Atrial flutter (AFL) represents a prevalent variant of supraventricular tachycardia, distinguished by a macro-reentrant pathway encompassing the cavotricuspid isthmus (CTI). Radiofrequency (RF) catheter ablation stands as the favored therapeutic modality for managing recurring CTI-dependent AFL. Intracardiac echocardiography (ICE) has been proposed as a method to reduce radiation exposure during CTI ablation. This study aims to comprehensively compare procedural parameters between ICE-guided CTI ablation and fluoroscopy-only procedures. A total of 370 consecutive patients were enrolled in our single-center retrospective study. In 151 patients, procedures were performed using fluoroscopy guidance only, while 219 patients underwent ICE-guided CTI ablation. ICE guidance significantly reduced fluoroscopy time (73 (36; 175) s vs. 900 (566; 1179) s; p < 0.001), fluoroscopy dose (2.45 (0.6; 5.1) mGy vs. 40.5 (25.7; 62.9) mGy; p < 0.001), and total procedure time (70 (52; 90) min vs. 87.5 (60; 102.5) min; p < 0.001). Total ablation time (657 (412; 981) s vs. 910 (616; 1367) s; p < 0.001) and the time from the first to last ablation (20 (11; 36) min vs. 40 (25; 55) min; p < 0.01) were also significantly shorter in the ICE-guided group. Acute success rate was 100% in both groups, and no major complications occurred in either group. ICE-guided CTI ablation in patients with AFL resulted in shorter procedure times, reduced fluoroscopy exposure, and decreased ablation times, compared to the standard fluoroscopy-only approach.

Radiofrequency (RF) catheter ablation is an effective treatment option for targeting the slow pathway (SP) in atrioventricular nodal reentry tachycardia (AVNRT). Previous data suggested that using intracardiac echocardiography (ICE) guidance could improve procedural outcomes when compared to using fluoroscopy alone. In this prospective study, we aimed to compare the effectiveness of an electroanatomical mapping system (EAMS)-guided approach with an ICE-guided approach for SP ablation. Eighty patients undergoing SP ablation for AVNRT were randomly assigned to either the ICE-guided or EAMS-guided group. If the procedural endpoint was not achieved after 8 RF applications; patients were allowed to crossover to the ICE-guided group. The ICE-guided approach reduced the total procedure time (61.0 (56.0; 66.8) min vs. 71.5 (61.0; 80.8) min, p < 0.01). However, the total fluoroscopy time was shorter (0 (0–0) s vs. 83.5 (58.5–133.25) s, p < 0.001) and the radiation dose was lower (0 (0–0) mGy vs. 3.3 (2.0–4.7) mGy, p < 0.001) with EAMS-guidance. The ICE-guided group had a lower number of RF applications (4 (3–5) vs. 5 (3.0–7.8), p = 0.03) and total ablation time (98.5 (66.8–186) s vs. 136.5 (100.5–215.8) s, p = 0.02). Nine out of 40 patients (22.5%) in the EAMS-guided group crossed over to the ICE-guided group, and they were successfully treated with similar RF applications in terms of number, time, and energy compared to the ICE-guided group. There were no recurrences during the follow-up period. In conclusion, the utilization of ICE guidance during SP ablation has demonstrated notable reductions in procedural time and RF delivery when compared to procedures guided by EAMS. In challenging cases, an early switch to ICE-guided ablation may be the optimal choice for achieving successful treatment.

Background: Atrial fibrillation is the most common sustained arrhythmia worldwide. Pulmonary vein isolation (PVI) is the most effective catheter ablation technique for treating paroxysmal atrial fibrillation (pAF). Common ablation methods include point-by-point radiofrequency (RF) ablation and single-shot techniques such as cryoballoon ablation (CB). This single-center, prospective study aimed to compare the efficacy of ablation index-guided RF ablation (AI-RF) and CB in patients with symptomatic, antiarrhythmic-resistant pAF. Methods: A total of 154 patients undergoing initial PVI were divided into two groups (CB: 51, AI-RF: 103), based on the operators’ decision. Procedural data (total procedure time, fluoroscopy time, radiation dose, complication rate) and recurrence rates were analyzed over a 12-month follow-up period. Results: The CB group had a significantly shorter total procedure time compared to the AI-RF group (64 [57; 74.8] minutes vs. 92 [76; 119] minutes; p < 0.001). However, the CB group experienced higher fluoroscopy times (559 [395; 868] seconds vs. 167 [126; 224] seconds; p < 0.001) and a greater fluoroscopy dose (21.8 [11.7; 40.1] mGy vs. 7.65 [5.21; 14.5] mGy; p < 0.001). Recurrence rates were similar during both the blanking period (11.7% vs. 10.7%; p = 0.84) and the 12-month follow-up period (22.7% vs. 13.4%; p = 0.22). No major complications were reported during this study. Conclusions: In this single-center study, there were no significant differences in long-term recurrence or complication rates between the CB and AI-RF groups for patients with antiarrhythmic-refractory, symptomatic pAF. While the CB group benefited from a significantly shorter procedure time, it required a higher fluoroscopy dose and a longer fluoroscopy time.

Aims: Atrial fibrillation is the most common sustained cardiac arrhythmia, associated with considerable morbidity and mortality. Early detection is essential for optimal management. While wearable smart devices have shown promise, smartphone applications using photoplethysmography have also emerged as potential screening tools, but their diagnostic accuracy has not been adequately validated. This study aimed to compare the diagnostic performance of two commercially available photoplethysmography-based smartphone applications. Methods and results: In this prospective multicentre study, consecutive patients from three cardiology centres underwent simultaneous recordings with the FibriCheck® and Preventicus Heartbeats® applications and a 12-lead electrocardiogram during hospital admission or outpatient evaluation. Electrocardiograms were independently interpreted by blinded cardiologists. Diagnostic accuracy, rate of inconclusive recordings, technical performance, features, and pricing were compared between the two applications. A total of 206 patients (median age 69.5 years, 64.1% male) with 216 electrocardiograms were analysed; atrial fibrillation was present in 43.1%. Successful photoplethysmography recordings were obtained in 97.7% of FibriCheck (mean attempts 1.2 ± 0.7) and 87.5% of Preventicus Heartbeats (1.6 ± 1.3) measurements. Sensitivity and specificity were 89.0% and 100.0% for FibriCheck, and 86.4% and 99.0% for Preventicus Heartbeats. Inconclusive reading rates (where the algorithm indicated a suspicion of mild arrhythmia) were 8.5% and 11.1%, respectively. Conclusion: Both smartphone applications demonstrated high and comparable diagnostic accuracy for atrial fibrillation detection in a real-world population. These tools represent a viable, non-invasive option for early rhythm screening and follow-up, potentially improving patient outcomes, although further refinement is needed to reduce inconclusive recordings.

(1) Background: During pulmonary vein isolation (PVI) for atrial fibrillation (AF), multipolar mapping catheters (MMC) are often used. We aimed to compare the procedural outcomes of two MMCs, specifically a circular-shaped and a five-spline-shaped MMC. (2) Methods: We enrolled 70 consecutive patients in our prospective, observational trial undergoing PVI procedures for paroxysmal AF. The initial 35 patients underwent PVI procedures with circular-shaped MMC guidance (Lasso Group), and the procedures for the latter 35 cases were performed using five-spline-shaped MMC (PentaRay Group). (3) Results: No significant differences were identified between the two groups in total procedure time (80.2 ± 17.7 min vs. 75.7 ± 14.8 min, p = 0.13), time from femoral vein puncture to the initiation of the mapping (31.2 ± 7 min vs. 28.9 ± 6.8, p = 0.80), mapping time (8 (6; 13) min vs. 9 (6.5; 10.5) min, p = 0.73), duration between the first and last ablation (32 (30; 36) min vs. 33 (26; 40) min, p = 0.52), validation time (3 (2; 4) min vs. 3 (1; 5) min, p = 0.46), first pass success rates (89% vs. 91%, p = 0.71), left atrial dwelling time (46 (37; 53) min vs. 45 (36.5; 53) min, p = 0.56), fluoroscopy data (time: 150 ± 71 s vs. 143 ± 56 s, p = 0.14; dose: 6.7 ± 4 mGy vs. 7.4 ± 4.4 mGy, p = 0.90), total ablation time (1187 (1063; 1534) s vs. 1150.5 (1053; 1393.5) s, p = 0.49), the number of ablations (78 (73; 93) vs. 83 (71.3; 92.8), p = 0.60), and total ablation energy (52,300 (47,265; 66,804) J vs. 49,666 (46,395; 56,502) J, p = 0.35). (4) Conclusions: This study finds comparable procedural outcomes bet-ween circular-shaped and five-spline-shaped MMCs for PVI in paroxysmal AF, supporting their interchangeability in clinical practice for anatomical mapping.

Introduction: Catheter ablation is the preferred treatment for typical atrial flutter (AFl), although it can pose challenges due to anatomical abnormalities. The integration of 3D electroanatomical mapping systems (EAMS) has notably diminished the need for fluoroscopy in AFl ablation procedures. Intracardiac echocardiography (ICE) has also demonstrated advantages in reducing radiation exposure during AFl ablation. Nevertheless, there is a lack of evidence on the feasibility of ICE-guided, zero-fluoroscopy AFl ablation without the use of EAMS. Methods: In this prospective study, we enrolled 80 patients with CTI-dependent AFl. The initial 40 patients underwent ablation guided by standard fluoroscopy along with ICE (Standard ICE group), whereas the remaining 40 patients underwent zero-fluoroscopy ablation exclusively using ICE (Zero ICE group). Procedure outcomes, including acute success, procedural duration, fluoroscopy duration, radiation dose, and any associated complications, were compared between the groups. Results: Both groups achieved a 100% acute success rate. In the Zero ICE group, the zero-fluoroscopy approach was successfully executed in 39 out of 40 cases (97.5%). There were no significant differences in procedure time (55.5 (46.5; 66.8) min vs. 51.5 (44.0; 65.5), p=0.50) and puncture to first ablation time (18 (13.5; 23) min vs. 19 (15; 23.5) min, p=0.50) between the groups. The Zero ICE group had significantly lower fluoroscopy time (57 (36.3; 90) sec vs. 0 (0; 0) sec, p<0.001) and dose (3.17 (2.27; 5.63) mGy vs. 0 (0; 0) mGy, p<0.001 compared to the Standard ICE group. Total ablation time was longer in the Standard ICE group (597 (447; 908) sec vs. 430 (260; 750), p=0.02), but total ablation energy (22458 (14836; 31116) Ws vs. 17043 (10533; 29302) Ws, p=0.10) did not differ significantly. First-pass bidirectional conduction block of the CTI and acute reconnection rates were comparable between the groups. No complications or recurrences were noted during the follow-up period. Conclusion: ICE-guided, zero-fluoroscopy CTI ablation for AFl using only ICE is feasible and safe. This method effectively eliminates radiation exposure without compromising procedural duration, total ablation time, or acute success rates.isthmus ablation by ICE