Background: Catheter ablation (CA) remains challenging due to suboptimal success rates in persistent atrial fibrillation (AF). Existing mapping technologies cannot reliably distinguish sources in this patient population. Recently, the novel electrographic flow (EGF) mapping system was developed using a modified Horn‐Schunk optical flow algorithm to detect and quantify patterns of electrical wavefront propagation in the atria.Objectives: To test the hypothesis that targeted source ablation based on EGF mapping is superior to empiric AF ablation.Methods: We included all consecutive patients undergoing EGF guided ablation for persistent AF. All patients underwent pulmonary vein isolation (PVI) and were treated with the same EAM system (CARTO). The outcome of PVI+EGF guided CA was compared with data of PVI‐only procedures (PVI‐only group) and PVI plus additional empiric adjunctive linear and substrate ablations (PVI+LINES group). 12‐months outcome as freedom from AF and atrial tachycardia/flutter (AT/AFL), procedural safety and efficiency characterized by procedure duration, fluoroscopy use, radiofrequency applications and duration, were analyzed. Both intention‐to‐treat and per protocol analysis were conducted.Results: A total number of 70 patients (39 in PVI+EGF, 16 in PVI‐only and 15 patients in PVI+LINES group) were enrolled. Intention‐to‐treat analysis showed fewer AF recurrences in PVI+EGF as compared with the PVI‐only or PVI+LINES groups at 12 months (25.6% vs. 62.5% vs. 53.3%, p = .02). There were no differences in AT/AFL recurrence (17.9% vs. 37.5% vs. 20.0%, p = .37). Procedure times were longer in PVI+EGF group (p < .01), and there were no differences in fluoroscopy use (p = .67).Conclusion: Our data suggest that patients treated with EGF‐guided CA developed fewer AF recurrences. Although the procedure times are longer, it seems to be safe and offers a more targeted, patient‐specific ablation strategy beyond PVI than adjunctive empiric lines and substrate ablation in this complex group of patients.

Background: Catheter ablation (CA) has become a well-established first-line therapy for a broad spectrum of arrhythmias, including atrial tachycardias (ATs). In this study we aimed to assess the performance of the integrated novel high-resolution new generation noncontact mapping system (AcQMap) with robotic magnetic navigation (RMN) system in CA procedures for patients with ATs including comparing patient subgroups based on the utilized mapping modality, arrhythmia mechanism, localization and type of procedure. Methods: All patients undergoing CA for AT using the AcQMap-RMN system were included. Procedural safety and efficacy were characterized by intra- and post-procedural complications. Acute procedural success and the long-term outcome were assessed in the overall group and in the subgroups. Results: A total number of 70 patients were referred for CA with atrial arrhythmias including 67 AT/AFL (mean age 57.1 ± 14.4 years), and 3 additional patients with inappropriate sinus tachycardia. Thirty-eight patients had de novo AT, 24 had post-PVI AT including 2 patients with perinodal AT, and 5 had post-MAZE AT. Two patients (2.9%) suffered post-procedural complications including 1 patient with groin hematoma and 1 patient with a transient ischemic attack. Acute success was achieved in 63/67 (94.0%) procedures. Thirteen patients (19.4%) had documented recurrence at the end of the 12-months follow-up period. The performance of AcQMap was equally good in focal vs. reentry mechanisms (p = 0.61, acute success), in the left and right atrium (p = 0.21). Conclusions: AcQMap-RMN integration might improve success rates in CA of ATs with low number of complications.

Background: Short runs of atrial tachycardias (ATs) and infrequent premature atrial contractions (PACs) are difficult to map and ablate using sequential electrophysiology mapping techniques. The AcQMap mapping system allows for highly accurate mapping of a single atrial activation. Objectives: We aimed to test the value of a novel dipole charge density-based high-resolution mapping technique (AcQMap) in the treatment of brief episodes of ATs and PACs. Methods: Data of all patients undergoing catheter ablation (CA) using the AcQMap mapping system were reviewed. Results: Thirty-one out of 219 patients (male n = 8; female n = 23) had short runs of ATs (n = 23) and PACs (n = 8). The mean procedural time was 155.3 ± 46.6 min, with a mean radiation dose of 92.0 (IQR 37.0–121.0) mGy. Total radiofrequency application duration 504.0 (271.0–906.0) s. Left atrial localization of ATs and PACs was identified in 45.1% of the cases, right atrium localization in 45.1%, and septal origins in 9.8% of the cases. Acute success was achieved in 30/31 (96.8%), and recurrence during the follow-up developed in six patients (19.4%), including four patients with PACs and two patients with short-lived ATs. One patient presented procedure-related groin hematoma as minor complication. Conclusion: Brief episodes of highly symptomatic ATs and infrequent PACs can be mapped using charge density mapping and successfully ablated with high acute and long-term success rates.

Background: Left ventricular (LV) non-compaction (NC) is a rare ventricular phenotype characterized by a thin compacted epicardial layer and an extensive non-compacted endocardial layer with prominent LV trabeculations and deep intertrabecular recesses. According to the recent literature, no information is available regarding the abnormalities of the aortic valve annulus (AVA) in LVNC. Therefore, the aim of the present study was to perform a detailed analysis of the AVA by three-dimensional speckle-tracking echocardiography (3DSTE) in LVNC patients and to compare the findings with matched healthy controls. Methods: The present study comprised 21 isolated LVNC patients, from which 9 cases were excluded due to inferior image quality. The remaining group consisted of 12 patients with isolated LVNC (mean age: 54.6 ± 13.6 years, 7 males). Jenni’s echocardiography criteria served as a definition of LVNC. The 12 patients’ results were compared to 38 healthy age- and gender-matched controls (mean age: 48.2 ± 8.0 years, 19 males). Subgroups of patients having a greater end-diastolic versus end-systolic AVA area were also compared. Results: Most of AVA dimensions did not differ significantly between LVNC patients and controls; however, most LVNC patients showed a larger end-diastolic AVA area (9 out of 12, 75%), which was a significantly larger ratio as seen in matched controls (11 out of 38, 29%, p < 0.05). Aortic valve annular plane systolic excursion (AAPSE) proved to be significantly reduced in all LVNC patients (1.12 ± 0.24 cm vs. 0.78 ± 0.28 cm, p < 0.05) and in LVNC subjects with a greater end-diastolic AVA area (1.11 ± 0.21 cm vs. 0.72 ± 0.21 cm, p < 0.05). Basal LV radial (RS) and longitudinal (LS) strains were reduced in healthy adults with a greater end-diastolic AVA area as compared to cases with a greater end-systolic AVA area. In LVNC, not only basal LV-RS and LV-LS, but also LV circumferential strain (CS) proved to be reduced regardless of whether the AVA was greater in end-diastole or in end-systole. Conclusions: In patients with isolated LVNC, the AVA is not dilated; however, the presence of a greater end-diastolic AVA area is observed more frequently than in healthy controls. AAPSE and basal LV-RS, LV-LS and LV-CS values are significantly reduced in LVNC irrespective of whether the end-systolic or end-diastolic AVA area is greater.

: Patients with brief arrhythmias is a challenging group to treat effectively with catheter ablation. Current standard approaches in the localization and treatment of brief arrhythmias suffer from ...