The safety of direct transeptal puncture using a radiofrequency guidewire combined with a 17Fr pulsed field ablation sheath.

Transseptal puncture (TSP) is widely used in catheter-based cardiac interventions to gain left atrial (LA) access, but its workflow has remained largely unchanged and is still a source of serious complications. Pulsed field ablation (PFA) for pulmonary vein isolation (PVI) has been shown to be at least comparable with radiofrequency ablation (RFA) in terms of safety and efficacy. However, PFA catheter delivery to the LA typically requires a standard TSP and an over the wire sheath exchange which can limit workflow and lengthen procedure time-a shorter procedure time being a proposed advantage of PFA over RFA.

Streamlining atrial fibrillation ablation management using a digitization solution.

Aims: Catheter ablation is a widely accepted intervention for atrial fibrillation (AF) management. Prior to undertaking this procedure, thorough patient education on its efficacy and potential complications is crucial. Additionally, educating patients about stroke risk management and anticoagulant therapy is imperative.

A simple method for radiation exposure reduction during atrial fibrillation ablation: the lead-apron-free approach.

Background: Radiofrequency catheter ablation (RFCA) is a well-established treatment for atrial fibrillation (AF). Fluoroscopy, a widely used imaging method for RFCA, has significant implications for human health. Although no fluoroscopy or near-zero fluoroscopy strategies have gained popularity, they have limitations, such as long procedure times, additional equipment, and expertise.

One-Day Interruption of NOAC Is Associated with Low Risk of Periprocedural Adverse Events during Pulmonary Vein Isolation If Combined with Left Atrial Thrombus Exclusion with Computed Tomography.

Background: Safety, efficacy, and patient comfort are the expectations during pulmonary vein isolation (PVI). We aimed to validate the combined advantages of pre- and periprocedural anticoagulation with non-vitamin K anticoagulants (NOACs) and rigorous left atrial appendage thrombus (LAAT) exclusion with computed tomography (CT).

Methods: This study included a population of consecutive patients, between March 2018 and June 2020, who underwent cardiac CT within 24 h before PVI to guide the ablation and rule out LAAT.

Concomitant Transatrial and Transapical CRT-D Lead Implantation in a Patient with Chest Burn Injury.

Cardiac resynchronization therapy device with defibrillator (CRT-D) implantation is indicated for patients with a history of malignant ventricular arrhythmias, symptomatic heart failure, wide QRS, or high-degree atrioventricular block. A 67-year-old patient with dilated cardiomyopathy received a CRT-D with the conventional method but 1 month later skin necrosis was diagnosed above the device. The complete system was extracted from the patient and we utilized negative pressure wound therapy for the treatment of the remaining tissue.

Selection of an impedance- or magnetic field-based electro-anatomical mapping platform does not affect outcomes of outflow tract premature ventricular complex manual ablation.

Comparative data are virtually missing about the performance of different electro-anatomical mapping (EAM) system platforms on outflow tract (OT) premature ventricular complex (PVC) ablation outcomes with manual ablation catheters. We aimed to compare the acute success-, complication-, and long-term recurrence rates of impedance-based (IMP) and magnetic field-based (MAG) EAM platforms in manual OT PVC ablation. Single-centre, propensity score matched data of 39-39 patients ablated for OT PVCs in 2015-17 with IMP or MAG platforms were analysed.

Left atrial appendage size is a marker of atrial fibrillation recurrence after radiofrequency catheter ablation in patients with persistent atrial fibrillation.

Introduction: There are no consistently confirmed predictors of atrial fibrillation (AF) recurrence after catheter ablation. Therefore, we aimed to study whether left atrial appendage volume (LAAV) and function influence the long-term recurrence of AF after catheter ablation, depending on AF type.

Methods: AF patients who underwent point-by-point radiofrequency catheter ablation after cardiac computed tomography (CT) were included in this analysis.

[Modern therapeutic approaches of cardiac arrhythmias in pregnancy].

Összefoglaló. A ritmuszavarok előfordulása gyakoribb a terhes nők esetén, mint a nem várandósok körében. A legtöbb esetben terápiás beavatkozás nélkül is kihordható a magzat.

Implementation of a zero fluoroscopic workflow using a simplified intracardiac echocardiography guided method for catheter ablation of atrial fibrillation, including repeat procedures.

Objective: Pulmonary vein isolation (PVI) is the cornerstone of the interventional treatment of atrial fibrillation (AF). Traditionally, during these procedures the catheters are guided by fluoroscopy, which poses a risk to the patient and staff by ionizing radiation. Our aim was to describe our experience in the implementation of an intracardiac echocardiography (ICE) guided zero fluoroscopic (ZF) ablation approach to our routine clinical practice.

Orientation of the right superior pulmonary vein affects outcome after pulmonary vein isolation.

Aims: Controversial results have been published regarding the influence of pulmonary vein (PV) anatomical variations on outcomes after pulmonary vein isolation (PVI). However, no data are available on the impact of PV orientation on the long-term success rates of point-by-point PVI. We sought to determine the impact of PV anatomy and orientation on atrial fibrillation (AF)-free survival in patients undergoing PVI using the radiofrequency point-by-point technique.

[The issue of permanent pacemaker implantation following cardiac surgery].

The issue of postoperative arrhythmias requiring pacemaker therapy is widely studied in the field of cardiac surgery and it is a complex perioperative problem. The aim of this paper is to summarize the relevant international guidelines and recommendations and to present our hospital's experience. We present the current, decisive recommendations and important studies, and present patients who underwent pacemaker implantation within one month after cardiac surgery between 01.

Long-term single-centre large volume experience with transseptal endocardial left ventricular lead implantation.

Aims: The aim of our study was to investigate the long-term efficacy and safety of transseptal endocardial left ventricular lead implantation (TELVLI).

Methods And Results: Transseptal endocardial left ventricular lead implantation was performed in 54 patients (44 men, median age 69, New York Heart Association III-IV stage) between 2007 and 2017 in a single centre. In 36 cases, the transseptal puncture (TP) was performed via the femoral vein, and in 18 cases, the TP and also the left ventricular (LV) lead placement were performed via the subclavian vein.

[Assessment of the extent of myocardial necrosis following radiofrequency catheter ablation of different supraventricular arrhythmias].

Introduction: Levels of cardiac necroenzymes, high-sensitive troponin (hsTnT) and creatine kinase muscle-brain (CKMB) increase as a result of a myocardial damage following catheter ablation.

Aim: To analyze the mid-term alteration of hsTnT and CKMB levels following radiofrequency ablation (RFCA) for atrial fibrillation (AF), atrial flutter (AFlu), AV-nodal reentry tachycardia (AVNRT) and electrophysiological studies (EPS) without ablation.

Method: Patients undergoing RFCA for various indications and EPS were consecutively enrolled in our prospective study.

Repeat procedure is a new independent predictor of complications of atrial fibrillation ablation.

Aims: Atrial fibrillation (AF) ablation has made huge progress with respect to innovation, efficacy, and safety, however, complications are still present. Recent studies examined various predictors of complications. However, limited data exist regarding the role of a repeat procedure.

Quality of life measured with EuroQol-five dimensions questionnaire predicts long-term mortality, response, and reverse remodelling in cardiac resynchronization therapy patients.

Aims: There are previous studies on quality of life (QoL) in cardiac resynchronization therapy (CRT) patients; however, there are no data with the short EuroQol-five dimensions (EQ-5D) questionnaire predicting outcomes. We aimed to assess the predictive role of baseline QoL and QoL change at 6 months after CRT with EQ-5D on 5-year mortality and response.

Methods And Results: In our prospective follow-up study, 130 heart failure (HF) patients undergoing CRT were enrolled.

The impact of cardiac resynchronization therapy on routine laboratory parameters.

Background: Cardiac resynchronization therapy (CRT) in chronic heart failure has been shown to improve mortality and morbidity. However, comprehensive data are not available as concerns how circulating biomarkers reflecting different organ functions, such as serum uric acid, blood urea nitrogen (BUN), albumin, cholesterol, or various liver enzymes, change over time as a consequence of CRT. The aim of this prospective study was to overview these possible changes.

Minimal invasive right ventricular and atrial pacemaker lead repositioning as a first alternative is superior in avoiding pocket complications with passive fixation leads.

Purpose: Lead dislocations of pacemaker systems are reported in all and even in high-volume centers. Repeated procedures necessitated by lead dislocations are associated with an increased risk of complications. We investigated a minimal invasive method for right atrial and ventricular lead repositioning.

Minimal Invasive Left Ventricular Lead Repositioning is Safe and Effective in Distal Left Ventricular Lead Positions.

Background: Treatment of left ventricular electrode dislocation and phrenic nerve stimulation remains an issue in the era of new electrode designs.

Methods: Safety and efficacy of minimal invasive lead repositioning and pocket opening reposition procedures were evaluated between December 2005 and December 2012 at our center. Minimal invasive method was developed and widely utilized at our center to treat phrenic nerve stimulation.

Complement C3a predicts outcome in cardiac resynchronization therapy of heart failure.

Background: The chronic inflammation plays an important role in heart failure and complement components might be useful markers of the prognosis. We set out to evaluate their predictive value in the clinical outcomes of patients with cardiac resynchronization therapy (CRT).

Methods: We determined the complement levels C3, C3a, sC5b-9 and also the N-terminus of the prohormone brain natriuretic peptide (NT-proBNP) of 126 heart failure patients in a prospective, single-center observational study before and 6 months after CRT implantation.

Respiratory gating algorithm helps to reconstruct more accurate electroanatomical maps during atrial fibrillation ablation performed under spontaneous respiration.

Purpose: Electroanatomical mapping is a useful tool during the ablation of atrial fibrillation. Respiratory movement might influence the mapping accuracy and merging. This study aims to investigate the effect of respiratory gating on the accuracy of magnetic-field-based electroanatomical mapping under spontaneous respiration.

[Successful direct thrombin inhibitor treatment of a left atrial appendage thrombus developed under rivaroxaban therapy].

The authors present the history of a 62-year-old man on continuous rivaroxaban therapy who was scheduled for pulmonary vein isolation due to persistent atrial fibrillation. Preoperative transesophageal echocardiography detected the presence of left atrial appendage thrombus. Thrombophilia tests showed that the patient was heterozygous carrier of the methylene-tetrahydrofolate reductase gene mutation.

Ablation of the epicardial substrate in the right ventricular outflow tract in a patient with Brugada syndrome refusing implantable cardioverter defibrillator therapy.

Brugada syndrome is associated with a high risk of sudden cardiac death. Currently, the cornerstone of therapy is implantation of an implantable cardioverter defibrillator (ICD). Recently, a novel approach to preventively ablate the substrate located in the anterior epicardial region of the right ventricular outflow tract showed promising results by reducing the number of ventricular fibrillation episodes in patients with ICD.

Impact of respiration gating on image integration guided atrial fibrillation ablation.

Background: Radiofrequency (RF) catheter ablation guided by electroanatomic mapping systems is an effective therapy for atrial fibrillation. However, it may be affected by respiration movements. The aim of this study was to determine the impact of respiratory gating on procedural parameters in patients undergoing catheter ablation of atrial fibrillation (AF).