An approach to electroanatomical mapping with a pentaspline pulsed field catheter to guide atrial fibrillation ablation.

Background: Pulsed field ablation (PFA) of atrial fibrillation (AF) using a pentaspline multi-electrode catheter is commonly performed under fluoroscopic guidance. No data exist on the integration of this catheter within a three-dimensional electroanatomical mapping (3D-EAM) system for left atrial voltage and activation mapping, posterior wall isolation (PWI), or redo ablation. This technical report reviews an approach whereby mapping is performed using the pentaspline PFA catheter itself within an open architectural impedance-based 3D-EAM system.

Predictors of the need for atrioventricular nodal ablation following redo ablation for atrial fibrillation.

Background: Patients who have recurrent atrial fibrillation (AF) following redo catheter ablation may eventually be managed with a pace-and-ablate approach, involving pacemaker implant followed by (AVNA). We sought to determine which factors would predict subsequent AVNA in patients undergoing redo AF ablation.

Methods: We analyzed patients undergoing redo AF ablations between 2013 and 2019 at our institution.

Cost, efficiency, and outcomes of pulsed field ablation vs thermal ablation for atrial fibrillation: A real-world study.

Background: With the exponential growth of catheter ablation for atrial fibrillation (AF), there is increasing interest in associated health care costs. Pulsed field ablation (PFA) using a single-shot pentaspline multielectrode catheter has been shown to be safe and effective for AF ablation, but its cost efficiency compared to conventional thermal ablation modalities (cryoballoon [CB] or radiofrequency [RF]) has not been evaluated.

Objective: The purpose of this study was to compare cost, efficiency, effectiveness, and safety between PFA, CB, and RF for AF ablation.

Delineating postinfarct ventricular tachycardia substrate with dynamic voltage mapping in areas of omnipolar vector disarray.

Background: Defining postinfarct ventricular arrhythmic substrate is challenging with voltage mapping alone, though it may be improved in combination with an activation map. Omnipolar technology on the EnSite X system displays activation as vectors that can be superimposed onto a voltage map.

Objective: The study sought to optimize voltage map settings during ventricular tachycardia (VT) ablation, adjusting them dynamically using omnipolar vectors.

Durability of thermal pulmonary vein isolation in persistent atrial fibrillation assessed by mandated repeat invasive study.

Background: No study has assessed the durability of pulmonary vein isolation (PVI) with radiofrequency (RF) and cryoballoon (CB) in patients with persistent atrial fibrillation. These data are especially lacking for those with significantly diseased left atria (LA).

Objectives: The goals of this study were to assess PVI durability in patients with significant LA disease and to compare reconnection rates between RF and CB.

Silent pulmonary veins at redo ablation for atrial fibrillation: Implications and approaches.

Background: Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Despite promising success rates, redo ablation is sometimes required. At redo, PVs may be found to be isolated (silent) or reconnected.

UltraSOUND-based characterization of ventricular tachycardia SCAR and arrhythmogenic substrate: The SOUNDSCAR study.

Background: Intracardiac echocardiography (ICE) represents a valuable image integration technique, with the unique advantage of dynamic real-time scar characterization.

Objectives: The goals of this study were to assess the correlation between ICE-defined and electroanatomic mapping (EAM)-defined scar in patients with ischemic cardiomyopathy and to define the outcomes of ICE-guided ventricular tachycardia (VT) ablation.

Methods: Thirty-eight patients with ischemic cardiomyopathy (SOUNDSCAR cohort) underwent full left ventricular (LV) ICE imaging and EAM.

An approach to help differentiate postinfarct scar from borderzone tissue using Ripple Mapping during ventricular tachycardia ablation.

Background: Ventricular scar is traditionally highlighted on a bipolar voltage (BiVolt) map in areas of myocardium <0.50 mV. We describe an alternative approach using Ripple Mapping (RM) superimposed onto a BiVolt map to differentiate postinfarct scar from conducting borderzone (BZ) during ventricular tachycardia (VT) ablation.

Incidence of vascular complications for electrophysiology procedures in the ultrasound era: a single-centre experience over 10,000 procedures in the long term.

Background: Ultrasound (US) is being increasingly used to guide vascular access for electrophysiology (EP) procedures in many centres. Nonetheless, the incidence and predictors of vascular complications in the US era are limited. In this study, we describe our experience of vascular access-related complications associated with EP procedures which were performed with the routine use of US-guided vascular access.

Impact of COVID-19 on patients awaiting ablation for atrial fibrillation.

Objective: Atrial fibrillation (AF) ablation services were significantly affected by the COVID-19 pandemic. We aimed to evaluate a symptom-based clinician prioritisation scheme for waiting list management compared with patient-completed quality of life (QoL) scores. We also sought to understand factors influencing QoL, particularly the impact of COVID-19, on patients awaiting AF ablation, via a bespoke questionnaire.

Complication rates following ventricular tachycardia ablation in ischaemic and non-ischaemic cardiomyopathies: a systematic review.

Background: Catheter ablation of ventricular tachycardia (VT) is associated with potential major complications, including mortality. The risk of acute complications in patients with ischaemic cardiomyopathy (ICM) and non-ischaemic cardiomyopathy (NICM) has not been systematically evaluated.

Methods: PubMed was searched for studies of catheter ablation of VT published between September 2009 and September 2019.

Relationship between sodium channel function and clinical phenotype in SCN5A variants associated with Brugada syndrome.

The identification of a pathogenic SCN5A variant confers an increased risk of conduction defects and ventricular arrhythmias (VA) in Brugada syndrome (BrS). However, specific aspects of sodium channel function that influence clinical phenotype have not been defined. A systematic literature search identified SCN5A variants associated with BrS.

The feasibility and effectiveness of a streamlined single-catheter approach for radiofrequency atrial fibrillation ablation.

Background: Catheter ablation for atrial fibrillation (AF) traditionally requires the use of circular mapping catheter (CMC) for pulmonary vein isolation (PVI). This study aimed to assess the feasibility and effectiveness of a CMC-free approach for AF ablation performed by a contiguous optimized (CLOSE) ablation protocol.

Methods: A CLOSE-guided and CMC-free PVI protocol with a single transseptal puncture was attempted in 67 patients with AF.

Same-day discharge in selected patients undergoing atrial fibrillation ablation.

Background: Atrial fibrillation (AF) ablation is a complex procedure, generally requiring at least one overnight hospital stay. We investigated the safety and feasibility of early mobilization and same-day discharge following streamlined peri-ablation management for AF.

Methods: From 2014, we offered same-day discharge to selected patients who underwent uncomplicated AF ablation on the morning lists, with ultrasound-guided femoral access, uninterrupted warfarin or minimal interruption in novel oral anticoagulants, and reversal of intraprocedural heparin with protamine.

Early experience of thoracoscopic vs. catheter ablation for atrial fibrillation.

Aims: Video-assisted thoracoscopic surgery (VATS) ablation has been advocated as a treatment option for non-paroxysmal atrial fibrillation (AF) in recent guidelines. Real-life data on its safety and efficacy during a centre's early experience are sparse.

Methods And Results: Thirty patients (28 persistent/longstanding persistent AF) underwent standalone VATS ablation for AF by an experienced thoracoscopic surgeon, with the first 20 cases proctored by external surgeons.

Use of Ablation Index-Guided Ablation Results in High Rates of Durable Pulmonary Vein Isolation and Freedom From Arrhythmia in Persistent Atrial Fibrillation Patients: The PRAISE Study Results.

Background Catheter ablation for persistent atrial fibrillation (AF) is associated with less favorable outcomes than for paroxysmal AF. Substrate modification is often added to pulmonary vein isolation (PVI) to try to improve success rates. Recent studies have shown improved clinical outcomes with use of regional ablation index (AI) targets for PVI.

Demonstration of pulmonary vein exit block following pulmonary vein isolation: A novel use for adenosine.

Introduction: Demonstration of exit block after pulmonary vein isolation (PVI) is the cornerstone of ablation for atrial fibrillation (AF). It requires the demonstration of local pulmonary vein (PV) capture and absence of conduction to the atrium but is often challenging due to the inability to see local paced PV-evoked potentials. We retrospectively examined the ability of adenosine to augment this technique during CARTO-based radiofrequency ablation procedures.

Systematic re-evaluation of SCN5A variants associated with Brugada syndrome.

Background: A large number of SCN5A variants have been reported to underlie Brugada syndrome (BrS). However, the evidence supporting individual variants is highly heterogeneous.

Objective: We systematically re-evaluated all SCN5A variants reported in BrS using the 2015 American college of medical genetics and genomics and the association for molecular pathology (ACMG-AMP) guidelines.

Natural progression of QRS duration in ICD-only patients.

Purpose: The aim of our study is to determine if there is a natural progression of QRSd in ICD-only patients.

Methods And Results: Retrospective study over a 7-year period of 86 consecutive patients who underwent ICD-only implantation in 2008 at the Liverpool Heart and Chest Hospital, UK. The mean age at ICD implantation was 62.