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ObjectivesWe sought to test how catheter ablation using an open irrigation catheter (OIC) compares with standard catheters for pulmonary vein antrum isolation.BackgroundOpen irrigation catheters have the advantage of delivering greater power without increasing the temperature of the catheter tip, which enables deeper and wider lesions without the formation of coagulum on catheters.MethodsCatheter ablation was performed using an 8-mm catheter (8MC) or an OIC. Patients were randomized to 3 groups: 8MC; OIC-1, OIC with a higher peak power (50 W); and OIC-2, OIC with lower peak power (35 W).ResultsA total of 180 patients were randomized to the 3 treatment strategies. Isolation of pulmonary vein antra was achieved in all patients. The freedom from atrial fibrillation was significantly greater in the 8MC and OIC-1 groups compared with the OIC-2 group (78%, 82%, and 68%, respectively, p = 0.043). Fluoroscopy time was lower in OIC-1 compared with OIC-2 and 8MC (28 ± 1 min, 53 ± 2 min, and 46 ± 2 min, respectively, p = 0.001). The mean left atrium instrumentation time was lower in the OIC-1 compared with the OIC-2 and 8MC groups (59 ± 3 min, 90 ± 5 min, and 88 ± 4 min, respectively, p = 0.001). However, there was a greater incidence of “pops” in the OIC-1 (100%, 0%, 0%, p < 0.001) along with higher incidences of pericardial effusion (20%, 0%, 0%, p < 0.001) and gastrointestinal complaints (17% in OIC-1, 3% in 8MC, and 5% in OIC-2, p = 0.031).ConclusionsAlthough there was a decrease in fluoroscopy and left atrium instrumentation time with the use of OIC at higher power, this setting was associated with increased cardiovascular and gastrointestinal complications.

MacHaalany et al. ([1][1]) recently reported that incidental findings (IFs) on computed tomography performed to diagnose coronary artery disease (CAD) are common but do not predict noncardiac death, and investigating them further “is not without cost or risk.” Although we appreciate the

ICD with resynchronization therapy can provide information on the intrathoracic fluid status of the pts by measuring transpulmonary electric bioimpedance, Out of 2185 consecutive pts undergoing catheter ablation for AF with an open irrigated catheter, 132 (6p) had heart failure (HF). CRT-D

Results: During 18±9 months of follow-up, 6 (38%) patients received appropriate ICD shock for rapid sustained VT. No baseline clinical and noninvasive inding predicted the occurrence of ICD shock at follow-up. Electroanatomic scar was present in 14 (88%) patients, and no signiicant correlation was found between the presence and extension of RV scar the occurrence of ICD shocks at follow-up. Ten (63%) patients presented slow conduction channels (i.e., fractionated, isolated and very late potentials) within scar. Reduced HRV parameters were found in patients with slow conduction channels within the scar (standard deviation of RR intervals [SDNN] 87.8±35.6 vs. 140.2±33.5 ms, P=0.01 in the time-domain; low frequency amplitude [LF] 19.2±15.2 vs. 34.5±13.5 ms, P=0.04 in the frequency-domain). Presence of slow-conduction channels within scar (P=0.034) and reduced HRV parameters (P=0.007 for the SDNN; P