Combined approach of high-power and very high-power, short-duration ablation in superior vena cava isolation.

Introduction: The effectiveness and safety of 50 W, high-power, short-duration (HPSD) ablation in superior vena cava isolation (SVCI) for patients with atrial fibrillation (AF) have been reported. However, the acute outcomes of SVCI combined with 90 W/4 s, very high-power, short-duration (vHPSD) ablation remain unknown. In this study, we aimed to investigate a novel approach that combines 50 W-HPSD and 90 W/4 s-vHPSD ablation in SVCI and to elucidate the characteristics, outcomes, and safety of this approach by comparing SVCI with conventional ablation index (AI)-guided middle-power, middle-duration (MPMD) ablation.

A novel approach to typical atrioventricular nodal reentrant tachycardia with high-resolution mapping using the CARTO 3 cardiac mapping system.

Background: We hypothesized that high-resolution activation mapping during sinus rhythm (SR) in Koch's triangle (KT) can be used to describe the most delayed atrial potential around the atrioventricular node and evaluated whether ablation targeting of this potential is safe and effective for the treatment of patients with typical atrioventricular nodal reentrant tachycardia (AVNRT).

Methods: We conducted a prospective, non-randomized, observational study using high-resolution activation mapping from the sinus node to KT with a PENTARAY or OCTARAY catheter using the CARTO 3 cardiac mapping system (Biosense Webster) during SR in 62 consecutive patients (22 men; age [mean ± standard deviation] = 55 ± 14 years) treated for typical AVNRT at our institution from August 2021 to March 2023.

Results: In all cases, the most delayed atrial potential was observed near the His potential within KT.

Dual linear lesions for right atrial flutter after mitral valve surgery via the superior transseptal approach.

Background: The superior transseptal approach (STA) for mitral valve surgery is associated with a higher risk of developing macroreentrant incisional atrial flutter (AFL) than the left atrial approach. This study aimed to describe the linear lesions for the complex AFL circuit after the STA and to propose an option for the linear ablation target site.

Methods: Of the 26 patients who underwent radiofrequency catheter ablation for AFL after mitral valve surgery, data from seven patients with STA incisions were retrospectively analyzed.

Predicting the clinical course in hypertrophic cardiomyopathy using thallium-201 myocardial scintigraphy.

Aims: This study aimed to evaluate the changes in left ventricular remodelling with time in patients with hypertrophic cardiomyopathy (HCM) using thallium-201 myocardial scintigraphy.

Methods And Results: Forty-eight patients with HCM participated in the study. The extent score (ES) and a newly devised index termed the 'mean count change' (MCC) were used to evaluate the myocardial perfusion defects.

Simple and novel technique to confirm complete mitral isthmus block.

Background: Differential pacing technique to confirm mitral isthmus (MI) block is sometimes challenging due to destroyed tissues after extensive ablation. The purpose of this study is to set an endpoint of MI ablation using conduction time around the mitral annulus (MA).

Methods: Forty-five consecutive patients with persistent atrial fibrillation who received MI linear ablation were included.

The proportion of asymptomatic recurrence after catheter ablation of atrial fibrillation in patients with a pacemaker for sick sinus syndrome.

Background: Catheter ablation (CA) of paroxysmal atrial fibrillation (PAF) is an effective treatment. However, the frequency of asymptomatic AF recurrence after CA in patients with PAF and sick sinus syndrome (SSS) is not clear. The aim of this study was to elucidate the real AF recurrence after CA in patients with PAF and a pacemaker for SSS.

Airway support using a pediatric intubation tube in adult patients with atrial fibrillation: A simple and unique method to prevent heart movement during catheter ablation under continuous deep sedation.

Background: The present study aimed to elucidate the safety and effectiveness of a noble and unique airway management technique in which a pediatric intubation tube is used in adult patients with atrial fibrillation (AF) undergoing catheter ablation (CA) under continuous deep sedation.

Methods: In total, 246 consecutive patients with AF (mean age, 65±10 years; 60 women) underwent CA under dexmedetomidine-based continuous deep sedation. A 4-mm pediatric intubation tube guided by a 10-French intratracheal suction tube was inserted smoothly, and the tip of the tube was located at the base of the epiglottis.

A case of ventricular fibrillation as a consequence of capecitabine-induced secondary QT prolongation: A case report.

Capecitabine is an oral fluoropyrimidine which can prolong QT interval. However, there have been no reports that capecitabine induced ventricular fibrillation (VF) due to secondary QT prolongation in patients with no structural heart disease. A 39-year-old woman developed VF during the chemotherapy of capecitabine for colon cancer.

HotBalloon Ablation of the Pulmonary Veins for Paroxysmal AF: A Multicenter Randomized Trial in Japan.

Background: Point-by-point catheter ablation is an established treatment for drug-refractory paroxysmal atrial fibrillation (PAF). However, it is time consuming, requires excellent technique to achieve complete pulmonary vein (PV) isolation, and is associated with severe complications.

Objectives: The purpose of this study was to evaluate the safety and effectiveness of a HotBalloon ablation (HBA) compared with antiarrhythmic drug therapy (ADT) for the treatment of PAF.

Impact of Alcohol Consumption on the Outcome of Catheter Ablation in Patients With Paroxysmal Atrial Fibrillation.

Background: Although several studies have reported an association between atrial fibrillation (AF) and alcohol, the impact of alcohol consumption on the outcome after catheter ablation (CA) for AF has not been discussed. We aimed to elucidate the effect of alcohol consumption on the outcome of CA for paroxysmal AF.

Methods And Results: We examined 1361 consecutive patients with paroxysmal AF (mean age, 61±11 years, 334 women) who underwent CA, including 623 (45.

Long-term outcome after catheter ablation of paroxysmal atrial fibrillation: Impact of different atrial fibrillation foci.

Background: We aimed to determine whether differing foci in paroxysmal atrial fibrillation (PAF) affected the long-term outcome of catheter ablation (CA).

Methods: A total of 865 consecutive PAF patients (age, 61±10years; 670 male) undergoing initial AF ablation were included. After pulmonary vein (PV) isolation, superior vena cava (SVC) isolation was performed for SVC foci; other non-PV foci were focally ablated.

Impact of anteroinferior transseptal puncture on creation of a complete block at the mitral isthmus in patients with atrial fibrillation.

Purpose: Achieving complete mitral isthmus (MI) conduction block for atrial fibrillation (AF) ablation remains challenging. We hypothesized that transseptal puncture (TSP) at the anteroinferior aspect of the atrial septum (anteroinferior TSP) could shorten the distance to the MI and improve catheter contact and stability, enabling complete MI block. This study investigated the efficacy of anteroinferior TSP for MI ablation in AF patients.

Reversible Atrial Fibrillation with Bradycardia Associated with Primary Cardiac B-Cell Lymphoma.

Primary cardiac lymphoma (PCL) only rarely occurs and it is defined as a lymphoma in which the bulk of the tumor is located within the heart and pericardium. A 53-year-old woman was referred due to dyspnea, and an electrocardiogram exhibited atrial fibrillation (AF). Echocardiography revealed no abnormal findings.

The mechanism of mitral regurgitation assessed by preprocedural echocardiography is associated with the outcome of catheter ablation in patients with paroxysmal atrial fibrillation.

Background: Mitral regurgitation (MR) is generally classified as either primary (organic) or secondary (functional). Although patients with atrial fibrillation (AF) often exhibit MR, the relation between the etiology of MR and the outcome of catheter ablation (CA) remains unknown. We conducted this study in order to elucidate this association.

Apixaban versus Warfarin for the Prevention of Periprocedural Cerebral Thromboembolism in Atrial Fibrillation Ablation: Multicenter Prospective Randomized Study.

Introduction: Stroke can be a life-threatening complication of atrial fibrillation (AF) catheter ablation. Uninterrupted warfarin treatment contributes to minimizing the risk of stroke complications.

Methods And Results: This was a prospective, open-label, randomized, multicenter study assessing the safety and efficacy of apixaban for the prevention of cerebral thromboembolism complicating AF catheter ablation.

Verapamil-Sensitive Upper Septal Idiopathic Left Ventricular Tachycardia: Prevalence, Mechanism, and Electrophysiological Characteristics.

Objectives: This study sought to demonstrate the prevalence, mechanism, and electrocardiographic and electrophysiological characteristics of upper septal idiopathic left fascicular ventricular tachycardia (US-ILVT).

Background: ILVT is classified into left anterior and posterior types with no clear data about US-ILVT.

Methods: Among 193 ILVT patients, we identified 12 patients (6.

Sudden manifestation of sinus arrest nine months after catheter ablation treatment for persistent atrial fibrillation.

A 39-year-old man with a seemingly non-remodeled, small heart suffered persistent atrial fibrillation (AF). Extensive isolation of the pulmonary vein, superior vena cava, and posterior left atrium, in conjunction with right atrium focal ablation, was performed to ablate multiple AF foci during two catheter ablation sessions. Sinus arrest occurred suddenly during follow-up, despite the absence of recurrent AF, ultimately necessitating pacemaker implantation.

Rapid Mapping of Right Atrial Tachycardia Using a New Multielectrode Basket Catheter.

Introduction: The mapping of atrial tachycardia (AT) can often be challenging and time-consuming, especially in patients with ATs that develop following cardiac surgery or are concomitant with atrial fibrillation. Recently, a new multielectrode basket catheter (MBC) has become available; we hypothesized that the MBC could be utilized to diagnose AT circuits.

Methods And Results: This study included 51 consecutive patients undergoing catheter ablation of clinically documented right-sided ATs (including 17 cases following cardiac surgery).

Intracardiac Echocardiography in Catheter Ablation for Atrial Fibrillation: It Is Better to See What You Are Doing?

Current advanced technology allows the accurate three-dimensional reconstruction of cardiac structures using multiple images from two-dimensional intracardiac echocardiography (ICE). This technology is applicable to atrial fibrillation (AF) ablation and provides real-time anatomical information on relevant atrial structures and myocardial thickness as well as suitable sites for transseptal puncture. ICE allows radiofrequency to be delivered away from structures resistant to ablation and the monitoring of possible complications during AF ablation.

Relation between dabigatran concentration, as assessed using the direct thrombin inhibitor assay, and activated clotting time/activated partial thromboplastin time in patients with atrial fibrillation.

Dabigatran is a direct thrombin inhibitor that has been approved for preventing stroke in patients with atrial fibrillation. In this study, we aimed to assess the associations between the dabigatran concentration (calculated through plasma-diluted thrombin time, as assessed using the Hemoclot assay) and the activated partial thromboplastin time (aPTT) and activated clotting time (ACT). We recruited 137 patients with atrial fibrillation who were receiving a normal dose of dabigatran (300 mg/d) or a reduced dose of dabigatran (220 mg/d, usually administered to patients who were elderly, had moderate renal dysfunction, or who were also receiving verapamil).

Impact of Non-Pulmonary Vein Foci on the Outcome of the Second Session of Catheter Ablation for Paroxysmal Atrial Fibrillation.

Background: Paroxysmal atrial fibrillation (AF) is primarily triggered by pulmonary veins (PVs). However, non-PV AF foci may also trigger AF.

Methods: We examined 207 patients (mean age, 62 ± 11 years; 166 men) who underwent a second catheter ablation (CA) and evaluated the clinical significance of non-PV AF foci on the outcomes.

The prognostic value of the serum eicosapentaenoic acid to arachidonic acid ratio in relation to clinical outcomes after endovascular therapy in patients with peripheral artery disease caused by femoropopliteal artery lesions.

Background: The EPA/AA ratio has emerged as a predictor of mortality endpoints in cardiac disease; however, its prognostic value in peripheral artery disease (PAD) patients is unclear. We assessed the serum eicosapentaenoic acid (EPA) to arachidonic acid (AA) ratio in patients with PAD caused by femoropopliteal artery lesions, to determine whether it predicts clinical outcomes after endovascular therapy (EVT).

Methods And Results: We obtained serum EPA/AA ratios from 132 consecutive patients with PAD caused by femoropopliteal artery lesions before EVT.

Simultaneous isolation of superior and inferior pulmonary veins on both the left and right sides could yield better outcomes in patients with paroxysmal atrial fibrillation.

Aims: This study investigated whether disappearance patterns of pulmonary vein (PV) potentials (PVPs) during PV isolation (PVI) affect the outcome of catheter ablation (CA) in patients with paroxysmal atrial fibrillation (PAF).

Methods And Results: Extensive PVI was performed in 1149 PAF patients (age, 61 ± 10 years). Clinical and demographic characteristics, ablation data, and follow-up outcomes were prospectively collected.