Predictability of indicators in local activation time mapping of ablation success for premature ventricular contractions.

Introduction: Differences in predictability of ablation success for premature ventricular contractions (PVCs) between earliest isochronal map area (EIA), local activation time (LAT) differences on unipolar and bipolar electrograms (⊿LAT), LAT prematurity on bipolar electrograms (LAT), and unipolar morphology of QS or Q pattern remain unclear. We verified multiple statistical predictabilities of those indicators of ablation success on mapped cardiac surface.

Methods: Thirty-five patients with multiple PVCs underwent catheter ablation after LAT mapping using multipolar mapping catheters with unipolar-based annotation.

Coexistence Case of Papillary Fibroelastoma and Lambl's Excrescence of the Left Heart, Which Is Occasionally Associated with Significant Stroke.

Papillary fibroelastoma (PFE) is a benign tumor that arises mostly from left-sided valves. PFE can cause stroke, and surgical resection may be needed. Lambl's excrescence (LE) is a filiform valvular lesion and is considered a possible cause of stroke.

Impedance-guided modified CLOSE protocol ablation can reduce ablation index necessary for pulmonary vein isolation in patients with atrial fibrillation.

Background: Real-time monitoring of generator impedance drop is not considered in CLOSE protocol pulmonary vein (PV) isolation (PVI) in patients with atrial fibrillation (AF). We verified whether additional information of impedance drop could minimize ablation index required for PVI using modified CLOSE protocol (target ablation index ≥ 500 on anterior wall and ≥400 on posterior wall along with inter-lesion distance of 3-6 mm and maximum power of 35 W) without any adverse effect of procedural data and efficacy.

Methods: Sixty consecutive Japanese AF patients [paroxysmal AF: 43 (72 %) patients] underwent first-time PVI with modified CLOSE protocol with real-time monitoring of impedance drop (impedance-guided modified CLOSE protocol).