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Introduction Negative component abolition of the unipolar signal (unipolar signal modification [USM]) reflects the lesion transmurality. The purpose of this study was to compare the procedural safety and outcome between high‐power and conventional‐power atrial radiofrequency applications during a pulmonary vein isolation (PVI) using USM as a local endpoint. Methods and Results High‐power (50 W) and conventional‐power (25‐40 W) applications were compared among 120 consecutive patients with paroxysmal atrial fibrillation who underwent a USM‐guided PVI. The first 60 patients were treated with conventional‐power (CP) group and last 60 with high‐power (HP) group. The atrial radiofrequency applications lasted for 5 to 10 seconds (CP group) or 3 to 5 seconds (HP group) after the USM. All procedures were performed using 3D mapping systems with image integration and esophageal temperature monitoring. The baseline characteristics were similar between the two groups. The HP group had fewer acute PV reconnections (62% vs 78%; P = .046) and a reduced procedure time (119.3 ± 28.1 vs 140.1 ± 51.2 minutes; P = .04). Freedom from recurrence after a single ablation procedure without any antiarrhythmic drugs was higher in the HP group than CP group (88.3% vs 73.3% at 12‐months after the procedure, log‐rank; P = .0423). There were no major complications that required any intervention. Conclusions The high‐power PVI guided by USM decreased the procedural time and may improve the procedural outcomes without compromising the safety.

Background A challenging decision exists as whether to abandon or remove noninfectious superfluous leads during lead revisions or cardiac implantable electronic device (CIED) upgrades. There is insufficient data in the Asian population to guide decision making. Methods This study investigated the safety and efficacy of transvenous lead extractions (TLEs) in a high‐volume Japanese center. Among a total of 341 patients who underwent lead revisions or CIED upgrades between 2008 and 2018, 53 patients (16%) who underwent TLEs to remove the superfluous leads were analyzed. Results Indications for TLE were vascular issues (60%), recalled leads (21%), growth of the body size (6%), abandoned leads in young patients (6%), switch to a subcutaneous implanted cardiac defibrillator (4%), need for an MRI conditional CIED (2%), and risks of vascular injury (2%). The population included 29 patients (55%) with nonfunctional leads and 24 (45%) with functional abandoned leads. A total of 74 target leads (mean 1.4 leads/person, median lead age 6.7 years) were extracted with a complete removal achieved in 98%. All coexisting leads, intended for continued use, were not damaged. All new leads (mean 1.4 leads/person) that had been simultaneously implanted during the TLE procedures were successfully implanted. There was one minor complication (2%) involving a pericardial effusion but it did not affect the hemodynamics. Conclusions In this Japanese single center experience, the removal of noninfectious superfluous leads with TLEs seemed to be a safe and effective therapeutic option.

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Study Population This retrospective observational study screened 1,077 consecutive patients undergoing radiofrequency catheter ablation for AF (Figure 1). Of patients undergoing circumferential pulmonary vein isolation (PVI) between August 2009 and May 2019, 195 who had impaired LVEF (<50%) were enrolled in the present study. Patients who underwent cardiac resynchronized therapy after the procedure, those who were followed up for <6 months after the procedure, and those who did not receive echocardiographic evaluations 3 months after the index procedure were excluded. AF ablation was indicated based on previous expert consensus statements. 7-9 Within the 1 month prior to each session, patients underwent 3-dimensional cardiac computed A trial fibrillation (AF) is often associated with impaired left ventricular ejection fraction (LVEF) and poor prognosis due to the absence of atrioventricular synchrony, a deficiency of atrial kick, irregularity, or tachycardia. 1 Several randomized control studies have reported that AF ablation is associated with a good prognosis and significant LVEF improvement. 2,3 In addition, several studies have reported predictors of LVEF improvement after AF ablation in heart failure patients. 4-6 Nevertheless, the definition of LVEF improvement varies among studies, meaning that the relationship between LVEF improvement and prognosis is not clear. Therefore, the aim of the present study was to investigate the relationship between post-procedural LVEF (3 months after the procedure) and prognosis in patients who underwent AF ablation.