Adding Electroanatomical Mapping to Cryoballoon Pulmonary Vein Isolation Improves 1-Year Clinical Outcome and Durability of Pulmonary Vein Isolation: A Propensity Score-Matched Analysis.

Adding electroanatomical left atrial (LA) voltage mapping to cryoballoon ablation (CBA) improves validation of acute pulmonary vein isolation (PVI). To determine whether the addition of mapping can improve outcome and PVI durability. One-year outcome and PV reconnection (PVR) rate at first repeat ablation were studied in 400 AF patients in a propensity-matched analysis (age, AF type, CHADS-VASc score) between Achieve catheter-guided CBA with additional EnSite LA voltage maps performed pre- and post-CBA (mapping group; N = 200) and CT- and Achieve catheter-guided CBA (control group; N = 200).

Impact of Diagnosis-to-Ablation Time on AF Recurrence: Pronounced the First 3 Years, Irrelevant Thereafter.

Background: Diagnosis-to-ablation time (DAT) strongly predicts recurrence of atrial fibrillation (AF) after ablation. Whether this association holds with any lower and/or upper limits is unknown.

Objectives: The goal of this study was to assess the impact of DAT on AF recurrence in search of lower and upper DAT thresholds.

An Unusual Case of Chronic Total Occlusion Secondary to Late-Diagnosed Recurrent Spontaneous Coronary Dissection.

We report a case of a male patient, aged 44 years, with a long history of percutaneous and surgical revascularizations, who presented with progressive effort angina and a "dynamic total occlusion" of the left circumflex coronary artery, which turned out to be an unrecognized spontaneous coronary artery dissection. In conclusion, spontaneous coronary artery dissection is a rare cause of acute coronary syndrome and it is even less frequent in male patients; therefore, a high level of suspicion, especially in the case of young patients without major cardiovascular risk factors, is mandatory for prompt diagnosis and adequate strategy. Our case highlights how a missed proper initial diagnosis can dramatically evolve.

The absence of real-time pulmonary vein isolation during cryoballoon ablation is associated with atrial fibrillation recurrence and pulmonary vein reconnection : Insights from the Middelheim-PVI Registry 2.

Background: Absence of real-time pulmonary vein (PV) isolation (PVI) occurring in 15-40% of PVs during cryoballoon ablation (CBA) of atrial fibrillation (AF) raises doubt about adequate PVI. Aim of the present study is to determine whether real-time PVI during CBA is predictive of long-term clinical outcome and durability of PVI.

Methods: Eight hundred three AF patients (64 ± 10 years, 68% males) undergoing CBA were studied.