Santi Raffa

Long-term outcome in diabetic heart failure patients treated with cardiac resynchronization therapy

Diabetes mellitus is an independent risk factor for increased morbidity and mortality in heart failure (HF) patients.

Voltage mapping and pacing to assess the level of pulmonary venous isolation achieved with a novel circular multielectrode ablation catheter

AIMS The aim of the study was to determine the level of pulmonary vein (PV) isolation achieved with the use of a novel radiofrequency circular multielectrode ablation catheter [pulmonary vein ablation catheter (PVAC)] in patients with paroxysmal atrial fibrillation. Although some efficacy data have been presented, the level of PV isolation, which is crucial both for efficacy and safety of the ablation, has not been defined with this new ablation catheter. METHODS AND RESULTS Detailed sinus rhythm voltage maps using an electroanatomic mapping system and projected on 3D computed tomography-derived reconstructions of the left atrium (LA) were obtained before and after PV isolation with the PVAC. Left atrium-PV entry and exit block was assessed for each vein. The population consisted of 12 patients, mean age 57+/-6 years, seven male. After ablation, an extensive zone of potential reduction that included the ostium of each PV was observed in all patients. Bipolar voltages were significantly reduced in all PVs and in the LA close to the vein ostia, the mean voltage reduction was >80%. CONCLUSION Using the PVAC, (i) PVs are isolated at the level of the PV ostium and, importantly, outside the tubular portion and (ii) significant voltage reduction is also recorded at various extent proximal to the PV ostium at the level of the antral region.

Electrocardiographic and Electrophysiological Characteristics of Atrial Tachycardia With Early Activation Close to the His-Bundle.

Radiofrequency (RF) ablation of atrial tachycardia (AT) with earliest activation at the His‐bundle may be associated with the risk of AV block, and detection of this AT origin using the electrocardiogram (ECG) would be helpful in planning ablation. Aim of this study was to characterize the P‐wave morphology and intracardiac electrograms at the successful ablation site for this group of ATs.

Right Heart Failure Due to Loss of Right Ventricular Capture in a Patient with Atrioventricular Junction Ablation and Biventricular Pacing

We describe the case of a patient with atrioventricular (AV) junction ablation and chronic biventricular pacing in which intermittent dysfunction of the right ventricular (RV) lead resulted in left ventricular (LV) stimulation alone and onset of severe right heart failure. Restoration of biventricular pacing by increasing device output and then performing lead revision resolved the issue. This case provides evidence that LV pacing alone in patients with AV junction ablation may lead to severe right heart failure, most likely as a result of iatrogenic mechanical dyssynchrony within the RV. Thus, probably this pacing mode should be avoided in pacemaker‐dependent patients with heart failure.

Catheter ablation of ventricular ectopy with para‐hisian origin: importance of mapping both sides of the interventricular septum and understanding when to stop ablating

Catheter ablation of para‐Hisian premature ventricular contractions (PVCs) still represents a challenge and is a compromise between success and inadvertent AV block. We describe a possible strategy to address PVCs from this location with high‐amplitude His‐bundle potentials at the site of earliest activation.