Preserving Cognitive Function in Patients with Atrial Fibrillation.

Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and is associated with significant morbidity and mortality. Its prevalence increases with increasing age, and is one of the leading causes of thromboembolism, including ischemic stroke. The prevalence of cognitive dysfunction also increases with increasing age.

Incidence and anatomical locations of catheter instability during circumferential pulmonary vein isolation using contact force.

In addition to contact force (CF), catheter stability is considered to be an important factor in creating radiofrequency lesions.To evaluate the catheter stability during pulmonary vein isolation (PVI) using CF-sensing catheter.PVI was performed in 32 patients using a CF-sensing catheter.

Ventricular arrhythmias arising from the left ventricular outflow tract below the aortic sinus cusps: mapping and catheter ablation via transseptal approach and electrocardiographic characteristics.

Background: Ventricular arrhythmias (VAs) originating from the anterosuperior left ventricular outflow tract (LVOT) represent a challenging location for catheter ablation. This study investigates mapping and ablation of VA from anterosuperior LVOT via a transseptal approach.

Methods And Results: This study included 27 patients with symptomatic VA, of which 13 patients had previous failed ablations.

THERMOCOOL® SMARTTOUCH® CATHETER - The Evidence So Far for Contact Force Technology and the Role of VISITAG™ MODULE.

Catheter ablation has become an important modality in the treatment of most cardiac arrhythmias. In recent years there has been significant development of new ablation energies and technologies in an attempt to improve clinical outcomes and decrease disease burden. Ablation failure is often associated with inadequate lesion formation, and catheter-to-myocardial contact force (CF) and catheter stability are two of the parameters required to produce effective lesions during radiofrequency energy application.

Repeated radiofrequency ablation of atrial tachycardia in restrictive cardiomyopathy secondary to myofibrillar myopathy.

Myofibrillar myopathy is characterized by nonhyaline and hyaline lesions due to mutations in nuclear genes encoding for extra-myofibrillar or myofibrillar proteins. Cardiac involvement in myofibrillar myopathy may be phenotypically expressed as dilated, hypertrophic, or restrictive cardiomyopathy. Radiofrequency ablation of atrial fibrillation and flutter has so far not been reported in myofibrillar myopathy.

[Syncope : epidemiology, definition, classification, pathophysiology and prognosis].

Syncope is a common clinical issue. Around 40 % of the total population experience syncope during their lifetime. Serious injuries and reduced quality of life are often observed after syncope.

One-year clinical outcome after pulmonary vein isolation using the second-generation 28-mm cryoballoon.

Background: The use of second-generation cryoballoon for pulmonary vein isolation in patients with paroxysmal atrial fibrillation has demonstrated encouraging acute and mid-term results. Long-term outcome data are not yet available.

Methods And Results: Fifty patients (18 women; mean age, 61±11 years; mean left atrial diameter, 43±5 mm) with paroxysmal (36 of 50 patients; 72%) or short-standing (<3-month duration) persistent atrial fibrillation (14 of 50 patients; 28%) underwent cryoballoon-based pulmonary vein isolation.

Electrical isolation of a substrate after myocardial infarction: a novel ablation strategy for unmappable ventricular tachycardias--feasibility and clinical outcome.

Aims: Catheter ablation can abolish clinical ventricular tachycardia (VT) in patients after myocardial infarction (MI). However, VT frequently recurs after ablation. The best ablation strategy is still unknown, particularly in patients with unmappable VTs.

Effects of sex on the incidence of cardiac tamponade after catheter ablation of atrial fibrillation: results from a worldwide survey in 34 943 atrial fibrillation ablation procedures.

Background: Cardiac tamponade is the most dramatic complication observed during atrial fibrillation (AF) ablation and the leading cause of procedure-related mortality. Female sex is a known risk factor for complications during AF ablation; however, it is unknown whether women have a higher risk of tamponade.

Methods And Results: A systematic Medline search was used to locate academic electrophysiological centers that reported cases of tamponade occurring during AF ablation.

In vivo left-ventricular contact force analysis: comparison of antegrade transseptal with retrograde transaortic mapping strategies and correlation of impedance and electrical amplitude with contact force.

Aims: Clinical outcomes following radiofrequency ablation of ventricular tachycardias (VTs) depend on catheter tip-to-tissue contact force (CF). Left-ventricular (LV) mapping is performed via antegrade-transseptal or retrograde-transaortic approaches, and the applied CF may depend on the approach used. This study evaluated (i) the impact of antegrade-transseptal vs.

The incidence of phrenic nerve injury during pulmonary vein isolation using the second-generation 28 mm cryoballoon.

Introduction: The second-generation cryoballoon (CB; Arctic Front Advance, Medtronic Inc., Minneapolis, MN, USA) has demonstrated greater procedural efficacy compared to the original CB. Whether increased efficacy translates into a higher incidence of phrenic nerve (PN) injury needs further evaluation.

In vivo contact force analysis and correlation with tissue impedance during left atrial mapping and catheter ablation of atrial fibrillation.

Background: The aim of this study was to evaluate in vivo contact force (CF) and the correlation of CF with impedance during left atrial 3-dimensional electroanatomical mapping and ablation.

Methods And Results: CF during point-by-point left atrial mapping was assessed in 30 patients undergoing atrial fibrillation ablation. Operators were blinded to the real-time CF data.

Wide circumferential versus individual isolation of pulmonary veins using the endoscopic ablation system.

Introduction: The endoscopic ablation system (EAS) allows for effective pulmonary vein isolation (PVI). The feasibility of wide circumferential as compared to individual PVI using the EAS has not been formally assessed.

Methods: Patients with paroxysmal or short-persistent atrial fibrillation were assigned to individual PVI (group A) or wide circumferential PVI (group B).

Asymptomatic brain lesions following laserballoon-based pulmonary vein isolation.

Aims: Laserballoon-based pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) has proven safe and effective. Silent brain lesions after AF ablation detected on magnetic resonance imaging (MRI) have been described for several technologies, but its incidence following laserballoon PVI is unknown. The current study sought to assess the incidence of new asymptomatic brain lesions in patients undergoing laserballoon-based PVI.

Left atrial isthmus line ablation using a remote robotic navigation system: feasibility, efficacy and long-term outcome.

Background: Left atrial isthmus (LAI)-ablation in addition to circumferential pulmonary vein isolation (CPVI) may improve outcomes in select patients with atrial fibrillation (AF). However, bidirectional LAI-block is difficult to obtain. No systematic evaluation reporting on the feasibility and efficacy of LAI-ablation using a robotic navigation system (RNS) exists.

Increased incidence of esophageal thermal lesions using the second-generation 28-mm cryoballoon.

Background: Pulmonary vein isolation is an established treatment option for atrial fibrillation. To date, the incidence and quality of ablation-induced esophageal thermal lesions (ETLs) using the recently introduced second-generation cryoballoon (CB, ArcticFront Advance, Medtronic) is unknown.

Methods And Results: In patients with drug-refractory paroxysmal atrial fibrillation or short-standing persistent atrial fibrillation, pulmonary vein (PV) isolation was performed using the second-generation CB.

A survey of German centres performing invasive electrophysiology: structure, procedures, and training positions.

Aims: To provide a nationwide survey (and reference for the future) on cardiac electrophysiologists, types and numbers of invasive electrophysiological procedures, and training opportunities in 2010.

Methods And Results: German cardiology centres performing invasive electrophysiology were identified from quality reports and contacted to fill a questionnaire. A majority of 122 centres (65%) responded.

[Catheter ablation of paroxysmal atrial fibrillation. Optimal approach and result].

The gold standard in ablation of paroxysmal atrial fibrillation (PAF) is radiofrequency (RF) based point by point pulmonary vein isolation (PVI). In the majority of patients with PAF (80 %) PVI can restore stable SR even during long-term follow-up of up to 5 years. However multiple procedures are often required.

Aborted sudden cardiac death due to radiofrequency ablation within the coronary sinus and subsequent total occlusion of the circumflex artery.

We report a case of aborted sudden cardiac death and subsequent development of malignant drug-refractory incessant ventricular tachycardia/fibrillation in a patient with acute coronary artery occlusion following radiofrequency ablation within the CS. Catheter ablation is a well-established therapy for treatment of atrial fibrillation (AF). In patients with longstanding persistent AF extensive left atrial ablation and ablation inside the coronary sinus (CS) is frequently performed.

Study design of the man and machine trial: a prospective international controlled noninferiority trial comparing manual with robotic catheter ablation for treatment of atrial fibrillation.

Background: Pulmonary vein isolation (PVI) has become the cornerstone procedure for the treatment of symptomatic drug-resistant atrial fibrillation (AF). At the present time, circumferential PVI (CPVI) using irrigated radiofrequency (RF) is the mostly used ablation technique. However, for CPVI, precise catheter navigation and excellent catheter stability is crucial thereby requiring experienced operators.