Background-Paroxysmal atrial fibrillation (AF) naturally progresses toward chronic AF at an estimated rate of 15% to 30% over a 1-to 3-year period. Pulmonary vein (PV) isolation is increasingly performed for the treatment of drug-refractory paroxysmal AF. The long-term data on clinical outcome after circumferential PV isolation are limited. Methods and Results-From

AimsWe investigated the presence and clinical outcome of inducibility of atrial tachyarrhythmias after circumferential pulmonary vein isolation (CPVI) in patients with paroxysmal atrial fibrillation (PAF).Methods and resultsSixty patients with symptomatic PAF underwent CPVI guided by 3D mapping and double Lasso technique. After achievement of CPVI, the induction was performed. The left atrium (LA) volume and the isolated LA area around the right and left-sided pulmonary veins were measured by the 3D mapping system. Sustained atrial tachyarrhythmias (>10 min) were induced after CPVI in 17 of 60 patients (28%). Patients with inducible atrial tachyarrhythmias had significantly smaller isolated areas when compared with the group with non-inducible tachyarrhythmias (16.7 ± 2.3 vs. 18.8 ± 2.9%, P < 0.05). After the initial procedure, recurrence occurred in 18 of 43 (42%) patients in the non-inducible group and in 7 of 17 (41%) in the inducible group during follow-up. A repeat procedure was performed in all 25 patients with recurrence. Five patients had a recurrence after the repeat procedure during 20.8 ± 7.5 months, and there was no difference between the two groups.ConclusionInducibility of atrial tachyarrhythmias is associated with proportionally smaller isolated area and does not predict the clinical efficacy of CPVI in patients with PAF.

Catheter ablation has become the curative treatment modality for various arrhythmias. Extending the indications for catheter ablation from simple supraventricular tachycardias to complex arrhythmias such as ventricular tachycardia or atrial fibrillation, the investigator faces prolonged procedure times, fluoroscopy exposure and the need for stable and reproducible catheter movement. Recently, remote-controlled robotic catheter ablation has emerged as a novel ablation concept to meet these requirements. This review describes the two available robotic ablation systems and summarizes their clinical applications and current human experience.

Intramyocardial injection of MSC or MNC do not increase fragmentation and duration of endocardial electrograms in the injected ischemic myocardium but attenuate ischemic damage and therefore may not create an electrophysiological substrate for reentry tachycardias.

Die kathetergeführte Aortenklappenimplantation zur Therapie der Aortenklappenstenose findet rasche Akzeptanz. Sie erlaubt aktuell v. a. eine Versorgung von Patienten, die bezüglich ihrer Lebensqualität nur bedingt von einem chirurgischen Aortenklappenersatz profitieren. Die Indikationsstellung sollte weiterhin streng erfolgen, da in diesem Patientengut die 30-Tages-Mortalität auch bei der transkutanen Implantation immer noch bei 10% liegt. Da Langzeitdaten bisher fehlen, bleibt die Indikation konkret auf Patienten älter als 75 Jahre sowie mit einem STS-Score >10 bzw. einem logEuro-Score >20 beschränkt. Patienten mit einer Lebenserwartung <1 Jahr oder einer Anulusgröße <17 mm bzw. >27 mm sollten derzeit von einer kathetergeführten Aortenklappenimplantation ausgeschlossen werden. Aus laufenden aktuellen Studien werden in Kürze wichtige Erkenntnisse zur Sicherheit, Effektivität und insbesondere auch zum Langzeitverlauf erwartet. Die technische sowie wissenschaftliche Entwicklung in diesem Bereich wird absehbar eine kontinuierliche Neubestimmung des Stellenwertes dieser Prozedur auf der Basis der verfügbaren Daten erfordern. AbstractTrans catheter aortic valve implantation (TAVI) is rapidly gaining acceptance in the treatment of severe aortic valve stenosis in the elderly. The technique is especially beneficial for patients, where surgical aortic valve replacement is indicated but is associated with a prolonged reduction concerning quality of life. The indication for TAVI should be restricted to such patients, since mortality in the high-risk population treated so far with TAVI was found to be close to 10% at 30 days. In addition reliable long-term data beyond 2 years are missing for the currently available devices. Therefore TAVI should currently be restricted to patients older than 75 years that present with an STS score of >10 or a logEuroScore of >20. Currently, patients with a life expectancy of less than 1 year or an aortic annulus of <18 mm or >27 mm should not be treated with TAVI. Ongoing studies will shortly provide an even more solid base concerning safety, efficacy and long-term results in large patient cohorts treated with TAVI. The technical and scientific development in this field warrants continuous readjustments concerning the value of TAVI in the treatment of aortic stenosis; currently all available data point to an increasing role of these techniques in the treatment of aortic stenosis.