The slope of the initial temperature drop predicts acute pulmonary vein isolation using the second-generation cryoballoon.

Aims: There is no objective, early indicator of occlusion quality, and efficacy of cryoballoon pulmonary vein isolation. As previous experience suggests that the initial cooling rate correlates with these parameters, we investigated the slope of the initial temperature drop as an objective measure.

Methods And Results: A systematic evaluation of 523 cryoapplications in 105 patients using a serial ROC-AUC analysis was performed.

Predictors of early and late left atrial tachycardia and left atrial flutter after catheter ablation of atrial fibrillation: long-term follow-up.

Background: The aim of the study was identification of the predictors of left atrial tachycardia and left atrial flutter (LATAFL) after radiofrequency catheter ablation of atrial fibrillation (CAAF).

Methods: We followed 598 patients (71% male, 41% paroxysmal AF; median follow-up: 36 months) after a single step-wise CAAF procedure. The time to first documented LATAFL lasting longer than 30 s, documented in any kind of electrocardiography (ECG), was defined as an end-point.

Cryoballoon ablation of atrial fibrillation: How important is the proper selection of patients?

Background: Relation between pre-procedural selection of patients and the success rate after a single cryoballoon ablation (CAB) procedure is unknown.

Methods: CAB was performed in 378 (65% male, median age 58 years, 85% paroxysmal atrial fibrillation [AF]) consecutive patients with symptomatic and drug refractory AF. The combined ALARMEc (Atrial fibrillation type, Left Atrium size, Renal insufficiency, Metabolic syndrome, cardiomyopathy) risk score was calculated for each individual patient.

Clinical impact of a novel three-dimensional electrocardiographic imaging for non-invasive mapping of ventricular arrhythmias-a prospective randomized trial.

Aims: ECVUE™ technology, a novel, three-dimensional, non-invasive mapping system, offers a unique arrhythmia characterization and localization. We sought to evaluate the clinical impact of this system in routine clinical mapping and ablation of ventricular arrhythmias (VAs).

Methods And Results: Patients with monomorphic premature ventricular contractions with or without monomorphic ventricular tachycardia were enrolled prospectively and randomized into two groups: ventricular ectopy localization using either 12-lead electrocardiogram (ECG) algorithms or with ECVUE™, followed by conventional guided ablation.

Cryoballoon ablation in young patients with lone paroxysmal atrial fibrillation.

Introduction And Objectives: Long-term efficacy following cryoballoon ablation of lone paroxysmal atrial fibrillation remains unknown. We describe long-term follow-up results of the single cryoballoon ablation procedure.

Methods: Pulmonary vein isolation was performed in 103 patients (72 male; median age 52 years) with symptomatic lone paroxysmal atrial fibrillation.

Learning curve in cryoballoon ablation of atrial fibrillation: eight-year experience.

Background: We analyzed the procedural experience cryoballoon ablation (CBA) of atrial fibrillation (AF) gained over 8 years in a high-volume centre to understand the influence of the learning curve on feasibility, safety and clinical outcome.

Methods And Results: In 424 patients (62% male) with drug-refractory AF, CBA was performed between 2005 and 2012. The analyzed period was divided into 8 calendar years.

Score associated with the outcome after multiple ablation procedures in patients with atrial fibrillation.

Background: Catheter ablation (CA) of atrial fibrillation (AF) is now established therapeutic option. Multiple procedures (MPs) are often needed to achieve the satisfactory outcome. The aim of the study was to assess the outcome after MPs in AF patients categorized to risk-score groups.

Atrial Fibrillation and Renal Disease.

Co-incidence of atrial fibrillation and renal dysfunction in general population is described in many epidemiological studies. Major issue is optimal anticoagulation in patients with atrial fibrillation and renal disease warranting balance between risks of ischemic stroke and hemorrhages. The second issue is catheter ablation of AF patients with renal dysfunction.

Ipsilateral circumferential radiofrequency ablation of atrial fibrillation with irrigated tip catheter: long-term outcome and pre-procedural predictors.

Background: Predictors of long-term outcome of atrial fibrillation (AF) ablation are unknown. The predictors of 5-year follow-up (FU) after single ipsilateral circumferential antrum pulmonary vein isolation (PVI) with irrigated tip catheter were investigated.

Methods And Results: In 356 patients (74% male) with AF (44% paroxysmal AF [PAF]) PVI was performed.

Repeated catheter ablation of atrial fibrillation: how to predict outcome?

Background: Pre-procedural predictors (PP) of atrial fibrillation (AF) recurrence (AFR) after repeated catheter ablation of AF (RCAF) are unknown. The aim of this study was identification of PP of outcome after RCAF.

Methods And Results: In 213 patients (73% male) with drug-refractory AF (47% paroxysmal AF; PAF) RCAF was performed.

Cryoballoon ablation of paroxysmal atrial fibrillation: 5-year outcome after single procedure and predictors of success.

Aims: Long-term efficacy following cryoballoon (CB) ablation of atrial fibrillation (AF) remains unknown. This study describes 5 years follow-up results and predictors of success of CB ablation in patients with paroxysmal atrial fibrillation (PAF).

Methods And Results: In total, 163 patients were enrolled with symptomatic, drug refractory PAF.

Major determinants of myocardial injury after pulmonary vein isolation with radiofrequency ablation.

Background: Radiofrequency (RF) current is used as a common energy source to perform pulmonary vein isolation (PVI) in patients with atrial fibrillation. We applied measurements of the blood concentration of cTnI as a surrogate parameter for the injured cell mass.

Aim: To clarify which parameters are major determinants of myocardial injury, estimated by cTnI, after PVI with RF ablation.

Impact of impaired renal function and metabolic syndrome on the recurrence of atrial fibrillation after catheter ablation: a long term follow-up.

Background: The goal of this study was to analyze impact of metabolic syndrome (MetS) and impaired renal function on long-term follow-up after catheter ablation of atrial fibrillation (AF).

Methods And Results: A total of 702 consecutive patients with AF (age = 58 year, history of AF = 5 year, male = 478, paroxysmal atrial fibrillation = 416, coronary artery disease = 62, hypertension = 487) considered for catheter ablation were enrolled in the study. The MetS was diagnosed at admission in 276 patients.

Which standard biomarkers are useful for the evaluation of myocardial injury after pulmonary vein isolation with cryoballoon?

Background: Many studies have used creatinine kinase (CK), myocardial bound for CK (CK-MB), and cardiac troponin I (cTnI) and T (cTnT) to evaluate myocardial cells injury after ablation. We applied measurements of the blood concentration of cardio-specific biomarkers as surrogates for the injured cell mass.

Aim: To clarify which of the standard biomarkers are useful in the evaluation and quantification of lesions produced by cryoballoon ablation (CBA) during pulmonary vein isolation.

Limitations of biomarkers serum levels during pulmonary vein isolation.

Introduction And Objectives: Several biomarkers have been used for evaluation and quantification of myocardial injury after effective ablation. We studied possible different thermal stability and usability of the proteins released by cardiac cells injured by different energy sources.

Methods: Firstly, we tested in vitro thermal stability of creatinine kinase (CK), myocardial bound creatinine kinase (CKMB), cardiac troponins I (cTnI) and cardiac troponins T (cTnT) in collected blood samples from 15 patients (pts) with confirmed ST-segment elevated myocardial infarction (STEMI).

MEDAFI-Trial (Micro-embolization during ablation of atrial fibrillation): comparison of pulmonary vein isolation using cryoballoon technique vs. radiofrequency energy.

Aims: Cerebral embolism is a possible serious complication during catheter ablation of atrial fibrillation (AF). The purpose of this prospective pilot study was to analyse the incidence and possible impact of cryo ablation on cerebral lesions and possible differences to radiofrequency (RF) ablation during pulmonary vein isolation (PVI).

Methods And Results: Pulmonary vein isolation was performed in 89 patients, either with the cryoballoon technique (n = 45) or with RF ablation (n = 44).

Pulmonary vein antrum isolation and terminal part of the P wave.

Background: Delayed interatrial conduction, manifested on the electrocardiogram as a P wave >or=110 ms (interatrial block, IAB), is highly prevalent and associated with atrial fibrillation (AF). It is correlated with P-terminal force (Ptf; product of the duration and amplitude of the negative terminal phase of the P wave in lead V1). Our purpose was to describe the modifications of the P-wave duration and Ptf after pulmonary vein antrum isolation (PVAI) in patients with paroxysmal AF.

Electrocardiographic and further predictors for permanent pacemaker requirement after transcatheter aortic valve implantation.

The objective of this study was to identify electrocardiographic (ECG) and further predictors for atrioventricular (AV) block with a need for pacemaker (PM) implantation after transcatheter aortic valve implantation (TAVI). Pre- and post-procedural ECGs of patients with severe aortic stenosis and ongoing TAVI were investigated in a prospective study. From 50 consecutive patients enrolled in the study (mean age 80 +/- 6 years, 46% men), 17 (34%) experienced an AV block with subsequent requirement of a permanent PM [16 of 36 (44.

Acute and long-term results of PVI at antrum using a novel high-density mapping catheter without help of 3D electro-anatomic mapping in patients with paroxysmal and chronic atrial fibrillation.

Purpose: Multi-electrode circumferential mapping catheters have been developed by several manufacturers to facilitate catheter ablation procedures for atrial fibrillation (AF). We tested the effectiveness and safety of a conventional, fully endocardial electrogram-guided circumferential antrum isolation (PVI) with a novel mapping device.

Methods: The study enrolled 250 consecutive patients with paroxysmal or chronic AF.

Pulmonary vein stenting for the treatment of acquired severe pulmonary vein stenosis after pulmonary vein isolation: clinical implications after long-term follow-up of 4 years.

Introduction: Severe pulmonary vein stenosis (PVS) after catheter ablation of atrial fibrillation (AF) is a well-recognized complication with a further reported incidence of 1.3%. The preferred therapy for symptomatic PVS is pulmonary vein (PV) angioplasty, but this treatment modality is followed by restenosis in 44-70%.