Bipolar catheter ablation with dedicated radiofrequency system for highly refractory ventricular arrhythmia-Does the rate of success depend on arrhythmia origin?

Introduction: Despite rapid technological progress, some arrhythmias are still resistant to standard unipolar ablation. These include arrhythmias arising from the base of the heart, cardiac crux, or epicardium. Bipolar radiofrequency ablation (B-RFA) may be useful in some cases, however, data on the efficacy of this approach in various arrhythmia localizations are scarce.

Cardioneuroablation for reflex asystolic syncope: Mid-term safety, efficacy, and patient's acceptance.

Background: Cardioneuroablation (CNA) is a promising therapy for reflex asystolic syncope; however, convincing data on the mid-term safety and efficacy of this procedure are lacking.

Objective: The purpose of this study was to assess the mid-term safety, efficacy, and patient acceptance of CNA.

Methods: This prospective observational single-center study included 115 consecutive patients (mean age 39 ± 13 years; 58% female) treated between 2016 and 2022 who completed at least 1-year follow-up.

Subclinical Dysfunction of Left Atrial Compliance after Cryoballoon versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation.

It has been suggested that cryoballoon (CB) ablation for paroxysmal atrial fibrillation (PAF) may lead to more extensive left atrial (LA) injury than radiofrequency (RF) ablation; however, results are conflicting. We sought to address this issue using modern echocardiographic techniques estimating the LA function after successful CB and RF ablation for PAF. A total of 90 patients (66% males, mean age 57 ± 10 years) successfully treated (no AF recurrences confirmed in serial 4-7 day ECG Holter monitoring) with RF (51%) or CB (49%) ablation for PAF were retrospectively studied.

Is catheter-tissue contact force value important for ablation of ventricular arrhythmias originating from the left ventricular papillary muscles?

Background: Good catheter-tissue contact is mandatory to create effective ablation lesions. The minimal contact force value for ablation of arrhythmias originating from the left ventricle is 8.0-10.

Cardioneuroablation for Reflex Syncope: Efficacy and Effects on Autonomic Cardiac Regulation-A Prospective Randomized Trial.

Background: Treatment of cardioinhibitory vasovagal syncope (VVS) is difficult. Recently, cardioneuroablation (CNA) has emerged as a new therapeutic option.

Objectives: This study sought to assess the effects of CNA on syncope recurrences in patients with VVS.

Ultrasound-guided extracardiac vagal stimulation-New approach for visualization of the vagus nerve during cardioneuroablation.

Background: Fluoroscopy-guided extracardiac vagal stimulation (ECVS) from the internal right and left jugular veins (RIJV and LIJV) is routinely used to document vagal response (sinus arrest and/or atrioventricular block) during cardioneuroablation. Ultrasound-guided ECVS allows direct visualization and selective stimulation of the vagus nerve (VN).

Objectives: The objectives of this study were to assess the feasibility of ultrasound-guided ECVS and to compare it with fluoroscopy-guided ECVS.

Daily ECG transmission versus serial 6-day Holter ECG for the assessment of efficacy of ablation for atrial fibrillation - the AGNES-ECG study.

Purpose: To compare daily ECG transmissions using trans-telephonic monitoring (TTM) with repeated 6-day Holter ECG in detecting atrial fibrillation (AF) episodes following ablation.

Methods: Each patient underwent two types of recordings: daily ECG TTM lasting 30 s and standard 6-day ambulatory ECG monitoring performed 3, 6, and 12 months after ablation. Number of patients with detected AF recurrences, time to first detected recurrence of AF, and AF burden were assessed.

Cardioneuroablation changes the type of vasovagal response in patients with asystolic reflex syncope.

Background: Cardioneuroablation (CNA) has been recently proposed as a new therapy in patients with asystolic vasovagal syncope (VVS) caused by parasympathetic overactivity.

Objective: To assess the impact of CNA on the type of VV response during tilt testing (TT).

Methods: The study group consisted of 20 patients (7 males, mean age 38 ± 9).

Cardioneuroablation - Induced shift in sinus node activation: A new parameter of vagal denervation?

Experimental studies demonstrated a shift in the leading pacemaker site based on parasympathetic or sympathetic dominance. Radiofrequency catheter ablation of ganglionated plexi (GP) might be used to overcome deleterious effects of enhanced parasympathetic tone. Herein, we present two patients who underwent GP ablation due to cardioinhibitory type reflex syncope and symptomatic bradycardia, respectively.

Ablation for paroxysmal atrial fibrillation-real-life results from a middle-volume electrophysiology laboratory.

Introduction: A significant improvement in safety and efficacy of ablation for paroxysmal atrial fibrillation (PAF) has been reported by experienced centers over recent years; however, data from real-life surveys and smaller electrophysiology (EP) laboratories have been less optimistic.

Aim: To asses efficacy of ablation for PAF in a middle-volume EP center over last years.

Methods: Retrospective analysis of 1 year efficacy and safety of ablation for PAF in three cohorts of patients treated between 2011 and 2014 (period I), 2015-2017 (period II), and 2018-2019 (period III).

Acceleration of sinus rhythm following ablation for atrial fibrillation: a simple parameter predicting ablation efficacy.

Background: Pulmonary vein isolation (PVI) is a well‑established treatment method in patients with paroxysmal atrial fibrillation (AF). However, the predictors of a successful outcome are less well known. It has been suggested that PVI‑induced changes in autonomic control of sinus rate (SR) may correspond to ablation efficacy.

Long-term follow-up and comparison of techniques in radiofrequency ablation of ventricular arrhythmias originating from the aortic cusps (AVATAR Registry).

Introduction: Radiofrequency ablation (RFA) of outflow tract ventricular arrhythmia (VA) that originates from the aortic cusps can be challenging. Data on long‑ term efficacy and safety as well as optimal technique after aortic cusp ablation have not previously been reported.

Objectives: This aim of the study was to determine the short- and long‑ term outcomes after RFA of aortic cusp VA, and to evaluate aortic valve injuries according to echocardiographic screening.

Risk of left atrial appendage thrombus in patients scheduled for ablation for atrial fibrillation: beyond the CHA2DS2VASc score.

Introduction: Atrial fibrillation (AF) increases the risk of thromboembolic events by promoting clot formation in the left atrial appendage (LAA). Transesophageal echocardiography (TEE) is routinely used to exclude the presence of an LAA thrombus before AF ablation. So far, it has not been established what is the optimal combination of noninvasive parameters for thromboembolic risk stratification in this setting and whether patients at very low risk require TEE.

Intracardiac echocardiography for immediate detection of intracardiac thrombus formation.

An 85-year-old man with persistent atrial flutter (AFL) with slow ventricular rate of 44/min, causing fatigue and presyncope, was referred for urgent treatment. In spite of thromboembolic risk scale value 4, he had not been treated with anticoagulants because of high risk of bleeding. The decision was made to perform urgent catheter ablation to interrupt and cure AFL.

Intracardiac echocardiography for detection of thrombus in the left atrial appendage: comparison with transesophageal echocardiography in patients undergoing ablation for atrial fibrillation: the Action-Ice I Study.

Background: Transesophageal echocardiography (TEE) is the gold standard for the exclusion of thrombi in the left atrial appendage (LAA) before ablation for atrial fibrillation. Intracardiac echocardiography (ICE) is used to assist atrial fibrillation ablation; however, it can also be used for LAA imaging. The aim of our study was to determine whether ICE could replace TEE and to identify the optimal ICE placement for LAA visualization.

Impact of radiofrequency catheter ablation on echocardiographic and cardiopulmonary performance in patients with ventricular extrasystolic beats and suspected arrhythmia-induced cardiomyopathy.

Integrated backscatter intravascular ultrasound (IB-IVUS) is a useful method for analyzing coronary plaque tissue. We evaluated whether tissue composition determined using IB-IVUS is associated with the progression of stenosis in coronary angiography. Sixty-three nontarget coronary lesions in 63 patients with stable angina were evaluated using conventional IVUS and IB-IVUS.

Ablation of atrioventricular nodal reentrant tachycardia: predictors of long-term success.

Background: Atrioventricular nodal reentrant tachycardia (AVNRT) is the commonest regular supraventricular tachyarrhythmia. Ablation in the area of slow pathway (SP) has been successfully implemented in everyday clinical electrophysiological practice for more than 20 years. Although the procedure is generally regarded as effective and safe, data on long-term effects and predictors of success or failure are incomplete.

Antazoline for rapid termination of atrial fibrillation during ablation of accessory pathways.

Background And Aim: To assess safety and efficacy of antazoline for termination of atrial fibrillation (AF) occurring during ablation of accessory pathways (AP).

Methods: We analyzed electrophysiological mechanism of antazoline (changes in A-A interval) and the percentage of pre-excited QRS complexes before and after antazoline administration. The total dose administered and the time from the start of injection to sinus rhythm restoration were also measured.

"Rescue" ablation of electrical storm in arrhythmogenic right ventricular cardiomyopathy in pregnancy.

Background: Radiofrequency ablation (RFCA) became a treatment of choice in patients with recurrent ventricular tachycardia, ventricular fibrillation, and appropriate interventions of implanted cardioverter-defibrillator (ICD), however, electrical storm (ES) ablation in a pregnant woman has not yet been reported.

Case Presentation: We describe a case of a successful rescue ablation of recurrent ES in a 26-year-old Caucasian woman during her first pregnancy (23rd week). The arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) was diagnosed 3 years earlier and several drugs as well as 2 ablations failed to control recurrences of ventricular tachycardia.

Benign symptomatic premature ventricular complexes: short- and long-term efficacy of antiarrhythmic drugs and radiofrequency ablation.

Background: There is little data on the long-term efficacy of antiarrhythmic drugs (AADs) and radiofrequency catheter ablation (RFCA) in patients with symptomatic premature ventricular complexes (PVCs) and no organic heart disease.

Aim: To evaluate the short- and long-term efficacy and tolerance of AAD therapy and RFCA in patients with idiopathic PVCs.

Methods: This was a prospective, crossover, open-label study performed in 84 consecutive patients (mean age 47 ± 15 years; 60% women) with symptomatic idiopathic PVCs (mean PVCs/24 h, 13,768 ± 9,424; range 1,693-42,687).

Efficacy of low energy rectilinear biphasic cardioversion for regular atrial tachyarrhythmias.

Background: External, rectilinear biphasic cardioversion (RBC), as against monophasic cardioversion, requires lower energy and has been documented to be more effective in restoring sinus rhythm in atrial fibrillation (AF). There is, however, limited data on the optimal protocol of low energy RBC in atrial flutter (AFl) and regular atrial tachyarrhythmias (AT).

Methods And Results: A prospective, single-center study was conducted, wherein 50 consecutive patients (mean age: 70.

[Pulmonary vein isolation with the use of high-density mesh ablator - a case report].

We present a case of a 49 year-old man without structural heart disease who suffered from frequent episodes of atrial fibrillation. We performed pulmonary vein isolation using a new system High-Density Mesh Ablation. All four pulmonary veins were isolated and during an 8-month follow-up period no arrhythmia recurrences were noted.

First experience with microprobe transoesophageal echocardiography in non-sedated adults undergoing atrial fibrillation ablation: feasibility study and comparison with intracardiac echocardiography.

Aims: Imaging of the left atrium (LA) is mandatory during catheter ablation of atrial fibrillation (AF) and may be achieved by echocardiography. The aim of the present study was to assess the feasibility of using a recently released transoesophageal echocardiography (TEE) microprobe (micro-TEE) in non-sedated adult patients undergoing AF ablation and to directly compare this new technique with intracardiac echocardiography (ICE).

Methods And Results: The study group consisted of 12 consecutive patients (8 males, mean age 49 ± 14 years) who underwent first radiofrequency AF ablation.