Corrado Tomasi

Is electrocardiography a reliable tool for identifying patients with isthmus-dependent atrial flutter?

AIMS To verify the reliability of the surface ECG to discriminate between cavotricuspid isthmus-dependent atrial flutter (CTI-AFL) and non-CTI-AFL. METHODS AND RESULTS We reviewed the ECGs of 186 consecutive patients who underwent catheter ablation of AFL between January 2004 and January 2008. The ECG pattern was defined typical for CTI-AFL, if F-waves were: (i) dominantly negative in the inferior leads and positive in V1 (CCW) or (ii) dominantly positive in the inferior leads and negative in V1 (CW). At the electrophysiological study (EPS), 138 patients (74.2%) had a CTI-AFL and 48 patients (25.8%) had a non-CTI-AFL. A CTI-AFL was found not only in 90.5% of patients having a typical ECG, but also in 40% of patients having an atypical ECG. Thus, a typical AFL ECG showed a sensitivity of 0.83 and a specificity of 0.75 to predict a CTI-AFL, with a positive predictive value of 90.5% and a negative predictive value of 60%. CONCLUSION Typical AFL ECG is a good predictor of CTI-AFL, and in this case, an ablation procedure can be recommended. On the contrary, an atypical AFL ECG does not rule out a CTI-AFL; so, even in this group of patients, an EPS should not be denied when indicated by the clinical circumstances.

Intra-atrial thrombolysis of left atrial thrombus guided by intracardiac echocardiography during catheter ablation of atrial fibrillation.

KEYWORDS Atrial fibrillation ablation complications; Intra-atrial thrombolysis; Intracardiac echocardiography; Thrombosis in left atrium ABBREVIATIONS ACT activated clotting time; AF atrial fibrillation; ICE intracardiac echocardiography; INR international normalized ratio; LA left atrium; LSPV left superior pulmonary vein; OAC oral anticoagulant; PV pulmonary vein; RF radiofrequency; RFCA radiofrequency catheter ablation; TS transseptal; UFH unfractionated heparin (Heart Rhythm 2011;8:1773‐1776)

Impact of pacemaker longevity on expected device replacement rates: Results from computer simulations based on a multicenter registry (ESSENTIAL)

The rate of device replacement in pacemaker recipients has not been investigated in detail.

An exploratory study on coronary sinus lead tip three-dimensional trajectory changes in cardiac resynchronization therapy

BACKGROUND Prediction of response to cardiac resynchronization therapy (CRT) is still an unsolved major issue. The interface between left ventricular mechanics, coronary sinus (CS) lead, and pacing delivery has been little investigated. OBJECTIVE To investigate CS lead tip movements at baseline and during biventricular pacing (BiV) in the hypothesis that they could provide some insights into left ventricular mechanical behavior in CRT. METHODS Three-dimensional reconstruction of CS lead tip trajectory throughout the cardiac cycle using a novel fluoroscopy-based method was performed in 22 patients with chronic heart failure (19 men; mean age 70 ± 10 years). Three trajectories were computed: before (T-1) and immediately after (T0) BiV start-up and after 6 months (T1). CRT response was the echocardiographic end-systolic volume reduction ≥15% at T1. Metrics describing trajectory at T0, T-1, and T1 were compared between 9 responders (R) and 13 nonresponders (NR). RESULTS At T-1 trajectories demonstrated heterogeneous shapes and metrics, but at T0 the variations in the ratio between the two main axes (S1/S2) and in the eccentricity were statistically different between R and NR, pointing out a trajectorys change toward a significantly more circular shape at BiV start-up in R. Remarkably, R and NR could be completely separated by means of the percent variation in S1/S2 from T-1 to T0 (R: 47.5% [31.5% to 54.1%] vs. NR: -25.6% [-67% to -6.5%]). This single marker computed at T0 would have predicted CRT response at T1. CONCLUSIONS Preliminary data showed that CS lead tip trajectory changes induced by BiV were related to mechanical resynchronization.