Transseptal approach for catheter ablation of left-sided accessory pathways in children with Marfan syndrome:A case report

BACKGROUND Left-sided accessory pathways(APs)can be accessed with either a transaortic(TA)or transseptal approach(TS).For children with Marfan syndrome(MFS)who have aortic disease,the use of TA can aggravate the disease,making TS the best choice for these patients.CASE SUMMARY A 10-year-old girl was hospitalized because of intermittent heart palpitations and chest tightness.She was diagnosed with MFS,supraventricular tachycardia,Wolff-Parkinson-White syndrome,and left-sided AP was detected by cardiac electrophysiological.Catheter ablation was successfully performed via TS under the guidance of the Ensite system.During the follow-up,no recurrence or complications occurred.CONCLUSION The TS for catheter ablation of left-sided APs can be considered in children with MFS.Adequate evaluation and selection of the appropriate puncture site are particularly important.

Catheter ablation of atrial fibrillation in elderly population

Background Although elderly patients have been included in published series of catheter ablation for atrial fibrillation （AF）, clinicalbenefit and safety remain still less defined in this population. A retrospective analysis of the results of catheter ablation for AF in a large volumecenter focused on comparison of elderly patients with the rest of the patient cohort was conducted in this study. Methods Consecutive patientswho underwent catheter ablation for AF between January 2001 and December 2016 were analysed. A total population of 3197 patients wasdichotomized by the age of 70 years （394 elderly vs. 2803 younger subjects）. Patients were followed in terms of arrhythmia status and sur-vival for a median period of 18 vs. 21 and 35 vs. 57 months, respectively. Results Elderly patients were more frequently females （49% vs.29%, P 〈 0.0001）, had a history of hypertension （79% vs. 57%, P 〈 0.0001）, diabetes （16% vs. 11%, P 〈 0.01）, stroke （9% vs. 6%, P 〈 0.01）,coronary/peripheral artery disease （14% vs. 8%, P 〈 0.0001）, and CHAzDS2-VASc score （3.1 ± 1.3 vs. 1.5 ± 1.2 s, P 〈 0.0001）. Major com-plications were more frequent in elderly （5.3% vs. 3.2%, P = 0.03）; however, this difference was driven by vascular complications （3.6% vs.1.9%, P = 0.04）. There were comparable rates of cerebrovascular （0.3 vs. 0.3%） or nonvascular complications （1.8 vs. 1.2%）. Good arrhyth-mia control was inferior in elderly patients as compared with the rest of the cohort, both without and with antiarrhythmic drugs： 44.2% vs.58.2% （P 〈 0.0001） and 78.2 vs. 83.2% （P 〈 0.01）, respectively. Poor arrhythmia control was associated with relative risk of all-cause mor-tality of 2.7 （95% CI： 1.1-6.4） in elderly patients and 1.4 （95% CI： 0.9-2.0） in younger subjects. Conclusions Catheter ablation for AF inelderly patients is safe although somewhat less effective. Good arrhythmia control is associated with better survival, especially in elderly patients.

Clinical outcomes of radiofrequency catheter ablation of atrial fibrillation in octogenarians lO-year experience of a one high-volume center

Background Prevalence of atrial fibrillation （AF） increases with age. Radiofrequency catheter ablation （RFCA） is an establishedtreatment option superior to antiarrhythmics （AAs）. In this study, we investigated safety and efficacy of RFCA of AF in octogenarians.Methods From our database, we extracted procedural and follow-up data for patients 〉 80 years with symptomatic AF undergoing RFCAand compared this population to RFCA patients 〈 50 years. All patients underwent pulmonary vein isolation （PVI） supplemented by linearlesions in PVI-nonresponders. Arrhythmia-free survival was assessed using seven day Holter every three months post procedure. All patientscompleted their 12 months follow-up. Results Fifty patients aged ≥80 years （80.5 ± 1.6 years） were compared to 259 patients aged 〈 50years （43.5±5.5 years）. The RFCA complication rate did not vary between groups. No differences in procedural characteristics were seenafter being analyzed by type of AF. Among patients with paroxysmal AF, 71.4% octogenarian vs. 84.7% young patients was free of anyarrhythmia, without AAs, after single procedure. For non-paroxysmal AF, arrhythmia-free survival without AAs, was considerably lower（58.6% octogenarians vs. 81.2% younger patients, P = 0.023）. If AAs were used, arrhythmia-free survival for paroxysmal AF increased to90.5% and 92.1% in octogenarians and younger patients, respectively; and in non-paroxysmal AF it increased to 79.3% vs. 88.4%. ConclusionsRFCA is a safe and effective strategy to achieve normal sinus rhythm in a highly selected group of octogenarians. Paroxysmal AF ablation inoctogenarians has similar clinical effectiveness as that seen in much younger patients. Non-paroxysmal AF ablation has lower, but still rea-sonable clinical effectiveness.

Value of cystatin C in predicting atrial fibrillation recurrence after radiofrequency catheter ablation

Backgroud Recent studies have demonstrated that cystatin C is a valuable risk marker for cardiovascular disease morbidity and mortality.Therefore,we hypothesized that the pre-ablation cystatin C level was associated with post-ablation atrial fibrillation(AF)recurrence.Methods 207 patients were enrolled and completed in this prospective observational study.Patients with AF scheduled for receive radiofrequency catheter ablation(RFCA)therapy were screened for the study.Before ablation therapy,electrocardiogram,24 h holter monitor,transesophageal echocardiography,serum cystatin C,high-sensitivity C-reactive protein,creatinine levels,and routine blood examinations were examined.After ablation,patients were followed up every week for the first month,and then at 2,3,6,9,and 12 months.Thereafter,patients came back to out-patient clinic every six months regularly.Electrocardiogram or 24 h holter monitor were repeated if the patient experienced palpitations or every six months.AF recurrence was defined as atrial flbrillation/atrial flutter or atrial tachycardia lasting≥30 seconds within three months after therapy.Results Compared to patients with no AF recurrence,patients with recurrence had longer AF history(P=0.007),more early recurrence(P=0.000),a larger left atrium(P=0.004),and higher pre-ablation cystatin C levels(P=0.000).Multivariate regression analysis revealed that cystatin C and left atria(LA)diameter were risk factors for AF recurrence.After adjusting for LA diameter,the risk of AF recurrence increased 30%with every milligram cystatin C elevation(95%CI:1.117-1.523).Conclusions Pre-ablation cystatin C levels were associated with AF recurrence after RFCA therapy,an optimal cut-off value of 1.190 mg/L(sensitivity=0.576;specificity=0.851).

Catheter ablation of atrial fibrillation: Radiofrequency catheter ablation for redo procedures after cryoablation

AIM: To evaluate the effectiveness of two different strategies using radiofrequency catheter ablation for redo procedures after cryoablation of atrial fibrillation.METHODS: Thirty patients(paroxysmal atrial fibrillation: 22 patients,persistent atrial fibrillation: 8 patients) had to undergo a redo procedure after initially successful circumferential pulmonary vein(PV) isolation with the cryoballoon technique(Arctic Front Balloon,CryoCath Technologies/Medtronic).The redo ablation procedures were performed using a segmental approach or a circumferential ablation strategy(CARTO;Biosense Webster) depending on the intra-procedural findings.After discharge,patients were scheduled for repeated visits at the arrhythmia clinic.A 7-day Holter monitoring was performed at 3,12 and 24 mo after the ablation procedure.RESULTS: During the redo procedure,a mean number of 2.9 re-conducting pulmonary veins(SD ± 1.0 PVs) were detected(using a circular mapping catheter).In 20 patients,a segmental approach was sufficient to eliminate the residual pulmonary vein conduction because there were only a few recovered pulmonary vein fibres.In the remaining 10 patients,a circumferential ablation strategy was used because of a complete recovery of the PV-LA conduction.All recovered pulmonary veins could be isolated successfully again.At 2-year follow-up,73.3% of all patients were free from an arrhythmia recurrence(22/30).There were no major complications.CONCLUSION: In patients with an initial circumferential pulmonary vein isolation using the cryoballoon technique,a repeat ablation procedure can be performed safely and effectively using radiofrequency catheter ablation.

Catheter ablation for atrial fibrillation is associated with reduced risk of mortality in the elderly:a prospective cohort study and propensity score analysis

Background It is unclear whether catheter ablation(CA)for atrial fibrillation(AF)affects the long-term prognosis in the elderly.This study aims to evaluate the relationship between CA and long-term outcomes in elderly patients with AF.Methods Patients more than 75 years old with non-valvular AF were prospectively enrolled between August 2011 and December 2017 in the Chinese Atrial Fibrillation Registry Study.Participants who underwent CA at baseline were propensity score matched(1:1)with those who did not receive CA.The outcome events included all-cause mortality,cardiovascular mortality,stroke/transient ischemic attack(TIA),and cardiovascular hospitalization.Results Overall,this cohort included 571 ablated patients and 571 non-ablated patients with similar characteristics on 18 dimensions.During a mean follow-up of 39.75±19.98 months(minimum six months),24 patients died in the ablation group,compared with 60 deaths in the non-ablation group[hazard ratio(HR)=0.49,95%confidence interval(CI):0.30-0.79,P=0.0024].Besides,6 ablated and 29 non-ablated subjects died of cardiovascular disease(HR=0.25,95%CI:0.11-0.61,P=0.0022).A total of 27 ablated and 40 non-ablated patients suffered stroke/TIA(HR=0.79,95%CI:0.48-1.28,P=0.3431).In addition,140 ablated and 194 non-ablated participants suffered cardiovascular hospitalization(HR=0.84,95%CI:0.67-1.04,P=0.1084).Subgroup analyses according to gender,type of AF,time since onset of AF,and anticoagulants exposure in initiation did not show significant heterogeneity.Conclusions In elderly patients with AF,CA may be associated with a lower incidence of all-cause and cardiovascular mortality.

Impact of computed tomography image and contact force technology on catheter ablation for atrial fibrillation

AIM:To investigate the impact of using computed tomography(CT) and contact force(CF) technology on recurrence of atrial tachyarrhythmia after atrial fibrillation(AF) ablation.METHODS: This non-randomized study included 2 groups of patients. All patients had symptomatic recurrent paroxysmal or persistent AF and were treated with at least 1 anti arrhythmic medication or intolerant to medication. The first group included 33 patients who underwent circumferential pulmonary veins isolation(PVI) for AF during 2012 and 2013 guided by CT image integration(Cartomerge, Biosense Webster, Diamond Bar, CA, United States) of left atrium and pulmonary veins into an electroanatomic mapping(EAM) system(CT group) using standard irrigated radiofrequency catheter(Thermo Cool, Carto, Biosense Webster, Diamond Bar, CA, United States) or irrigated catheter with integrated CF sensor(Smart Touch, Carto, Biosense Webster, Diamond Bar, CA, United States). The second group included immediately preceding 32 patients who had circumferential PVI by standard irrigated catheter(Thermo Cool) using only EAM(Carto) system(EAM group). Linear lesions were performed according to the discretion of operator. RESULTS: Sex, age, and persistent AF were not different between groups. PVI was achieved in all patients in both groups. Linear ablations including cavo-tricuspid isthmus and or roof line ablation were not different between groups. Free of atrial tachyarrhythmia during follow-up of 24 mo was significantly higher among CT group compared to EAM group(81% vs 55%; respectively; P = 0.027). When 11 patients from CT group who had ablation using Smart Touch catheter were excluded, the difference between CT group and EAM became non significant(73% vs 55%; respectively; P = 0.16). Sub analysis of CT group showed that patients who had ablation using Smart Touch catheter tend to be more free of atrial tachyarrhythmia compared to patients who had ablation using standard irrigated catheter during follow-up(100% vs 73%; respectively; P = 0.07). Major complications(pericardial effusion, cerebrovascular accident/transient ischemic attack, vascular access injury requiring intervention) did not occurred in both groups.CONCLUSION:These preliminary results suggest that CT image integration and CF technology may reduce the recurrence of atrial tachyarrhythmia after catheter ablation for AF.

Mechanisms and clinical significance of early recurrences of atrial arrhythmias after catheter ablation for atrial fibrillation

Early recurrence of atrial arrhythmias(ERAA) after ablation is common and strongly predicts late recurrences and ablation failure. However, since arrhythmia may eventually resolve in up to half of patients with ERAA, guidelines do not recommend immediate reintervention for ERAA episodes occurring during a 3-mo postablation blanking period. Certain clinical demographic, electrophysiologic, procedural, and ERAA-related characteristics may predict a higher likelihood of longterm ablation failure. In this review, we aim to discuss potential mechanisms of ERAA, and to summarize the clinical significance, prognostic implications, and treatment options for ERAA.

Trigger elimination of polymorphic ventricular tachycardia and ventricular fibrillation by catheter ablation:trigger and substrate modification

Ventricular fibrillation （VF） is a malignant arrhythmia, usually initiated by a ventricular premature contraction （VPC） during the vulnerable period of cardiac repolarization. Ablation therapy for VF has been described and increasingly reported. Targets for VF triggers are VPCs preceded by Purkinje potentials or from the right ventricular outflow tract （RVOT） in structurally normal hearts, and VPC triggers preceded by Purkinje potentials in ischemic cardiomyopathy. During the session, mapping should be focused on the earliest activation and determining the earliest potential is the key to a successful ablation. However, suppression of VF can be achieved by not only the elimination of triggering VPCs, but also by substrate modification of possible reentry circuits in the Purkinje network, or between the PA and RVOT. The most important issue before the ablation session is the recording of the 12-lead ECG of the triggering event, which can prove invaluable in regionalizing the origin of the triggering VPC for more detailed mapping. In cases where the VPC is not spontaneous or inducible, ablation may be performed by pace mapping. Further studies are needed to evaluate the precise mechanisms of this arrhythmia.

Catheter ablation of premature ventricular complexes associated with false tendons: A case report

BACKGROUND False tendon is a common intraventricular anatomical variation. It refers to a fibroid or fibromuscular structure that exists in the ventricle besides the normal connection of papillary muscle and mitral or tricuspid valve. A large number of clinical studies have suggested that there is a significant correlation between false tendons and premature ventricular complexes. However, few studies have verified this correlation during radiofrequency catheter ablation of premature ventricular complexes.CASE SUMMARY A 45-year-old male was admitted to receive radiofrequency ablation for symptomatic premature ventricular complexes. A three-dimensional model of the left ventricle was established by intracardiac echocardiography using the CartoSound^TM mapping system. In addition to the left anterior papillary muscle,the posterior papillary muscle was mapped. False tendons were found at the base of the interventricular septum, and the other end was connected to the left ventricular free wall near the apex. An irrigated touch force catheter was advanced into the left ventricle via the retrograde approach. The earliest activation site was marked at the interventricular septum attachment of the false tendons and was successfully ablated.CONCLUSION This case verified that false tendons can cause premature ventricular complexes and may be cured by radiofrequency ablation guided by intracardiac echocardiography with the Carto Sound TM system.

Long-term results of single-procedure catheter ablation for atrial fibrillationin pre-and post-menopausal women

ObjectivesTo 地址经绝期是否由比较安全和长期的结果为 atrial 纤维性颤动(AF ) 影响导管脱离(CA ) 的结果一在经历了药倔强的 AF 的一个单个 CA 过程的 743 个女病人全部的绝经前、绝经后的 women.MethodsA 单个过程回顾地被分析。在为在绝经前的女人之间的 AF 的 CA 的临床的表示和结果的差别(PreM 组， 94 个病人， 12.7%) 并且绝经后的女人(PostM 组， 649 个病人， 87.3%) 在 PreM 组的 assessed.ResultsThe 病人更年轻(P &#x0003c；0.001 ) 并且不太可能有高血压(P &#x0003c；0.001 ) 并且糖尿病(P = 0.005 ) 比那些在 PostM 组。二个组关于伴随物的比例是类似的僧帽形的阀门流回冠的动脉疾病，左中庭尺寸，和左室的喷射部分。与 AF 脱离有关的复杂并发症的全面的率在两个组是类似的(P = 0.385 ) 。在 43 以后(16-108 ) 后续的月，脱离的成功率在 PreM 组是 54.3% ， 54.2% 在 PostM 组织(P = 0.842 ) 。从 atrial tachyarrhythmia 复发的全面自由在两个组是类似的。经绝期没被发现是为 AF 的单个过程的 CA 的长期的结果是的 atrial tachyarrhythmia.ConclusionsThe 的复发的一个独立预兆的因素在绝经前、绝经后的女人类似。结果显示 AF 的 CA 看起来在绝经前的女人同样象在绝经后的女人安全、有效。

Clinical Study on the Treatment of 325 Cases of Atrioventricular Node Reentrant Tachycardia by Radiofrequency Catheter Ablation

In order to improve the efficacy of modified inferior method or middle method of radiofrequency catheter ablation (RFCA) in the treatment of atrioventricular node reentrant tachycardia (AVNRT), the clinical data of 325 cases of AVNRT from March 1992 to Feb. 2000 being subjected to the treatment of RFCA were retrospectively analyzed. The results showed that the successful rate was increased and recurrence was decreased year by year. In the recent 4 years the effective rate was up to 100 %. The complication of three grade of AVB occurred in 3 % and recurrent rate in 9.1 % before March 1996, but both of them were zero in the last 3 years. The time of RFCA procedure and X ray exposure was significantly reduced. It was concluded that ablating more than 3 targets by modified inferior method or middle method with energy titrating and strict endpoint was the crux of obtaining satisfactory therapeutic effects and preventing recurrence.

Catheter ablation for atrial fibrillation in a subset of patients with concomitant hypertension

AIM:To study patients with atrial fibrillation and hypertension who had successful catheter ablation for changes in blood pressure 1 year later.METHODS:A retrospective study was performed on patients who had catheter ablation for atrial fibrillation(AF) and hypertension(HTN) which included local autonomic ganglionated plexi denervation and pulmonary veins isolation.Of the records of 119 patients,followup data was found in order to determine the presence of sinus rhythm and data on systolic(SBP) and diastolic blood pressure at 2 wk,3 mo,6 mo and 1 year after the ablation procedure.Transthoracic echocardiograms were taken at the time of the catheter procedure to determine left atrial dimensions(LADs) and left ventricular size.RESULTS:There was no significant difference in the preablation mean blood pressures between the two groups(P = 0.08).After 1 year 33 of the 60 with AF and HTN were in sinus rhythm,of whom 12 had normal LADs,≤ 4 cm Group 1,and 21 had enlarged left atria(LADs > 4 cm,Group 2).For Group 1,at 1 year of follow up,there was a significant difference in the SBP(119.2 ± 13 mm Hg) compared to pre-ablation(142.6 ± 13.7 mm Hg,P = 0.001).For Group 2,there was no significant difference in the SBP,pre-ablation(130.3 ± 17.5 mm Hg) and at 1 year of follow up(130.4 ± 13.4 mm Hg,P = 0.75).All patients were on similar anti-hypertensive medications.There was a trend for a greater left ventricular size in Group 2 compared to Group 1.CONCLUSION:We suggest that Group 1 had HTN due to sympathetic hyperactivity,neurogenic HTN;whereas HTN in Group 2 was based on arterial vasoconstriction.

Catheter ablation of atrial fibrillation facilitated by preprocedural three-dimensional transesophageal echocardiography: Long-term outcome

AIM To evaluate the long-term outcome of catheter ablation of atrial fibrillation(AF) facilitated by preprocedural threedimensional(3-D) transesophageal echocardiography.METHODS In 50 patients, 3D transesophageal echocardiography(3D TEE) was performed immediately prior to an ablation procedure(paroxysmal AF: 30 patients, persistent AF: 20 patients). The images were available throughout the ablation procedure. Two different ablation strategies were used. In most of the patients with paroxysmal AF, the cryoablation technique was used(Arctic Front Balloon, Cryo Cath Technologies/Medtronic; group A2). In the other patients, a circumferential pulmonary vein ablation was performed using the CARTO system [Biosense Webster; group A1(paroxysmal AF), group B(persistent AF)]. Success rates and complication rates were analysed at 4-year follow-up.RESULTS A 3D TEE could be performed successfully in all patients prior to the ablation procedure and all four pulmonaryvein ostia could be evaluated in 84% of patients. The image quality was excellent in the majority of patients and several variations of the pulmonary vein anatomy could be visualized precisely(e.g., common pulmonary vein ostia, accessory pulmonary veins, varying diameter of the left atrial appendage and its distance to the left superior pulmonary vein). All ablation procedures could be performed as planned and almost all pulmonary veins could be isolated successfully. At 48-mo followup, 68.0% of all patients were free from an arrhythmia recurrence(group A1: 72.7%, group A2: 73.7%, group B: 60.0%). There were no major complications.CONCLUSION3 D TEE provides an excellent overview over the left atrial anatomy prior to AF ablation procedures and these procedures are associated with a favourable long-term outcome.

Efficacy and safety of a novel multi-electrode radiofrequency ablation catheter for renal sympathetic denervation in pigs

ObjectiveTo 调查一根自我开发的新奇多电极 radiofrequency 脱离导管(火花) 的安全和功效因为 14 头试验性的缩小的猪全部的基于导管的肾的 denervation (RDN ).MethodsA 随机被划分成四个组(55 &#x000b0； &#x00026；5 瓦特， 55 &#x000b0； &#x00026；8 瓦特， 65 &#x000b0； &#x00026；5 瓦特，和 65 &#x000b0；&#x00026；8 瓦特组) 。火花被用于左和恰好肾的动脉 radiofrequency 脱离。象肾的动脉X线摄影法一样从肾的动脉和静脉收集的血样品以前在所有动物上被执行，立即在以后，并且在过程到以后的三个月评估血浆高血压蛋白原酶的火花 on the levels 的效果，醛固酮，血管收缩素我，并且象肾的 arteries.ResultsOne 猪的病理学的变化一样的血管收缩素 II 死于一个麻药事故， 13 头猪成功地经历了双边的肾的动脉脱离。与基本大小相比，在所有四个组的猪显著地减少了在过程以后的吝啬的动脉的压力。组织病理学说的分析证明这个过程能导致内层的增生，在象在 perineurium 的煽动性的细胞渗入和纤维变性那样的肾的动脉的重要外部同情的神经损坏，神经纤维的不平的分发，织物坏死，严重 vacuolization ，碎裂并且不清楚的 nucleoli 髓磷脂退化，稀少的轴突，并且连续性的打断。另外，肾的动脉 radiofrequency 脱离能显著地减少血浆高血压蛋白原酶的层次，醛固酮，血管收缩素我，和在 pigs.ConclusionsThe 结果的血管收缩素 II 建议那基于导管的 radiofrequency 脱离能有效地移开的这类多电极外部肾的同情的神经和还原剂在猪的全身的高血压蛋白原酶血管收缩素系统的活动，因此在猪便于全身的血压的控制。

The trend of change in catheter ablation versus antiarrhythmic drugs for the management of atrial fibrillation over time： a meta-analysis and meta-regression

ObjectiveTo 在 time.MethodsThe 上与 atrial 纤维性颤动(AF ) 在病人为节奏控制与 antiarrhythmic 药治疗(ADT ) 相比在导管脱离的功效和安全评估变化的趋势联机数据库 PubMed 和 EMBASE 被在找相关研究。STATA 软件(版本 12.0 ) 被用来执行元分析和 meta-regression.ResultsFifteen 包括有 AF 的 2249 个病人的使随机化的控制试用被识别。分享的结果证明那导管脱离与 ADT 相比在 AF 复发的风险与 52% 减小被联系[风险比率(RR )= 0.48， 95% 信心间隔(CI ) ：0.40-0.57，我 2=70.7%) 。亚群分析证明那导管脱离在 2011 前与研究相比在 2011 以后在研究展出了更少的功效(RR = 0.61， 95% CI：0.54-0.68，我 2=9.3% 并且 RR = 0.34， 95% CI：0.24-0.47，我 2=69.9% ，分别地) ，并且安全结果更高显示出 1.08 褶层不利事件的发生(14.2% 对 7.3% ；RR = 1.08， 95% CI：1.04-1.13 ) 在在 2011 .ConclusionsCatheter 以后的研究，脱离看起来比为节奏控制的 ADT 优异。然而，更少的功效和不利事件的更高的率在 2011 前与研究相比在 2011 以后在研究被观察。

Percutaneous transhepatic access for catheter ablation of a patient with heterotaxy syndrome complicated with atrial fibrillation:A case report

BACKGROUND Atrial fibrillation(AF)is one of the most common arrhythmias,and radiofrequency catheter ablation is the most effective treatment strategy.The inferior vena cava(IVC)is a common approach for radiofrequency ablation of AF.However,this approach may not be applied to some cases such as chronic venous occlusions,surgical ligation of the IVC,and heterotaxy syndrome(HS).CASE SUMMARY A 68-year-old man with HS suffered from severely symptomatic persistent AF for 9 years,and we successfully ablated by percutaneous transhepatic access.CONCLUSION In patients without femoral vein access,the use of the hepatic vein for pulmonary vein isolation is a viable alternative for invasive electrophysiology procedures.

RADIOFREQUENCY CURRENT CATHETER ABLATION OF THE LEFT ATRIOVENTRICULAR ACCESSORY PATHWAYS WITH PAROXYSMAL SUPRAVENTRICULAR TAC

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Catheter ablation for atrial fibrillation in heart failure:untying the Gordian knot

Atrial fibrillation(AF) and heart failure(HF) are complex clinical entities that occur concomitantly in a significant population of patients, and their prevalence is rising in epidemic proportions. Traditionally, both rate and rhythm control strategies have been regarded as equivalent in the management of dysrhythmia in this AF-HF cohort with escalation of treatment largely guided by symptoms. Both disorders are involved in an elaborate pathophysiological interplay with shared cardiovascular risk factors that contribute to the development and sustenance of both AF and HF. Recent studies and continued development of evidence to support catheter ablation for AF has brought into question the traditional belief in equivalence between rate and rhythm control. Indeed, recent trials, in particular the CASTLE-AF(Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation) study, suggest that catheter ablation for AF improves survival and rates of hospitalisation in patients with concomitant HF and AF, threatening a paradigm shift in the management of this patient cohort. The evident mortality benefit from clinical trials suggests that catheter ablation for AF should be considered as a therapeutic intervention in all suitable patients with the AF-HF syndrome as these patients may derive the greatest benefit from restoration of sinus rhythm. Further research is needed to refine the evidence base, especially to determine which subgroup of HF patients benefit most from catheter ablation and what is the optimal timing.