Role of inducibility and its dynamic change in the outcome of catheter ablation of atrial fibrillation: a single center prospective study.

Background: The role of atrial arrhythmia inducibility as an endpoint of catheter ablation of atrial fibrillation (AF) has been a controversial subject in many studies. Our goal is to evaluate the significance of inducibility, the impact of multiple sites or protocols of stimulation or the change in inducibility status in a prospective study including patients with AF undergoing first catheter ablation.

Methods: We studied 170 consecutive patients with AF (62.

Sex differences of resource utilisation and outcomes in patients with atrial arrhythmias and heart failure.

Objective: Atrial fibrillation or atrial flutter (AF) and heart failure (HF) often go hand in hand and, in combination, lead to an increased risk of death compared with patients with just one of both entities. Sex-specific differences in patients with AF and HF are under-reported. Therefore, the aim of this study was to investigate sex-specific catheter ablation (CA) use and acute in-hospital outcomes in patients with AF and concomitant HF in a retrospective cohort study.

In-hospital mortality of patients with atrial arrhythmias: insights from the German-wide Helios hospital network of 161 502 patients and 34 025 arrhythmia-related procedures.

Aims: Atrial fibrillation (AFib) and atrial flutter (AFlut) are common arrhythmias with increased use of invasive procedures. A steady re-evaluation of relevant safety endpoints is recommended and both quality management and pay-for-performance programs are evolving. Therefore, the aims of this study were (i) to investigate and report overall in-hospital mortality and mortality of invasive arrhythmia-related procedures and (ii) to identify mortality predictors in a German-wide hospital network.

Cardiac tamponade in catheter ablation of atrial fibrillation: German-wide analysis of 21 141 procedures in the Helios atrial fibrillation ablation registry (SAFER).

Aims: Catheter ablation is an established therapy in patients with symptomatic atrial fibrillation (AF) with increasing popularity. Pericardial effusion requiring intervention (PE) is one of the most threatening adverse outcomes. The aim of this study was to examine rates of PE after catheter ablation in a large 'real-world' data set in a German-wide hospital network.

Left ventricular wall motion analysis to guide management of CRT non-responders.

Aims: A discordant left ventricular (LV) lead position can be responsible for cardiac resynchronization therapy (CRT) non-response. In this study, tailored optimization of the individual LV wall motion was evaluated for the outcome in these patients.

Methods And Results: Two hundred and forty-six CRT outpatients were screened for non-response due to a discordant LV lead.

Ventriculoatrial conduction and related pacemaker-mediated arrhythmias in patients implanted for atrioventricular block: an old problem revisited.

Introduction: Ventriculoatrial (VA) conduction and related pacemaker-mediated tachyarrhythmias (PMT) have not been systematically investigated in a large cohort of patients implanted for symptomatic atrioventricular (AV) block.

Methods And Results: Two hundred fifty consecutive patients (71±14 years, 63% male) implanted for symptomatic second- or third-degree AV block were screened for retrograde VA conduction and related PMTs including endless loop tachycardia (ELT) and repetitive nonreentrant VA synchrony (RNRVAS). After a mean post-implantation period of 38±12 months, AV block was persistent in 137 (55%) and variable in 113 (45%) patients.

Diagnosis of arrhythmias in athletes using leadless, ambulatory HR monitors.

Exercise-related palpitations, vertigo, and syncope may be caused by benign etiologies but can also herald life-threatening arrhythmias. The precise diagnosis of these findings is therefore essential and potentially life saving but often is a challenge for sports physicians and cardiologists. Leadless, ambulatory HR monitors with chest strap transmitters have been designed to steer exercise intensity in athletes with a baseline sinus rhythm.

Individually tailored left ventricular lead placement: lessons from multimodality integration between three-dimensional echocardiography and coronary sinus angiogram.

Aims: Non-responder rates for cardiac resynchronization therapy (CRT) vary from 11% to 46%. Retrospective data imply a better outcome with stimulation of the latest contracting left ventricular (LV) region. Our study analysed the feasibility, safety and clinical outcome of prospectively planned LV lead placement at the site of latest mechanical activation.

Effects of baseline P-wave duration and choice of atrial septal pacing site on shortening atrial activation time during pacing.

Background: Atrial septal pacing (ASP) has been shown to shorten P-wave duration (PWD) and reduce recurrence of atrial fibrillation (AF) in patients with bradyarrhythmias. However, variability of interatrial connections and atrial conduction properties may explain ASP's modest clinical benefit. The aim of this study was to assess the effect of ASP site on the duration of the paced P wave.

Long-term efficacy of single procedure remote magnetic catheter navigation for ablation of ischemic ventricular tachycardia: a retrospective study.

Background: Remote magnetic navigation (RMN) aims to reduce some inherent limitations of manual radiofrequency (RF) ablation. However, data comparing the effectiveness of both methods are scarce. This study evaluated the acute and long-term success of RMN guided versus manual RF ablation in patients with ischemic sustained ventricular tachycardia (sVT).

Effect of limb lead electrodes location on ECG and localization of idiopathic outflow tract tachycardia: a prospective study.

Background: Different kinds of the surface ECG limb electrode positions may affect the limb lead vector and therefore the accuracy of the 12-lead ECG in localization of outflow tract ventricular tachycardia (OTVT). This study was intended to evaluate and compare the accuracy of the standard and the modified 12-lead ECG for localization of OTVT using the current published criteria.

Methods And Results: Twenty consecutive patients (10 men, mean age, 51.

Performance of an implantable automatic atrial fibrillation detection device: impact of software adjustments and relevance of manual episode analysis.

Aims: Implantable loop recorders (ILRs) with specific atrial fibrillation (AF) detection algorithms (ILR-AF) have been developed for continuous AF monitoring. We sought to analyse the clinical value of a new AF monitoring device and to compare it to serial 7-day Holter.

Methods And Results: Sixty-four consecutive patients suffering from paroxysmal AF were included in this prospective analysis and received an ILR-AF.

Steerable versus nonsteerable sheath technology in atrial fibrillation ablation: a prospective, randomized study.

Background: Steerable sheath technology is designed to facilitate catheter access, stability, and tissue contact in target sites of atrial fibrillation (AF) catheter ablation. We hypothesized that rhythm control after interventional AF treatment is more successful using a steerable as compared with a nonsteerable sheath access.

Methods And Results: One hundred thirty patients with paroxysmal or persistent drug-refractory AF undergoing their first ablation procedure were prospectively included in a randomized fashion in 2 centers.

Catheter ablation of atrial fibrillation using remote magnetic catheter navigation: a case-control study.

Aims: To compare the acute and the 6 month outcome of catheter ablation of atrial fibrillation (AF) using irrigated tip magnetic catheter and remote magnetic cathter navigation (RMN) with manual catheter navigation (MCN) in patients with paroxysmal and persistent AF.

Methods And Results: In this retrospective analysis 356 patients (235 male, mean age: 57.9 ± 10.

Catheter ablation of scar-related ventricular tachycardia in patients with electrical storm using remote magnetic catheter navigation.

Background: A remote magnetic navigation system (MNS) has been used for ablation of ventricular arrhythmias. However, irrigated tip catheter has not been evaluated in large series of patients.

Objective: To evaluate acute and long-term efficiency of the newly available irrigated tip magnetic catheter for radiofrequency (RF) ablation of scar-related ventricular tachycardia (VT) in patients with ischemic heart disease.

Six-month follow-up of isthmus-dependent right atrial flutter ablation using a remote magnetic catheter navigation system: a case-control study.

Objective: The objective of this study was to compare results between the magnetic navigation system (MNS) and conventional catheter ablation of cavo-tricuspid isthmus (CTI)-dependent right atrial flutter (AFL) in a case control study.

Background: A remote MNS has been used for ablation of various arrhythmias including CTI-dependent AFL but comparative results between MNS and conventional ablation are not available.

Methods: Between May and September 2007, a total of 51 consecutive patients (45 men, mean age 65.

Catheter ablation of electrical storm due to monomorphic ventricular tachycardia in patients with nonischemic cardiomyopathy: acute results and its effect on long-term survival.

Background: Electrical storm due to recurrent ventricular tachycardia (VT) in patients with implantable cardioverter defibrillator (ICD) can adversely affect their long-term survival. This study evaluates the efficiency of the radiofrequency catheter ablation of electrical storm due to monomorphic VT in patients with idiopathic dilated cardiomyopathy (DCM) and assesses its long-term effects on survival.

Methods And Results: Between April 2004 and October 2008, 13 consecutive patients (nine men, mean age 56.

Safety of remote magnetic navigation in patients with pacemakers and implanted cardioverter defibrillators.

Background: Remote magnetic catheter navigation (MNS) has been shown to be feasible and safe for radiofrequency catheter ablation of various cardiac arrhythmias. However, its safety in patients with implanted pacemakers or cardioverter-defibrillators has not yet been studied.

Objectives: This retrospective case series study intends to assess the acute and short-term safety of remote MNS in patients with implanted pacemakers or cardioverter-defibrillators.

[Analysis of intracardial electrograms in pacemakers and ICD systems by Biotronik].

Detailed analysis of stored electrograms is essential for the interpretation of arrhythmias, programming changes, and optimization of the medical therapy in patients with implanted pacemakers and defibrillators. The physician who cares for patients with implantable electrical devices has to be able to understand the detection and treatment algorithms of those devices. Biotronik pacemakers of newer generations are capable of storing intracardiac electrograms.

A latent atrioventricular decrementally conducting accessory pathway mimicking a bystander nodoventricular fiber.

A 41-year-old woman with recurrent wide-QRS tachycardia is reported. Electrophysiologic findings were consistent with the diagnosis of a preexcited atrioventricular nodal reentrant tachycardia due to a bystander nodo-ventricular fiber. However, slow pathway ablation did not preclude tachycardia recurrence.

Cardiac resynchronization therapy with individualized placement of two left ventricular leads at the sites of latest mechanical left ventricular contraction: guided by 3D-echocardiography and coronary sinus rotation angiography.

A 78-year-old woman with dilated cardiomyopathy was admitted for advanced dyspnoea and recurrent cardiac decompensation despite optimal medical therapy. Implantation of a cardiac resynchronization therapy (CRT) device was indicated according to current guidelines. The day before CRT implantation, three-dimensional echocardiography was performed together with coronary sinus (CS) rotation angiography, which identified two sites of latest mechanical left ventricular (LV) contraction with adjacently available target veins.

Circumferential pulmonary vein isolation and linear left atrial ablation as a single-catheter technique to achieve bidirectional conduction block: the pace-and-ablate approach.

Background: Pulmonary vein (PV) isolation has become a cornerstone for ablation of atrial fibrillation (AF). Circular mapping catheter (CMC)-guided techniques for detection of lesion gaps are challenging.

Objective: The present study describes a new concept of circumferential PV ablation aiming at bidirectional conduction block based on simultaneous pacing and ablation through the tip of a single mapping/ablation catheter.