Aims Incorporating a steerable sheath that can be visualized using an electroanatomical mapping (EAM) system may allow for more efficient mapping and catheter placement, while reducing radiation exposure, during ablation procedures for atrial fibrillation (AF). This study evaluated fluoroscopy usage and procedure times when a visualizable steerable sheath was used compared with a non-visualizable steerable sheath for catheter ablation for AF. Methods and results In this retrospective, observational, single-centre study, patients underwent catheter ablation for AF using a steerable sheath that is visualizable using the CARTO EAM (VIZIGO; n = 57) or a non-visualizable steerable sheath (n = 34). The acute procedural success rate was 100%, with no acute complications in either group. Use of the visualizable sheath vs. the non-visualizable sheath was associated with a significantly shorter fluoroscopy time [median (first quartile, third quartile), 3.4 (2.1, 5.4) vs. 5.8 (3.8, 8.6) min; P = 0.003], significantly lower fluoroscopy dose [10.0 (5.0, 20.0) vs. 18.5 (12.3, 34.0) mGy; P = 0.015], and significantly lower dose area product [93.0 (48.0, 197.9) vs. 182.2 (124.5, 355.0) μGy·m2; P = 0.017] but with a significantly longer mapping time [12.0 (9.0, 15.0) vs. 9.0 (7.0, 11.0) min; P = 0.004]. There was no significant difference between the visualizable and non-visualizable sheaths in skin-to-skin time [72.0 (60.0, 82.0) vs. 72.0 (55.5, 80.8) min; P = 0.623]. Conclusion In this retrospective study, use of a visualizable steerable sheath for catheter ablation of AF significantly reduced radiation exposure vs. a non-visualizable steerable sheath. Although mapping time was longer with the visualizable sheath, the overall procedure time was not increased.

radioisotope were administered intravenously via a brachial vein (t=40secs), and then at 2-minute intervals from the start of Regadenoson administration until any QTc prolongation (if present) had resolved. Results Median baseline QTc was 425 ms (range: 389 ms -460 ms, figure 1). Median QTc at peak prolongation (observed at 40 secs in 32 patients and 4 mins in 2 patients) was 477 ms (range 434 ms -545 ms) including, of note, 4 (11%) patients with QTc prolongation >500ms. The median time for QTc to return to £460ms was 4 mins (2 mins -32 mins). No significant side effects or dysrhythmias were reported. Conclusion Regadenoson administration was well tolerated by patients. As a result of the QTc prolongation of >500ms seen in some patients, albeit with the absence of dysrhythmia, regadenoson administration should be undertaken by experienced staff in an appropriate clinical setting. However, more research is needed to ascertain with greater accuracy the average QTc prolongation of Regadenoson, as it shows promise as a potential agent where exercise is either not possible or not permitted due to restrictions.

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Results 129 patients (age 81.1±11.0, male 55%) undergoing GC in 2014-16 (Group A) were compared with 195 patients (age 81.6±1.0, male 49%) from 2018-2020 (Group B) who were assessed using the new algorithm (table 1). Follow up was longer in group A patients (5.99 vs 2.38 years p=<0.001.) 24/195 (12.3%) were upgraded at GC and 171/ 195 (87.7%) had GC only. There was no difference in two-