Left atrial total emptying fraction measured by cardiovascular magnetic resonance imaging predicts low-voltage areas detected during electroanatomical mapping.

Aims: Low-voltage areas (LVAs) found during left atrial (LA) electroanatomical mapping are increasingly targeted by radiofrequency catheter ablation (RFCA) on top of pulmonary vein isolation to improve arrhythmia-free survival in patients with atrial fibrillation (AF). However, pre-procedural prediction of LVAs remains challenging. The purpose of the present study was to describe the association between parameters of LA function and dimensions, respectively, derived from pre-procedural cardiovascular magnetic resonance (CMR) imaging, and the presence of LVAs on LA voltage mapping.

Major incidental findings on routine cardiovascular magnetic resonance imaging prior to first-time catheter ablation of atrial fibrillation.

Introduction: Preprocedural cardiovascular magnetic resonance (CMR) or computed tomography (CT) imaging of the left atrium/pulmonary veins is usually employed to guide catheter ablation of atrial fibrillation (AFCA). Incidental findings (IFs) are common on cardiac imaging prior to AFCA. However, previous studies have mainly focused on extracardiac IFs detected on CT scan.

Oesophageal Probe Evaluation in Radiofrequency Ablation of Atrial Fibrillation (OPERA): results from a prospective randomized trial.

Aims: The aim of the study was to determine the incidence of oesophageal lesions after radiofrequency ablation (RFA) of atrial fibrillation (AF) with or without the use of oesophageal temperature probes.

Methods And Results: Two hundred patients were prospectively randomized into two groups: the OPERA+ group underwent RFA using oesophageal probes (SensiTherm™); the OPERA- group received RFA using fixed energy levels of 25 W at the posterior wall without an oesophageal probe. All patients underwent post-interventional endoscopy and Holter-electrocardiogram after 6 months.

Combined single-session cardiovascular magnetic resonance: stress perfusion and three-dimensional pulmonary vein angiography for stratification of atrial fibrillation patients with chest pain syndromes prior to catheter ablation.

Aims: To determine the clinical utility of a combined single-session cardiovascular magnetic resonance (CMR) imaging protocol integrating adenosine stress perfusion and three-dimensional pulmonary vein angiography for stratification of atrial fibrillation (AF) patients referred for pulmonary vein isolation (PVI) and complaining about chest pain syndromes.

Methods And Results: The preprocedural CMR examination (adenosine stress perfusion, late gadolinium enhancement, and three-dimensional pulmonary vein angiography) was performed in 357 consecutive AF patients with chest pain syndromes referred for PVI. Stress perfusion results were used for stratification: ischaemia positive patients underwent invasive coronary angiography, ischaemia negative patients underwent PVI, and follow-up/outcome data were collected (combined primary endpoint of cardiac death/non-fatal myocardial infarction).

Effect of remote ischemic preconditioning on electrophysiological parameters in nonvalvular paroxysmal atrial fibrillation: The RIPPAF Randomized Clinical Trial.

Background: Atrial fibrillation (AF) remains the most relevant arrhythmia with a prevalence of 2%. The treatment options are either highly invasive and cost-intensive or limited by potential side effects or insufficient efficacy. However, no direct means of prevention that could reduce the burden of AF have been tested.

Atrial Fibrillation and Cognitive Impairment: New Insights and Future Directions.

Introduction: Atrial fibrillation (AF) has been recognised as the most prevalent sustained arrhythmia. Recently, a growing body of evidence has suggested that AF might be involved in the progression of cognitive impairment (CIM), potentially extending into types of dementia. Accordingly, the purpose of the present study was to summarise the findings of investigations examining association between AF and cognitive function as well as highlighting the possible causes of discrepancy between the findings and reviewing the probable mechanisms of CIM in patients affected with AF.

Catheter ablation of atrial fibrillation: current status, techniques, outcomes and challenges.

Atrial fibrillation (AF) is the most common human arrhythmia. Interventional treatment with catheter ablation is an established technique that is increasingly applied and has become one of the main treatment modalities in patients with AF. Ablation results in significant improvement of symptoms and the quality of life.

Catheter ablation of atrial fibrillation with nonfluoroscopic catheter visualization-a prospective randomized comparison.

Purpose: The application of a novel platform for nonfluoroscopic catheter sensor tracking within pre-recorded x-ray loops in the context of catheter ablation of atrial fibrillation (AF) demonstrated significant potential for reduction of fluoroscopy. We sought to provide the first prospective randomized comparison of fluoroscopy needs, procedure times, and complications in AF catheter ablation with or without additional use of nonfluoroscopic catheter visualization (NFCV).

Methods: Patients with AF were randomized into two groups before scheduled radiofrequency ablation: (1) using established mapping systems and fluoroscopy as needed (CONV group) or (2) with additional NFCV (NFCV group).

Safety profile of near-zero fluoroscopy atrial fibrillation ablation with non-fluoroscopic catheter visualization: experience from 1000 consecutive procedures.

Aims: Efforts to reduce radiation exposure during catheter ablation procedures have included the use of various technological measures. Significant results have been achieved to the point where near lead-free procedures in routine clinical practice has become a realistic goal. The integration of MediGuide technology [non-fluoroscopic catheter visualization technology (NFCV)] and three-dimensional electroanatomical mapping is one of the methods developed in response to radiation reduction initiatives.

Individually tailored vs. standardized substrate modification during radiofrequency catheter ablation for atrial fibrillation: a randomized study.

Aims: This randomized single-centre study sought to compare the efficacy and safety of pulmonary vein isolation (PVI) plus voltage-guided ablation vs. PVI with or without linear ablation depending on the type of atrial fibrillation (AF).

Methods And Results: Overall, 124 ablation-naive patients with paroxysmal or persistent AF were randomized to PVI with (persistent AF) or without (paroxysmal AF) additional linear ablation (control group) vs.

Predictors of ventricular arrhythmia after left ventricular assist device implantation: A large single-center observational study.

Background: Ventricular arrhythmias (VAs) are common in patients after left ventricular assist device (LVAD) implantation.

Objective: The purpose of this study was to determine the predictors of VAs and their impact on mortality in LVAD patients.

Methods: A total of 98 consecutive patients with an implantable cardioverter-defibrillator (ICD) (86 [88%] male, mean age 57 ± 10 years), 57 [58%] with nonischemic dilated cardiomyopathy) who had received an LVAD between May 2011 and December 2013 at our institution were included in the study.

Supraventricular arrhythmias in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy associate with long-term outcome after catheter ablation of ventricular tachycardias.

Aims: This study aimed to assess the impact of supraventricular tachycardia (SVT) on long-term results of radiofrequency catheter ablation therapy of ventricular tachycardia (VT) in a large cohort of patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C).

Methods And Results: Supraventricular tachycardia occurrence has been studied in patients from our ARVD/C registry (70 patients, 48 male, age 53.2 ± 14.

Myocardial voltage ratio in arrhythmogenic right ventricular dysplasia/cardiomyopathy.

Aims: This study aimed to analyze the influence of scar distribution between the endocardium and the epicardium in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C).

Methods: Electroanatomical mapping data were derived from our ARVD/C registry. Myocardial voltage distribution between the endocardium and the epicardium was analyzed in 28 patients (18 men, 49.

Successful Repeat Catheter Ablation of Recurrent Longstanding Persistent Atrial Fibrillation With Rotor Elimination as the Procedural Endpoint: A Case Series.

Background: There remains a lack of consensus regarding the ideal ablation strategy for atrial fibrillation (AF), particularly in patients with persistent or longstanding persistent AF. Given increasing evidence from clinical imaging studies that rotors sustain AF, rotor elimination may be a desirable procedural endpoint. However, there is no description to date of the clinical outcomes using rotor elimination during ablation as the procedural endpoint.

Prospective, multicenter validation of a clinical risk score for left atrial arrhythmogenic substrate based on voltage analysis: DR-FLASH score.

Background: Left atrial (LA) low-voltage areas (LVAs) are frequently observed in patients with atrial fibrillation (AF) and may predict AF recurrence after catheter ablation.

Objective: The aim of this study was to develop and validate a clinical tool to identify LVAs that are associated with AF recurrence after pulmonary vein isolation (PVI).

Methods: In a cohort of 238 patients, voltage maps were created during LA procedures.

Non-fluoroscopic catheter tracking for fluoroscopy reduction in interventional electrophysiology.

A technological platform (MediGuide) has been recently introduced for non-fluoroscopic catheter tracking. In several studies, we have demonstrated that the application of this non-fluoroscopic catheter visualization system (NFCV) reduces fluoroscopy time and dose by 90-95% in a variety of electrophysiology (EP) procedures. This can be of relevance not only to the patients, but also to the nurses and physicians working in the EP lab.

Tailored atrial substrate modification based on low-voltage areas in catheter ablation of atrial fibrillation.

Background: Reduced electrogram amplitude has been shown to correlate with diseased myocardium. We describe a novel individualized approach for catheter ablation of atrial fibrillation (AF) based on low-voltage areas (LVAs) in the left atrium (LA). We sought to assess (1) the incidence of LVAs in patients undergoing AF catheter ablation, (2) the distribution of LVAs within the LA, and (3) the effect of an individualized ablation strategy on long-term rhythm outcomes.

Impact of metabolic syndrome on left atrial electroanatomical remodeling and outcomes after radiofrequency ablation of nonvalvular atrial fibrillation.

Background: Recent studies reported worse outcomes after atrial fibrillation (AF) ablation in patients with metabolic syndrome (MetS). However, mechanisms of AF recurrence in MetS remain unclear.

Method And Results: We performed pulmonary vein isolation and voltage mapping in 236 patients with AF (age 61±9.

Novel oral anticoagulants in a real-world cohort of patients undergoing catheter ablation of atrial fibrillation.

Aims: Experiences with novel oral anticoagulants (NOACs) early after atrial fibrillation (AF) catheter ablation are limited and show controversial results. We aimed to assess the longer-term safety, efficacy, and acceptance of NOACs in a large real-world cohort of patients presenting for AF catheter ablation.

Methods And Results: From July 2010 until June 2012, 259 patients undergoing AF catheter ablation were prospectively included.

Catheter ablation of atrial fibrillation supported by novel nonfluoroscopic 4D navigation technology.

Background: The MediGuide technology (MGT) represents a novel sensor-based electromagnetic 4-dimensional (4D) navigation system allowing real-time catheter tracking in the environment of prerecorded X-ray loops.

Objective: To report on our clinical experience in atrial fibrillation (AF) ablation with recently available MGT-enabled ablation catheters.

Methods: The MGT was used in addition to a conventional 3D mapping system in 80 patients with AF (age 61 ± 10 years; 47 men; 40 with persistent AF), who underwent circumferential pulmonary vein isolation and voltage mapping with and without substrate modification.

Use of electrical coupling information in AF catheter ablation: a prospective randomized pilot study.

Background: Catheter contact is important for radiofrequency (RF) ablation. Local electrical catheter-to-tissue coupling has been described as a tool to objectively measure contact.

Objective: We hypothesized that pulmonary vein isolation (PVI) ablation using electrical coupling information (ECI) would yield higher rates of PVI than an approach without ECI.

Quantitative analysis of isolation area and rhythm outcome in patients with paroxysmal atrial fibrillation after circumferential pulmonary vein antrum isolation using the pace-and-ablate technique.

Background: We sought to determine the relationship between the size of the left atrial isolated surface area (ISA) after pulmonary vein antrum isolation for paroxysmal atrial fibrillation (AF) and rhythm outcome during a 12-month follow-up.

Methods And Results: One hundred one consecutive patients with paroxysmal AF (mean age, 59±11 years; median [range] AF history, 36 [24-96] months; mean left atrial size, 42±6 mm) were enrolled. The ISA was defined as the ratio of the total isolated antral surface area excluding the pulmonary veins to the sum of the total isolated antral surface area and the left atrial posterior wall surface area, while considering the individual characteristics of antral anatomy.