Background The Home Monitoring (HM) system of cardiac implantable electronic devices (CIEDs) permits early detection of arrhythmias or device system failures. The aim of this pilot study was to examine how the safety and efficacy of the HM system in patients after ambulatory implanted primary CIEDs compare to patients with a standard procedure and hospitalization. Hypothesis We hypothesized that HM and their modifications would be a useful extension of the present concepts for ambulatory implanted CIEDs. Methods This retrospective analysis evaluates telemetric data obtained from 364 patients in an ambulatory single center over 6 years. Patients were assigned to an active group (n = 217), consisting of those who were discharged early on the day of implantation of the primary CIED, or to a control group (n = 147), consisting of those discharged and followed up with the HM system according to usual medical practices. Results The mean duration of hospitalization was 73.2% shorter in the active group than in the control group, corresponding to 20.5 ± 13 fewer hours (95% confidence interval [CI]: 6.3‐29.5; P < 0.01) spent in the hospital (7.5 ± 1.5 vs 28 ± 4.5 h). This shorter mean hospital stay was attributable to a 78.8% shorter postoperative period in the active group. The proportion of patients with treatment‐related adverse events was 11% (n = 23) in the active group and 17% (n = 25) in the control group (95% CI: 5.5‐8.3; P = 0.061). This 6% absolute risk reduction (95% CI: 3.3‐9.1; P = 0.789) confirmed the noninferiority of the ambulatory implanted CIED when compared with standard management of these patients. Conclusions Early discharge with the HM system after ambulatory CIED implantation was safe and not inferior to the classic medical procedure. Thus, together with lower costs, HM and its modifications would be a useful extension of the present concepts for ambulatory implanted CIEDs.

The treatment of typical AFL using a hexapolar catheter with a multipolar, duty-cycled, bipolar-unipolar RF generator offers comparable effectiveness relative to conventional RF while providing improved procedural efficiency.

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A stroke attack in the brainstem area as a serious complication of atrial fibrillation (AF) in a 51 year old woman with known paroxysmal AF (CHADS² score 3) was treated with LAA occlusion procedure after the complication of arterial bleeding secondary to anticoagulation therapy. LAA closure device embolisation was developed following the LAA occlusion procedure. The device was located and removed successfully from the systemic circulation.

Ensite Array balon haritalama ve Hansen-Sensei robot Coolpath kateter ile WPW sendromunun RF ablasyonla tedavisi Wolff-Parkinson-White syndromes (WPW) are examples of preexcitation that affects approximately 0.15-0.2% of the general population (2). Of these individuals, 60-70% has no other heart disease, men are affected more often and typically, those affected are young, or healthy individuals. Death from WPW is secondary to the associated arrhythmias or mistreatment of them. RF ablation remains the first line therapy in symptomatic WPW patients.A 22-year-old woman with known preexcitation, WPW was diagnosed at age of 11, had developed 4 episodes of sustained symptomatic palpitations with a pulse up to 190 beats/min., in the past 4 weeks. WPW had been diagnosed in grandfather and aunt. An echocardiography performed in the patient did not demonstrate any abnormalities.The patient's WPW has been asymptomatic until 4 weeks prior to presentation. Due to the clinical manifestations, an electrophysiological study (EPS) was performed aiming to map and ablate the accessory pathway (3). Catheters were placed to right atrium, ventricle and coronary sinus (CS). During the programmed atrial stimulation, an antegrade transmitting right sided posterior septal pathway was found. Following multiple radiofrequency (RF) ablations, the pre-excitation signal was remained. The EPS was ended, in order to plan a new RF-ablation with the Ensite Array (SJM, St. Paul, MN, USA) (EA) balloon mapping (3). EA provides a virtual activation of intracardiac transmission on a beat-to -beat basis (3).At the second EPS, a catheter was placed in the CS, a non-contactmapping EA balloon at the right atrium and the ablation catheter by means also superior and inferior vena cava, and right atrium is mapped. The EA balloon mapped capture beat documented an accessory pathway at the right side of the posterior septum (3). A CS imaging was also performed in order to assess an aneurysm, with a negative result.RF-ablation was performed using remote navigation system, coolpath radiofrequency (Hansen-Sensei, Mountain View, CA, USA) (RNS) (4). The RNS improves the catheter stability and increase procedural success and the safety by avoiding serious complications (4). Focal RF-ablation of the accessory path through RNS was performed, with a total time of 606sec and 8983Ws energy. The ablation of the pathway was successful.In this manner, although the high cost, we have decided to use both EA and RNS considering the young age, and the cardiac anatomy of the patient. In some cases, even though in WPW ablations, the EA and/or RNS usage could be considered in order to increase the success rate and minimize the potential complications of an ablation.