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Background: A left atrial posterior wall isolation (LAPWI) is one of the atrial fibrillation (AF) ablation strategies., Hypothesis: We hypothesized that an additional empirical LAPWI would increase the freedom from recurrent atrial arrhythmias as compared to standard AF ablation in persistent AF patients., Methods: The CORNERSTONE AF study is a prospective, randomized, multicenter study investigating patients with AF persisting for >7 days and <3 years undergoing first-time AF ablation. They will be randomized to pulmonary vein isolation (PVI) or PVI + LAPWI in a 1:1 manner. Although PVI can be performed with either radiofrequency catheters or cryoballoons, only radiofrequency catheters will be permitted to achieve LAPWIs. Additional focal ablation targeting non-pulmonary vein triggers will be allowed. A total of 516 patients will be enrolled in 17 centers between August 2022 and February 2024 based on the calculation with 80% power, considering the assumption that 65% and 75% of the PVI and PVI + LAPWI group patients will be free from atrial arrhythmia recurrence 18-months postprocedure (10% of dropout). The primary endpoint is freedom from documented atrial arrhythmias 18 months postsingle procedures. Clinical follow-up will include 7-day ambulatory electrocardiograms and routine outpatient consultations by electrophysiologists at 1, 3, 6, 9, 12, and 18 months postprocedure., Results: As of August 2023, a total of 331 patients (68 ± 9 years, 270 men, 43 longstanding persistent AF) have been enrolled., Conclusions: The CORNERSTONE AF study is a prospective, randomized, multicenter trial designed to evaluate the efficacy and safety of an adjunctive empirical LAPWI following standard AF ablation in persistent AF patients., (© 2023 The Authors. Clinical Cardiology published by Wiley Periodicals, LLC.)

Background: Differential pacing technique to confirm mitral isthmus (MI) block is sometimes challenging due to destroyed tissues after extensive ablation. The purpose of this study is to set an endpoint of MI ablation using conduction time around the mitral annulus (MA)., Methods: Forty-five consecutive patients with persistent atrial fibrillation who received MI linear ablation were included. The geometry and activation times of the left atrium around the MA were collected using a multipolar catheter before ablation. During coronary sinus (CS) pacing, the time between the stimulus and the wave-front collision at the opposite side of the MA (defined as T/2) was calculated, and the doubled value was defined as the estimated perimitral conduction time (E-PMCT). The endpoint for complete MI block was when the stimulus (at distal CS) minus the maximal delayed potential (St-MDP) on the MI interval reached the E-PMCT., Results: St-MDP reached E-PMCT during MI ablation in 44/45 patients. Among these 44 patients, differential pacing revealed bidirectional block in 39/44 (88.6%), whereas in 5/44 (11.4%), the differential pacing was not possible because of the loss of capture of local potentials due to extensive applications around the linear line. In one patient, the St-MDP did not reach E-PMCT (E-PMCT: 148 ms, St-MDP :130 ms) and differential pacing revealed no MI block. E-PMCT values (median 176 ms) correlated strongly with St-MDP (median 185 ms, P < 0.0001, R = 0.98)., Conclusions: Although E-PMCT differs between individuals, the value is significantly correlated with the St-MDP. This technique may be useful in providing an individual endpoint of MI ablation as an alternative to differential pacing., (© 2018 Wiley Periodicals, Inc.)

Background: The aim of this study was to categorize the conduction patterns between the right atrium (RA) and the superior vena cava (SVC), and to determine the ideal procedure for SVC isolation using a novel high-resolution mapping system.Methods and Results:RA-SVC conduction was evaluated using the RHYTHMIA system in 113 patients (age 62.8±11.5 years, paroxysmal: 67) with atrial fibrillation (AF) after pulmonary vein (PV) isolation. In 56 patients, a line of conduction block was found to run obliquely just above the sinus node (Block group). The remaining 57 patients did not have block (Non-block group). Non-PV foci were spontaneous or provoked with isoproterenol after electrical cardioversion of pacing-induced AF. In 43 patients with SVC foci (Block group: 22, Non-Block group: 21), SVC was isolated by radiofrequency applications delivered along the line connecting the open ends of the block line (Block group) or by conventional methods (Non-block group). The Block group required fewer radiofrequency deliveries for SVC isolation than the Non-Block group (4.2±0.9 vs. 10.2±2.8 times; P<0.0001). The isolated SVC area was larger in the Block group (15.7±3.7 vs. 10.5±3.1 cm 2 ; P<0.0001)., Conclusions: We found that approximately half of patients with AF had a diagonal line of block at the RA-SVC junction that could be utilized to isolate the SVC with fewer radiofrequency deliveries.

Purpose: Achieving complete mitral isthmus (MI) conduction block for atrial fibrillation (AF) ablation remains challenging. We hypothesized that transseptal puncture (TSP) at the anteroinferior aspect of the atrial septum (anteroinferior TSP) could shorten the distance to the MI and improve catheter contact and stability, enabling complete MI block. This study investigated the efficacy of anteroinferior TSP for MI ablation in AF patients., Methods: Three hundred and twenty consecutive patients (mean age: 62 ± 9 years, 84 % male) with persistent AF undergoing AF ablation, including MI ablation, were enrolled. MI ablation was performed through the conventional (posterior) TSP site (group C, n = 170) or the anteroinferior TSP site (group A, n = 150)., Results: Left atrial diameter (LAD) enlargement was greater in group A than in group C (45.8 ± 5.3 mm vs. 44.1 ± 5.0 mm, p = 0.002). Complete MI block at the initial session was significantly higher in group A than in group C (141/150 [94 %] vs. 144/170 [85 %], p = 0.011). At the repeat session for AF recurrence, the rate of persistent complete MI block was significantly higher in group A than in group C (36/48 [75 %] vs. 28/67 [42 %], p < 0.001). LAD (p = 0.011) and left ventricular diastolic dimension (p = 0.037) were significant predictors of failed MI block, while anteroinferior TSP was significantly associated with successful MI block (p < 0.001)., Conclusion: Anteroinferior TSP could improve the initial success rate and long-term persistence of complete MI block for AF ablation.

Background: We aimed to determine whether differing foci in paroxysmal atrial fibrillation (PAF) affected the long-term outcome of catheter ablation (CA)., Methods: A total of 865 consecutive PAF patients (age, 61±10years; 670 male) undergoing initial AF ablation were included. After pulmonary vein (PV) isolation, superior vena cava (SVC) isolation was performed for SVC foci; other non-PV foci were focally ablated. Long-term outcomes were compared among patients with SVC foci (Group SVC), other non-PV foci (Group Non-PV), and those without these foci (Group PV)., Results: Groups PV, SVC, and Non-PV contained 740 (85.8%), 57 (6.6%), and 68 (7.6%) patients, respectively. Structural heart disease (P=0.01) and duration of AF history (P=0.04) were significantly associated with Group Non-PV, and female sex (P=0.0002) was significantly associated with Group SVC. AF recurrence-free rates at 5years in Group PV, SVC, and Non-PV were 62.0%, 66.3%, and 49.3%, respectively (P=0.03), after the initial CA, and 84.7%, 83.9%, and 77.0%, respectively (P=0.02), after the final CA. The duration of AF history (HR, 1.04, P<0.0001) and left atrial dimension (HR, 1.37 per 10mm increase, P=0.0003) were significant predictors of AF recurrence after the initial CA. Although Group Non-PV was weakly associated (HR 1.38, P=0.08) with AF recurrence, Group SVC was not associated with AF recurrence., Conclusions: Long-term outcome of CA of PAF was significantly worse in patients with non-PV foci other than SVC foci. These foci may affect the outcome not independently but as an aspect of atrial remodeling., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Although several studies have reported an association between atrial fibrillation (AF) and alcohol, the impact of alcohol consumption on the outcome after catheter ablation (CA) for AF has not been discussed. We aimed to elucidate the effect of alcohol consumption on the outcome of CA for paroxysmal AF., Methods and Results: We examined 1361 consecutive patients with paroxysmal AF (mean age, 61±11 years, 334 women) who underwent CA, including 623 (45.8%) patients who consumed alcohol. The clinical characteristics and outcomes of CA were compared between patients who did and did not consume alcohol. No significant differences were seen in the left atrial size, duration of AF history, and incidence of nonpulmonary vein foci between 2 groups (P=NS). Although the AF recurrence-free rate after the initial CA was higher in patients who did not consume alcohol (261/623 [41.9%] versus 252/738 [34.1%]; mean follow-up, 44.4±30.7 months; P=0.003), the outcome after the final CA was similar between 2 groups (patients who consumed alcohol: 111/628 [17.7%] versus patients who did not consume alcohol: 138/738 [18.7%]; mean follow-up, 53.1±25.8 months; P=0.67). The frequency (hazard ratio 1.07 per 1 day/week increase, CI 1.00-1.15, P=0.04) of alcohol consumption was significantly associated with AF recurrence after CA., Conclusions: The frequency of alcohol consumption may be associated with AF recurrence after the initial CA for paroxysmal AF, but it may not affect the outcome after the final CA., (© 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)

Background: Mitral regurgitation (MR) is generally classified as either primary (organic) or secondary (functional). Although patients with atrial fibrillation (AF) often exhibit MR, the relation between the etiology of MR and the outcome of catheter ablation (CA) remains unknown. We conducted this study in order to elucidate this association., Methods: Among 1330 consecutive paroxysmal AF patients who underwent initial catheter ablation in our institution, 92 patients (62 men, mean age 65 ± 7 years) who had moderate or severe MR were included in this study; 46 were classified to have primary and the remaining 46 to have secondary MR by preoperative echocardiography. These patients were prospectively monitored after the CA., Results: During a mean follow-up period of 27.9 ± 28.8 months, AF recurred in 26/46 (56.6 %) of primary MR patients and in 15/46 (32.6 %) of those with secondary MR (P < 0.02). Although univariate analysis found that diabetes, left atrial volume indexed by body surface area (LAVI), and primary MR were significantly associated with AF recurrence, primary MR (hazard ratio (HR), 2.47; 95 % confidence interval (CI), 1.30-4.88; P = 0.006) and LAVI (HR, 1.03/1 mL/m(2) increase; 95 % CI, 1.00-1.06; P = 0.03) remained significant predictors on multivariate analysis. The AF recurrence-free rate was lower in patients with primary MR after both the initial and final CA., Conclusion: In patients with paroxysmal AF and moderate or severe MR, primary MR may increase the risk of AF recurrence after the initial and final CA.

Introduction: Stroke can be a life-threatening complication of atrial fibrillation (AF) catheter ablation. Uninterrupted warfarin treatment contributes to minimizing the risk of stroke complications., Methods and Results: This was a prospective, open-label, randomized, multicenter study assessing the safety and efficacy of apixaban for the prevention of cerebral thromboembolism complicating AF catheter ablation. Two hundred patients with drug-resistant AF were equally assigned to take either apixaban (5 mg or 2.5 mg twice daily) or warfarin (target international normalized ratio, 2-3) for at least 1 month before AF ablation. Neither drug regimen was interrupted throughout the operative period. Diffusion-weighted magnetic resonance imaging was performed for all patients to detect silent cerebral infarction (SCI) after the ablation. Primary outcomes were defined as the occurrence of stroke, transient ischemic attack, SCI, or major bleeding that required intervention. The secondary outcome was minor bleeding. The groups did not statistically differ in patients' backgrounds or procedural parameters. During AF ablation, the apixaban group required administration of more heparin to maintain an activated clotting time > 300 seconds than the warfarin group (apixaban, 14,000 ± 4,000 units; warfarin, 9,000 ± 3,000 units). Three primary outcome events occurred in each group (apixaban, 2 SCI and 1 major bleed; warfarin, 3 SCI, P = 1.00), and 3 and 4 secondary outcome events occurred in the apixaban and warfarin groups (P = 0.70), respectively., Conclusion: Apixaban has similar safety and effectiveness to warfarin for the prevention of cerebral thromboembolism during the periprocedural period of AF ablation., (© 2016 Wiley Periodicals, Inc.)

Background: Paroxysmal atrial fibrillation (AF) is primarily triggered by pulmonary veins (PVs). However, non-PV AF foci may also trigger AF., Methods: We examined 207 patients (mean age, 62 ± 11 years; 166 men) who underwent a second catheter ablation (CA) and evaluated the clinical significance of non-PV AF foci on the outcomes., Results: Electrical reconnections between the PVs and left atrium (LA) were observed in 162 patients (78.3%). Non-PV AF foci were identified in 95 patients (45.9%, 60 patients with successfully ablated non-PV AF foci and 35 with unmappable non-PV AF foci). During a median follow-up period of 22.7 months, 61 patients (29.5%; 18/112 [16.1%] without non-PV AF foci vs. 20/60 [33.3%] with successfully ablated non-PV AF foci vs. 23/35 [65.7%] with unmappable non-PV AF foci, P < 0.0001) developed AF recurrence; 52 (85.2%) developed recurrence within 1 year. The presence of non-PV AF foci was a significant clinical predictor of AF recurrence after the second CA; successfully ablated non-PV AF foci increased the AF recurrence risk by 2.24 times (95% confidence interval [CI], 1.12-4.54; P = 0.02), and unmappable AF foci increased this risk by 5.58 times (95% CI, 2.73-11.63; P < 0.0001)., Conclusion: Nearly half of the patients had non-PV AF foci at the second CA session. AF recurred after the second CA session in approximately 30%, with most recurrences happening within 1 year. The presence of non-PV AF foci significantly increased the AF recurrence risk after a second CA. When non-PV AF foci were unmappable, the AF recurrence rate was extremely high., (© 2015 Wiley Periodicals, Inc.)

Aims: This study investigated whether disappearance patterns of pulmonary vein (PV) potentials (PVPs) during PV isolation (PVI) affect the outcome of catheter ablation (CA) in patients with paroxysmal atrial fibrillation (PAF)., Methods and Results: Extensive PVI was performed in 1149 PAF patients (age, 61 ± 10 years). Clinical and demographic characteristics, ablation data, and follow-up outcomes were prospectively collected. During an initial CA, simultaneous disappearance of superior and inferior PVPs in both right and left PVs was observed in 464 (40.4%) patients (Group S). Atrial fibrillation-recurrence free rates at 1, 3, and 5 years after the initial CA in Group S were 78.9, 71.9, and 68.1%, respectively, which were higher than those in Group Non-S (P = 0.004). However, those were similar after the final CA between both groups. The incidence of PV-left atrium (LA) electrical reconnection was significantly lower in Group S than in Group Non-S in the second (Group S, 65.6% vs. Group Non-S, 82.1%; P = 0.004) and third (Group S, 8.3% vs. Group Non-S, 47.6%; P = 0.03) CAs. Furthermore, the reconnections more frequently occurred on the side of PVs where simultaneous PVP elimination had not been achieved at the initial CA. Simultaneous disappearance of superior and inferior PVPs in both right and left PVs independently reduced the risk of AF recurrence after the initial CA by 26%., Conclusions: The simultaneous disappearance of superior and inferior PVPs in both right and left PVs is associated with less frequent PV-left atrium reconnection and may yield a better clinical outcome after the initial CA., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.)

Background: The aim of this study was to investigate the incidence and predictors (which have not previously been fully elucidated) of late-phase thromboembolism (TE) after catheter ablation (CA) for paroxysmal atrial fibrillation (AF)., Methods and Results: We studied 1,156 consecutive patients (61±10 years; 891 men; CHADS2score, 0.8±1.0) after CA for symptomatic paroxysmal AF and examined the details of late-phase TE. During a follow-up of 49.5±21.9 months (median, 47 months; range, 6-113 months) after CA, 9 patients (0.78%) developed late-phase TE, all of which were ischemic stroke. Of these, 5 patients with AF recurrence experienced cardioembolism; the AF was asymptomatic at recurrence. The remaining 4 without AF recurrence experienced cardioembolism (n=1), small-vessel occlusion (n=1), large-artery atherosclerosis (n=1), and stroke of other determined etiology (n=1). On Kaplan-Meier analysis patients with structural heart disease (P=0.003), AF recurrence after the final CA (P=0.01), prior stroke (P=0.002), CHADS2score ≥2 (P=0.0002), left ventricular ejection fraction <50% (P<0.0001), and spontaneous echo contrast on transesophageal echocardiogram (P=0.0004) had a significantly higher risk of late-phase TE. Multivariate analysis indicated that CHADS2score ≥2 (HR, 4.49; 95% CI: 1.08-22.56; P=0.04) independently predicted late-phase TE., Conclusions: The incidence of TE was low after CA for paroxysmal AF, but CHADS2score ≥2 independently increased the risk of late-phase TE.

Background: In our previous study, we classified the radicality (R grading) of percutaneous radiofrequency ablation (RFA) therapy for single hepatocellular carcinoma (HCC) according to the extent of the ablated margin, and demonstrated that this grading system was useful for predicting local tumor progression (LTP) after RFA. The aim of this study was to measure the overall survival (OS), the recurrence free survival (RFS), and the distant recurrence (DR) rate for each R grade (A-D), and to examine the relationship between clinical outcome and R grading., Methods: This study involved 368 patients with solitary HCC who had undergone RFA. The mean tumor diameter was 2.0 ± 0.7 cm. We calculated the post-RFA cumulative OS, RFS, and DR rate for each R grade and analyzed the factors contributing to clinical outcomes., Results: In the multivariate analysis, significant factors were as follows: tumor size >2 cm, serum albumin >3.5 g/dL, prothrombin time >70 %, HCC recurrence within 1 year, and R grading (grade A) in OS; cause of liver disease (hepatitis B), gamma glutamyl transpeptidase (GGT) >80 IU/L, platelet count >10 × 10(4)/mm(3), and R grading (grade A or B) in RFS; GGT >80 IU/L, platelet count >10 × 10(4)/mm(3), and R grading (grade A or B) in DR. In patients with sufficient Lipiodol accumulation (n = 219), very similar results were obtained. However, in patients with grade A and B (n = 232), R grade was not a significant independent factor linked to OS, although grade A patients had lower LTP rate., Conclusions: Our proposed R grading system appears to be useful for predicting clinical outcomes after RFA.

Goals: To elucidate whether long-term supplementation with branched-chain amino acid (BCAA) granules improves overall survival (OS) and recurrence-free survival (RFS) after radiofrequency thermal ablation (RFA) in patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC)≤3 cm in diameter with up to 3 nodules and a serum albumin level before RFA of ≤3.5 g/dL., Background: Whether BCAA treatment after curative RFA for patients with HCV-related HCC improves OS and RFS remains unclear., Study: We compared the OS rate and the RFS rate between the BCAA group (n=115) and the control group (n=141). We also examined factors contributing to OS and RFS., Results: The 1 and 3 years OS rates after RFA were 94.0% and 70.0%, respectively, in the BCAA group, and 94.0% and 49.8%, respectively, in the control group (P=0.001). The corresponding RFS rates 1 and 3 years after RFA were 61.8% and 28.0%, respectively, in the BCAA group, and 52.0% and 12.0%, respectively, in the control group (P=0.013). In the multivariate analysis, in terms of OS, BCAA treatment, and serum albumin level of ≥3.4 g/dL, and in terms of RFS, age 70 years or older, BCAA treatment, and a serum albumin level of ≥3.4 g/dL were significant independent factors, respectively., Conclusions: BCAA treatment may improve OS and RFS after RFA in patients with HCV-related HCC≤3 cm in diameter with up to 3 nodules and a serum albumin level before RFA of 3.5 g/dL.

The aim of the present study was to elucidate the effectiveness of transcatheter arterial infusion chemotherapy (TAI) of the whole liver using an epirubicin-mitomycin-lipiodol emulsion, prior to radiofrequency thermal ablation (RFA), in preventing intrahepatic distant recurrence (IDR) from single hepatocellular carcinoma (HCC). Of the 269 consecutive patients who underwent RFA in our institute for single HCC, a total of 182 patients were analyzed in the present study. The primary endpoint was comparison of the post-RFA IDR-free survival rates in patients treated using TAI with an epirubicin-mitomycin-lipiodol emulsion via the proper hepatic artery (TAI-EML) prior to RFA, and patients that received lipiodol infusion-alone prior to RFA. The secondary endpoints were local tumor progression (LTP) and overall survival (OS). Lipiodol infusion-alone prior to RFA was performed in 88 patients and TAI-EML prior to RFA in 94 patients. The mean tumor size was 2.06 cm (range, 0.9-3.2 cm) in the TAI group and 1.97 cm (range, 0.9-3.3 cm) in the lipiodol-alone group, respectively. The cumulative IDR-free survival rates at 1, 2 and 3 years were 74.0, 50.8 and 34.9%, respectively, in the lipiodol-alone group, and 90.8, 74.8 and 70.0%, respectively, in the TAI group (P<0.001). In terms of the OS, there was a significant difference between these two groups (P=0.048), although there was no significant difference in terms of the LTP (P=0.145). We concluded that TAI-EML prior to RFA appears to be useful in reducing post-RFA IDR and may contribute to improved survival rates.

Background: In the present study we classified the radicality of percutaneous radiofrequency thermal ablation (RFA) therapy according to the extent of the ablated margin. We measured the local recurrence rate for each radicality grade to evaluate the significance of the grading system in assessing the therapeutic effectiveness of RFA and predicting local tumor progression., Methods: This retrospective study involved 269 patients with solitary hypervascular hepatocellular carcinoma who had undergone RFA. The mean ± SD observation period after RFA, number of treatment sessions, and tumor diameter were 25.7 ± 19.9 months, 1.2 ± 0.5, and 2.1 ± 0.7 cm, respectively. Patients were evaluated using dynamic computed tomography. We classified the radicality of RFA treatment into four grades (R grades: A, B, C, and D) according to the extent of the ablated tumor margin, calculated the post-RFA cumulative local recurrence rate for each R grade, and analyzed the factors (patient characteristics, biochemical data, contiguous vessels, and tumor marker) contributing to local recurrence., Results: The cumulative local recurrence rates at 3 years were 6.7, 17.6, 55.8, and 82.2% for Grades A, B, C, and D, respectively. Using univariate analysis, R grade, tumor size (> 2 cm), and des-γ-carboxy prothrombin (DCP) (> 200 mA U/mL) were shown to be significant factors contributing to local recurrence. However, using multivariate analysis, only the R grade was found to be a significant independent factor., Conclusions: The proposed R grading method is a valid and useful method for assessing treatment efficacy, and for predicting local tumor progression after RFA.

Introduction: Recent studies have reported the efficacy of the cryoballoon (CB)‐guided left atrial roof block line (LARB) creation in patients with persistent atrial fibrillation (AF). However, it can be technically challenging to attach the balloon to the left atrial (LA) roof due to its anatomical variations. We designed a new procedure called the "Raise‐up Technique," which may facilitate the firm adhesion of the CB to the LA roof during freezing. This study aimed to evaluate the efficacy of the Raise‐up technique in LARB creation. Methods and Results: In total, 100 consecutive patients with persistent AF who underwent CB‐LARB creation were enrolled. Fifty‐seven patients underwent LARB creation using the Raise‐up technique (Raise‐up group), and the remaining 43 did not use it (control group). The Raise‐up technique was performed as follows: An Achieve catheter was inserted as deeply as possible into the upper branch of the right superior pulmonary vein to anchor the CB. The balloon was placed below the targeted site on the LA roof and frozen. When the temperature of the CB reached approximately −10°C and the CB was easier to attach to the LA tissue, the CB was raised and pressed against the LA roof immediately by sheath advancement. Then the balloon could be in firm contact with the target site on the roof. If necessary, additional sheath advancement after sufficient freezing (−20°C to −30°C) was allowed the CB to have more firm and broad contact with the target site. LARB creation without touch‐up ablation was achieved in 54 of 57 patients (94.7%) in the Raise‐up group and 33 of 43 patients (76.7%) in the control group (p <.05). The lesion size of the LARB in the Raise‐up group was significantly larger than that in the control group (15.2 cm2 vs. 12.8 cm2, p <.05). Moreover, the width of the LARB lesion in the Raise‐up group was wider than that in the control group (32.0 mm vs. 26.6 mm, p <.05). Conclusion: The Raise‐up technique enabled the creation of seamless and thick LARB lesions with a single stroke. In addition, the CB‐LARB lesions created using the Raise‐up technique tended to be large, resulting in extensive debulking of the LA posterior wall arrhythmia substrates. In CB ablation for persistent AF, the Raise‐up technique can be considered one of the key strategies for LARB creation. [ABSTRACT FROM AUTHOR]

Background The present study aimed to elucidate the safety and effectiveness of a noble and unique airway management technique in which a pediatric intubation tube is used in adult patients with atrial fibrillation (AF) undergoing catheter ablation (CA) under continuous deep sedation. Methods In total, 246 consecutive patients with AF (mean age, 65±10 years; 60 women) underwent CA under dexmedetomidine-based continuous deep sedation. A 4-mm pediatric intubation tube guided by a 10-French intratracheal suction tube was inserted smoothly, and the tip of the tube was located at the base of the epiglottis. The maximum shifting distance of the heart (MSDH) was measured with the 3D mapping system (Ensite NavX system) before and after inserting the pediatric intubation tube. Results At baseline, the MSDH of patients under continuous deep sedation was 23±14 mm. The pediatric intubation tube reduced the MSDH to 13±6 mm (mean reduction from baseline, 38.4±21.7%; P <0.0001). In contrast, oxygen saturation was significantly increased from 89±8% to 95±3% ( P <0.0001). The mean distance between the nostril and base of the epiglottis was 16.6±0.5 mm. Major periprocedural complications occurred in 9 (3.6%) patients including 3 (1.2%) cardiac tamponade and 6 (2.4%) phrenic nerve injury cases. Larger MSDH (odds ratio, 1.13; 95% confidence interval, 1.04–1.25; P =0.007) was a significant predictor of major periprocedural complications. No major airway complications occurred, except in 3 patients (1.2%) who had minor nasal bleeding. Conclusion This unique airway management technique using a pediatric intubation tube for CA procedures performed in adult patients with AF under continuous deep sedation was easy, safe, and effective. [ABSTRACT FROM AUTHOR]

Basket Catheter for Mapping Atrial Tachycardia Introduction The mapping of atrial tachycardia (AT) can often be challenging and time-consuming, especially in patients with ATs that develop following cardiac surgery or are concomitant with atrial fibrillation. Recently, a new multielectrode basket catheter (MBC) has become available; we hypothesized that the MBC could be utilized to diagnose AT circuits. Methods and Results This study included 51 consecutive patients undergoing catheter ablation of clinically documented right-sided ATs (including 17 cases following cardiac surgery). Using a NavX system, 2 activation maps of the ATs were created, one using the new MBC (32 mm, 31 poles) and the other using a circular catheter. The time needed to complete the activation maps and the points acquired with both mapping catheters were compared. In all 64 ATs, including 34 non-cavotricuspid isthmus-dependent ATs, the AT activation maps created by both catheters were essentially identical. The number of points acquired to complete the activation maps did not differ significantly between the MBC and the circular catheter (387 [285-511] vs. 374 [269-533], P = 0.19), but the mapping time was significantly shorter using the MBC (4.0 [3.0-6.0] minutes vs. 8.0 [6.5-10.0] minutes, P < 0.0001). Inadvertent mechanical AT termination (n = 6) was observed only during mapping with the circular catheter. Conclusion In patients with right-sided ATs, the use of an MBC could save mapping time. [ABSTRACT FROM AUTHOR]