Contact-force local impedance algorithm to guide effective pulmonary vein isolation in AF patients: 1-year outcome from an international multicenter clinical setting.

Background: The combination of highly localized impedance (LI) and contact force (CF) may improve tissue characterization and lesion prediction during radiofrequency (RF) pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF).

Objective: We report the outcomes of our acute and long-term clinical evaluation of CF-LI-guided PVI in consecutive AF ablation cases from an international multicenter clinical setting.

Methods: Three hundred twenty-four consecutive patients from 20 European centers undergoing RF catheter ablation with the Stablepoint™ catheter were enrolled in the CHARISMA registry.

Insight into contact force local impedance technology for predicting effective pulmonary vein isolation.

Background: Highly localized impedance (LI) measurements during atrial fibrillation (AF) ablation have the potential to act as a reliable predictor of the durability of the lesions created.

Objective: We aimed to collect data on the procedural parameters affecting LI-guided ablation in a large multicenter registry.

Methods: A total of 212 consecutive patients enrolled in the CHARISMA registry and undergoing their first pulmonary vein (PV) isolation for paroxysmal and persistent AF were included.

Improved procedural workflow for catheter ablation of paroxysmal AF with high-density mapping system and advanced technology: Rationale and study design of a multicenter international study.

Background: The antral region of pulmonary veins (PV)s seems to play a key role in a strategy aimed at preventing atrial fibrillation (AF) recurrence. Particularly, low-voltage activity in tissue such as the PV antra and residual potential within the antral scar likely represent vulnerabilities in antral lesion sets, and ablation of these targets seems to improve freedom from AF. The aim of this study is to validate a structured application of an approach that includes the complete abolition of any antral potential achieving electrical quiescence in antral regions.

When local impedance meets contact force: preliminary experience from the CHARISMA registry.

Purpose: Highly localized impedance (LI) measurements during atrial fibrillation (AF) ablation have emerged as a viable real-time indicator of tissue characteristics and the consequent durability of the lesions created. We investigated the impact of catheter-tissue contact force (CF) on LI behavior during pulmonary vein isolation (PVI).

Methods: Forty-five consecutive patients of the CHARISMA registry undergoing de novo AF radiofrequency (RF) catheter ablation with a novel open-irrigated-tip catheter endowed with CF and LI measurement capabilities (Stablepoint™ catheter, Boston Scientific) were included.

Contact-Force Guided Posterior Wall Isolation as an Adjunctive Ablation Strategy for Persistent Atrial Fibrillation.

Background: The efficacy of posterior wall isolation (PWI) on top of pulmonary vein isolation (PVI) in patients affected by persistent atrial fibrillation (AF) is still controversial and little is known about the impact of contact-force (CF) technology.

Objective: In this retrospective study, we present our experience with PWI using CF sensing catheters and its efficacy and safety as an adjunctive ablation strategy on top of PVI for management of patients with persistent and longstanding persistent AF.

Methods: A total of 73 consecutive patients (20.

Combined therapy with subcutaneous implantable cardiac defibrillator and leadless pacemaker in a patient with persistent left superior vena cava and mega coronary sinus: A challenging case for the best treatment.

In a patient requiring pacing and defibrillation therapy, but without superior venous access, combined therapy with S-ICD and leadless pacemaker could be the best solution. An appropriate programming of both devices represents the technical challenge in order to avoid inappropriate shocks due to leadless pacing oversensing.

Updated national multicenter registry on procedural safety of catheter ablation for atrial fibrillation.

Introduction: Despite catheter ablation (CA) becoming an accepted treatment option for symptomatic, drug-resistant atrial fibrillation (AF), safety of this procedure continues to be cause for concern. Aim of the present multicenter registry was to assess the incidence of early CA complications and detect their predictors in a contemporary, unselected AF population

Methods And Results: From January 1, 2011 to December 31, 2011, data from 2,323 consecutive patients who underwent CA (median age 60 [52-67]; 72.3% male) for AF in 29 Italian centers were collected.

Selection of Medications to Prevent Stroke Among Individuals With Atrial Fibrillation : Update on Prevention of Stroke in Patients with AF.

Vitamin K antagonists have been the only available orally active anticoagulants for decades. Although effective, their numerous limitations have driven the introduction of new oral anticoagulants (NOAs) that showed effectiveness at fixed doses without the need for routine coagulation monitoring. However, the safety and efficacy observed in controlled clinical trials may be hard to translate in clinical practice.

Nonfluoroscopic mapping reduces radiation exposure in ablation of atrial fibrillation.

Background: Radiofrequency catheter ablation (RFCA) of atrial fibrillation is an effective and definitive treatment. The methods used to guide RFCA have evolved over the years from a purely electrophysiological approach, in which anatomical lesions were guided solely by fluoroscopy and angiographic imaging of the pulmonary veins, to an approach guided by modern nonfluoroscopic electroanatomical mapping, integrated or not with computed tomography (CT). The aim of this study was, therefore, to compare radiation exposure of RFCA based on a fast three-dimensional nonfluoroscopic mapping system with 'traditional' mapping integrated with CT imaging.

Catheter ablation of atrial fibrillation in patients with diabetes mellitus type 2: results from a randomized study comparing pulmonary vein isolation versus antiarrhythmic drug therapy.

Introduction: Atrial fibrillation (AF) and diabetes mellitus type 2 (DM2) often coexist; however, a small number of patients with DM2 undergoing catheter ablation (CA) of AF have been included in previous studies. The aim of this study was to evaluate safety and efficacy of ablation therapy in DM2 patients with drug refractory AF.

Methods And Results: From January 2005 to September 2006, 70 patients with a diagnosis of DM2 and paroxysmal (n = 29) or persistent (n = 41) AF were randomized to receive either pulmonary vein isolation or a new antiarrhythmic drug treatment (ADT) with a 1-year follow-up.

Gender-related differences in catheter ablation of atrial fibrillation.

Aims: Women have an increased risk for atrial fibrillation (AF)-related complications and there is evidence towards a reduced efficacy of the rhythm control strategy than men. A catheter-based strategy is therefore widely attractive, but the impact of gender on catheter ablation (CA) of AF remains undefined.

Methods And Results: We included 221 consecutive patients (150 men) who underwent CA of drug-refractory AF.

Estimation of coronary flow reserve by Tc-99m sestamibi imaging in patients with coronary artery disease: comparison with the results of intracoronary Doppler technique.

Background: This study compared coronary flow reserve (CFR) estimated by technetium 99m sestamibi imaging with the results obtained with intracoronary Doppler in patients with coronary artery disease. Intraobserver and interobserver reproducibility of the radionuclide-estimated CFR was also assessed.

Methods And Results: Fourteen consecutive patients (mean age, 54 +/- 7 years) with documented coronary artery disease in whom percutaneous coronary intervention was planned underwent dipyridamole (0.