Initial experience in ablation of typical atrial flutter using a novel three-dimensional catheter tracking system.

AIMS: Three-dimensional (3D) mapping has been established for clinical routine in an interventional electrophysiology (EP). Recently, a novel sensor-based 3D catheter tracking system has been introduced integrating 3D non-fluoroscopic catheter navigation into the environment of pre-recorded 2D fluoroscopy [MediGuide™ Technology (MG)]. We are reporting on the first clinical experience for ablation of typical atrial flutter. First we aimed to demonstrate safety and feasibility of this new technique. Secondly, procedural aspects such as effectiveness, procedure, and fluoroscopy time should be evaluated. METHODS AND RESULTS: Ten consecutive patients (100% male, age 68 ± 8 years) were ablated using MG technology. Two steerable diagnostic EP catheters (MediGuide Enabled Livewire™ Catheter, SJM) were used for coronary sinus cannulation and anatomical cavo-tricuspidal isthmus (CTI) reconstruction within the EnSite NavX™ System (NavX). Ablation was performed with a conventional 8 mm tip ablation catheter (IBI, SJM). In all 10 patients both sensor-equipped MG catheters could be tracked non-fluoroscopically. Successful anatomical CTI reconstruction was performed and complete isthmus block was documented after the ablation. Total procedure duration was comparable with conventional procedures (55 ± 8 min). Usage of the MG tracking system resulted in a fluoroscopy time of 2.5 ± 2 min. No adverse events occurred during the procedures. CONCLUSIONS: For the first clinical application of the MG technology in an interventional electrophysiology we found a stable system enabling excellent 3D orientation for spatial catheter positioning on the basis of underlying pre-recorded cine loops. Clinically, the MG technology allowed successful procedures with short fluoroscopy times, even though a sensor-equipped ablation catheter was not yet available for use in the study.

Results of a survey concerning atrial fibrillation ablation strategies in Poland.

BACKGROUND: Catheter ablation is an effective treatment for patients with atrial fibrillation (AF). Despite the increasing availability of the procedure, current treatment patterns of invasive AF treatment in Poland are unknown. AIMS: The aim of the study was to assess data on the contemporary approaches to AF ablation in Poland, such as: target population, patients' characteristics, ablation techniques, procedural results, and complication rates. METHODS: The survey including 36 questions was conducted among 38 representatives of Polish electrophysiology centers performing AF catheter ablation to test the methods and outcomes in their laboratories. RESULTS: The survey was conducted among 38 out of 69 Polish electrophysiology centers performing AF ablation. There were 88 ablation laboratories in 2018 in Poland. They have performed 16 566 ablations, of which 6680 were AF ablations, according to the Polish National Health Fund data. Therefore, 3745 AF ablations analyzed in this study constituted 22.6% of all ablations and 56% of AF ablations performed in Poland in 2018.Paroxysmal AF was the most common type of AF in all surveyed centers. In 69% of the centers, the preferred method was cryoballoon ablation and in 31%, radiofrequency point­by­point circumferential pulmonary vein isolation. The reported complication rate was low (6.4%), with localadverse events being the most frequent. The mean reported incidence of atrial flutter or tachycardia after ablation was low (5%). Repeated procedures were performed mainly with radiofrequency ablation (89%). Procedural techniques and the type of venous access did not vary between the centers. CONCLUSIONS: Paroxysmal AF was the most common indication for percutaneous ablation of that arrhythmia in Polish electrophysiology laboratories. The preferred method was cryoballoon ablation.

Does the origin of ablated premature ventricular contractions determine the level of left ventricular function improvement?

BACKGROUND: Premature ventricular contractions (PVCs) are associated with tachycardiomyopathy and high mortality rate. The treatment depends on the engaged ventricle. For PVCs originating from the right outflow tract (OT), radiofrequency catheter ablation (RFCA) is recommended (class IB­R recommendation) in preference to pharmacotherapy. In those originating from the left ventricle, ablation is a class IIa B­NR recommendation. AIMS: The aim of the study was to assess the success of RFCA of PVCs based on arrhythmia origin. METHODS: A total of 110 consecutive patients with monomorphic PVCs referred for ablation were enrolled and divided according to the site of ablation to the OT group and the ventricles (VENT) group. Holter electrocardiography and echocardiography were performed before the procedure and at 6­month follow­up. RESULTS: Long­term RFCA success was achieved in 93 (85%) patients (89% in the OT group and 82% in the VENT group; P = 0.39). The PVC reduction was similar in both groups (median [interquartile range] 99.55% [14] and 99.88% [6], respectively; P = 0.56). The OT group presented greater left ventricle (LV) recovery than the VENT group (odds ratio, 2.01; 95% CI, 1.15-10.75; P = 0.015). The procedure in the VENT group was longer, required additional access, the complication rate was similar, and 1 serious adverse event (aortic dissection) was observed in a patient with arrhytmia originating in the LV outflow tract. CONCLUSIONS: The origin of PVCs does not determine the success of arrhythmia elimination. The OT origin may predict LV improvement. The duration of RFCA in the VENT group was longer. The outflow tract origin may predict reversal of LV deterioration.

The effect of radiofrequency catheter ablation of frequent premature ventricular complexes and arrhythmia burden on left ventricular function.

BACKGROUND: Frequent premature ventricular complexes (PVC) are related to reversible tachycardia-induced cardiomyopathy. However, the role of arrhythmia burden on the outcome of the catheter ablation has not been fully recognised. AIM: The aim of this study was to assess the effect of catheter ablation and PVC burden in patients with and without structural heart disease (SHD) on left ventricular ejection fraction (LVEF). METHODS: Transthoracic echocardiography was done before and six months after radiofrequency catheter ablation in 109 consecutive patients (61 men, age 55 ± 17 years) with frequent PVCs. Sixty-five (59.6%) patients had underlying SHD. RESULTS: The catheter ablation procedure was successful in 93 (85.3%) patients. Baseline PVC burden was higher in patients with SHD (22,267 ± 12,934) compared to those without concomitant SHD (15,546 ± 7888), p = 0.005. Nevertheless, patients with LVEF ≤ 50% at baseline presented greater LVEF recovery (from 44% to 56%) than those with LVEF > 50% at baseline after catheter ablation. In both groups, the LVEF improved (p < 0.001); however, no difference was observed be-tween patients with SHD (5.7% ± 1.37%) and without (4.6% ± 0.96%) SHD; p = 0.89. PVC burden was higher in patients with (24,350 ± 2776 PVC/day) compared to those without (17,588 ± 1970 PVC/day) improvement of LVEF. In multivariate regression analysis PVC burden > 20,000/day (but not age, p = 0.95; gender, p = 0.89; presence of SHD, p = 0.53; QRS complex width of the treated PVC, p = 0.21, LVEF before ablation, p = 0.19; and site of origin, p = 47) predicted improvement in LVEF after successful catheter ablation (odds ratio: 3.53; 95% confidence interval: 1.15-10.75; p = 0.023). CONCLUSIONS: Catheter ablation of frequent PVCs improves left ventricular function in multivariate analysis predicted improvement of LVEF within six months after the successful catheter ablation procedure in patients with PVC burden exceeding 20,000/24 h.