Areas with CFAEs represent a defined electrophysiologic substrate and are ideal target sites for ablations to eliminate AF and maintain normal sinus rhythm.

CFAE-targeted ablation of AF is effective in maintaining SR in selected high-risk AF patients and might allow patients to stop warfarin therapy. SR after AF ablation is a marker of relatively low mortality and stroke risk. Our findings support conducting further randomized studies to determine whether AF ablation is associated with mortality and/or stroke reduction.

Sympathetic blockade is superior to the antiarrhythmic therapy recommended by the ACLS guidelines in treating ES patients. Our study emphasizes the role of increased sympathetic activity in the genesis of ES. Sympathetic blockade-not class 1 antiarrhythmic drugs-should be the treatment of choice for ES.

The recent introduction of a nonfluoroscopic electroanatomical cardiac mapping system (CARTO) is an exciting development in catheter ablation treatment of cardiac arrhythmias. The system uses ultralow magnetic fields to locate a sensor positioned near the tip of a regular mapping and ablation catheter. The catheter location and electrograms are recorded and reconstructed in real-time and presented as a three-dimensional geometrical mapped color coded with the electrophysiological information. The CARTO represents an important tool to guide the ablation of patients who have focal tachycardia (e.g., right ventricular outflow tract [RVOT] tachycardia and idiopathic left ventricular [ILV] tachycardia). This study describes how the CARTO system is useful in mapping and ablating these arrhythmias. Two case illustrations, one patient with RVOT tachycardia and another with ILV tachycardia, are described in this article. The tachycardia was mapped and ablated using the new electromagnetic catheter technology creating an electroanatomical map of the arrhythmia focus for each tachycardia without fluoroscopy; both tachycardias were successfully ablated, terminated, and rendered noninducible. The CARTO system is useful in mapping and guiding the ablation of focal tachycardia and merits further study.

The electroanatomic three-dimensional mapping technique reduced fluoroscopy time and resulted in excellent outcome without increasing the procedure time.