The internal jugular approach for baffle puncture and ablation of atrial arrhythmias in patients with atrial switch procedures: a retrospective analysis.

Background: Patients with transposition of the great arteries (TGA) who undergo atrial switch procedures may develop symptomatic atrial arrhythmias necessitating ablation. We present a single-centre retrospective analysis of a novel approach using jugular access for catheter ablation in this unique patient population.

Methods: A 5-year retrospective analysis was conducted on patients referred for atrial arrhythmia ablation following atrial switch procedures.

Predictors of the need for atrioventricular nodal ablation following redo ablation for atrial fibrillation.

Background: Patients who have recurrent atrial fibrillation (AF) following redo catheter ablation may eventually be managed with a pace-and-ablate approach, involving pacemaker implant followed by (AVNA). We sought to determine which factors would predict subsequent AVNA in patients undergoing redo AF ablation.

Methods: We analyzed patients undergoing redo AF ablations between 2013 and 2019 at our institution.

Cost, efficiency, and outcomes of pulsed field ablation vs thermal ablation for atrial fibrillation: A real-world study.

Background: With the exponential growth of catheter ablation for atrial fibrillation (AF), there is increasing interest in associated health care costs. Pulsed field ablation (PFA) using a single-shot pentaspline multielectrode catheter has been shown to be safe and effective for AF ablation, but its cost efficiency compared to conventional thermal ablation modalities (cryoballoon [CB] or radiofrequency [RF]) has not been evaluated.

Objective: The purpose of this study was to compare cost, efficiency, effectiveness, and safety between PFA, CB, and RF for AF ablation.

Delineating postinfarct ventricular tachycardia substrate with dynamic voltage mapping in areas of omnipolar vector disarray.

Background: Defining postinfarct ventricular arrhythmic substrate is challenging with voltage mapping alone, though it may be improved in combination with an activation map. Omnipolar technology on the EnSite X system displays activation as vectors that can be superimposed onto a voltage map.

Objective: The study sought to optimize voltage map settings during ventricular tachycardia (VT) ablation, adjusting them dynamically using omnipolar vectors.

Silent pulmonary veins at redo ablation for atrial fibrillation: Implications and approaches.

Background: Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Despite promising success rates, redo ablation is sometimes required. At redo, PVs may be found to be isolated (silent) or reconnected.

An approach to help differentiate postinfarct scar from borderzone tissue using Ripple Mapping during ventricular tachycardia ablation.

Background: Ventricular scar is traditionally highlighted on a bipolar voltage (BiVolt) map in areas of myocardium <0.50 mV. We describe an alternative approach using Ripple Mapping (RM) superimposed onto a BiVolt map to differentiate postinfarct scar from conducting borderzone (BZ) during ventricular tachycardia (VT) ablation.

Incidence of vascular complications for electrophysiology procedures in the ultrasound era: a single-centre experience over 10,000 procedures in the long term.

Background: Ultrasound (US) is being increasingly used to guide vascular access for electrophysiology (EP) procedures in many centres. Nonetheless, the incidence and predictors of vascular complications in the US era are limited. In this study, we describe our experience of vascular access-related complications associated with EP procedures which were performed with the routine use of US-guided vascular access.

Impact of COVID-19 on patients awaiting ablation for atrial fibrillation.

Objective: Atrial fibrillation (AF) ablation services were significantly affected by the COVID-19 pandemic. We aimed to evaluate a symptom-based clinician prioritisation scheme for waiting list management compared with patient-completed quality of life (QoL) scores. We also sought to understand factors influencing QoL, particularly the impact of COVID-19, on patients awaiting AF ablation, via a bespoke questionnaire.

Impact of bridging with left ventricular assist device on right ventricular function following heart transplantation.

Aims: Patients awaiting orthotopic heart transplantation (OHT) can be bridged utilizing a left ventricular assist device (LVAD) that reduces left ventricular filling pressures, decreases pulmonary artery wedge pressure, and maintains adequate cardiac output. This study set out to examine the poorly investigated area of if and how pre-treatment with LVAD impacts right ventricular (RV) function following OHT.

Methods And Results: We prospectively evaluated 59 (LVAD n = 20) consecutive OHT patients.

Right ventricular stroke work index by echocardiography in adult patients with pulmonary arterial hypertension.

Background: In adult patients with pulmonary arterial hypertension (PAH), right ventricular (RV) failure may worsen rapidly, resulting in a poor prognosis. In this population, non-invasive assessment of RV function is challenging. RV stroke work index (RVSWI) measured by right heart catheterization (RHC) represents a promising index for RV function.

Echocardiographic assessment of chamber size and ventricular function during the first year after heart transplantation.

Aims: Detecting changes in ventricular function after orthotopic heart transplantation (OHT) using transthoracic echocardiography (TTE) is important but interpretation of findings is complicated by lack of data on early graft adaptation. We sought to evaluate echocardiographic measures of ventricular size and function the first year following OHT including speckle tracking derived strain. We also aimed to compare echocardiographic findings to haemodynamic parameters obtained by right heart catheterization (RHC).

The feasibility and effectiveness of a streamlined single-catheter approach for radiofrequency atrial fibrillation ablation.

Background: Catheter ablation for atrial fibrillation (AF) traditionally requires the use of circular mapping catheter (CMC) for pulmonary vein isolation (PVI). This study aimed to assess the feasibility and effectiveness of a CMC-free approach for AF ablation performed by a contiguous optimized (CLOSE) ablation protocol.

Methods: A CLOSE-guided and CMC-free PVI protocol with a single transseptal puncture was attempted in 67 patients with AF.

Right ventricular function parameters in pulmonary hypertension: echocardiography vs. cardiac magnetic resonance.

Background: Right ventricular (RV) function is a major determinant of outcome in patients with pulmonary hypertension. Cardiac magnetic resonance (CMR) is gold standard to assess RV ejection fraction (RVEF), however this is a crude measure. New CMR measures of RV function beyond RVEF have emerged, such as RV lateral atrio-ventricular plane displacement (AVPD), maximum emptying velocity (S'), RV fractional area change (FAC) and feature tracking of the RV free wall (FWS).

Same-day discharge in selected patients undergoing atrial fibrillation ablation.

Background: Atrial fibrillation (AF) ablation is a complex procedure, generally requiring at least one overnight hospital stay. We investigated the safety and feasibility of early mobilization and same-day discharge following streamlined peri-ablation management for AF.

Methods: From 2014, we offered same-day discharge to selected patients who underwent uncomplicated AF ablation on the morning lists, with ultrasound-guided femoral access, uninterrupted warfarin or minimal interruption in novel oral anticoagulants, and reversal of intraprocedural heparin with protamine.

Impact of gender on echocardiographic characteristics in heart transplant recipients.

Aims: Assessment following heart transplantation (HTx) is routinely performed using transthoracic echocardiography. Differences in long-term mortality following HTx related to donor-recipient matching have been reported, but effects of gender on cardiac size and function are not well studied. The aims of this study were to evaluate differences in echocardiographic characteristics of HTx recipients defined by gender.

Early experience of thoracoscopic vs. catheter ablation for atrial fibrillation.

Aims: Video-assisted thoracoscopic surgery (VATS) ablation has been advocated as a treatment option for non-paroxysmal atrial fibrillation (AF) in recent guidelines. Real-life data on its safety and efficacy during a centre's early experience are sparse.

Methods And Results: Thirty patients (28 persistent/longstanding persistent AF) underwent standalone VATS ablation for AF by an experienced thoracoscopic surgeon, with the first 20 cases proctored by external surgeons.

Echocardiographic right ventricular strain from multiple apical views is superior for assessment of right ventricular systolic function.

Background: Right ventricular (RV) systolic function is an important determinant of outcome in patients with pulmonary hypertension (PH). Conventional echocardiographic measures of RV are mainly based on longitudinal contractility. Recently, measurement of RV global longitudinal strain derived from multiple windows (RVGLS) has emerged as an option but has not been well evaluated.

Demonstration of pulmonary vein exit block following pulmonary vein isolation: A novel use for adenosine.

Introduction: Demonstration of exit block after pulmonary vein isolation (PVI) is the cornerstone of ablation for atrial fibrillation (AF). It requires the demonstration of local pulmonary vein (PV) capture and absence of conduction to the atrium but is often challenging due to the inability to see local paced PV-evoked potentials. We retrospectively examined the ability of adenosine to augment this technique during CARTO-based radiofrequency ablation procedures.

Systematic re-evaluation of SCN5A variants associated with Brugada syndrome.

Background: A large number of SCN5A variants have been reported to underlie Brugada syndrome (BrS). However, the evidence supporting individual variants is highly heterogeneous.

Objective: We systematically re-evaluated all SCN5A variants reported in BrS using the 2015 American college of medical genetics and genomics and the association for molecular pathology (ACMG-AMP) guidelines.

Natural progression of QRS duration in ICD-only patients.

Purpose: The aim of our study is to determine if there is a natural progression of QRSd in ICD-only patients.

Methods And Results: Retrospective study over a 7-year period of 86 consecutive patients who underwent ICD-only implantation in 2008 at the Liverpool Heart and Chest Hospital, UK. The mean age at ICD implantation was 62.

Pulmonary Vein Re-Isolation as a Routine Strategy Regardless of Symptoms: The PRESSURE Randomized Controlled Trial.

Objectives: The goal of this study was to determine whether a strategy of early re-isolation of pulmonary vein (PV) reconnection in all patients, regardless of symptoms, would reduce the recurrence of atrial fibrillation (AF) and improve quality of life.

Background: Lasting pulmonary vein isolation (PVI) remains elusive. PV reconnection is strongly linked to the recurrence of arrhythmia.

Normal Reference Ranges for Transthoracic Echocardiography Following Heart Transplantation.

Background: Heart function following heart transplantation (HTx) is influenced by numerous factors. It is typically evaluated using transthoracic echocardiography, but reference values are currently unavailable for this context. The primary aim of the present study was to derive echocardiographic reference values for chamber size and function, including cardiac mechanics, in clinically stable HTx patients.

Right ventricular speckle tracking assessment for differentiation of pressure- versus volume-overloaded right ventricle.

Background: Right ventricular (RV) dysfunction may be caused by either pressure or volume overload. RV function is conventionally assessed with echocardiography using tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RVFAC), tricuspid lateral annular systolic velocity (S') and RV index of myocardial performance (RIMP). The purpose of this study was to evaluate whether RV global longitudinal strain (RVGLS) and RV-free wall strain (RV-free) could add additional information to differentiate these two causes of RV overload.

Long-term outcomes after ablation of persistent atrial fibrillation: an observational study over 6 years.

Objectives: To address the limited long-term outcome data for catheter ablation (CA) of persistent atrial fibrillation (PeAF), we analysed consecutive ablations performed at our centre from 1 January 2008 to 31 December 2010 and followed patients prospectively until January 2014.

Methods: Both arrhythmia recurrence and symptom relief were assessed. Follow-up data were collected from hospital records, supplemented by data from general practitioners and referring hospitals.