Effect of transcoronary ablation of septal hypertrophy on clinical outcome in hypertrophic obstructive cardiomyopathy associated with atrial fibrillation

Atrial tachycardias following circumferential pulmonary vein ablation: observations during catheter ablation

Circumferential pulmonary vein ablation performing linear lesions around the ostia of the pulmonary veins has been shown to be effective for the treatment of atrial fibrillation. During the follow-up period, persistent atrial tachycardia may occur as a proarrhythmic complication. Only little information is available about the underlying mechanism. In our study, atrial tachycardia following circumferential pulmonary vein ablation was identified in 13 out of 84 consecutive patients (15.5%), as a transient appearance in four and with recurrences for more than 3 months in nine patients (10.7%). Electrophysiological study and ablation was performed in eight cases, revealing common atrial flutter in two, a focal origin secondary to conduction recovery from the pulmonary vein to the left atrium in two and macro reentrant left atrial flutter in four patients. The electrophysiological characteristics demonstrated by electroanatomic activation mapping CARTO and consecutive ablation therapy with a 100% success rate are described and discussed with regard to the literature.

The prognostic impact of successful cardioversion of atrial fibrillation in patients with organic heart disease

The aim of the study was to evaluate the prognostic impact of successful cardioversion (CV) compared to failed CV in patients with atrial fibrillation (AF) and organic heart disease. A total of 471 consecutive patients with organic heart disease from the prospective single center anticoagulation registry ANTIK who underwent CV of AF or atrial flutter were analyzed. 417 patients (89%) could be successfully cardioverted. In 54 patients (11%) CV failed, these patients remained in AF. After 5 years there were 92 (24%) deaths among patients with restored sinus rhythm at index admission and 20 (38%) deaths among those who remained in AF after CV (unadjusted OR 1.9, 95% CI 1.1-3.6). After adjustment for age, gender and ejection fraction, successful CV was not associated with a beneficial effect on mortality (OR 0.72, 95% CI 0.43-1.21). Thus, successful CV is not an independent predictor of mortality on multivariate analysis. However, it remains a marker for a better prognosis in patients with organic heart disease as these patients have a lower unadjusted longterm mortality.