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Atrial fibrillation (AF) and premature ventricular complexes (PVC) are common arrhythmias. We aimed to investigate AF prevalence in patients with PVC and its impact on PVC ablation outcomes.Consecutive patients undergoing PVC ablation at a single institution between 2016 and 2019 were included and prospectively followed for 2 years. Patients with severe valvular heart disease, hyperthyroidism, malignancy, alcohol use disorder and advanced renal/hepatic diseases were excluded. Twelve-lead electrocardiograms were used to diagnose AF and assess PVC morphology. All PVCs were targeted for ablation using 4-mm irrigated-tip catheters at standardized radiofrequency power guided by 3-D mapping and intracardiac echocardiography. Patients were followed with remote monitoring, device interrogations and office visits every 6 months for 2 years. Detection of any PVCs in follow-up was considered as recurrence.A total of 394 patients underwent PVC ablation and 96 (24%) had concurrent AF. Patients with PVC and AF were significantly older (68.2 ± 10.8 vs. 58.3 ± 15.8 years, p .001), had lower LV ejection fraction (43.3 ± 13.3% vs. 49.6 ± 12.4%, p .001), higher CHAAF was documented in 1/4 of patients undergoing PVC ablation and was associated with lower procedural success at long-term follow-up. This was likely attributed to older age, worse LV function and higher prevalence of multiple PVC morphologies in patients with concurrent AF.

Transvenous pacing is nowadays the cornerstone of interventional management of bradyarrhythmias. It is still associated, however, with significant complications, mostly related to indwelling transvenous leads or device pocket. In order to reduce these complications, leadless pacemakers have been recently introduced into clinical practice, but no guidelines are yet available to indicate who are those patients that might benefit the most and whether leadless pacing should be preferred in the old or young population. This survey aims to describe the use of leadless pacemaker devices in a real-world setting.Eleven arrhythmia centers in the Lombardy region (out of a total of 17 participating centers) responded to the proposed questionnaire regarding patient characteristics and indications to leadless pacing.Out of a total of 411 patients undergoing leadless pacing during 4.2 ± 0.98 years, the median age was 77 years, with 0.18% of patients having less than 18 years, 29.9% 18-65 years, 34.3% 65-80 years and 35.6%80 years. The most common indication was slow atrial fibrillation (49% of patients), followed by atrioventricular block and sinoatrial dysfunction. Two centers reported in-hospital complications.Leadless pacemakers proved to be a safe pacing strategy actually destined mostly to elderly patients.

Antecedent use of renin-angiotensin system inhibitors (RASi) prevents clinical deterioration and protects against cardiovascular/thrombotic complications of COVID-19, for indicated patients. Uncertainty exists regarding treatment continuation throughout infection and doing so with concomitant medications. Hence, the purpose of this study is to evaluate the differential effect of RASi continuation in patients hospitalized with COVID-19 according to diuretic use. We used the Coracle registry, which contains data of hospitalized patients with COVID-19 from 4 regions of Italy. We used Firth logistic regression for adult (>50 years) cases with admission on/after February 22, 2020, with a known discharge status as of April 1, 2020. There were 286 patients in this analysis; 100 patients (35.0%) continued RASi and 186 (65%) discontinued. There were 98 patients treated with a diuretic; 51 (52%) of those continued RASi. The in-hospital mortality rates in patients treated with a diuretic and continued versus discontinued RASi were 8% versus 26% (p = 0.0179). There were 188 patients not treated with a diuretic; 49 (26%) of those continued RASi. The in-hospital mortality rates in patients not treated with a diuretic and continued versus discontinued RASi were 16% versus 9% (p = 0.1827). After accounting for age, cardiovascular disease, and laboratory values, continuing RASi decreased the risk of mortality by approximately 77% (odds ratio 0.23, 95% confidence interval 0.06 to 0.95, p = 0.0419) for patients treated with diuretics, but did not alter the risk in patients treated with RASi alone. Continuing RASi in patients concomitantly treated with diuretics was associated with reduced in-hospital mortality.

Aims Micra-VR transcatheter pacing system (TPS) has shown strong stability of electrical parameters over time. Nevertheless, a small percentage of patients develops high pacing threshold (PT) (>1 V@0.24 ms) which can decrease the longevity of battery. Our study sought to investigate the intraoperative electrical parameters able to predict device electrical performances during the time. Methods and results Patients (pts) implanted with Micra-VR TPS from March 2018 to January 2021 were prospectively considered at the Cardiology Department of Spedali Civili Hospital (Brescia) and Luigi Sacco Hospital (Milan). R-wave sensing amplitude (mV), pacing impedance (Ohm), and PT (V@0.24 ms) were recorded twice: upon Micra final positioning, and after removal of the delivery system. All pts received a follow-up visit at 1- and 12-month after discharge. Electrical parameters were recorded at each visit. A total of 93 pts underwent Micra-VR implantation were enrolled. When compared to the first assessment, R-wave amplitude increased of 19.1% at second control performed after 13 ± 4 min (+1.71 ± 0.2 mV, 95% CI: 1.4–2.02; P < 0.001). Conversely, PT significantly decreased of 22.1% at 12-month follow-up respect to baseline (−0.22 ± 0.03 V, 95% CI: −0.13 to − 0.31; P < 0.001) (Figure 1). Among patients with high PT, acute increase of R-wave sensing of 1.5 mV after 14 ± 4 min significantly predicted PT normalization (≤1 V@0.24 ms) 12 months post-implant (R = 0.72, 95% CI: 0.13–0.33, P < 0.001) (Figure 2), with a sensitivity of 87.5% (95% CI: 0.61–0.98) and a specificity of 88.8% (95% CI: 0.51–0.99) (Figure 3). Conclusions A 1.5 mV increase in R-wave amplitude at implant time is predictive of PT normalization ( 536 Figure

Contact point-to-point electroanatomic mapping (Pt-Map) is a validated tool to evaluate right ventricular (RV) substrate. When using the EnSite NavX system (St. Jude Medical, St Paul, Minnesota), geometry reconstruction by dragging the mapping catheter (Geo-Map) allows for quicker acquisition of a large number of points and better definition of anatomy, but it is not validated for substrate mapping.This study evaluates the feasibility and accuracy of Geo-Map.Thirteen patients (mean age 38 +/- 12 years) with RV arrhythmias and an apparently normal heart underwent cardiac magnetic resonance imaging (MRI), Pt-Map, and Geo-Map. The 2 maps were compared in terms of mapping procedural time, radiation time, and total number of points acquired. We finally compared the number and characteristics of low-potential areas on each patient's Pt-Map, Geo-Map, and cardiac MRI.Geo-Map required significantly shorter mapping and radiation times in comparison to Pt-Map (12.4 +/- 4.6 vs. 31.9 +/- 10.1 and 5.8 +/- 2.1 vs. 12.1 +/- 3.9, P.001). Furthermore, Geo-Map was based on a significantly higher density of points in comparison to Pt-Map (802 +/- 205 vs. 194 +/- 38, P.001). Taking into consideration the total number of RV regions analyzed, the Pt-Map and Geo-Map disagreed in 2 of 65 (3%) regions (P = NS), which only Geo-Map identified as low-potential areas and indeed corresponded to wall motion abnormalities on MRI.Voltage maps obtained through RV geometry acquisition have accuracy comparable to that of conventional point-by-point mapping in detecting low-voltage areas, have a good correlation with MRI wall motion abnormalities, and allow a significant reduction in procedural time and x-ray exposure.

Introduction: The best treatment option for the management of patients (pts) with heart failure (HF) and persistent AF is unknown. The AATAC trial showed that catheter ablation (CA) is superior to Amiodarone in achieving freedom from AF at follow up. In this analysis we present the outcome sorted by type of AF procedure. Methods: AATAC was a randomized multicenter study. Pts with persistent AF, dual chamber ICD or CRTD, NYHA II-III and LV EF Results: PVI was performed in 22 patients undergoing ablation, while PVI+PW+NPV ablation was performed in 80 patients. Baseline characteristics were not different between the groups. At 26±8 months follow-up, the success rates in PVI, PVI+PW+NPV, and AMIO groups were 8 [36.4%] and 63 [78.8%] and 34 (34.0%) respectively, p Conclusion: This randomized study shows that PVI alone has a low success rate similar to Amiodarone when compared to PVI plus posterior wall plus non pv trigger in patients with heart failure and persistent AF.

Background: Cavo-tricuspid isthmus isolation (CTI) effectively targets typical atrial flutter (AFL) with a reported success rate of >85%. However, the incidence of new-onset atrial fibrillation (AF) following CTI remains high at around 50%. Purpose: This study examined the risk of AF and AFL in

Introduction: Catheter ablation of cavo-tricuspid isthmus (CTI) is considered to be the most effective therapy for eliminating target arrhythmia in lone atrial flutter (AFL). However, many patients subsequently develop AF after CTI ablation. Therefore, prophylactic pulmonary vein antrum isolation (PVAI) along with CTI ablation could be considered as an alternate option in these patients. We aimed to compare long-term incidence of post-ablation atrial fibrillation following CTI alone or CTI plus PVAI in patients presenting with isolated AFL and no history of atrial fibrillation. Methods: This multi-center prospective randomized study enrolled 216 patients undergoing catheter ablation for isolated typical atrial flutter. Patients were randomized to CTI alone (group 1, n=108, 61.2±9.7 year, 75% male, LVEF 59±10%) or combined ablation CTI+PVAI (group 2, n=108, 62.4±9.3 year, 73% male, LVEF 57±11%). Insertible Loop Recorder (ILR) was implanted in 21 and 19 patients from group 1 and 2 respectively, on the day of the ablation procedure. Remaining patients were monitored for recurrence with event recorders, ECG, 7-day Holter and cardiology evaluation. All patients were followed up for 18±6 months for recurrence. Results: Compared to group 1, group 2 had significantly longer average procedural duration (75.9±33 min vs. 161±48 min [p Conclusion: Prophylactic PVAI in lone atrial flutter caused marked reduction in new-onset AF in patients ≥ 55 years whereas younger patients (

We intended to evaluate the incidence of electrical and mechanical failure of QuickSite (QS) and QuickFlex (QF) left ventricular (LV) leads which are a part of a lead advisory. We invited all 154 alive patients who had the QS and QF leads implanted at our center to participate in this prospective

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.