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Introduction The outcomes of atrial fibrillation (AF) ablation remain suboptimal. It is important to identify which AF patients will most likely benefit from ablation and who are more likely to show treatment failure, especially in those with structural heart disease such as hypertrophic cardiomyopathy (HCM). Methods and results We enrolled 120 HCM patients who underwent primary AF ablation (48 with persistent AF). Preprocedural QTc was measured and corrected using the Bazett's formula, and the distribution of fragmentation of the QRS complex (fQRS) was recorded. Arrhythmia recurrence was defined as any kind of documented atrial tachyarrhythmia of more than 30 seconds. Overall, arrhythmia recurrence occurred in 69 patients after 13.4 months' follow-up. fQRS was present in 71 (59.17%) patients and was most commonly (81.69%) observed in the inferior leads. QTc more than 448 ms could predict arrhythmia recurrence with a sensitivity of 68.1% and specificity of 68.6%. Patients with QTc more than 448 ms (hazard ratio [HR]: 1.982; 95% confidence interval [CI]: 1.155-3.402; P = .013) or those with fQRS+ (HR: 1.922; 95% CI: 1.151-3.210; P = .012) were at an increased risk of recurrence. A combination of fQRS+ and QTc more than 448 ms was superior to fQRS or QTc alone in predicting arrhythmia recurrence. Conclusion In patients with HCM undergoing AF ablation, QTc prolongation, specifically >448 ms, and presence of fQRS are independent risk factors for arrhythmia recurrence at follow-up. The combination of these two parameters has greater predictive value and would help to identify patients who are at the highest risk of procedural failure.

Background To evaluate the impact of family history of atrial fibrillation (FAF) on postablation atrial tachyarrhythmia (AT) recurrence. Methods All the 8198 patients undergoing initial AF ablation registered in the Chinese Atrial Fibrillation Registry study were analyzed. FAF was defined as having first-degree relatives diagnosed as AF at age 65 years or younger, and before the time the case in this study was diagnosed. Cox proportional hazards models were used to evaluate the impact of FAF on postablation AT recurrence. Age, sex, body mass index, AF type, history of congestive heart failure, hypertension, diabetes mellitus, prior stroke/transient ischemic attack/systemic embolism, vascular diseases, use of contact force-sensing catheter, and completion of high school were adjusted. The definition of AT recurrence was any documented AF, atrial flutter, or AT lasting more than or equal to 30 s after 3 months blanking period. Results After a mean follow-up of 26.2 ± 19.6 months, 318 out of the 645 patients (49.3%) with FAF and 3339 out of the 7553 patients (44.2%) without FAF experienced AT recurrence, corresponding to annual recurrence rates of 22.8% and 20.2%, respectively. Patients with FAF had a significant higher risk of AT recurrence (adjusted hazard ratio 1.129, 95% confidence interval 1.005-1.267) in multivariable analysis. Moreover, FAF had a significant higher impact on AT recurrence in the subgroup of patients diagnosed with AF at age 50 years or younger (p for interaction = .036). Conclusion FAF is a risk factor for postablation AT recurrence. This is especially true in those with AF diagnosed at 50 years or younger.

Objective To investigate the feasibility and safety of wire-guided pericardial access without contrast. Methods From January 2014 to February 2019, patients who received epicardial mapping and ablation of ventricular tachycardia in the Beijing Anzhen Hospital were entered into the current study. They were divided into contrast-guided access group or wire-guided access group according to the pericardial puncture technique used. The baseline variables, procedure parameters, complications were collected and compared. Results During the study period, a consecutive of 73 patients received epicardial access. The initial 32 patients received contrast-guided puncture with success achieved in 30 patients, the remaining 41 patients underwent wire-guided puncture with success achieved in 40 patients (30/32 and 40/41, P = .581). Fluoroscopy time (4.45 ± 0.52 and 4.38 ± 0.46 minutes, P = .891) and access time (5.14 ± 0.58 and 5.34 ± 0.50 minutes, P = .657) were comparable between the two groups. Inadvertent right ventricular puncture occurred more commonly in the contrast-guided group (5/32 and 1/41, P = .038). Though more pericardial effusions (2/32 and 1/41, P = .575), tamponade (2/32 and 1/41, P = .575), and surgical repair (1/32 and 0/41, P = .432) occurred in the contrast-guided group, they reached no statistical difference. Conclusion Wire-guided pericardial puncture exhibits better safety and similar success rates to contrast-guided technique with a trend towards less complications.

INTRODUCTION Linear ablation in addition to pulmonary vein antrum isolation (PVAI) has failed to improve the success rate for persistent atrial fibrillation (PeAF), due to incomplete block of ablation lines, especially in the mitral isthmus (MI). METHODS AND RESULTS The study enrolled 191 patients (66 in group 1 and 125 in group 2). In group 1, ethanol infusion into the vein of Marshall was first performed, followed by radiofrequency (RF) applications targeting bilateral PVAI and bidirectional block in the roofline, cavotricuspid isthmus, and MI. In group 2, PVAI and the three linear ablations were completed using only RF energy. MI block was achieved in 63 (95.5%) and 101 (80.8%) patients in groups 1 and 2, respectively (p = .006). Patients in group 1 had shorter ablation time for left pulmonary vein antrum (8.15 vs. 12.59 min, p

INTRODUCTION To assess the long-term outcome of catheter ablation in patients with hypertrophic cardiomyopathy (HCM), especially in patients with apical HCM (ApHCM). METHODS AND RESULTS From 9,249 AF ablation cases, 97 patients (28 with ApHCM and 69 with non-ApHCM) were enrolled. Another 97 patients matched by age, AF type, AF duration, and left atrial diameter were selected as the control group. After a mean follow-up of (44.3 ± 29.6) months, success rate after a single procedure was 42.9% in the ApHCM patients (P = 0.725), 36.2% in the non-ApHCM patients (P = 0.136) versus 50.5% in the control group. After multiple procedures, success rate both in the ApHCM group (50%, P = 0.047) and in the non-ApHCM group (50.4%, P = 0.017) were lower than in the controls (68.0%). More patients in the ApHCM and in the non-ApHCM group suffered very late recurrence beyond 1 year after the index procedure. Left atrial diameter (hazard ratio [HR] 1.04, 95% confidential interval [CI] 1.01-1.08, P = 0.018) and AF duration (HR 1.01, 95% CI 1.00-1.01, P = 0.005) were independent predictors of recurrence after the index ablation. There was no difference in thromboembolic events between the HCM group and the control group (8.2% vs. 3.1%, P = 0.082). CONCLUSIONS Patients with ApHCM or non-ApHCM had similar success rate of AF ablation after single procedure and lower success rate after multiple procedure compared with the control group.

Pouched Mitral Isthmus and Ablation Block Background Previous studies have described the impact of mitral isthmus (MI) anatomy on the likelihood of achieving MI linear block in patients with native mitral valves (NMV) who underwent atrial fibrillation (AF) ablation. However, none have investigated that issue in AF patients with mechanical mitral valve replacements (MMVR). Methods and Results Twenty-nine consecutive patients who developed symptomatic persistent AF post-MMVR and referred for ablation were enrolled. Twenty-nine patients with NMV who underwent ablation of persistent AF during the same period were matched. With preprocedural cardiac computed tomographic imaging, MI anatomical features of all the participants were analyzed. Pouched MI was observed in 19 (65.5%) MMVR patients versus to 6 (20.7%) controls (P = 0.001). Bidirectional linear block across MI was achieved in 21 (72.4%) MMVR patients and 22 (75.9%) in the controls (P = 0.764). In the multivariable analysis, pouched MI was an independent predictor of incomplete MI block. Conclusions Pouched MI accounts for the majority of AF patients with MMVR and may be associated with incomplete bidirectional linear block of MI.

Previous studies have described the impact of mitral isthmus (MI) anatomy on the likelihood of achieving MI linear block in patients with native mitral valves (NMV) who underwent atrial fibrillation (AF) ablation. However, none have investigated that issue in AF patients with mechanical mitral valve replacements (MMVR).Twenty-nine consecutive patients who developed symptomatic persistent AF post-MMVR and referred for ablation were enrolled. Twenty-nine patients with NMV who underwent ablation of persistent AF during the same period were matched. With preprocedural cardiac computed tomographic imaging, MI anatomical features of all the participants were analyzed. Pouched MI was observed in 19 (65.5%) MMVR patients versus to 6 (20.7%) controls (P = 0.001). Bidirectional linear block across MI was achieved in 21 (72.4%) MMVR patients and 22 (75.9%) in the controls (P = 0.764). In the multivariable analysis, pouched MI was an independent predictor of incomplete MI block.Pouched MI accounts for the majority of AF patients with MMVR and may be associated with incomplete bidirectional linear block of MI.

A left-sided accessory pathway (AP) with atrial insertion away from the mitral annulus (MA) may result in difficulty or failed ablation along the MA. We report our initial experience of ablating this rare form of AP by a 3-dimensional electroanatomical mapping system (CARTO).From January 2007 to August 2011, 29 patients with left-sided APs who failed previous ablations in other centers were enrolled in this study. Left atrium (LA) was reconstructed during orthodromic atrioventricuar reentry tachycardias (AVRTs) or ventricle pacing by using a 3-dimensional electroanatomical mapping system. The AP atrial insertion was defined as the earliest retrograde atrial activation and successful ablation of the AP at the site.Among the 29 patients who had failed previous ablation, 7 patients were found to have atrial insertions away from the MA. Out of the 7 patients, atrial insertions were at the base of the LA appendage in 5 patients and at the anterior roof of LA in 2 patients. Ablation at the atrial insertion successfully abolished AP conduction. The mean distance between the atrial insertion sites and the MA was 24.9 ± 4.9 mm. No patients reported recovered AP conduction or recurrent tachycardias after at least 12-month follow-up.Left-sided APs may have atrial insertions away from the MA. By using the CARTO system, atrial insertions can be reliably identified and ablated.