The potential role of scar mapping in assessing of paroxysmal atrial fibrillation recurrence after cryoballoon application

Cryoballoon ablation for atrial fibrillation (AF) has become a frequently used therapy after failure of at least one antiarrhythmic drug. The main target of AF ablation has been durable pulmonary vein isolation. However, it is unclear if ablation strategies need to be modified after recurrence. Herein, we presented a female patient undergoing successful pulmonary vein re-connection ablation after left atrial scar mapping. In electroanatomical mapping, gray area shows intense scar tissue. Gray, red, and purple areas indicate atrial potentials <0.5 mV, 0.5–1.5 mV, and >1.5 mV, respectively. Please note that there is a non-scar area in the bottom of right inferior pulmonary vein (arrow)

Fractionated Mapping-Guided Ablation Strategy in Patients with Long-Standing Persistent Atrial Fibrillation: a Case Series

Although pulmonary vein isolation (PVI) remains the cornerstone of ablation for paroxysmal atrial fibrillation (AF), optimal ablation strategy for long-standing persistent AF (LSPAF) remains unclear. This article presents two patients with LSPAF in whom acute AF termination was achieved during ablation by using fractionated-guided extended PVI, posterior wall isolation, and mitral isthmus

ACUTE EFFECTS OF SYNTHETIC CANNABINOIDS ON VENTRICULAR REPOLARIZATION

Objective: The usage of synthetic cannabinoids (SCs) has increased both in Turkey and all worldwide. Here, we evaluate if SCs cause ventricular repolarization abnormalities using initial and after 12th-hour electrocardiograms in patients with acute intoxication of SCs. We examined changes in the QTc and cTp-e parameters to demonstrate ventricular repolarization effects of the usage of SCs. Material and Methods: We used a prospective study design. Twenty patients were included who visited the emergency department, complaining of clouding of consciousness after using SCs. The QT, QTc and Tp-e intervals and several other electrocardiographic parameters were measured at baseline and 12 hours after the usage of SCs. Results: The QRS duration was significantly decreased (102.1±15.5 ms vs 95.0±10.7 ms; p=0.022). We noted a significant decrease in cQT measurements at the end of the 12th hour (426.6±47.2 ms vs 390.4±42.9 ms; p=0.002). Similarly, the Tp-e and cTp-e values decreased significantly when SCs lost its acute effect (93.4±21.1 ms vs 77.4±21.0 ms; p=0.014, 105.3±28.5 ms vs 88.1±21.5 ms; p=0.01). Conclusions: The usage of SCs affects ventricular repolarization heterogeneity based on QTc and Tp-e intervals

Corrigendum to: Preventive Ventricular Tachycardia Ablation in Patients with Ischaemic Cardiomyopathy: Meta-analysis of Randomised Trials

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A worldwide survey on incidence, management and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: The POTTER-AF study.

AIMS Oesophageal fistula represents a rare but dreadful complication of atrial fibrillation catheter ablation. Data on its incidence, management and outcome are sparse. METHODS AND RESULTS This international multicenter registry investigates the characteristics of oesophageal fistulae after treatment of atrial fibrillation by catheter ablation. A total of 553,729 catheter ablation procedures (radiofrequency: 62.9%, cryoballoon: 36.2%, other modalities: 0.9%) were performed at 214 centers in 35 countries. In 78 centers 138 patients (0.025%, radiofrequency: 0.038%, cryoballoon: 0.0015% (p<0.0001)) were diagnosed with an oesophageal fistula. Periprocedural data were available for 118 patients (85.5%). Following catheter ablation, the median time to symptoms and the median time to diagnosis were 18 (7.75, 25; range: 0-60) days and 21 (15, 29.5; range: 2-63) days, respectively. The median time from symptom onset to oesophageal fistula diagnosis was 3 (1, 9; range: 0-42) days. The most common initial symptom was fever (59.3%). The diagnosis was established by chest computed tomography in 80.2% of patients. Oesophageal surgery was performed in 47.4% and direct endoscopic treatment in 19.8%, and conservative treatment in 32.8% of patients. The overall mortality was 65.8%. Mortality following surgical (51.9%) or endoscopic treatment (56.5%) was significantly lower as compared to conservative management (89.5%) (odds ratio 7.463 (2.414, 23.072) p<0.001). CONCLUSIONS Oesophageal fistula after catheter ablation of atrial fibrillation is rare and occurs mostly with the use of radiofrequency energy rather than cryoenergy. Mortality without surgical or endoscopic intervention is exceedingly high

Phrenic Nerve Injury During Cryoballoon-Based Pulmonary Vein Isolation: Results of the Worldwide YETI Registry.

BackgroundCryoballoon-based pulmonary vein isolation (PVI) has emerged as an effective treatment for atrial fibrillation. The most frequent complication during cryoballoon-based PVI is phrenic nerve injury (PNI). However, data on PNI are scarce.MethodsThe YETI registry is a retrospective, multicenter, and multinational registry evaluating the incidence, characteristics, prognostic factors for PNI recovery and follow-up data of patients with PNI during cryoballoon-based PVI. Experienced electrophysiological centers were invited to participate. All patients with PNI during CB2 or third (CB3) and fourth-generation cryoballoon (CB4)-based PVI were eligible.ResultsA total of 17 356 patients underwent cryoballoon-based PVI in 33 centers from 10 countries. A total of 731 (4.2%) patients experienced PNI. The mean time to PNI was 127.7±50.4 seconds, and the mean temperature at the time of PNI was -49±8°C. At the end of the procedure, PNI recovered in 394/731 patients (53.9%). Recovery of PNI at 12 months of follow-up was found in 97.0% of patients (682/703, with 28 patients lost to follow-up). A total of 16/703 (2.3%) reported symptomatic PNI. Only 0.06% of the overall population showed symptomatic and permanent PNI. Prognostic factors improving PNI recovery are immediate stop at PNI by double-stop technique and utilization of a bonus-freeze protocol. Age, cryoballoon temperature at PNI, and compound motor action potential amplitude loss >30% were identified as factors decreasing PNI recovery. Based on these parameters, a score was calculated. The YETI score has a numerical value that will directly represent the probability of a specific patient of recovering from PNI within 12 months.ConclusionsThe incidence of PNI during cryoballoon-based PVI was 4.2%. Overall 97% of PNI recovered within 12 months. Symptomatic and permanent PNI is exceedingly rare in patients after cryoballoon-based PVI. The YETI score estimates the prognosis after iatrogenic cryoballoon-derived PNI. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03645577. Graphic Abstract: A graphic abstract is available for this article

Electromechanical association: a subtle electrocardiogram artifact

Artifacts on electrocardiogram (ECG) can simulate serious cardiac disorders. Although most common ECG artifacts can be easily recognized, in some exceptional situations, some patterns may hide pretty well even from experienced eyes. We recently reported an unusual ECG artifact caused by radial arterial impulse that closely imitates abnormal T wave. We now report 3 more examples and caught-in-the-act evidence of this subtle and dangerous artifact source. (C) 2012 Elsevier Inc. All rights reserved

Fractionation mapping software to map ganglionated plexus sites during sinus rhythm

Ablation of ganglionated plexuses (GPs) is a relatively new technique in patients with vasovagal syncope. Due to individual variation of GP settlement, reproducible GP detection methods are needed to during electrophysiologic study. In the present case, fractionation mapping software of Ensite system was tested to detect localization of GPs and first compared with previously validated fractionated electrograms based strategy