Background Pulsed field ablation (PFA) is a novel ablation technology recently adopted in the treatment of atrial fibrillation (AF). Currently, little is known about the durability of PFA ablation lesions. Methods We investigated patients who underwent redo-ablation due to recurrent AF/atrial-flutter or tachycardia (AFL/AT) following PVI with PFA. We report electrophysiological findings and ablation strategy during redo-ablation. Results Of 447 patients undergoing index PVI with PFA, 14 patients (age: 61.9±10.8 years; 7 (50.0%) males; left atrial volume index (n=10): 39.4±14.6 mL/m2) were referred for redo-ablation. Initial indication was paroxysmal-AF in 7 patients, persistent-AF in 6 and long-standing-persistent-AF in one patient. Mean time-to-recurrence was 4.9±1.9 months. Three patients received additional posterior-wall-isolation during index PFA. Twelve (85.7%) patients suffered AF recurrence and 5/12 had concomitant AFL. In the remaining 2 patients, one had a (box-dependent) AFL, and one had an atypical AT. No patients had all PVs reconnected. Reconnection in zero, one, two or three PVs was found in 35.7%, 21.4%, 14.3%, and 28.6% of patients, respectively. All 7 patients with zero or one reconnection with AF recurrence received additional/repeat posterior-wall-isolation during re-ablation, while in the others, PVs were re-isolated. Patients with only AFL/AT had no reconnection of PVs, and the substrate was successfully ablated. Conclusions Durable PVI (all PV’s isolated) was observed in over one-third of patients at re-do. The predominant recurrent arrhythmia following PVI-only was AF. Concomitant (35.7%) or isolated (14.3%) AFL/AT recurrence was observed in 50% of patients.

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An AXIOM Sensis XP system (Siemens AG, Munich, Germany) was also used during the procedure.Narrow complex tachycardia with a cycle length (CL) of 360 ms was ongoing. The earliest atrial activations were recorded in the left posterolateral wall (ie, at 4 o'clock according to the clinical standard nomenclature by Cosio) with the shortest ventriculoatrial (VA) interval equal to 104 ms. Few sinus complexes were recorded with concentric ventricular activation (Figure 2A). The atrium to His (AH) and His to ventricle intervals were 94 ms and 50 ms, respectively ( Figure 2B). The post-pacing interval was 492 ms with a ventricle-atrium-ventricle (VAV) response during overdrive pacing and entrainment of tachycardia from the right ventricle ( Figure 2C). Ventricular pacing within 40 ms of the His potential advanced the atrium and the atrial activation sequence to the same as that seen during tachycardia ( Figure 2D). The ventricular pacing given earlier terminated the tachycardia without advancing to the atrium ( Figure 2E). The VA interval was not decremental, although the tachycardia CL fluctuated from 310 ms to 360 ms. Because of the incessant tachycardia, we could not pace the atrium in sinus rhythm; however, the short attempts showed that the AH intervals during the sinus complexes and the atrial pacing in tachycardia CL were similar. Orthodromic atrioventricular reentrant tachycardia (AVRT) with concealed slow conductive accessory pathway (AP) was diagnosed. Case presentationA nine-year-old girl was admitted to our clinic having presented with palpitation, dyspnea, and heart failure (New York Heart Association functional classification class II). A 12-lead resting electrocardiogram (ECG) revealed regular narrow complex tachycardia (Figure 1). Echocardiography revealed reduced left ventricular systolic function (ejection fraction was 35%) and normal biatrial diameter. Tachycardia was incessant, lasting more than 50% of monitoring time prior to drug administration. Intravenous adenosine and b-blocker medication were ineffective. The patient was referred for electrophysiology (EP) study and catheter ablation. The procedure was performed with the patient under sedation with intubation. A steerable decapolar catheter (Abbott Laboratories, Chicago, IL, USA) was inserted into the coronary sinus via the subclavian vein, a quadripolar catheter (Abbott Laboratories, Chicago, IL, USA) was positioned in the right ventricle, and an ablation catheter (Marinr ® MC; Medtronic, Minneapolis, MN, USA) was placed in the His position via the right femoral vein during the EP study.ABSTRACT. The case of a pediatric patient with a history of incessant narrow complex tachycardia is presented. The patient underwent successful catheter ablation for an uncommon concealed slow accessory pathway. The mechanism and ablation location are discussed.

Introduction In this case, we present a child with a diagnosis of anorexia and no known cardiac disease, who was referred to our clinic for a routine cardiac monitoring. ‘Asymptomatic’ high degree of atrioventricular block (AVB) was revealed. She underwent successful pacemaker (PM) implantation and losing of the weight stopped. Case presentation In this case, the abrupt AVB with more than 6 s ventricular pauses without escape rhythm during the day-time most possible is a type of neurally mediated AVB which was presented by anorexia, underweighting, and refusing to eat in a 12-year-old girl. All symptoms disappeared after PM implantation, and weight gain was recorded during 6 months of follow-up. Discussion The causal link between AVB and anorexia is discussed. In this case, patient’s eating disorder was related to her AV conduction abnormality. The main reason of this case report is to emphasize, that in children with unexplained anorexia and underweighting cardiogenic origin must be excluded.

Background: The number of cardiac implantable electronic device implantation procedures has increased dramatically in recent decades due to population aging and expansion of indications. At the same time, the number of cardiac implantable electronic device associated complications has increased too. Infection is a very important and heavy complication of cardiac implantable electronic device implantation, which significantly increases mortality and morbidity. This study aimed to estimate the risk of cardiac implantable electronic device infection in a group of patients who received an aggressive scheme of postoperative antibiotic therapy and compare this with the risk of infection in another group, where a mild antibiotic therapy scheme was used. Methods: A retrospective, observational study was performed. The study sample included 355 patients. Two antibiotic prophylaxis and wound follow-up protocols (mild and aggressive) were used. In this study the effectiveness of both methods to prevent a cardiac implantable electronic device related infection was compared. Results: The prevalence of infection was 3.5% in the group with mild scheme and 1.13% in the group with the aggressive scheme. The difference in two subgroups was not significant (p=0,149). According to this study severe renal failure, chronic obstructive pulmonary disease and thyroid dysfunction were found as significant predictors for having cardiac implantable electronic device infection. In participants who underwent a reimplantation and in those with postoperative hematoma the odds of having infection was higher, compared to patients with primary implantation and absence of hematoma. Age of participants with cardiac implantable electronic device infection was younger compared to patients without infection. Conclusion: According to this study there is no statistically significant difference on cardiac implantable electronic device infection between mild and aggressive antibiotic therapy schemes.