A Natale

..Despite the high success rate of radiofrequency (RF) ablation, pharmacologic therapy is still considered the standard initial therapeutic approach for atrial flutter...

..Standard mapping and ablation of focal sources of atrial fibrillation are associated with very long procedure times and low efficacy. An anatomic approach to complete pulmonary vein isolation could overcome these limitations...

..Armed with this new knowledge, we are pursuing strategies of permanently preventing atrial fibrillation by destroying these foci using radiofrequency ablation...

..Electrophysiological testing was performed and the sites of earliest activation were localized within the left ventricle in the absence of significant scar tissue. After ablation, PVCs subsided and there were no further VF recurrences...

..Further simplification of the isolation techniques and refinement in the catheter design will allow more widespread use of this procedure and higher success rate...

..True electrical isolation of the pulmonary veins was associated with a higher likelihood of long-term success. Left atrial flutter was seen in a significant number of patients at long-term follow-up...

..6 months. CONCLUSIONS: Normal heart VT with left bundle branch block, inferior axis and early precordial transition can be ablated in the majority of patients from either the left or the noncoronary aortic sinus of Valsalva...

..The activation sequence and relative timing of the recordings obtained with our catheter configuration was highly predictive of right and left atrial origin and, more importantly, of right and left PV foci...

..We usually reserve these adjunctive ablative therapies for patients with persistent or chronic atrial fibrillation and those with unsuccessful prior catheter ablation...

..Energy delivery at the ostium with a temperature > 60 degrees C may be important to maximize success. Reconfiguration of the system to overcome the shortcomings identified in the initial experience could increase its performance...

..We sought to determine the accuracy of MDCT to qualitatively and quantitatively detect severe spontaneous echo contrast (SEC) or thrombus by TEE in the left atrial appendage (LAA)...

..We aimed at assessing the feasibility and efficacy of remote magnetic navigation (MN) and ablation in patients with atrial fibrillation (AF)...

..The risk of procedural complications, especially thromboembolic events, appears to be higher in the elderly age group. This observation needs to be considered while assessing potential candidates for the procedure...

..This case highlights the potential role of the pulmonary veins in the pathophysiology of postoperative AF...

..CTI block reduced early postablation recurrence of arrhythmias, which in the majority of patients reflects a short-term clinical problem...

..It seems to be associated with high success rates over long term follow-up. Future refinements in catheter technology should provide simpler and faster procedures and render catheter ablation of AF more widespread and accepted...

..We aimed to evaluate left atrial appendage (LAA) exclusion in patients undergoing mitral valve surgery with respect to thromboembolic events...

..CONCLUSIONS: Endocardial catheter navigation and mapping using the robotic catheter remote control is safe and feasible. Moreover, the CCS could be used to perform transseptal puncture and left atrial instrumentation...

..Although our sample size was nonrandomized, our results suggest PVI may be a feasible therapeutic option in AF patients with impaired EF. Randomized studies with more patients and longer follow-up are warranted...

..Although distal isolation can be achieved with fewer lesions, ostial isolation is required in the majority of patients to eliminate arrhythmogenic PACs and AF...

..The advent of sophisticated device-based therapy and of more precise and effective catheter ablation approaches will expand clinicians' ability to gain control of this multifaceted arrhythmia syndrome...

..Esophagus variability makes the avoidance of lesions along its course difficult. Rather than avoiding posterior lesions, emphasis could be placed on better esophagus monitoring for creation of safer lesions...

..These results have implications for our understanding of the pathophysiology of AF in patients with moderate valvular heart disease or past cardiac surgery and should be considered when discussing treatment options in these patients...

..Thus, diagnosis and isolation of the left SVC appears critical to preventing AF recurrence in patients with AF when ablation is considered...

..The long-term occurrence of atrial fibrillation in patients presenting with atrial flutter alone is unknown. We report the long-term follow-up in patients who underwent cavotricuspid isthmus ablation for treatment of lone atrial flutter...

..However, the success of this approach is dependent on the accuracy of the image integration process. This study aims to evaluate the in vivo accuracy and reliability of the integrated image...

..01). CONCLUSIONS: Pre-existent LAS in patients undergoing PVAI for AF is a powerful, independent predictor of procedural failure. Left atrial scarring is associated with a lower EF, larger LA size, and increased inflammatory markers...

..However, history of PCS is associated with a higher recurrence of AFL after PVAI. In a significant number of patients with PCS, AFL ablation is required to achieve a cure...

..The objective of this study is to compare the use of transesophageal echocardiography (TEE) vs multidetector computed tomography (MDCT) for detecting pulmonary vein stenosis...

..In the absence of PVCs, both substrate mapping and ablation appear to be equally effective...

..It was hemodynamically superior to AVN ablation with either r-RVP or i-RVP, indicating that the benefits of preserving the physiological antegrade ventricular activation sequence outweigh the detrimental effect of irregularity...

..The r value between flow and stenosis was only 0.09 (P = NS). CONCLUSION: Acute changes in PV flow immediately after ostial PV isolation do not appear to be a strong predictor of chronic PV stenosis...

..CONCLUSIONS: In patients with postoperative right atrial incisional scar and flutter, multiple ablation lines that target both scar-related and classic isthmuses appear necessary to prevent long-term recurrence...

..Ablation for atrial fibrillation (AF) requires energy delivery in close proximity to the esophagus (Eso) which has accounted for the LA-Eso fistula, a rare but life-threatening complication...

..Overall, patients with AF do not have larger sizes of PV ostia. Multiple ramifications from the right inferior PV ostium is a common pattern and may represent a protective anatomic variant...

..The difference in caudal shift seen after esmolol administration and following SN modification suggests that adrenergic hypersensitivity is not the only mechanism responsible for the inappropriate behavior of the SN...

..We evaluated the relationship between lesion formation, pressure, and the development of complications...

..CONCLUSION: Midodrine appeared to provide a significant benefit in patients with neurocardiogenic syncope. To prevent recurrence of symptoms, dose adjustments were required in about one third of patients...

..C-reactive protein (CRP), a marker of systemic inflammation, predicts cardiovascular events and stroke, a common sequela of AF. We hypothesized that CRP is elevated in patients with atrial arrhythmias...

..Navigation, mapping, and ablation in the coronary cusps can be challenging. Remote magnetic navigation may offer an alternative to conventional manually operated catheters...

..Whether a complete Cox-maze procedure is needed to ablate permanent atrial fibrillation in patients undergoing concomitant cardiac surgery is unknown. Our objective was to assess the effectiveness of different lesion sets in such patients...

..Moreover, incisional AFL seems to be a common finding in this group of patients. Catheter-based mapping and ablation of these arrhythmias seems to be feasible and effective...

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..In patients with structural heart disease, multiple ablative procedures may be required to achieve cure. Ongoing clinical research will provide further insight into future criteria for patient selection...

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..This animal study evaluates luminal esophageal temperature and its relation to the temperature of the external esophageal tissue during left atrial lesions using the 8 mm solid tip and the open irrigated tip catheters (OIC)...

..Pulmonary vein stenosis (PVS) is a rare but significant complication of pulmonary vein isolation (PVI). Dilation and stent angioplasty have been described but not compared...

..These vagal inputs are clustered in autonomic ganglia (AG) that are close to the pulmonary vein antrum (PVA) borders, but whether standard intracardiac echocardiography (ICE)-guided PVA isolation (PVAI) affects these inputs is unknown...

..Atrial fibrillation (AF) ablation may be performed utilizing this system. We report our management of complications with early experience of this system...

..We sought to test how catheter ablation using an open irrigation catheter (OIC) compares with standard catheters for pulmonary vein antrum isolation...

..0%, 100% +/- 0.0%, and 95% +/- 11%, respectively). CONCLUSION: Radiofrequency fat pad ablation may not achieve long-term suppression of AF induction in this canine model...

..We recently described a LVOT-VT variant, which may be epicardial in nature, in a group of patients in whom prior ablation attempts had failed. A trans-aortic ablation approach to outflow tract VT was successful in these patients...

..Although further follow-up is necessary to determine long-term success, our data indicate better pulmonary vein flow and symptomatic improvement in the majority of patients undergoing dilation of postablation pulmonary vein stenosis...

..Our data suggest that computed tomography is a potential alternative for assessing the anatomy of the left atrial appendage and for detecting thrombi...

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..This article describes contemporary and emerging surgical approaches to AF, synthesizes results of these operations, and proposes a strategy for choice of operation based on patient presentation...

..There does not appear to be any mortality difference between ES patients with VT and VF, but mortality is increased in patients with ES versus control ICD patients without ES...

..Patients with pre-existing LA scar tend to have recurrence requiring further ablation including linear lesions, and continue to need antiarrhythmic medications...

..The epicardial location of an arrhythmia could be responsible for unsuccessful endocardial catheter ablation...

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..Our objective was to assess the impact of different surgical treatments for this arrhythmia in patients undergoing mitral valve surgery...

..Suppression of VF arising from focal triggers in patients with frequent ventricular ectopy and normal heart can be achieved with catheter ablation, but further studies are needed to evaluate the prevalence of such a mechanism...

..Therefore, we sought to determine the time-related prevalence of atrial fibrillation and its risk factors after combined Cox maze and mitral valve surgery...

..These results suggest that inflammation may have a role in the pathogenesis of AF resistant to antiarrhythmic drugs...

..CRP was not independently predictive of ICD therapies when compared with BNP...

..In one patient, the tachycardia had resulted in cardiomyopathy. Slow AV nodal pathway ablation performed in both patients resulted in cure of their tachycardias and recovery of ventricular function in the patient with cardiomyopathy...

..Pulmonary-vein isolation is increasingly being used to treat atrial fibrillation in patients with heart failure...

..CONCLUSIONS: Intracardiac echocardiography improves the outcome of cooled-tip PVI. Power adjustment guided by direct visualization of microbubble formation reduces the risk of PV stenosis and improves long-term cure...

..Trigger site localization is obtained by matching the P wave integral map morphology of a premature atrial contraction (PAC) with the reference database of 34 mean paced P wave integral map patterns...

..3. Avoiding risk of PV stenosis by ablating outside of the antrum. 4. Minimizing risk of other complications, such as perforation and stroke, by direct visualization during transseptal access and radiofrequency (RF) ablation...

..However, whether adding ablation of such sites to standard ICE-guided PVAI improves outcome is not well known...