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Introduction: The decremental properties of the nodoventricular pathway (NVP) are uncertain. Methods and Results: During short RP supraventricular tachycardia, a His‐refractory premature ventricular contraction (PVC) consistently terminated the tachycardia without atrial capture immediately after the PVC. Whereas a slightly earlier PVC failed to reset the subsequent His but terminated the tachycardia without atrial capture one cycle later. Conclusion: These observations are diagnostic of slow‐fast atrioventricular nodal reentrant tachycardia (AVNRT) with a bystander concealed‐NVP and can be explained by decremental properties in the NVP itself; greater prematurity of the PVC resulted in more decremental conduction over the NVP, causing the AVNRT termination one cycle later. [ABSTRACT FROM AUTHOR]

The article describes the case of a 79-year-old man with ischemic heart disease who underwent catheter ablation of persistent atrial tachycardia (AT). The man received a pulmonary vein isolation, left atrial (LA) posterior wall isolation, and lateral mitral isthmus linear ablation of atrial fibrillation and AT. Also discussed are the earliest activation site in the LA and the need of physicians to pay attention when using AT entertainment pacing in macro-reentrant tachycardias.

Introduction: It has not been clarified how to identify the electrophysiological junction between right atrium (RA) and superior vena cava (SVC). The aim of this study was to identify the electrophysiological RA–SVC junction according to slow conduction or conduction bock and to examine the electrophysiological SVC isolation procedure. Methods: Seventy‐three consecutive atrial fibrillation patients who underwent SVC mapping using a CARTO 3 system were enrolled in this study. Slow conduction or conduction block between the RA and SVC was identified by adjusting the lower threshold criteria of the early meets late function and was described as a white line. The SVC isolation was performed along the white line and with pacing maneuvers to confirm direct SVC capture. Results: Activation mapping (1296 ± 631 points) was obtained in 66 patients (90%) in 4.6 ± 1.8 min. Slow conduction or conduction block was observed in all patients. The threshold for detecting slow conduction or conduction block was 24 ± 8 ms. The location of the electrophysiological RA–SVC junction was higher in the anterior portion (anterior‐septal, anterior, and anterior‐lateral) than in the posterior portion (posterior‐septal, posterior, and posterior‐lateral) (−2.3 ± 6.2 mm vs. 7.1 ± 6.3 mm, p <.001). The SVC isolation at the electrophysiological RA–SVC junction was successful in all patients without any injury to the sinus node function. Asymptomatic phrenic nerve injury was observed in three patients (4.5%). Conclusion: In all patients, the electrophysiological RA–SVC junction determined by slow conduction or conduction block was identified and the electrophysiological SVC isolation was performed successfully and safely. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 77-year-old woman with palpitations. An electrocardiogram during the tachycardia showed a narrow complex tachycardia with a long RP supraventricular tachycardia which was diagnosed as atypical atrioventricular nodal reentrant tachycardia (AVNRT) with a concealed nodofascicular (NF) or nodoventricular (NV) bypass tract. Also noted is the condition's termination by a ventricular premature depolarization (VPD).

Introduction Methods Results Conclusion The impact of combining ablation index (AI)‐guided and very high‐power short‐duration (vHPSD) ablation on procedural factors at the posterior wall near the esophagus is unclear.Atrial fibrillation patients who underwent initial ablation using three‐dimensional mapping were enrolled. Patients were classified into two groups: those who underwent only AI‐guided pulmonary vein isolation (PVI) (AI group) and those who underwent vHPSD ablation at the posterior wall adjacent to the esophagus in addition to AI‐guided PVI (AI + vHPSD group). Differences in myocardial injury, inflammation, procedural characteristics, and pulmonary vein (PV) reconnection patterns were assessed between the two groups.This study included 167 patients (AI group, 83 patients; AI+vHPSD group, 84 patients). No significant differences in high‐sensitive troponin I or changes in inflammatory markers between pre‐ and Postablation were observed in either group. Total application time and total application energy were significantly lower in the AI+vHPSD group than in the AI group (p < 0.001 for both) despite no significant difference in the total number of applications between the groups. The incidence of esophagus temperature ≥40 degrees was significantly lower in the AI+vHPSD group than in the AI group (p = 0.036). However, the incidence of PV reconnections near the esophagus was significantly higher in the AI+vHPSD group than in the AI group (11.9% vs 3.6%, p = 0.046), despite no significant difference in the incidence of PV reconnections overall.The combination of AI‐guided PVI and vHPSD adjacent to the esophagus demonstrated reduced application energy requirements and maintained safety and effectiveness during the perioperative period. [ABSTRACT FROM AUTHOR]

Background Methods and Results Conclusions Heart failure (HF) with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) are associated with high morbidity and mortality. Recently, sinus rhythm (SR) maintenance (SRM) after catheter ablation (CA) of AF (AFCA) in HFpEF has shown to reduce adverse events as compared to medical treatment. However, it remains unclear whether SRM after a repeat CA for recurrent AF has the same effect as SRM after the initial CA in patients with AF and HFpEF.We studied 244 AF patients with HFpEF who maintained SR after repeat AFCA (repeat CA‐SRM group, n = 54) and initial AFCA (initial CA‐SRM group, n = 190). HFpEF were defined as HFA‐PEFF score of 5 or 6 and left ventricular ejection fraction ≥ 50% before the initial CA. The primary endpoint was a composite of all‐cause mortality, HF hospitalizations, or strokes within 3 years after the initial or repeat CA. The incidence of the primary endpoint was similar between the repeat CA‐SRM and initial CA‐SRM groups (3 of 54 [5.6%] vs. 8 of 190 [4.2%], p = .423 by a log‐rank test). There was no significant difference in the 12‐month HFA‐PEFF score and the proportion of a 12‐month HFA‐PEFF score <5 between the repeat CA‐SRM and the initial CA‐SRM groups (5 [4,6] vs. 5 [4,6], p = .915, and 46% vs. 35%, p = .426, respectively).In patients with AF and HFpEF diagnosed by HFA‐PEFF score, the primary endpoint of all‐cause mortality, HF hospitalizations, and strokes was similar between the repeat CA‐SRM and initial CA‐SRM groups. [ABSTRACT FROM AUTHOR]