Ablation guided by automated detection of CFAE proved feasible, and was associated with a high AF termination rate in paroxysmal, but not persistent AF. As an adjunct to conventional techniques, it was associated with excellent long-term single procedure outcomes in both groups. Criteria for identifying optimal CFAE sites for ablation, and selection of patients most likely to benefit, require additional study.

ABBREVIATIONS CIED = cardiovascular implantable electronic device; CT = computed tomography; EP = electrophysiology; FDA = U.S. Food and Drug Administration; ICD=implantable cardioverterdefibrillator; MRI = magnetic resonance imaging; QA = quality assurance; QI = quality improvement; RF = radiofrequency; VT = ventricular tachycardia (Heart Rhythm 2014;11:e9-e51) Developed in collaboration with and endorsed

As the volume and complexity of catheter ablation of atrial fibrillation (AF) continue to rise, there is increasing attention directed at reducing exposure to ionizing radiation. This has led to the emergence of intracardiac echocardiography (ICE) as a stand-alone imaging modality guiding AF ablation. In addition to directing transseptal puncture, ICE may be used to identify left atrial structures and to guide the manipulation of catheters. ICE may also be used to visualize the esophagus in real-time and to assist with early identification of procedural complications. This review provides detailed step-by-step directions for identification of relevant structures and summarizes the use of ICE during AF ablation.

Up to one-third of post-radiofrequency MAZE circuits are typical isthmus-dependent RA flutters, despite a highly atypical surface ECG morphology. Therefore, diagnostic electrophysiological studies should commence with entrainment at the cavo-tricuspid isthmus in order to exclude typical flutter, regardless of the surface ECG appearance. Incomplete surgical lesions at the mitral and cavo-tricuspid isthmus likely predispose to the development of post-radiofrequency MAZE flutter.

No abstract