L. De Luca

P.1. Supraventricular Arrhythmias

Introduction The role of Pacemaker Diagnostics for the management of Atrial Fibrillation (AF) was evaluated in the CORRELATE registry. Methods In this interim analysis data on hybrid treatment from 173 patients was evaluated. Results In 98 patients AF was detected after 6weeks follow-up. 55 Patients reported symptoms; 40 patients showed irregular ventricular rate during AF; mainly diagnosed by detailed-onset-reports (88% of patients). After 6weeks follow-up therapy adaptations were made: ![Graphic][1] After 6months follow-up 19 of 40 patients were a-symptomatic. This a-symptomatic group had less patients with AF (79% vs. 100%) and less ventricular irregularities (42% vs. 71%) compared to the symptomatic group. Conclusion An irregular ventricular rate was diagnosed by means of pacemaker diagnostics in the majority of symptomatic AF patients (73%). Hybrid therapy resulted in effective suppression of symptoms in 48% of patients. Ongoing AF and ventricular irregularities is however still present in a considerable amount of patients, so symptoms alone are not a reliable tool to evaluate these patients [1]: /embed/graphic-1.gif

P.1. Supraventricular ArrhythmiasP.1.4 WPW and Non Compaction-Case Report

Introduction The role of Pacemaker Diagnostics for the management of Atrial Fibrillation (AF) was evaluated in the CORRELATE registry. Methods In this interim analysis data on hybrid treatment from 173 patients was evaluated. Results In 98 patients AF was detected after 6weeks follow-up. 55 Patients reported symptoms; 40 patients showed irregular ventricular rate during AF; mainly diagnosed by detailed-onset-reports (88% of patients). After 6weeks follow-up therapy adaptations were made: ![Graphic][1] After 6months follow-up 19 of 40 patients were a-symptomatic. This a-symptomatic group had less patients with AF (79% vs. 100%) and less ventricular irregularities (42% vs. 71%) compared to the symptomatic group. Conclusion An irregular ventricular rate was diagnosed by means of pacemaker diagnostics in the majority of symptomatic AF patients (73%). Hybrid therapy resulted in effective suppression of symptoms in 48% of patients. Ongoing AF and ventricular irregularities is however still present in a considerable amount of patients, so symptoms alone are not a reliable tool to evaluate these patients [1]: /embed/graphic-1.gif

7. Pulmonary Veins: Anatomy and Transcatheter Electrical Isolation

Background To atrial fibrillation catheter ablation a second transseptal puncture is usually advocated to perform the procedure. Aim To report a retrospective data about a single transseptal puncture for AF ablation. Methods A thousand patients were recruited in whom ablation of (AF) was performed. After the transseptal puncture a guidewire was then anchored in the LSPV and the transseptal assembly pulls back to the right atrium. Then a catheter was advanced approaching the septum parallel to the guidewire and guiding the crossing. After the catheter was positioned in the left atrium, the transseptal system was advanced to the left atrium over the guidewire. Results In 5/1000 (0.5 %) cases a second transseptal puncture was required. Neither complications of the transseptal were reported nor were catheter properly manoeuvred. In a year follow up no persistent atrial defect were observed. Conclusions This data on a large cohort of pts shows that single transseptal puncture AF ablation is a highly successful and safe maneuver with a very low morbidity in the majority of pts. This can avoid potential complications related to a second transseptal puncture.

6. AVNRT: Electrophysiological Aspects and Ablation Results

Background During a supraventricular tachycardia an eccentric retrograde atrial activation usually suggests a left side accessory pathway (AP) Aim of the Study To report cases AVNRT with eccentric retrograde atrial activation. Methods Among 526 patients (pts) referred for electrophysiological evaluation for recurrent supraventricular tachycardia, we selected 6 pts (2 males, mean age 39±14 yrs) with AV node reentrant tachycardia (AVNRT) showing an eccentric retrograde atrial activation during tachycardia. An AT was ruled out by VAV response during entrainment by ventricular pacing. Pacing maneuvers were employed such as ventricular pre-excitation during atrial pacing, advancement of atrial activation by a premature ventricular contraction during His refractoriness, recording of an AP, lengthening of VA interval during bundle branch block to rule out the conduction over an AP. Ablation aiming at the slow AV nodal pathway potential was successful in eliminating and preventing tachycardia inducibility in all patients. Conclusions Detailed electrophysiological evaluation is required for correct diagnosis and elimination of tachycardia is usually achieved by ablating the slow AV nodal pathway at the right posteroseptal area.

6. AVNRT: Electrophysiological Aspects and Ablation Results6.3 AVNRT that Mimics Left Side Accessory Pathway

Background During a supraventricular tachycardia an eccentric retrograde atrial activation usually suggests a left side accessory pathway (AP) Aim of the Study To report cases AVNRT with eccentric retrograde atrial activation. Methods Among 526 patients (pts) referred for electrophysiological evaluation for recurrent supraventricular tachycardia, we selected 6 pts (2 males, mean age 39±14 yrs) with AV node reentrant tachycardia (AVNRT) showing an eccentric retrograde atrial activation during tachycardia. An AT was ruled out by VAV response during entrainment by ventricular pacing. Pacing maneuvers were employed such as ventricular pre-excitation during atrial pacing, advancement of atrial activation by a premature ventricular contraction during His refractoriness, recording of an AP, lengthening of VA interval during bundle branch block to rule out the conduction over an AP. Ablation aiming at the slow AV nodal pathway potential was successful in eliminating and preventing tachycardia inducibility in all patients. Conclusions Detailed electrophysiological evaluation is required for correct diagnosis and elimination of tachycardia is usually achieved by ablating the slow AV nodal pathway at the right posteroseptal area.