Bedside Electrophysiological Study Using a Temporary Pacemaker May Predict Recurrence of Atrioventricular Block After Transcatheter Aortic Valve Replacement.

High-degree atrioventricular block (HAVB) or complete heart block (CHB) is a common complication associated with transcatheter aortic valve replacement (TAVR). However, some patients with HAVB/CHB recover with time. The results of electrophysiological studies (EPSs) using permanent pacemaker implantation (PPI) in patients with suspicious HAVB/CHB are considered controversial.This study aimed to evaluate whether HAVB/CHB induction at the bedside using a temporary pacemaker can predict recurrence in patients who had recovered from HAVB/CHB after TAVR.We enrolled a total of 11 patients who had recovered from HAVB/CHB and evaluated their electrophysiology using right ventricular pacing and/or procainamide administration.HAVB/CHB induction was positive. Three patients tested positive for HAVB/CHB, whereas 8 tested negative. The ejection fraction and the interval between HAVB/CHB onset and EPS were found to be significant. HAVB/CHB positive patients underwent PPI. A patient with a balloon-expandable valve tested positive just before recovery of CHB, but tested negative 5 days later and was included in the negative group. The 4 patients who tested negative received a cardiovascular implantable electric device (CIED). We observed HAVB/CHB in 2 patients who had previously tested positive after 3 months. Among those who tested negative, those with CIED had no HAVB/CHB, and others showed neither HAVB/CHB on electrocardiogram nor experienced syncope or sudden death.Our EPS revealed that HAVB/CHB induction may predict HAVB/CHB recurrence after TAVR. Valve type and EPS timing may affect the results.

Organization and procedures in contemporary catheter ablation centres: data from the 2018 Italian Catheter Ablation Registry.

AIMS: This report describes the findings of the 2018 Italian Catheter Ablation Registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC). METHODS: The Italian Catheter Ablation Registry systematically collects data on the ablation procedures performed in Italy. Data collection was retrospective. A standardized questionnaire was completed by participating centres. RESULTS: We collected data on 15 714 catheter ablation procedures performed in Italy during 2018 in 94 electrophysiology centres. In most centres (75/94, 80%), a single electrophysiology laboratory was available, and a hybrid electrophysiology laboratory was available in 15% (14/94) of centres. In most (93%) centres, at least two electrophysiologists were involved in the catheter ablation procedures. In only 13 out of 94 (14%) electrophysiology laboratories, an anaesthesiologist assists every electrophysiology procedure; in most cases (74/94, 79%), an on-demand anaesthesiology service was available. On-site cardiothoracic surgery was reported in 43 out of 94 (46%) centres.Nonfluoroscopic navigation systems were available in most centres (88/94, 93%). Intracardiac echocardiography was used in 59 out of 94 (63%) electrophysiology laboratories. Atrial fibrillation (31%) was the most frequently treated ablation target, followed by atrioventricular nodal re-entrant tachycardia (20%) and cavo-tricuspid isthmus (15%). In 61.7% of all procedures, a 3D mapping system was used. In about one-third of procedures, a near-zero approach was performed. CONCLUSION: In most Italian electrophysiology centres, a single electrophysiology laboratory was available and at least two electrophysiologists were involved in the ablation procedures. An increasing number of procedures were performed by means of a nonfluoroscopic mapping system with a near-zero approach.

Predictors of AVNRT Recurrence After Slow Pathway Modification.

Atrioventricular nodal reentry tachycardia (AVNRT) is the most common regular supraventricular tachycardia (SVT). Slow pathway modification (SPM) is the accepted first line treatment with reported success rates around 95%. Information regarding possible predictors of AVNRT recurrence is scarce.Out of 4170 consecutive patients with SPM in our department from 1993-2018, we identified 78 patients (1.9%) receiving > 1 SPM (69% female, median age 50 years) with a recurrence of AVNRT after a successful SPM. We matched these patients for age, gender and number of radiofrequency applications during first SPM with 78 patients who received one successful SPM in our center without AVNRT recurrence. Both groups were analyzed for possible predictors of a recurrence of AVNRT during long-term follow-up. The recurrence group contained a significantly lower proportion of patients with an occurrence of junctional beats during SPM (69% versus 89%, P = 0.006). Moreover, significantly more cases of previously diagnosed atrial fibrillation/tachycardia (AF/AT; 21% versus 5%, P = 0.007) and inducible AF/AT during electrophysiology study (23% versus 6%, P = 0.006) were present in the recurrence group. While more than half of patients had a recurrence within the first year, in 20% symptoms reappeared ≥ 4 years after ablation.In a small percentage of patients, AVNRT recurs after an initially successful ablation. Interestingly, these patients had significantly fewer junctional beats during ablation and a higher rate of other (inducible) arrhythmias. AVNRT recurrence spanned a considerable timeframe and should remain a differential diagnosis, even years after ablation.

Impacto de la pandemia COVID-19 en la práctica de la electrofisiología cardíaca en Latinoamérica: una encuesta de la Sociedad Latinoamericana del Ritmo Cardíaco / Impact of the COVID-19 pandemic on the practice of cardiac electrophysiology in Latin America: a survey of the Latin American Heart Rhythm Society / Impacto da pandemia COVID-19 na prática da eletrofisiologia cardíaca na América Latina: uma pesquisa da Sociedade Latino-Americana de Ritmo Cardíaco

Al comienzo de la pandemia COVID-19 se implementaron pautas clínicas restrictivas de la asistencia que incluyeron los Servicios de Electrofisiología (SEF). Objetivo: analizar la actividad asistencial y conocer la situación de los SEF en Latinoamérica a dos meses de iniciadas las restricciones. Método: estudio observacional descriptivo-analítico y transversal, utilizando una encuesta a médicos electrofisiólogos en marzo/2020. Se comparó la actividad clínica e invasiva que se realizaba antes y durante la pandemia. Resultados: se incluyeron 147 encuestas, de 74 ciudades y 18 países de Latinoamérica. Los actos clínicos semanales se redujeron de 75 (45/127) a 20 (10/40) (p<0,001), bajaron 71%. Los procedimientos invasivos mensuales se redujeron de 26 (13/39) a 4 (2/9) (p<0,001), bajaron 77%. El 49% encuestado trabajaban en ≥3 centros asistenciales y 89% compartía laboratorio con un servicio de hemodinamia. La ocupación de camas en los hospitales era baja 37%, intermedia 28% y alta 35%. El 30% refirió algún médico de su equipo fue puesto en cuarentena por infección/contacto. El 53% refirió no se hacía ninguna prueba de tamizaje a los pacientes previa a los procedimientos y 77% al personal. La mayoría percibía dificultades como importantes o muy importantes, pero 63% estaba considerando la reapertura al funcionamiento normal. Conclusiones: hubo una reducción importante de la actividad clínica e invasiva. La mayoría no tenía alta ocupación de camas. Los encuestados trabajaban en varios centros y en salas de hemodinamia. Aún no se habían implementado totalmente las medidas de prevención. Existía la percepción de que en poco tiempo se retomaría la normalidad

At the beginning of the COVID-19 pandemic, restrictive clinical guidelines were implemented, including Electrophysiology Services (EFS). Objectives: analyze the healthcare activity and to know the situation of the EFS in Latin America two months after the restrictions began. Method: descriptive-analytical and cross-sectional observational study, using a survey of electrophysiologists in March / 2020. The clinical and invasive activity carried out before and during the pandemic was compared. Results: 147 surveys were included, from 74 cities in 18 Latin American countries. Weekly clinical events were reduced from 75 (45/127) to 20 (10/40) (p <0.001), they fell 71%. Monthly invasive procedures were reduced from 26 (13/39) to 4 (2/9) (p <0.001), down 77%. Forty-nine percent surveyed worked in ≥3 healthcare centers and 89% shared a laboratory with a hemodynamic service. Hospital bed occupancy was low 37%, intermediate 28% and high 35%. Thirty percent referred a doctor from their team was quarantined for infection / contact. Fifty-three percent reported that no screening test was done on the patients prior to the procedures and 77% on the staff. Most perceived difficulties as important or very important, but 63% were considering reopening to normal functioning. Conclusion: There was a significant reduction in clinical and invasive activity. Most did not have high bed occupancy. Respondents worked in various centers and in hemodynamic rooms. Prevention measures had not yet been fully implemented yet. There was a perception that in a short time normality would return.

No início da pandemia de COVID-19 foram implementadas diretrizes clínicas, incluindo os Serviços de Eletrofisiologia (SEF). Objetivo: analisar a atividade assistencial e conhecer a situação do SEF na América Latina dois meses após o início das restrições. Método: estudo descritivo-analítico e observacional transversal, por meio de questionário com eletrofisiologistas em março / 2020. Foi comparada a atividade clínica e invasiva realizada antes e durante a pandemia. Resultados: foram incluídos 147 inquéritos, de 74 cidades e 18 países latino-americanos. O número de procedimentos semanais foi reduzido de 75 (45/127) para 20 (10/40) (p <0,001), com redução de 71%. Os procedimentos invasivos mensais foram reduzidos de 26 (13/39) para 4 (2/9) (p <0,001), com redução de 77%. Dos eletrofisiologistas que responderam ao questionário, 49% trabalhavam em 3 ou mais centros, e 89% compartilhavam o laboratório com serviço de hemodinâmica. A ocupação de leitos hospitalares foi baixa em 37%, intermediária em 28% e alta em 35%. Dos que responderam al questionário, 30% relataram que um médico de sua equipe foi colocado em quarentena por infecção ou contato. Foi relatado que, dentre os que responderam, 53% não realizava teste de triagem nos pacientes antes dos procedimentos, e em 77% na equipe. A maioria percebeu as dificuldades como importantes ou muito importantes, mas 63% consideravam a reabertura ao funcionamento. Conclusões: houve redução significativa da atividade clínica e invasiva. A maioria não tinha grande ocupação de leitos. Os entrevistados trabalhavam em vários centros e em salas de hemodinâmica. As medidas de prevenção ainda não haviam sido totalmente implementadas, porém havia a percepção de que em pouco tempo a normalidade voltaria

An evaluation of some assumptions underpinning the bidomain equations of electrophysiology.

Tissue level cardiac electrophysiology is usually modelled by the bidomain equations, or the monodomain simplification of the bidomain equations. One assumption made when deriving the bidomain equations is that both the intracellular and extracellular spaces are in electrical equilibrium. This assumption neglects the disturbance of this equilibrium in thin regions close to the cell membrane known as Debye layers. We first demonstrate that the governing equations at the cell, or microscale, level may be adapted to take account of these Debye layers with little additional complexity, provided the permittivity within the Debye layers satisfies certain conditions that are believed to be satisfied for biological cells. We then homogenize the microscale equations using a technique developed for an almost periodic microstructure. Cardiac tissue is usually modelled as sheets of cardiac fibres stacked on top of one another. A common assumption is that an orthogonal coordinate system can be defined at each point of cardiac tissue, where the first axis is in the fibre direction, the second axis is orthogonal to the first axis but lies in the sheet of cardiac fibres and the third axis is orthogonal to the cardiac sheet. It is assumed further that both the intracellular and extracellular conductivity tensors are diagonal with respect to these axes and that the diagonal entries of these tensors are constant across the whole tissue. Using the homogenization technique we find that this assumption is usually valid for cardiac tissue, but highlight situations where the assumption may not be valid.

Recommendations for the use of electrophysiological study: Update 2018.

The field of cardiac electrophysiology has greatly developed during the past decades. Consequently, the use of electrophysiological studies (EPSs) in clinical practice has also significantly augmented, with a progressively increasing number of certified electrophysiology centers and specialists. Since Zipes et al published the Guidelines for Clinical Intracardiac Electrophysiology and Catheter Ablation Procedures in 1995, no official document summarizing current EPS indications has been published. The current paper focuses on summarizing all relevant data of the role of EPS in patients with different types of cardiac pathologies and provides up-to-date recommendations on this topic. For this purpose, the PubMed database was screened for relevant articles in English up to December 2018 and ESC and ACC/AHA Clinical Practice Guidelines, and EHRA/HRS/APHRS position statements related to the current topic were analyzed. Current recommendations for the use of EPS in clinical practice are discussed and presented in 17 distinct cardiac pathologies. A short rationale, evidence, and indications are provided for each cardiac disease/group of diseases. In conclusion, because of its capability to establish a diagnosis in patients with a variety of cardiac pathologies, the EPS remains a useful tool in the evaluation of patients with cardiac arrhythmias and conduction disorders and is capable of establishing indications for cardiac device implantation and guide catheter ablation procedures.

Registro Español de Desfibrilador Automático Implantable. XIV Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2017) / Spanish Implantable Cardioverter-defibrillator Registry. 14th Official Report of the Spanish Society of Cardiology Electrophysiology and Arrhythmias Section (2017)

Introducción y objetivos: El Registro Español de Desfibrilador Automático aporta datos de actividad desde el año 2002. Métodos: Los datos de este registro provienen de los centros implantadores, que cumplimentaron voluntariamente una hoja de recogida de datos. Resultados: Durante 2017 se han recibido 6.273 hojas de implante, frente a las 6.429 comunicadas por Eucomed (European Confederation of Medical Suppliers Associations); por lo tanto, se han recogido datos del 97,6% de los dispositivos implantados en España. El cumplimiento osciló entre el 99,7% en el campo «nombre del hospital implantador» y el 46,1% en la variable «clase funcional de la New York Heart Association». Comunicaron sus datos al registro 181 hospitales, lo que supone un aumento respecto a los que participaron en 2016 (177) y años anteriores (169 en 2015, 162 en 2014, 154 en 2013 o 153 en 2012). Conclusiones: Después de varios años de crecimiento en el número de implantes por millón de habitantes, este año se ha reducido. Como en los años previos, el número total de implantes en España sigue siendo muy inferior a la media de la Unión Europea, y la diferencia continúa aumentando, al igual que persisten las importantes diferencias entre comunidades autónomas españolas

Introduction and objectives: The Spanish Automatic Defibrillator Registry has provided activity data since 2002. Methods: The data in this registry are submitted by implantation centers that voluntarily complete a data collection sheet. Results: During 2017, a total of 6273 implant sheets were received, compared with 6429 reported by Eucomed (European Confederation of Medical Suppliers Associations). Therefore, the registry contains data on 97.6% of the devices implanted in Spain. Compliance ranged from 99.7% for the field "name of the implanting hospital " to 46.1% for the variable "New York Heart Association functional class ". A total of 181 hospitals reported data to the registry, representing an increase compared with the number of participating hospitals in 2016 (177) and in previous years (169 in 2015, 162 in 2014, 154 in 2013, and 153 in 2012). Conclusions: The number of implants per million inhabitants in Spain increased for several years but decreased in 2017. As in previous years, the total number of implants in Spain is still much lower than the European Union average, and the gap continues to widen. There are still substantial differences between autonomous communities

Updated Survey on Interventional Electrophysiology: 5-Year Follow-Up of Infrastructure, Procedures, and Training Positions in Germany.

OBJECTIVES: This study provides an update and comparison to a 2010 nationwide survey on cardiac electrophysiology (EP), types and numbers of interventional electrophysiological procedures, and training opportunities in 2015. BACKGROUND: In 2010, German cardiology centers performing interventional EP were identified and contacted to provide a survey on cardiac EP. METHODS: German cardiology centers performing interventional EP in 2015 were identified from quality reports and contacted to repeat the 2010 questionnaire. RESULTS: A majority of 131 centers (57%) responded. EP (ablation procedures and device therapy) was mainly part of a cardiology department (89%) and only independent (with its own budget) in 11%. The proportion of female physicians in EP training increased from 26% in 2010 to 38% in 2015. In total, 49,356 catheter ablations (i.e., 81% of reported ablations in 2015) were performed by the responding centers, resulting in a 44% increase compared with 2010 (the median number increased from 180 to 297 per center). Atrial fibrillation (AF) was the most common arrhythmia interventionally treated (47%). At 66% of the centers, (at least) 2 physicians were present during most catheter ablations. A minimum of 50 (75) AF ablations were performed at 80% (70%) of the centers. Pulmonary vein isolation with radiofrequency point-by-point ablation (62%) and cryoablation (33%) were the preferred ablation strategies. About one-third of centers reported surgical AF ablations, with 11 centers (8%) performing stand-alone surgical AF ablations. Only one-third of the responding 131 centers fulfilled all requirements for training center accreditation. CONCLUSIONS: Comparing 2010 with 2015, an increasing number of EP centers and procedures in Germany are registered. In 2015, almost every second ablation was for therapy for AF. Thus, an increasing demand for catheter ablation is likely, but training opportunities are still limited, and most centers do not fulfil recommended requirements for ablation centers.

Effect of Electrophysiology Assessment on Mortality and Hospitalizations in Patients With New-Onset Atrial Fibrillation.

Few patients with atrial fibrillation (AF) receive care by cardiac electrophysiologists. Although previous work has highlighted differential care for patients with AF treated by electrophysiologists, it is unclear whether this is associated with improved clinical outcomes. This retrospective population-level propensity score-matched cohort study included patients aged 20 to 80 years with new-onset AF presenting to an emergency department (ED) in Ontario, Canada, between 2010 and 2012. Patients were followed until March 31, 2015. Patients who saw an electrophysiologist within 1 year of the index ED visit were matched to patients who did not see an electrophysiologist. Linked administrative databases were used for cohort construction and allow 1-year follow-up to assess for the clinical end points of all-cause mortality and hospitalization for AF, heart failure, bleeding, and stroke. A total of 5,221 unique pairs of patients were matched. One hundred seventeen patients (2.2%) in the electrophysiologist cohort underwent an AF ablation procedure during the 1-year follow-up period. All-cause mortality (hazard ratio [HR] = 1.1, p = 0.17) and stroke (HR = 1.4, p = 0.09) were not significantly different between the 2 groups. Hospitalization for AF (HR = 1.4, p <0.001), bleeding (HR = 1.5, p = 0.0001), and congestive heart failure (HR = 1.5, p <0.0001) was increased in the group that saw an electrophysiologist. In conclusion, electrophysiologist care was not associated with improved clinical outcomes in patients with new-onset AF.

Gender Disparities Across the Spectrum of Advanced Cardiac Therapies: Real or Imagined?

Cardiovascular disease has been responsible for more deaths in women than in men each year since 1985. This review discusses federal laws that have influenced the inclusion of women in research and reporting sex-specific differences, then addresses gender differences and gender disparities in four areas of clinical cardiovascular medicine: coronary heart disease, valvular heart disease, electrophysiology, and heart failure. The prevalence of disease in women is highlighted, the clinical characteristics of women at the time of referral for advanced therapies are reviewed, and the clinical outcomes of women are discussed. With the emergence of new technology such as smaller devices and less invasive procedures, more women are being referred for advanced therapies. However, a gap in awareness and diagnosis remains, contributing to later referrals for women. Women who do undergo advanced therapies often have more comorbidities and worse outcomes than men. A call is made to increase awareness, educate healthcare providers, and report more sex-specific data to resolve these gender disparities.

Parallel Optimization of 3D Cardiac Electrophysiological Model Using GPU.

Large-scale 3D virtual heart model simulations are highly demanding in computational resources. This imposes a big challenge to the traditional computation resources based on CPU environment, which already cannot meet the requirement of the whole computation demands or are not easily available due to expensive costs. GPU as a parallel computing environment therefore provides an alternative to solve the large-scale computational problems of whole heart modeling. In this study, using a 3D sheep atrial model as a test bed, we developed a GPU-based simulation algorithm to simulate the conduction of electrical excitation waves in the 3D atria. In the GPU algorithm, a multicellular tissue model was split into two components: one is the single cell model (ordinary differential equation) and the other is the diffusion term of the monodomain model (partial differential equation). Such a decoupling enabled realization of the GPU parallel algorithm. Furthermore, several optimization strategies were proposed based on the features of the virtual heart model, which enabled a 200-fold speedup as compared to a CPU implementation. In conclusion, an optimized GPU algorithm has been developed that provides an economic and powerful platform for 3D whole heart simulations.

Snapshot of adult invasive cardiac electrophysiology in Canada: results of the web-based registry.

PURPOSE: Interventional cardiac electrophysiology (EP) has experienced a significant growth in Canada. Our aim is to establish a periodic registry as a nationwide initiative. METHODS: The registry is designed to collect information regarding EP laboratory infrastructure, human resources, and the spectrum and volumes of EP procedures. Respective administrative staff were contacted electronically. RESULTS: Out of 25 identified Canadian EP centers, 19 centers (76%) have participated in the registry. Responding centers have access on average to 5.3 lab days per week to perform EP studies/ablations; average lab time per full- and part-time (prorated to 0.5) EP physician is 0.8 day per week. Diagnostic EP studies and radio-frequency ablations are performed in all (19) centers; cryoablation is available in 83% of centers. Two centers have remote magnetic navigation systems. EnSite NavX is the most widely available 3D mapping system utilized in 15 (83%) centers, followed by CARTO and intracardiac echo which are each available in 14 (78%) centers; LocaLisa is actively used in one center. The number of full-time physicians ranges between 0 and 7, with a mean of 3.5 full-time physicians per center. The ratio of staff to trainees is 1.6:1. A total of 8,041 EP procedures are performed in the 19 centers per annum. On an annual average, 104 procedures per one operator and 159 procedures per trainee are performed. CONCLUSIONS: This registry provides contemporary information on invasive EP lab resources and procedures in Canada. It also demonstrates that Canadian EP procedural intensities of practice and training are comparable to international standards.

Diagnosis and management of pediatric brugada syndrome: a survey of pediatric electrophysiologists.

BACKGROUND: Brugada syndrome (BrS) can be difficult to diagnose and treat, especially in the young patient. As there is currently no consensus on the evaluation and treatment of BrS in the pediatric population, we sought to describe the current practice for the diagnosis and treatment of BrS among pediatric electrophysiologists. METHODS: A web-based survey was distributed to 204 physician members (MDs) of The Pediatric and Adult Congenital Electrophysiology Society (PACES). Practice characteristics, BrS patient attributes, and diagnostic and therapeutic preferences were collected. RESULTS: Responses were obtained from 83 pediatric electrophysiologists. The most common initial presentation was family history. There is a large variation in testing, particularly in the use of electrophysiology (EP) studies, drug challenge testing, and genetic testing. Despite limited treatment options, there is only consensus in the therapeutic approach to the pediatric patient with symptomatic BrS with 97% of physicians recommending an implantable cardioverter defibrillator (ICD). In the asymptomatic patient, a wide variation in therapy was seen with only 27% of physicians recommending an ICD CONCLUSIONS: Significant practice variation exists among pediatric electrophysiologists with deviation from accepted diagnostic and therapeutic practices for adult BrS patients. Further studies are necessary to establish best practice guidelines for BrS in the pediatric EP community.

Registro Español de Ablación con Catéter. IX Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2009) / Spanish Catheter Ablation Registry. 9th Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2009)

Introducción y objetivos. Se detallan los resultados del Registro Nacional de Ablación del año 2009. Métodos. La recogida de datos se llevó a cabo mediante dos sistemas: de forma retrospectiva con la cumplimentación de un cuestionario y de forma prospectiva a través de una base de datos común. La elección de uno u otro por cada centro fue voluntaria. Resultados. Se recogieron datos de 59 centros. El número total de procedimientos de ablación fue 8.546, con una media de 145 ± 101 procedimientos. Los tres sustratos abordados con más frecuencia fueron la taquicardia intranodal (n = 2.341; 27%), la ablación del istmo cavotricuspídeo (n = 1.859; 21,7%) y las vías accesorias (n = 1.758; 20,5%). El cuarto sustrato abordado (n = 1.188; 14%) fue la ablación de fibrilación auricular, que mostró un incremento del 44% con respecto al registro del año 2008. La tasa general de éxito fue del 93%; la de complicaciones mayores, del 1,9% y la de mortalidad, del 0,046%. Conclusiones. En el registro del año 2009 se mantiene una línea de continuidad ascendente en el número de ablaciones realizadas, se supera por primera vez los 8.000 procedimientos y, en líneas generales, se observa una elevada tasa de éxito y un número de complicaciones bajo. La ablación del istmo cavotricuspídeo como tratamiento del aleteo auricular típico continúa como el segundo sustrato más frecuentemente abordado. Se observa un mayor incremento en el número de procedimientos de ablación de fibrilación auricular con respecto a años anteriores (AU)

Introduction and objectives. This article reports the findings of the 2009 Spanish national Catheter Ablation Registry. Methods. Data were collected in two ways: retrospectively using a standard questionnaire and prospectively from a central database. Each center chose its own preferred method of data collection. Results. Data were collected from 59 centers. The total number of ablation procedures carried out was 8546, giving a mean of 145±101 procedures per center. The three most frequently treated conditions were atrioventricular nodal reentrant tachycardia (n=2341; 27%), typical atrial flutter (n=1859; 21.7%) and accessory pathways (n=1758; 20.5%). The fourth most common condition was atrial fibrillation (n=1188; 14%), the number of which has grown by 44% since the 2008 registry. The overall success rate was 93%, major complications occurred in 1.9%, and the mortality rate was 0.046%. Conclusions. Data from the 2009 registry show that the number of ablations carried out continued to increase and exceeded 8000 for the first time. In addition, they show, in general, a higher success rate and a lower number of complications. Cavotricuspid isthmus ablation, as treatment for typical atrial flutter, continued to be the second most common procedure. There was a substantial increase in the number of catheter ablations performed for atrial fibrillation compared with previous years (AU)