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Background We evaluated scar lesions following initial and repeat catheter ablation of atrial fibrillation (AF) and correlated these regions to low-voltage tissue on repeat electroanatomical (EA) mapping. We also identified gaps in lesion sets that could be targeted and closed during repeat procedures. Methods and Results One hundred forty-four patients underwent AF ablation and received a delayed-enhancement MRI (DE-MRI) at three months post-ablation. The number of pulmonary veins (PV) with circumferential lesions were assessed and correlated with procedural outcome. Eighteen patients with AF recurrence underwent repeat ablation. MRI scar regions were compared to electroanatomical (EA) maps during the repeat procedure. Regions of incomplete scar around the PVs were then identified and targeted during repeat ablation in order to ensure complete circumferential lesions. Following the initial procedure, complete circumferential scarring of all 4 PVA was achieved in only 7% of patients, with the majority of patients (69%) having <2 completely scarred PVA. After the first procedure, the number of PVs with complete circumferential scarring and total LA wall scar burden was associated with better clinical outcome. Patients with successful AF termination had higher average total LA wall scar of 16.4% ± 9.8 (p = 0.004) and percent PVA scar of 66.2 ± 25.4 (p = 0.01) compared to patients with AF recurrence who had an average total LA wall scar 11.3% ± 8.1 and PVA percent scar 50.0 ± 24.7. In patients who underwent repeat ablation, the PV antra scar percentage was 56.1% ± 21.4 after the first procedure compared to 77.2% ± 19.5 after the second procedure. The average total LA scar after the first ablation was 11.0% ± 4.1, while the average total LA scar after second ablation was 21.2% ± 7.4. All patients had increased number of completely scarred pulmonary vein antra after the second procedure. MRI scar after the first procedure and low voltage regions on EA obtained during repeat ablation demonstrated a positive quantitative correlation of R2 = 0.57. Conclusions Complete circumferential PV lesions is difficult to achieve but is associated with better clinical outcome. DE-MRI can accurately define scar lesions following AF ablation and can be used to target breaks in lesion sets during repeat ablation.

The 2017 competencies include 52 competencies.

The purpose of the Oncology Nursing Society (ONS) Oncology Nurse Navigator Role Delineation Study was to examine the job-function activities of the oncology nurse navigator, thus providing an understanding of this unique role. The Role Delineation Advisory Committee consisting mainly of oncology nurse navigators was formed to provide content expertise to Applied Measurement Professionals, which conducted the role delineation study. Three hundred and thirty nurses completed the survey. The study clearly defined tasks, knowledge areas, and skills that are very specific to the nurse navigator role; however, the overlap in knowledge with the general oncology nurse role needs to be explored. The ONS Board of Directors and the Oncology Nursing Certification Corporation Board of Directors currently are exploring the need for additional initiatives to help define the role and competencies of the oncology nurse navigator.

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