Background: EnSite Precision AutoMark Module (Abbott) refers to automated lesion creating tool. Only lesions meeting user-defined requirements are placed on the map. The amount of ablation is represented by the size and color of marking spheres. The aim of this study is to present our initial experience with AutoMark Module in AF ablation. Methods: Nine patients with AF underwent electroanatomic mapping and radiofrequency ablation (RF) using Au-toMark Module for marking RF lesions. Pulmonary vein isolation was performed in all patients. Cavo tricuspid isthmus ablation was done in 3 patients with atrial flutter. Lesions were marked in different colors depending on force-time integral, absolute impedance drop and RF duration as follows: white (<50 g; <6 Ω; < 5 s); yellow (50-150 g; 6-8 Ω; 5-15 s); orange (150-300 g; 8-10 Ω; 15-30 s); red (>300 g; >10 Ω; >30 s). An auto-mark was created when catheter remained in a stable location for more than 3 s, with a minimum distance between spheres (center-to-center) of 3 mm. Auto-marks were compared with manually placed spheres. 24-hour Holter ECG monitoring was performed regularly until the end of the follow-up. Results: Nine patients (mean age of 53 ± 10 years, 3 male) were included in the study with EHRA class 2b (44%) and class 3 (56%). Auto-marks were placed only when user-defined criteria were reached whereas manual points were marked subjectively. The auto-marks numbered 299 ± 82 per procedure and 5.39 ± 1.42 per RF application. Automarks provided good visualization of the ablation lines using the predefined criteria. AutoMark Module visualized probable gaps in the ablation line, which appeared as an area without spheres or with white spheres. That was not possible with manual marking because of its subjective nature. Conclusion: AutoMark is better than manual marking in providing real-time visual feedback on lesion creation. Our preselected lesion parameters ensure a tool to visualize possible gaps in the ablation line.

Introduction: Radiofrequency catheter ablation of idiopathic ventricular arrhythmias originating in the para-Hisian region could be challenging because of a potential risk of iatrogenic atrioventricular block. Uncommonly, shift of the exit site during the ablation can be observed. Consequently, different approaches of radiofrequency catheter ablation of para-Hisian ventricular foci can be needed. &nbsp; Case series presentation: Three patients (2 males) underwent electroanatomical mapping and catheter ablation for idiopathic premature ventricular contractions originating near the His bundle. Patients underwent 24-h ECG Holter monitoring during follow-up. All patients had premature ventricular contractions with left bundle branch block morphology and inferior or horizontal axis. However, change of QRS morphology during ablation was observed, due to a change in the exit site. In two patients there was reduction of the arrhythmia burden after initially unsuccessful procedure. Mapping and ablation in the aortic root were needed in one patient. There were no complications. &nbsp; Discussion: Radiofrequency catheter ablation of para-Hisian ventricular arrhythmias is feasible and safe when performed cautiously. A change in the premature ventricular contractions&rsquo; morphology and exit site during ablation may ensue; therefore, extensive mapping on both sides of the interventricular septum as well as in the aortic root may be warranted.

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