Transmural “Scar-to-Scar” Reentrant Ventricular Tachycardia

We describe a scar-related reentrant ventricular tachycardia circuit with a proximal segment in an endocardial basal septal scar and an exit in a region of slow conduction in a non-overlapping region of epicardial basal lateral scar. The 12-lead EKG demonstrates criteria for a basal lateral epicardial VT, however the same morphology could be produced with a longer stim-latency with pace mapping or VT induction from the endocardial septal region of scar. A significant segment of myocardium demonstrated no endocardial or epicardial scar on electroanatomic mapping, suggesting the presence of a mid-myocardial isthmus. Further evidence was provided by assessment of unipolar settings. The epicardial VT that initially appeared to originate from the basal lateral epicardial region, was successfully treated with radiofrequency ablation of the lateral aspect of the endocardial septal scar.     

QTc dispersion as a novel marker in identifying patients requiring an epicardial approach for ablation of scar mediated ventricular tachycardia

IntroductionEpicardial exit sites of ventricular tachycardia (VT) are frequently encountered during VT ablation requiring an epicardial ablation approach for successful elimination of VT. We sought to assess the utility of repolarization markers in identifying individuals requiring an epicardial ablation approach in addition to an endocardial approach.Methods32 patients who underwent successful ablation for scar mediated VT were included in the study. Fourteen patients who required a combined endocardial and epicardial VT ablation were defined as epicardial VT group (Epi) whereas 18 patients who were successfully ablated from the endocardium alone constituted the endocardial VT group (Endo). Repolarization markers during sinus rhythm were compared between the two groups.ResultsA higher QTc max and QTc dispersion were seen in the Epi group compared to Endo group (479 ± 34 vs 449 ± 20, p = 0.008 and 63 ± 13 vs 38 ± 8, p = 0.001, respectively). Ts-p and Ts-p/Tp-e were higher in the Epi group (166 ± 23 vs 143 ± 23, p = 0.008 and 1.55 ± 0.26 vs 1.3 ± 0.21, p < 0.005). On multivariate regression, QTc dispersion was an independent predictor of the need for an epicardial approach to ablation. A QTc dispersion more than 51.5 msec identified individuals requiring a combined epicardial and endocardial approach to ablation with a sensitivity of 92.9% and a specificity of 100%.ConclusionsPatients requiring an epicardial ablation have a higher QTc dispersion. A value greater than 51.5 msec reliably differentiates between the two groups with high sensitivity and specificity.     

Signaling via the Tgf-beta type I receptor Alk5 in heart development

Trophic factors secreted both from the endocardium and epicardium regulate appropriate growth of the myocardium during cardiac development. Epicardially-derived cells play also a key role in development of the coronary vasculature. This process involves transformation of epithelial (epicardial) cells to mesenchymal cells (EMT). Similarly, a subset of endocardial cells undergoes EMT to form the mesenchyme of endocardial cushions, which function as primordia for developing valves and septa. While it has been suggested that transforming growth factor-βs (Tgf-β) play an important role in induction of EMT in the avian epi- and endocardium, the function of Tgf-βs in corresponding mammalian tissues is still poorly understood. In this study, we have ablated the Tgf-β type I receptor Alk5 in endo-, myo- and epicardial lineages using the Tie2-Cre, Nkx2.5-Cre, and Gata5-Cre driver lines, respectively. We show that while Alk5-mediated signaling does not play a major role in the myocardium during mouse cardiac development, it is critically important in the endocardium for induction of EMT both in vitro and in vivo. Moreover, loss of epicardial Alk5-mediated signaling leads to disruption of cell-cell interactions between the epicardium and myocardium resulting in a thinned myocardium. Furthermore, epicardial cells lacking Alk5 fail to undergo Tgf-β-induced EMT in vitro. Late term mutant embryos lacking epicardial Alk5 display defective formation of a smooth muscle cell layer around coronary arteries, and aberrant formation of capillary vessels in the myocardium suggesting that Alk5 is controlling vascular homeostasis during cardiogenesis. To conclude, Tgf-β signaling via Alk5 is not required in myocardial cells during mammalian cardiac development, but plays an irreplaceable cell-autonomous role regulating cellular communication, differentiation and proliferation in endocardial and epicardial cells.     

Left ventricular endocardial or triventricular pacing to optimize cardiac resynchronization therapy in a chronic canine model of ischemic heart failure

Cardiac resynchronization therapy (CRT) is a proven treatment for heart failure but ~30% of patients appear to not benefit from the therapy. Left ventricular (LV) endocardial and multisite epicardial [triventricular (TriV)] pacing have been proposed as alternatives to traditional LV transvenous epicardial pacing, but no study has directly compared the hemodynamic effects of these approaches. Left bundle branch block ablation and repeated microembolizations were performed in dogs to induce electrical dysynchrony and to reduce LV ejection fraction to <35%. LVdP/dt(max) and other hemodynamic indexes were measured with a conductance catheter during LV epicardial, LV endocardial, biventricular (BiV) epicardial, BiV endocardial, and TriV pacing performed at three atrioventricular delays. LV endocardial pacing was obtained with a clinically available pacing system. The optimal site was defined as the site that increased dP/dt(max) by the largest percentage. Implantation of the endocardial lead was feasible in all canines (n = 8) without increased mitral regurgitation seen with transesophageal echocardiography and with full access to the different LV endocardial pacing sites. BiV endocardial pacing increased dP/dt(max) more than BiV epicardial and TriV pacing on average (P < 0.01) and at the optimal site (P < 0.01). There were no significant differences between BiV epicardial and TriV pacing. BiV endocardial pacing was superior to BiV epicardial and to TriV pacing in terms of acute hemodynamic response. Further investigation is needed to confirm the chronic benefit of this approach in humans.     

Electrotonic load triggers remodeling of repolarizing current Ito in ventricle

A change in activation sequence electrically remodels ventricular myocardium, causing persistent changes in repolarizing currents (T-wave memory). However, the underlying mechanism for triggering activation sequence-dependent remodeling is unknown. Optical action potentials were mapped with high resolution from the epicardial surface of the arterially perfused canine wedge preparation (n = 23) during 30 min of baseline endocardial stimulation, followed by 40 min of epicardial stimulation, and, finally, restoration of endocardial stimulation. Immediately after the change from endocardial to epicardial stimulation, phase 1 notch amplitude of epicardial cells was attenuated by 74 +/- 8% (P < 0.001) compared with baseline and continued to diminish during the period of epicardial pacing, suggesting progressive remodeling of the transient outward current (Ito). When endocardial pacing was restored, notch amplitude did not immediately recover but remained attenuated by 23 +/- 10% (P < 0.001), also consistent with a remodeling effect. Peak Ito current measured from isolated epicardial myocytes changed by 12 +/- 4% (P < 0.025), providing direct evidence for Ito remodeling occurring on a surprisingly short time scale. The mechanism for triggering remodeling of Ito was a significant reduction (by 14 +/- 4%, P < 0.001) of upstroke amplitude in epicardial cells during epicardial stimulation. Reduction in upstroke amplitude during epicardial pacing was explained by electrotonic load on epicardial cells by fully repolarized downstream endocardial cells. These data suggest a novel mechanism for triggering electrical remodeling in the ventricle. Electrotonic load imposed by a change in activation sequence reduces upstroke amplitude, which, in turn, attenuates Ito according to its known voltage-dependent properties, triggering downregulation of current.     

Successful Ablation of an Epicardial Accessory Pathway via the Subxiphoid Approach in a Child

Data is scarce regarding epicardial ablation in children. I herewith present a case of successful epicardial ablation in a child with previous unsuccessful attempts at endocardial ablation. This report could be used to guide further such attempts.     

王锦蛇心的位置及其组织学参数和 胶原纤维含量的增龄变化

为阐明王锦蛇（Elaphe carinata）心的位置、组织学参数和胶原纤维含量的发育可塑性,采用形态测量、苏木精-伊红染色和 Masson 染色方法,测定了 1 龄、2 龄以及 50 日龄内王锦蛇个体身体大小和心位置,同时测定并分析了 50 日龄内个体心内膜、心肌层和心外膜的厚度,以及胶原纤维含量的增龄变化。王锦蛇的体重、体全长和体重与体全长的比值都在 2 龄组最高,1 龄组其次,2 和 1 龄组均显著高于 50 日龄内各组（P < 0.05）。肥满度 3 日龄组和 7 ~ 10 日龄组都显著高于 1 和 2 龄组（P < 0.05）。心与吻端的距离,1 和 2 龄组都显著高于其他日龄组（P < 0.05）,但心与吻端的距离与体全长的比值未见组间差异（P > 0.05）。心肌层厚度 50 日龄组显著高于 3 日龄组、20 日龄组和 30 日龄组（P < 0.05）,心外膜和心内膜厚度未见日龄差异（P > 0.05）。心肌层和心壁胶原纤维含量 50 日龄组都显著高于 3 日龄组和 20 日龄组（P < 0.05）。王锦蛇心与吻端的距离与体全长的比值随发育进程无明显变化,在首次 蜕皮和主动摄食后,心肌层厚度增厚、胶原纤维含量增多,提示心肌功能逐渐增强。     

The first human experience of a contact force sensing catheter for epicardial ablation of ventricular tachycardia

Contact force (CF) is one of the major determinants for sufficient lesion formation. CF-guided procedures are associated with enhanced lesion formation and procedural success. We report our initial experience in epicardial ventricular tachycardia (VT) ablation with a force-sensing catheter using a new approach with an angioplasty balloon. Two patients with arrhythmogenic right ventricular cardiomyopathy who underwent prior unsuccessful endocardial ablation were treated with epicardial VT ablation. CF data were used to titrate force, power and ablation time.     

Epicardial Ablation on the Beating Heart: Limited Efficacy of a Novel, Cooled Radiofrequency Ablation Device

OBJECTIVE: To perform a minimally invasive procedure for atrial fibrillation without cardiopulmonary bypass, it is necessary to create transmural lesions on the beating heart. Although bipolar radiofrequency clamps can isolate the pulmonary veins, they have difficulty in performing any other left atrial lesions, particularly those of the traditional Cox-Maze procedure. This study examined the performance of an internally cooled, bipolar radiofrequency device designed for such an application. METHODS: Eleven domestic pigs underwent median sternotomy. Five animals had eight atrial lesions created with the radiofrequency device at times of 20, 30, 40, and 50 seconds. In six other pigs, the device was compared with another technology that has been used clinically for epicardial, beating heart ablation, the Guidant Flex 4 microwave device. The tissue was stained with 2,3,5-triphenyl-tetrazoluim chloride, and the lesions were sectioned at 5-mm intervals. Lesion width, depth, and transmurality were evaluated. RESULTS: The radiofrequency device had a linear dose-response relationship. Lesions were wider and deeper with increasing ablation times. A total of 40%, 45%, 60%, and 67% of lesions were transmural at times of 20, 30, 40, and 50 seconds, respectively. Ninety-one percent of lesions in tissue up to 4-mm thick were transmural after 50 seconds. However, performance in thicker tissue was poor. Lesions created by the device were deeper and more likely to be transmural than the Flex 4. CONCLUSIONS: This internally cooled, bipolar radiofrequency device can reliably create transmural lesions on tissue up to 4-mm thick and performs better than a microwave device.     

Transmural heterogeneity of calcium activity and mechanical function in the canine left ventricle

Although electrical heterogeneity within the ventricular myocardium has been the focus of numerous studies, little attention has been directed to the mechanical correlates. This study examines unloaded cell shortening, Ca(2+) transients, and inward L-type Ca(2+) current (I(Ca,L)) characteristics of epicardial, endocardial, and midmyocardial cells isolated from the canine left ventricle. Unloaded cell shortening was recorded using a video edge detector, Ca(2+) transients were measured in cells loaded with 15 microM fluo-3 AM and voltage and current-clamp recordings were obtained using patch-clamp techniques. Time to peak and latency to onset of contraction were shortest in epicardial and longest in endocardial cells; midmyocardial cells displayed an intermediate time to peak. When contraction was elicited using uniform voltage-clamp square waves, epicardial versus endocardial distinctions persisted and midmyocardial cells displayed a time to peak comparable to that of epicardium. The current-voltage relationship for I(Ca,L) and fluorescence-voltage relationship were similar in the three cell types when quantitated using square pulses. However, peak I(Ca,L) and total charge were significantly larger when an epicardial versus endocardial action potential waveform was used to elicit the current under voltage-clamp conditions. Sarcoplasmic reticulum Ca(2+) content, assessed by rapid application of caffeine, was largest in epicardial cells and contributed to a faster time to peak. Our data point to important differences in calcium homeostasis and mechanical function among the three ventricular cell types. These differences serve to synchronize contraction across the ventricular wall. Although these distinctions are conferred in part by differences in electrical characteristics of the three cell types, intrinsic differences in excitation-contraction coupling are evident.     

Cell junctions and their role in transmural diffusion in the embryonic chick heart

Summary Studies of cardiogenesis in the chick embryo focus attention upon the intercellular junctions of epicardial, myocardial, and endocardial cells, and the role they play in diffusion across the cardiac wall. Cell membranes of apposed epicardial cells approach as close together as 40 Å; those of the endocardium additionally form focal tight junctions. In the myocardium focal tight junctions are restricted to the apposed membranes of the superficial layer of cells. The majority of close appositions in all parts of the myocardium are 40 Å gap junctions. Desmosomes and fascia adherens are distributed throughout the myocardium.Diffusion of horseradish peroxidase through the epicardium and endocardium occurs primarily through the intercellular junctions. The width of the cleft between cells, 200–300 Å, also permits the diffusion between cells of the larger ferritin particles. Pinocytotic activity, responsible for ferritin transfer across mesothelial and endothelial cells in the adult, is not significant.Tracers injected into the pericardial cavity or vasculature can be observed passing through the heart in the direction of their respective diffusion gradients. Unlike the apical junctions of epithelial cells, to which they have been compared, membrane specializations of the superficial myocytes do not form a seal separating the pericardial cavity, or subepicardial space, from the extracellular spaces of the myocardium.Supported by the Medical Research Council of Canada.The author wishes to express his gratitude to Mrs. J. Blackbourn for her excellent technical assistance.     

Influence of resin cement thickness and temperature variation on mechanical behavior of dental ceramic fragment restoration

To evaluate the stress behavior of ceramic fragment restoration, varying the thickness of the cement layer and intraoral temperature variation. A solid model of a upper lateral incisor was obtained and a defect at enamel distal/incisal edge was restored with a ceramic fragment. Based on this initial model, 4 different models (M) were built: M1 – absence of cement layer (CL) (0?μm of thickness); M2 – CL with an uniform thickness of 50?μm; M3 – CL with 50?μm at the margin of ceramics and 100?μm in the inner area far from margins; M4 – CL with 50?μm at the margin of ceramics and 200?μm in the inner area far from margins. The environment temperature changed from 5?°C to 50?°C in 4 increments. The finite element analysis was performed. Increase the cement layer thickness generated higher stress levels on ceramic surface in all temperatures, as well as on cement interface. In general hot temperature was the worst scenario for ceramic fragments integrity, since tensile and compressive stress were more intense. The maximum principal stress on ceramic fragment was found 90?MPa for M4 at 50?°C, followed for M3 (87?Mpa). For CL, the peak of stress was found for M3 at 5?°C (47?MPa). Is it possible to conclude that thick resin cement layer contribute to higher stress concentration on ceramic fragment, and extremely hot temperatures increase the risk of structural failure, since both ceramic and \cl are exposed to higher compressive and tensile stresses.     

Distribution and some features of the biology of the eelpout Lycodes tanakae Jordan et Thompson, 1914 (Perciformes: Zoarcidae) in the Tatar Strait, Sea of Japan

Based on data from studies that were performed in 2006, 2007, and 2009, we analyzed the distribution and some features of the biology of the eelpout Lycodes tanakae, which inhabits the Tatar Strait. The young of this species (<30 cm in TL) predominantly occur to the north of 50° N. The largest individuals (>71 cm in TL) are found to the south of 49° N and medium-sized fish occur throughout the studied area. In the Tatar Strait, L. tanakae inhabits the 50?C615 m depth range, but the majority of the eelpouts (67.9%) were caught from depths of 200?C600 m. Small individuals of this species (<30 cm in TL) occur at depths of 50?C200 m, while medium-sized and large fish (>30 cm in TL) can be found at all depth horizons that were surveyed. The mean linear size of L. tanakae increases with an increase in the depth of their habitat. The relationship between the spatial distribution of L. tanakae and water temperature regime is discussed. The nutritional spectrum of L. tanakae includes 18 food items, with fish and shrimp predominating. Young L. tanakae (<30 cm in TL) are benthophages, 41?C50-cm individuals feed mainly on cephalopods and fish.     

Epicardial fat: from the biomolecular aspects to the clinical practice

Epicardial fat is the visceral fat depot of heart. It is a metabolically active organ with anatomical and functional contiguity to the myocardium. A dichotomous role has been attributed to the epicardial fat. Under physiological conditions, epicardial fat displays biochemical and thermogenic cardio-protective properties. Under pathological circumstances epicardial fat can locally affect the heart and coronary arteries through vasocrine or paracrine secretion of pro-inflammatory cytokines. Epicardial fat can be measured with imaging techniques. Epicardial fat thickness reflects intra-abdominal and myocardial fat and correlates with metabolic syndrome and coronary artery disease. Epicardial fat measurement may play a role in the stratification of the cardio-metabolic risk and serve as therapeutic target. Weight loss and anti-inflammatory drugs targeting the fat may modulate epicardial fat. Because epicardial and myocardial tissues share the same coronary arterial supply it is reasonable to hypothesize that improved local vascularisation may resume epicardial fat to its physiological role.     

Substrate Based Ablation of Ventricular Tachycardia Through An Epicardial Approach

Ventricular tachycardia (VT) occurring late after myocardial infarction is often due to reentry circuit in the peri-infarct zone. The circuit is usually located in the sub-endocardium, though subepicardial substrates are known. Activation mapping during VT to identify target regions for ablation can be difficult if VT is non inducible or poorly tolerated. In the latter, a substrate based approach of mapping during sinus rhythm in conjunction with pace mapping helps to define the reentry circuit and select target sites for ablation in majority of patients with hemodynamically unstable VT. Percutaneous epicardial catheter ablation has been attempted as an approach where ablation by a conventional endocardial access has been unsuccessful. We report a case of post myocardial infarction scar VT which could be successfully ablated with a substrate based approach from the epicardial aspect.     

Environmental controls on growth and lipid content for the freshwater diatom, Fragilaria capucina: A candidate for biofuel production

The use of microalgae for biofuel production has the potential to reduce fossil fuel consumption. Ideal candidate species of microalgae for bio-oil production need both relatively high growth rates and lipid content. Here, we report on the effects of temperature, nutrients (N, Si), and salinity on growth rates and lipid content of the common freshwater diatom, Fragilaria capucina (Desm), isolated from western Lake Erie. At low NaCl salinity, growth rate increased rapidly from 10 to 20°C, and then further increased slowly from 20 to 30°C, with a maximum specific growth rate of 0.61?day^?1. Growth rate declined with increasing salinity (e.g., reduced by ca. 50 and 100% at 137 and 274?mmol?L^?1 NaCl, respectively), and increased with increased N and Si concentration until ca. 100?μmol?L^?1 for each (with >85% of maximum growth rate at 10?μmol?L^?1). Lipid content (% total lipid per dry mass) in nutrient-replete cultures was 14% and (1) increased to >30% at low N and, especially, low Si; (2) was lower at 30°C vs. 20 or 10°C; and (3) decreased with salinity. Thus, F. capucina accumulates lipid to high levels even under N, Si, and temperature levels that permit a high growth rate for this species, and hence, this species is a candidate for use in biofuel production.     

Endocardial and epicardial derived FGF signals regulate myocardial proliferation and differentiation in vivo

The epicardium regulates growth and survival of the underlying myocardium. This activity depends on intrinsic retinoic acid (RA) and erythropoietin signals. However, these signals do not act directly on the myocardium and instead are proposed to regulate the production of an unidentified soluble epicardial derived mitogen. Here, we show that Fgf9, Fgf16, and Fgf20 are expressed in the endocardium and epicardium and that RA can induce epicardial expression of Fgf9. Using knockout mice and an embryonic heart organ culture system, we show that endocardial and epicardial derived FGF signals regulate myocardial proliferation during midgestation heart development. We further show that this FGF signal is received by both FGF receptors 1 and 2 acting redundantly in the cardiomyoblast. In the absence of this signal, premature differentiation results in cellular hypertrophy and newborn mice develop a dilated cardiomyopathy. FGFs thus constitute all or part of the epicardial signal regulating myocardial growth and differentiation.     

Immunohistochemical Study of the Origin of the Subepicardial Mesenchyme in the Dogfish (Scyliorhinus canicula)

A mesenchyme appears at the subepicardium of the vertebrate embryo closely following the epicardial ensheathing of the heart. We have suggested earlier that a localized epithelial-mesenchymal transition (= transdifferentialion) of the epicardial mesothelium might explain the origin of the subepicardial mesenchymal cells (SEMC) in a primitive vertebrate, the dogfish Scyliorhinus canicula. We have tested our hypothesis through the immunolocalization, in the embryonic dogfish heart, of three proteins involved in the epithelial—mesenchymal transitions. Fibronectin immunoreactivity (FN-IR) was present between epicardium and myocardium from the earliest stages of the epicardial development. However, in embryos ranging between 20 and 35 mm TL, FN-IR disappeared from the basal surface of the epicardial cells at the atrioventricular and conoventricular grooves and increased in association with the SEMC. Proliferating-cell nuclear antigen immunoreactivity was intense in most epicardial cells and SEMC in these areas and developmental stages, but it declined in later embryos. The JB3 antigen, a fibrillin-related protein, was delected in the cytoplasm and basal surface of the epicardial cells, as well as on the SEMC surface. These immunohistochemical patterns were remarkably similar at the subepicardium and at the endocardial cushions, which are populated by mesenchymal cells derived from the transdifferentiation of the endocardium. © 1998 The Royal Swedish Academy of Sciences. Published by Elsevier Science Ltd. All rights reserved     

Comparison of Ablation Zones among Different Tissues Using 2450-MHz Cooled-Shaft Microwave Antenna: Results in Ex Vivo Porcine Models

Background

For complete tumor ablation in different tissues, it is necessary to investigate the exact coagulation zone of microwave ablation in different tissues. The aim of this study was to compare the extent of microwave ablation zone in muscle, liver and adipose tissue in ex vivo porcine models and assess the shape of microwave coagulation zone among these tissues.

Materials and Methods

Microwave ablations were performed in ex vivo porcine muscle, liver and adipose tissue using 2450-MHz cooled-shaft microwave antenna. The content of water, fat and protein in these three tissues was determined. Two power increments (40 and 80 W) and five time increments (1, 3, 5, 7, and 10 minutes) were used in this study. Diameters and shapes of the ablation zones were assessed on gross specimens.

Results

The average percentages of water, fat and protein in these three tissues were significantly different (P < 0.001), respectively. The long-axis and short-axis diameters among these three tissues at each time-power combination were not significantly different (P > 0.05). The coagulation zones were all elliptical in muscle, liver and adipose tissue. When microwave ablation was performed in the tissue containing both muscle and adipose tissue, the coagulation zone was also elliptical. Regardless of the output power, the ellipticity index (EI) value of 1 minute treatment duration was higher than that of 10 minutes treatment duration (P < 0.05). Furthermore, the EI value did not decrease significantly when the treatment duration was more than 5 minutes (P > 0.05).

Conclusion

The extent of microwave ablation zones was not significantly different among completely different tissues. Microwave ablations with ≥ 5 minutes time duration can induce coagulation zones with clinical desirable shape. Future clinical studies are still required to determine the role of microwave ablation in different tissues.     

Effective contact and outcome after pulmonary vein isolation in novel circular multi-electrode atrial fibrillation ablation

Introduction

Pulmonary vein (PV) reconnection is frequently the cause of recurrence of atrial fibrillation (AF) after ablation. The second-generation gold multi-electrode ablation (Gold-MEA) catheter has a new design possibly resulting in improved lesion formation compared with its predecessor. We aimed to determine the association between effective radiofrequency applications with the Gold-MEA catheter and outcome after AF ablation.

Methods

50 consecutive patients with paroxysmal AF underwent Gold-MEA (PVAC GOLD^TM, Medtronic Inc.) ablation. The Gold-MEA catheter was navigated to the PV ostium by fluoroscopy. Duty-cycled radiofrequency ablations were performed at all PV ostia. Lesions were considered transmural when electrode temperature was >50 °C and power >3 W for >30 seconds. After the ablation procedure, patients visited the outpatient clinic at 3?month intervals including 24-hour Holter ECGs.

Results

Mean age was 56 years. All PVs were acutely isolated with the Gold-MEA catheter. Procedure time was 111 ± 22 minutes, ablation time was 24 ± 6.7 minutes and fluoroscopy time was 20 ± 8.1 minutes. No procedure-related complications were observed. One year after ablation, 60?% of patients were still free of arrhythmia recurrences after a single PV isolation attempt. The number of transmural lesions was associated with arrhythmia-free survival: 25.0?% in <72 transmural lesions, 64.3?% in 72–108 transmural lesions and 71.4?% in >108 transmural lesions (p = 0.029).

Conclusion

PV isolation can be performed successfully with the Gold-MEA catheter, with a favourable safety profile. Transmurality of lesions was associated with ablation success and may improve AF ablation success.