Heart rhythm : the official journal of the Heart Rhythm Society
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Editorial Comment
Simplifying atrial fibrillation ablation: how far can we go?
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Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited arrhythmia syndrome characterized by adrenergically induced ventricular arrhythmias in patients with structurally normal hearts. Initiating triggered arrhythmias, such as bidirectional ventricular tachycardia, often degenerate into reentrant arrhythmias, such as ventricular fibrillation (VF). ⋯ The effectiveness of ICD shock therapy in CPVT depends on the mechanism of the rhythm treated. Shocks delivered to initiating triggered arrhythmias nearly always fail, whereas those for subsequent VF are usually effective. ICD programming in these patients is exceptionally challenging.
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Randomized Controlled Trial Comparative Study
Left atrial appendage closure followed by 6 weeks of antithrombotic therapy: a prospective single-center experience.
Currently, 2 different left atrial appendage (LAA) closure systems are available for stroke prevention in nonvalvular atrial fibrillation but comparative data are lacking. ⋯ Implantation of both LAA closure devices can be performed with high success rates in high-risk patients. Postprocedural 6 weeks antithrombotic therapy followed by aspirin therapy needs to be confirmed in a larger study.
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Advanced techniques of electroanatomical mapping efficiently guide ventricular tachycardia (VT) ablation strategies; in this context, the adjunctive value of combining activation mapping (AMap) to improve accuracy has not been elucidated. ⋯ Our findings support the efficacy of a substrate-guided strategy targeting specific markers of arrhythmogenicity identified during sinus rhythm. AMap proves highly efficient acutely but does not improve overall VT-free survival, suggesting that in patients with advanced cardiac disease, life-threatening arrhythmias can be successfully treated by ablation in sinus rhythm, thus limiting procedural risks.
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Sustained ventricular arrhythmias (sVAs), such as polymorphic ventricular tachycardia or ventricular fibrillation, can complicate ajmaline challenge in patients with Brugada syndrome (BS). ⋯ sVA during ajmaline challenge is not a rare event in BS occurring in 9 (1.8%) patients. Despite its challenging acute treatment, the occurrence of ajmaline-induced sVAs in patients with BS might not identify a category at higher risk for further arrhythmic events.