Florian Spies

Incidence of new-onset atrial fibrillation after cavotricuspid isthmus ablation for atrial flutter

Aims In patients with cavotricuspid isthmus (CTI) ablation for atrial flutter (AFL), the decision to hold oral anticoagulation (OAC) often becomes an issue. The purpose of this study was to describe the incidence of the development of atrial fibrillation (AF) after CTI ablation in patients with documented AFL with and without a previous history of AF and to identify risk predictors for the occurrence of AF after CTI. Methods and results We included 364 consecutive patients undergoing successful CTI ablation. Thereof, 230 patients (170 male; age 66 ± 11 years) had AFL only (AFL group) and 134 patients (94 male; age 65 ± 11 years) had AFL and previously documented AF (AFL and AF group). Over a mean follow-up of 22 ± 20 months, 163 (71%) patients in the AFL group and 67 (50%) patients in the AFL and AF groups had no documentation of a recurrent atrial arrhythmia (P < 0.001). AF developed in 51 patients (22%) in the AFL group and in 57 (43%) patients in the AFL and AF groups (P < 0.001). In patients without history of AF, left atrial diameter was the only predictor of development of AF (HR 1.058 [95%CI 1.011-1.108], P = 0.016). Multivariate analysis of the total population identified history of AF (HR 1.918 [95%CI 1.301-2.830], P = 0.001) and BMI as predictors for AF development (HR 1.052 [95%CI 1.012-1.093], P = 0.011). Conclusion Our results indicate that new-onset AF develops in a significant proportion of patients undergoing CTI for AFL. One should therefore be careful to withhold OAC. Furthermore, pulmonary vein isolation should be considered in conjunction with CTI, particularly in patients with previously documented AF.

A quantitative comparison of the electrical and anatomical definition of the pulmonary vein ostium: SPIES et al.

Anatomically guided pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. However, the position where to confirm electrical isolation is ill‐defined. The aim of the current study was to quantify the relationship between the anatomical and electrical definition of the pulmonary vein ostium.

Electroanatomic mapping of atrial tachycardia—Manual vs automated annotation☆

Introduction The availability of novel mapping systems and software in combination with or without dedicated multipolar diagnostic catheters allows for automatic high-density 3-dimensional electroanatomic mapping that enables detailed insight into atrial tachycardia mechanisms. For the accuracy of the activation map, the consistency of electrogram annotation is crucial. Depending on the system used, numerous algorithms (eg, peak amplitude or rapid downstroke of the unipolar signal) are currently implemented that can be selected for automatic signal annotation. For reliable automatic high-density mapping with thousands of points acquired within a few minutes, the robustness of the implemented algorithm is critical, especially for fractionated signals or double potentials.

Remotely navigated ablation of RVOT tachycardia

Alternative route to the right cardiac chambers in a patient with an interrupted inferior vena cava.