Pulmonary vein isolation with catheter ablation is an effective treatment in patients with symptomatic atrial fibrillation refractory or intolerant to antiarrhythmic medications. The cryoballoon catheter was recently approved for this procedure. In this paper, the basics of cryothermal energy ablation are reviewed including its ability of creating homogenous lesion formation, minimal destructio...

Introduction Phrenic nerve injury is a recognized complication of catheter ablation procedures for atrial and ventricular arrhythmias. The posterolateral right atrium (RA) is a common site of origin for atrial tachycardias (AT), but ablation in this region can be hazardous because of the proximity of the right phrenic nerve (RPN). Proximity to the nerve may be identified by capture during pacin...

New remote navigation systems have been developed to improve current limitations of conventional manually guided catheter ablation in complex cardiac substrates such as left atrial flutter. This protocol describes all the clinical and invasive interventional steps performed during a human electrophysiological study and ablation to assess the accuracy, safety and real-time navigation of the Cath...

Introduction After seminal research demonstrated the pulmonary veins (PVs) and PV antrum contained substrates that can initiate and perpetuate paroxysmal atrial fibrillation (AF) in the majority of patients, catheter ablation with circumferential pulmonary vein isolation (PVI) has become the cornerstone treatment for the management of paroxysmal AF. However, in patients with persistent and long...

Figure 1 a: Surface ECG recorded during atrial tachycardia (AT). P-wave polarity during the AT was positive in leads II, III, aVF, and V1 and negative in leads I and aVL. The AT cycle length was 510 ms. b: Findings from ablation in the pulmonary artery. The earliest local atrial potential preceded P-wave onset by 52 ms. Ablation from that site temporarily accelerated the AT rate (116 to 159 bpm...

INTRODUCTION It is unclear whether early restoration of sinus rhythm in patients with persistent atrial arrhythmias after catheter ablation of atrial fibrillation (AF) facilitates reverse atrial remodeling and promotes long-term maintenance of sinus rhythm. The purpose of this study was to determine the relationship between the time to restoration of sinus rhythm after a recurrence of an atrial...

Backgrounds and Objective. During the procession of radiofrequency catheter ablation (RFCA) in persistent atrial fibrillation (AF), transthoracic electrical cardioversion (ECV) is required to terminate AF. The purpose of this study was to determine the impact of additional ECV on cardiac function and recurrence of AF. Methods and Results. Persistent AF patients received extensive encircling pul...

BACKGROUND Catheter ablation of pulmonary vein ectopic foci is a potentially curative treatment strategy for patients with atrial fibrillation. However, identification of arrhythmogenic pulmonary veins with conventional mapping is difficult, especially in patients with rare focal activity, multiple active foci, or extrapulmonary foci. The present study was designed to investigate use of simulta...

Catheter ablation is at the forefront of the management of a range of atrial arrhythmias. In this Series paper, we discuss the underlying mechanisms and the current role of catheter ablation for the three most common atrial arrhythmias encountered in clinical practice: focal atrial tachycardia, atrial flutter, and atrial fibrillation. The mechanisms of focal atrial tachycardia and atrial flutte...

Case Report A 64-year-old woman with a 3-year history of drug refractory paroxysmal atrial fibrillation was referred to our hospital for catheter ablation. Preprocedual echocardiography and enhanced computed tomography (CT) revealed no structural heart disease or anatomic anomalies (Figure 1A). Catheter ablation of the atrial fibrillation was performed under conscious sedation. Two 8.5-F long s...