The ecisions, nterventions, and oals in Implatable Cardioverter-Defbrillator herap (DIGNITY) Pilot Study.

Background: Implantable cardioverter-defibrillators (ICDs) are commonly implanted in older patients, including those with multiple comorbidities. There are few prospective studies assessing the clinical course and end-of-life circumstances for these patients.

Methods And Results: We prospectively followed 51 patients with ICDs for up to 18 months to longitudinally assess in terms of (1) advance care planning, (2) health status, (3) healthcare utilization, and (4) end-of-life circumstances through quarterly phone interviews and electronic medical record review.

Evaluation of left atrial lesions after initial and repeat atrial fibrillation ablation: lessons learned from delayed-enhancement MRI in repeat ablation procedures.

Background: We evaluated scar lesions after initial and repeat catheter ablation of atrial fibrillation (AF) and correlated these regions to low-voltage tissue on repeat electroanatomic mapping. We also identified gaps in lesion sets that could be targeted and closed during repeat procedures.

Methods And Results: One hundred forty-four patients underwent AF ablation and received a delayed-enhancement MRI at 3 months after ablation.

Initial experience of assessing esophageal tissue injury and recovery using delayed-enhancement MRI after atrial fibrillation ablation.

Background: Esophageal wall thermal injury after atrial fibrillation ablation is a potentially serious complication. However, no noninvasive modality has been used to describe and screen patients to examine whether esophageal wall injury has occurred. We describe a noninvasive method of using delayed-enhancement MRI to detect esophageal wall injury and subsequent recovery after atrial fibrillation ablation.

Magnetic resonance imaging-confirmed ablative debulking of the left atrial posterior wall and septum for treatment of persistent atrial fibrillation: rationale and initial experience.

Introduction: Though pulmonary vein (PV) isolation has been widely adopted for treatment of atrial fibrillation (AF), recurrence rates remain unacceptably high with persistent and longstanding AF. As evidence emerges for non-PV substrate changes in the pathogenesis of AF, more extensive ablation strategies need further study.

Methods: We modified our PV antrum isolation procedure to include abatement of posterior and septal wall potentials.

MRI in cardiac electrophysiology: the emerging role of delayed-enhancement MRI in atrial fibrillation ablation.

Catheter ablation of atrial fibrillation has emerged as a viable therapeutic option for those patients who have failed conventional medical therapy. This treatment strategy has been introduced in the past decade following the discovery of ectopic foci in the pulmonary veins capable of initiating this arrhythmia. The basis of current ablation techniques relies on inducing myocardial necrosis at distinct anatomical landmarks in order to electrically isolate these ectopic foci and to disrupt pulmonary vein and left atrial conduction pathways.

Temporal left atrial lesion formation after ablation of atrial fibrillation.

Background: Atrial fibrillation (AF) ablation uses radiofrequency (RF) energy to induce thermal damage to the left atrium (LA) in an attempt to isolate AF circuits. This injury can be seen using delayed enhancement magnetic resonance imaging (DE-MRI).

Objective: The purpose of this study was to describe DE-MRI findings of the LA in the acute and chronic stages postablation.