Pulmonary Vein Research Articles

Use of optimal fluoroscopic angulation to facilitate effective pulsed field ablation in a patient with atrial fibrillation.

The circular-shaped PulseSelect™ PFA catheter has demonstrated comparable efficacy to traditional thermal catheter ablation in achieving pulmonary vein isolation (PVI), while preventing thermally mediated complications. However, this catheter does not have any objective parameters to confirm real-time tissue-catheter contact. We report a case in which PVI was achieved through PFA using optimal biplane fluoroscopic angulations which were more useful for accurately assessing and adjusting the position and rotation of the circular catheter electrodes than the conventional fluoroscopic angulations.

Sex differences in atrial potential morphology.

Areas of conduction disorders play an important role in both initiation and perpetuation of AF and can be recognized by specific changes in unipolar potential morphology. For example, EGM fractionation may be caused by asynchronous activation of adjacent cardiomyocytes because of structural barriers such as fibrotic strands. However, it is unknown whether there are sex differences in unipolar potential morphology. Therefore, atrial potential morphologies during sinus rhythm (SR) were compared between male and female patients. Based on propensity score matching, 62 male and female patients in whom high-resolution mapping of the right atrium (RA), left atrium (LA), and pulmonary vein area (PVA) including Bachmann's bundle (BB) was performed during coronary bypass grafting surgery and/or valvular heart surgery. Unipolar potentials were classified as single potentials (SPs), short double potentials (SDPs), long double potentials (LDP), fractionated potentials (FPs) and fraction duration (FD). The proportion of conduction block lines was also determined. Female patients had a higher proportion of SDPs, LDPs and FPs at the RA, and SDPs at BB. At the PVA, there were less SPs and more SDPs and FPs. In females, FDs were longer at the RA and PVA, and potential voltages of only SPs were lower at the RA (all P<0.05). Females also had more CB at the RA and at PVA (P<0.05). In females, the proportion of single unipolar potentials indicative of smooth conduction, was lower compared to males, at the RA and PVA and to a lesser degree at BB. Females also had more CB at RA and PVA. Hence, these results may reflect sex-differences in the degree of electrical remodeling.

Usefulness of preprocedural 3-dimensional computed tomography planning in assisting one-stage pulmonary veins isolation with concomitant left atrial appendage occlusion procedure: A pilot study

Usefulness of preprocedural 3-dimensional computed tomography planning in assisting one-stage pulmonary veins isolation with concomitant left atrial appendage occlusion procedure: A pilot study

A case of obstructive shock and transient ischemic attack from intracardiac metastasis of non-small cell lung cancer (NSCLC)

Introduction: Cancer-associated stroke (CAS) is a serious complication in cancer patients, particularly those with lung cancer. This case highlights a 76-year-old male with metastatic squamous cell carcinoma of the lung who developed obstructive shock and a transient ischemic attack (TIA) due to intracardiac metastasis. Case presentation: The patient, with a history of coronary artery disease, chronic atrial fibrillation, and obstructive sleep apnea, was diagnosed with stage IIIB squamous cell carcinoma of the lung. Imaging revealed a tumor thrombus in the left atrium, extending from the right lower lobe of the lung via the pulmonary vein. The patient presented with hemodynamic instability and a fall. A TIA with right facial droop and left pronator drift developed, which resolved within six hours. Given his poor performance status (ECOG 3), he was started on palliative radiation therapy and discharged to hospice care. Clinical discussion: Intracardiac metastasis is a rare complication of lung cancer, leading to severe hemodynamic issues and neurological events like stroke. In this case, the tumor thrombus caused obstructive shock and increased the risk of ischemic stroke. Cancer-associated stroke is more common in patients with thoracic malignancies, underscoring the need for a multidisciplinary approach to manage these complex cases. Conclusion: This case highlights the importance of early recognition and a multidisciplinary approach in managing cancer-associated strokes, particularly in patients with advanced lung cancer. Palliative care is essential for symptom management and improving quality of life. Further research is needed to explore targeted treatments for cancer-associated thrombosis.

Branch pulmonary artery flows calculated using velocity time integral correlate with MRI in pediatric pulmonary vein stenosis

Abstract Background/Introduction In pulmonary vein stenosis (PVS), serial echocardiograms are the mainstay in assessment of pulmonary vein disease. Development of gradients in stenotic pulmonary veins indicate progression of disease and influences timing of intervention. However, pulmonary vein gradients should be interpreted in the context of relative branch pulmonary artery (PA) flows to avoid misinterpretation of worsening PVS. To date, the comparison of branch PA flows derived from echocardiography compared to gold-standard from MRI has not been described. Purpose To determine if branch PA flows calculated using velocity time integral (VTI) correlate with MRI. Methods Single-center retrospective assessment of cardiac MRIs and echocardiograms in pediatric patients with pulmonary vein stenosis between February 2019 to May 2022. Cardiac MRIs and echocardiograms obtained within a 6-month period were compared. All causes and severity of PVS were included. Patients were excluded if echocardiographic assessment did not adequately visualize either branch PA or pulse wave Dopplers in the PAs were not performed. 20 patients with a mean age of 7.72 ± 5.93 years were included. Branch PA flows were derived using PA diameter in systole from the high parasternal view from which cross-sectional area (CSA) was calculated using CSA = pi(radius)^2. Using pulse wave Doppler in the branch PAs, VTI was measured as an averaged area under the curves over 3 beats. Relative branch PA flows were calculated using a product of CSA and VTI. We present branch PA flows indexed to body surface area. Results Mean RPA flows by VTI and MRI were 2.18 ± 1.36L/min/m2 and 2.34 ± 1.29L/min/m2, respectively. Mean LPA flows by VTI and MRI were 1.64±0.77L/min/m2 and 1.94±1.13L/min/m2, respectively. There were statistically significant correlations in branch PA flows comparing VTI to MRI (RPA correlation coefficient 0.549, p=0.02, LPA correlation coefficient 0.621, p=0.01). Conclusion Relative branch PA flows calculated using VTI correlate significantly with gold-standard from MRI. Lower correlation in the RPA may be due to Doppler angle. This is a feasible, complementary tool easily integrated as part of the standard echocardiographic assessment of PVS, that allows early detection of disease progression while decreasing the frequency of general anesthesia required for MRIs in young children. Expansion to a larger cohort is necessary to strengthen demonstrated correlations. Future work includes integration of branch PA flows in addition to pulmonary vein gradients to develop a PVS severity score in pediatrics to guide management.

Immediately improved diastolic function as determined by pulmonic vein Doppler-intraoperative TEE in TAVR patients and the impact of valvulo-arterial impedance

Abstract Background A recent study demonstrates that most TAVR patients experience immediate improvement in diastolic function as determined by pulmonic vein Doppler (PvD) measurements. Valvulo-arterial impedance (Zva) is a marker of global LV load and represents both valvular and arterial load. Zva &amp;gt; 3.5 has been shown as a predictor of poor adverse outcomes. We hypothesize that Zva might have an effect on the change in pulmonic vein Doppler after TAVR. Purpose This study aims to demonstrate the impact of valvulo-arterial impedance and the immediate improvement of diastolic function in TAVR patients as assessed by pulmonic vein Doppler-intraoperative TEE. Materials and Methods Patients who underwent TAVR from January 2020 to September 2023 and were performed pulmonic vein Doppler by intraoperative TEE (right upper pulmonic vein from 90-110° mid-esophageal view) during TAVR and measured S-, D-, and A- wave velocity. We obtained the blood pressure and transthoracic echocardiographic parameters to calculate the Zva [(systolic blood pressure + mean pressure gradient across the aortic valve)/stroke volume index by LVOT doppler]. To compare the PvD change between Zva &amp;lt; 3.5 and Zva ≥ 3.5, use chi-square for categorical data and a paired t-test for continuous data. Results 79 patients (mean age was 80.6 ± 5.6 years, 43 female) were enrolled in this study. S-wave was the only parameter with significantly increased velocity from baseline (33.2 ± 13.8 cm/s vs. 49.1 ± 18.6 cm/s, p &amp;lt; 0.001), whereas D-wave and A-wave did not significantly change from baseline (33.1 ± 14.5 cm/s vs. 33.3 ± 12.0 cm/s, p = 0.88; and 12.7 ± 7.8 cm/s vs. 13.3 ± 7.3 cm/s, p = 0.52, respectively). Of the 37 patients who had an S/D ratio &amp;lt; 1 at baseline, 26 of them converted to an S/D ratio &amp;gt; 1 immediately post-TAVR (Figure 1). In the group of Zva &amp;lt; 3.5, the number of patients who had PvD changed significantly compared with the group of Zva ≥ 3.5 (Figure 2). Conclusion The majority of patients in this study demonstrated that diastolic function improved immediately following TAVR using a pulmonic vein Doppler. S/D &amp;gt; 1 has improved significantly in the group with normal valvulo-arterial impedance (Zva &amp;lt; 3.5). Figure 1 Figure 2

Using gamification tools to enhance self-organized echo-learning in a hospital setting

Abstract Background Gamification has been discussed in various settings of medical education, highlighting its potential to increase engagement and boost motivation. Tools like "points," "badges," or "leaderboards" are known to work well in any area of learning. Purpose In a mid-sized hospital, creating a structured echocardiography training curriculum for internal medicine residents can be challenging due to rotating teachers and students and a general lack of resources. A self-guided training curriculum using concepts from computer gaming seemed appropriate to engage and motivate trainees. Methods We set up a self-organized training program where residents without prior echocardiography skills could progress through a step-by-step curriculum to gain basic echocardiography expertise. After a brief introductory session and distribution of a paper curriculum, trainees were included in the daily echocardiography schedule. They could advance to higher "levels," each allowing them to use more advanced tools, such as spectral Doppler or the Simpson method ("weapons"). To complete each level, trainees had to answer theoretical questions, analyze echo loops stored on a network drive, and perform a short hands-on exam under the supervision of a senior cardiologist ("final boss"). We also published "highscores" regularly, highlighting residents with the most exams during a given interval. To enhance the skills of our senior cardiologists, we developed "challenges" introduced several times per year, covering techniques like lung ultrasound or pulmonary vein Doppler. Results The process was evaluated through an anonymous online questionnaire completed by about half of the residents. The training concept received positive feedback, but the results were overshadowed by the lack of time residents were able to allocate to perform echocardiographies at all. Additionally, the amount of in-depth personal supervision was criticized. Conclusions Although our echocardiography education concept did not fulfill all our expectations, developing a self-organized echocardiography training curriculum using gamification elements seems promising. Future refinements should include more supervision and regular training and briefing of all individuals involved in the process. Even more important seems to be a general allocation of resources to echocardiography training. Since medical education is vital for ensuring treatment quality and staff satisfaction, more research is necessary to test and compare different teaching approaches scientifically. In the future, an online or mobile-app based training platform could serve as a hub for echocardiography teaching, where institutions and learners register, access teaching resources, and track their progress, using gamification tools to motivate and engage trainees. Training scheme Challenge.jpg

Impact of cardiac position, morphology and operative technique on long-term fontan outcomes in heterotaxy.

This study aimed to assess the outcomes of heterotaxy patients undergone the Fontan operation, focusing on morphological features and surgical techniques. Eighty-two consecutive heterotaxy patients who underwent the Fontan operation from 1985 to 2021 were compared to 150 patients with tricuspid atresia (TA) and 144 patients with hypoplastic left heart syndrome (HLHS). The Kaplan-Meier method and Cox proportional hazard model were used to analyze transplant-free survival and predictor of outcomes. The 20-year transplant-free survival rates were comparable between Right Atrial Isomerism (RAI, n = 45) and Left Atrial Isomerism (LAI, n = 37) (RAI vs LAI, 76% [95% confidence interval, 57-87%] vs 68% [47-82%], p = 0.22), although more pulmonary vein interventions at Fontan were needed in RAI. Surgical techniques included extracardiac conduit in 66%, intra-atrial conduit in 9%, lateral tunnel in 18% of the cases. Cardiac position and apicocaval juxtaposition did not influence outcomes, but the inferior vena cava (IVC)-contralateral PA Fontan was associated with 100% survival, while the IVC-ipsilateral PA Fontan at the cardiac apex showed a 67% [34-87%] survival rate at 20 years. In-hospital mortality was higher in heterotaxy (9.8% [5-19%]) compared to TA (1.3% [0.3-5.3%], p < 0.01) and HLHS (2.8% [1.1-7.3%], p = 0.02), with no early death after 2000 in any group. The 20-year transplant-free survival in heterotaxy (72% [59-82%]) was similar to that in HLHS (80% [69-87%], p = 0.11). Various routing techniques can be successfully applied to overcome anatomical challenges in heterotaxy. Despite higher in-hospital mortality, overall survival was similar to HLHS. RAI had comparable survival to LAI with more pulmonary vein interventions at Fontan.

In Vivo Tissue Temperature Characteristics of Contact Force Catheter With a Mesh-Shaped Irrigation Tip: A Porcine Study.

Neither the actual in vivo tissue temperatures reached with a novel contact force sensing catheter with a mesh-shaped irrigation tip (TactiFlex SE, Abbott) nor the safety profile has been elucidated. In a porcine model (n=8), thermocouples were implanted epicardially in the superior vena cava, right pulmonary vein, and esophagus close to the inferior vena cava following a right thoracotomy. After chest closure, endocardial ablation was conducted near the thermocouples under fluoroscopic guidance. We compared tissue temperatures during 50W/13-s high-power short-duration (HPSD) and 30W/30-s standard ablation. No steam pops were observed in 34 HPSD and 35 standard ablation applications. Tmax (maximum tissue temperature when the thermocouple was located ≤5mm from the catheter tip) was modestly higher in HPSD compared to standard ablation (60.1°C±12.4°C vs. 57.8°C±12.9°C; p = 0.46). The peak tissue temperature correlated inversely with the catheter tip-to-thermocouple distance (HPSD: r = -0.40; standard: r = -0.57). Lethal temperatures (≥50°C) were reached faster with HPSD (6.5±3.2s vs. 10.3±8.6s; p=0.04) and the distance from the catheter tip achieving a lethal tissue temperature ≥50°C (indicative of the lesion depth) was slightly shallower with HPSD (4.2 and 4.8mm, respectively). The esophageal injury occurred superficially in both settings (0.98±0.22mm vs. 1.16±0.18mm; p=0.29). HPSD ablation produced a modestly higher and more rapid increase in the tissue temperature around the veno-atrial junction with a shorter catheter tip-to-thermocouple distance required to reach lethal temperatures. This data contributes to understanding effective lesion creation and collateral injury prevention with the TactiFlex catheter.

Pacing and Ablation Technique Using Microelectrode for Pulmonary Vein Isolation Using a Local Impedance-Guided Catheter.

The IntellaNav MiFi OI catheter (MiFi) is equipped with a sensor for local impedance (LI) monitoring and three mini-electrodes. In this study, we investigated the target LI values for a successful pulmonary vein isolation (PVI) under the pacing and ablation technique using the MiFi catheter. Twenty-seven patients underwent PVI using the MiFi catheter under mini electrode pacing from the MiFi catheter. The local impedance (LI) changes, generator impedance (GI) changes, and the time to capture loss were evaluated. First-pass isolations were obtained in 15 patients (57.7 %) for right PVs and in 22 patients (84.6 %) for left PVs. At gap sites, the impedance decrease was smaller than at non-gap sites (non-gap sites vs. gap sites; LI drop, 23.2 [±10.3] vs. 15.6 [±7.7] Ω, p < 0.0001; GI drop, 4.8 [±4.1] vs. 2.7 [3.9] Ω, p = 0.0026; %LI drop, -19.3 [±7.4] vs. -13.1 [±6.1] %, p < 0.0001; % GI drop, -5.1 [±4.2] vs. -2.9 [±4.2] %, p = 0.0020), suggesting that changes in impedance could be useful for predicting gaps. The cutoff values for predicting no gaps were identified as 15.0 Ω for the LI drop and -13.74% for the %LI drop. The LI showed greater changes than the GI and was also useful for predicting gaps. The cutoff values of 15.0 Ω for the LI drop and -13.74% for the %LI drop could predict conduction gaps. Under the monitoring of the LI, the pacing and ablation technique proved useful for PVI, even though the MiFi catheter does not have a CF sensor or ablation indices.

Predictors of Arrhythmia Recurrence After Cryoballoon Ablation for Persistent Atrial Fibrillation: A Sub-Analysis of the Cryo Global Registry.

Freedom from recurrences of atrial tachyarrhythmia (ATA) is suboptimal after pulmonary vein isolation (PVI) in patients with persistent atrial fibrillation (PsAF). This sub-analysis from the Cryo Global Registry sought to investigate predictors of ablation success after PVI using cryoballoon ablation (CBA) for PsAF. ATA recurrence was defined as ≥ 30 s recurrence of atrial fibrillation, atrial flutter or atrial tachycardia after a 90-day blanking period and through 12-months. Univariate and multivariable Cox regression analysis (with ATA recurrence as an endpoint) was performed to identify CBA responders. PsAF patients (N = 882) were on average 63.9 ± 11.3 years old (69.2% male), and freedom from ATA recurrence was 79.7% (76.8%-82.2%). Longer elapsed time from PsAF diagnosis to ablation (hazard ratio [HR] 1.07 (95% confidence interval [CI]: 1.03-1.11); p = 0.002) and a larger number of previously failed antiarrhythmic drugs (HR 1.39 (95% CI: 1.13-1.70); p < 0.002) were shown to be independent predictors of ATA recurrence in a multivariate model which included 703 evaluated patients. These real-world results provide important insights to guide referral of PsAF patients, including the benefits of earlier treatment via CBA.

Covered stent repair of a veno-venous cavopulmonary window: a case report.

A 69-year-old man had an abnormal intracardiac course of a pacemaker lead. CT angiography demonstrated a window between the right upper pulmonary vein and the superior caval vein. The window was treated with covered stents in the superior caval vein, which was complicated by a chronic pericardial effusion that was treated with a pericardial window 6 months later.

Automated 3D Quantitative Analysis of Intrapulmonary Vessel Volume on Noncontrast CT in Healthy Individuals

Objective: This study aimed to compare automated three-dimensional Intrapulmonary Vessel Volume (IPVV) differences between lung and mediastinal windows in healthy individuals using quantitative measurements obtained from chest Computed Tomography (CT) plain scans. Methods: A total of 258 participants (aged 21–83 years) with negative chest CT scans from routine physical examinations conducted between January to November 2023 were retrospectively enrolled. For each healthy participant, an algorithm was used to automatically extract total lung IPVVs as well as IPVVs for vessels of specific diameter. Differences in IPVVs were then compared between those extracted using the lung window and those extracted using the mediastinal window. Results: The IPVVs for the entire lung, intrapulmonary arteries, intrapulmonary veins, and small pulmonary vessels (categorized by different diameters) extracted from the lung window were significantly higher than those extracted from the mediastinal window (p&lt;0.01). No significant sex-based differences in IPVV were observed for pulmonary arteries and veins with diameters between 0.8 and 1.6 mm, as well as pulmonary veins with diameters between 2.4 and 3.2 mm. However, in pulmonary arteries and veins with diameters between 1.6 and 2.4 mm, females had significantly higher IPVVs than males. In all other cases, IPVVs were larger in males than in females. Conclusion: This method of automatic IPVV extraction and quantitative assessment has been proven to be feasible. Automated IPVV expression effectively identified morphological characteristics of intrapulmonary vessels. The study has concluded IPVVs extracted from the lung window to be generally larger than those extracted from the mediastinal window.

Real-world single-center preliminary experience of radiofrequency balloon pulmonary vein ablation for atrial fibrillation.

Atrial fibrillation (AF) is the most common cardiac arrhythmia and pulmonary vein isolation (PVI) by percutaneous transcatheter ablation is its pivotal treatment. Nowadays, several techniques using different energy sources are used, such as radiofrequency (RF), cryoablation and laser ablation. A new technology that combines the strengths of different techniques has been developed, in particular having both the speed of one-shot techniques and the selectivity and precision of point-by-point RF: the RF balloon (RFB). Recent clinical studies1-3 have demonstrated its efficacy and safety, with good results in terms of first pass isolation, procedural duration and fluoroscopy time. However, real-world data regarding RFB ablation is scarce, therefore with this study we aimed to describe the experience of our center with this technology (one of the first adopting it in our country). We prospectively enrolled in a single-center a total of 20 consecutive patients who underwent AF ablation with RFB. The primary endpoint, i.e. PVI defined as stable absence of any electrical conduction from and into the veins, was met by 18 patient (90%). Mean procedural and fluoroscopy times were 79±30.68 min and and 15.36±6.57 min, respectively, dwelling time was 30.3±8.09 min. The only complication reported was a single case mild pericardial effusion 24 h after the procedure, likely of inflammatory nature, which was treated conservatively and resolved before discharge. With this study we demonstrated that PVI with RFB appears to be an effective and safe technique in a real world setting, with many upsides and a reduced atrial dwelling time that theoretically could reduce the risk of thromboembolic complications. Further studies on larger number of patients are needed to confirm the results we obtained.

Rationale and Design of the InsightPFA Trial: A Prospective, Multicenter, Randomized Controlled Trial of the Irreversible Electroporation-Based Pulsed Field Ablation Versus Radiofrequency Ablation in Chinese Patients With Symptomatic Paroxysmal Atrial Fibrillation.

Pulsed field ablation (PFA) is gaining recognition as a nonthermal, tissue-specific technique for the treatment of atrial fibrillation (AF). The preclinical evaluation of the investigated novel PFA system from Insight Medtech Co. Ltd has demonstrated feasibility, safety, and 30-day efficacy for pulmonary vein isolation (PVI) in the swine model. We are currently conducting a randomized controlled trial to compare the PFA directly with ablation-index (AI)-guided radiofrequency ablation (RFA) for PVI. The InsightPFA trial is a prospective, multicenter, randomized controlled trial to compare the effectiveness and safety of PFA versus RFA for PVI in Chinese patients with symptomatic paroxysmal AF. Two hundred and ninety-two patients diagnosed with symptomatic paroxysmal AF will be randomly assigned to either the PFA group or the RFA group in a 1:1 ratio. All subjects will undergo PVI using PFA or AI-guided RFA and be followed up to 12 months. The primary endpoint is defined as freedom from any episodes of AF/AFL/AT without Class I or III antiarrhythmic drugs during the 9-month follow-up period after a 90-day blank period. The secondary endpoints of effectiveness include acute treatment success and procedural data. The safety evaluation includes a composite of death, stroke and transient ischemic attack, procedure-related complications, device-related adverse events, and serious adverse events. A noninferiority comparison will be conducted between the novel PFA system and the existing RFA system in terms of both effectiveness and safety. This trial aims to determine whether the InsightPFA for PVI is as effective and safe as standard RFA in the treatment of symptomatic paroxysmal AF. https://www. gov/study/NCT06014996; NCT06014996.

Mitral isthmus line: anatomical aspects relevant to linear catheter ablation

Atrial Fibrillation (AF) is a common cardiac arrhythmia for which Pulmonary Vein (PV) isolation remains a mainstay treatment. Several linear ablation lines have been suggested to improve the efficacy of PV isolation. The mitral isthmus line/region lies between the left inferior PV and mitral valve annulus within the left atrium and used for targeting non-PV triggers during AF. Unfavorable anatomy along this line leads to incomplete ablation and recurrence of AF. The aim of this study is to provide anatomical data of mitral isthmus region and its implications for linear catheter ablation procedure. Total fifty formalin-fixed cadaveric hearts were examined. The mitral isthmus line was evaluated for its length, shape and presence of any structures. The mitral isthmus line length was not uniform with ranges between 21.05-34.62 mm (mean- 28.55 ± 3.12 mm). In 40% of studied hearts, a high amount of anatomic heterogeneity was present in this region, with undesirable structures like crevices (28%) and diverticula (12%). These structures had thinner walls compared to the surrounding atrial wall. The mitral isthmus line had concave shape in majority of cases (98%). This study concludes that a high amount of anatomical variability and barriers are present in along the mitral isthmus line. This could make it difficult to achieve complete block during ablation with pertaining risks of complications. Individualized strategy for ablation after studying the local anatomy is suggested to improve procedural outcomes.

Comparative analysis of left atrial size and appendage morphology in paroxysmal and persistent atrial fibrillation patients.

Pulmonary vein isolation (PVI) is effective in treating atrial fibrillation (AF), but outcomes are worse for persistent AF (persAF) patients than paroxysmal AF (PAF) patients. The study aimed to identify differences in left atrial (LA) and left atrial appendage (LAA) anatomy in different AF types. In a single-center observational study, a blinded retrospective analysis of preprocedural cardiac computed tomography angiography (CCTA) images was performed. The study evaluated the dimensions of the LA and pulmonary veins (PV), as well as the size and morphology of the LAA using a 3D electroanatomical mapping system. Between 2012 and 2016, a total of 1103 patients underwent second-generation cryoballoon PVI. Of these, 725 patients (65.7%) had CCTA available, and 473 of these (65.2%) had sufficient quality for measurements. The mean age of the patients was 66.3 ± 9.5 years, and PAF was present in 277 (58.6%) participants. The study found that in persAF patients, LA dimensions such as LA volume [mL] (108; 125; p < .001) or PV ostial dimensions were significantly larger than in those with PAF. LAA volume [mL] (8.3; 9.2; p = .005) and LAA ostial area [mm2] (325; 353; p = .01) were enlarged in persAF. There were no significant differences regarding LAA morphology, with the overall distribution being "windsock" (51%), "chicken-wing" (20%), "cauliflower" (15%), and "cactus" (13%). Compared to PAF, persAF patients had significantly larger LA as well as LAA dimensions. LAA morphological types were distributed equally in both groups suggesting that LAA morphology may not be associated with the underlying AF type.

Pulmonary vein stenosis or occlusion resulting from radiofrequency ablation of atrial fibrillation can be mistakenly diagnosed as pneumonia: a case report

Pulmonary vein stenosis or occlusion resulting from radiofrequency ablation of atrial fibrillation can be mistakenly diagnosed as pneumonia: a case report

The Role of Fetal Echocardiography in Predicting Postnatal Pulmonary Venous Obstruction in Neonates with TAPVR: A Single Center Experience.

Total anomalous pulmonary venous return (TAPVR) is a high risk and rare cardiac malformation with a low prenatal detection rate and predicting obstruction in these cases is difficult. We sought to investigate fetal echocardiographic parameters associated with postnatal pulmonary venous obstruction (PPVO). We performed a retrospective review of 26 patients with TAPVR who had a fetal echocardiogram from 2010 to 2021. Blinded readers analyzed the fetal Doppler features of the pulmonary veins (PV) and vertical veins (VV) at final fetal assessment. Of the 26 patients, 17 (65%) were prenatally diagnosed and overall 10 (38.5%) developed PPVO. All patients had additional associated congenital heart disease. Compared to patients without PPVO, patients with PPVO had a lower VV variability index (VI) (0.51 (0.17-0.79) vs 1.43 (0.54-2.58); p = 0.003), a higher likelihood of having an abnormal VV or PV Doppler pattern (p = 0.042, p = 0.015), a higher VV minimum velocity (0.435m/s (0.17-1.05) vs 0.14m/s (-0.16 to 0.35) p = 0.001) and a higher VV mean velocity (0.641m/s (0.31-1.15) vs 0.321m/s (0.19-0.5); p = 0.009). A fetal VV VI of ≤ 0.8 was associated with PPVO (100% sensitivity, 86% specificity). Our data show that some fetal PV and VV Doppler indices are significantly different between those that develop PPVO and those who do not, with the most significant difference seen in the VV variability index and VV minimum velocity. Prenatal predictors of PPVO have the potential to influence prenatal counseling, perinatal care, surgical timing, and outcomes associated with this critical diagnosis.

An approach to fluoroless radiofrequency atrial fibrillation ablation

Atrial fibrillation is the most prevalent arrhythmia with a lifetime risk of nearly 30%. It can be associated with reduced quality of life and complications such as heart failure and stroke. Pulmonary vein isolation (PVI) is the most effective treatment for rhythm control. It has initially been performed with fluoroscopic catheter guiding. The advent of three-dimensional (3D) electro-anatomical mapping has significantly reduced the need for fluoroscopy. More recently, intracardiac echography (ICE) techniques have been used to eliminate the need for x-rays. Additional advantages include providing electrophysiology lab personnel with a lead-free working environment and avoiding radiation exposure for both patients and physicians. ICE may also enhance the safety of the procedure by enabling a safe trans-septal puncture and the early recognition of cardiac tamponade. In this article, we present our approach to fluoroless radiofrequency PVI using ICE and 3D electro-anatomical mapping.