibrillation (AF). However, this may predispose patients to thromboembolic complications. This study investigates the safety of CA for AF on uninterrupted DOACs compared to uninterrupted warfarin.

Association of genetic variation in telomere-related SNP and telomerase with ventricular arrhythmias in ischemic cardiomyopathy.

Background: Telomeres are known to provide genomic stability and telomere length has been associated with cardiovascular diseases. Moreover, a higher telomerase activity has been shown to be associated with ventricular arrhythmias (VA) in ischemic cardiomyopathy. Increasing evidence suggests that genetic variation in key telomere genes has an impact on telomerase activity.

Systematic review and meta-analysis of left ventricular endocardial pacing in advanced heart failure: Clinically efficacious but at what cost?

Introduction: Cardiac resynchronization using a left ventricular (LV) epicardial lead placed in the coronary sinus is now routinely used in the management of heart failure patients. LV endocardial pacing is an alternative when this is not feasible, with outcomes data sparse.

Objective: To review the available evidence on the efficacy and safety of endocardial LV pacing via meta-analysis.

Panoramic atrial mapping with basket catheters: A quantitative analysis to optimize practice, patient selection, and catheter choice.

Introduction: Panoramic mapping with basket catheters has been used to map atrial fibrillation (AF). However, the limited tissue contact and coverage achieved has raised concerns.

Methods And Results: Patients undergoing catheter ablation for atrial tachycardia (AT) and persistent AF were recruited.

Cell Size Critically Determines Initial Retention of Bone Marrow Mononuclear Cells in the Heart after Intracoronary Injection: Evidence from a Rat Model.

Intracoronary injection of bone marrow mononuclear cells (BMMNC) is an emerging treatment for heart failure. Initial donor cell retention in the heart is the key to the success of this approach, but this process remains insufficiently characterized. Although it is assumed that cell size of injected cells may influence their initial retention, no scientific evidence has been reported.

Lesson of the month 1: Pericardial mass and cardiac tamponade associated with Mycoplasma pneumoniae.

Mycoplasma pneumoniae primarily causes respiratory tract infections. Extrapulmonary manifestations are seen in 20-25% of cases. Cardiac involvement is rarely reported.

Does modification to the approach to contacting potential participants improve recruitment to clinical trials?

Background: It is critical that clinical trial researchers ensure efficient and successful patient recruitment. Recruitment is often slower than expected and required sample sizes not obtained within initial funding deadlines. There is little rigorous evidence supporting ways to improve recruitment.

Predictors of new onset atrial fibrillation in patients with heart failure.

Introduction: Stroke associated with atrial fibrillation (AF) is more frequent in heart failure. It is unknown what variables predict future AF in these patients and how AF might evolve over time. We investigated this in patients with implantable cardiac defibrillators (ICD) where AF detection is optimal.