Current recommendations avoid the use of antiarrhythmic drugs in pregnancy and support catheter ablation (CA) due to symptomatic arrhythmias prior to pregnancy. Zero-fluoroscopy (ZF) mapping and navigation with three-dimensional electroanatomical mapping systems (3D-EAMS) allowed routine and safe non-fluoroscopic guidance of the procedure without X-ray exposure. We present the first case of a pregnant patient who underwent successful ZF CA of symptomatic pre-excitation from non-coronary cusp (NCC). A 24-year-old Caucasian pregnant without structural heart disease at the 24 th week of pregnancy was referred for CA due to three recurrences of syncope and drug-refractory palpitations associated with Wolf-Parkinson-White (WPW) syndrome. Twelve months prior to pregnancy the woman had failed radiofrequency (RF) ablation procedure in another centre for para-Hisian right-sided pathway. A 12-lead electrocardiogram (ECG) showed pre-excitation with a positive delta wave in leads I, II, aVF, V4, and V5 and a negative delta wave in lead V1, suggesting a para-Hisian accessory pathway ( Fig. 1). She was referred to our hospital for rescue CA with ZF. Our centre had at least five years of experience with the minimally invasive non-fluoroscopic imaging and navigation approach using the Ensite NavX system (St. Jude Medical, St. Paul, MN) for CA of regular supraventricular arrhythmias and idiopathic ventricular arrhythmias. A multidisciplinary consultation reached the consensus that only pre-excitation is a substrate for syncope recurrences and poses a potential risk to the foetus and mother. The right femoral vein was cannulated with a 7 F or 8 F sheath and one ablation 4 mm Gold tip catheter and one diagnostic decapolar catheter (Biotronik, Berlin, Germany) were introduced. Atrial pacing protocols demonstrated a septal accessory pathway, but no isoproterenol was given to induce tachycardia. The refractory period of the accessory pathway was 300 ms. After six failed right-sided applications right sided mapping was stopped due to frequent junctional beats and proximity of His potential recordings. Then, the right femoral artery was cannulated with an 8 F introducer, and the ablation catheter was removed using a right to left retrograde approach (Fig. 2). Finally, six RF applications (240 s) were delivered approximately in the NCC and the accessory pathway was successfully ablated (Fig. 1). The procedure time was 71 min and no fluoroscopy was used. Several ECGs and Holter monitoring confirmed no pre-excitation and arrhythmias within 14 months. The patient delivered a healthy male child at 35 weeks of gestation by Caesarean section. Both mother and child had an uneventful postoperative course. The case documents that routinely using ZF for CA may support this approach even for unfavourable locations (e.g. NCC) and not only as the last resort for several arrhythmias including WPW-syndrome in pregnant patients.

This paper describes three cytological image segmentation methods. The analysis includes the watershed algorithm, active contouring and a cellular automata GrowCut method. One can also find here a description of image pre-processing, Hough transform based pre-segmentation and an automatic nuclei localization mechanism used in our approach. Preliminary experimental results collected on a benchmark database present the quality of the methods in the analyzed issue. The discussion of common errors and possible future problems summarizes the work and points out regions that need further research.

Radiofrequency catheter ablation (RFCA) is an established effective method for the treatment of typical cavo-tricuspid isthmus (CTI)-dependent atrial flutter (AFL). The introduction of 3-dimensional electro-anatomic systems enables RFCA without fluoroscopy (No-X-Ray [NXR]). The aim of this study was to evaluate the feasibility and effectiveness of CTI RFCA during implementation of the NXR approach and the maximum voltage-guided (MVG) technique for ablation of AFL.Data were obtained from prospective standardized multicenter ablation registry. Consecutive patients with the first RFCA for CTI-dependent AFL were recruited. Two navigation approaches (NXR and fluoroscopy based as low as reasonable achievable [ALARA]) and 2 mapping and ablation techniques (MVG and pull-back technique [PBT]) were assessed. NXR + MVG (n  =  164; age: 63.7 ± 9.5; 30% women), NXR + PBT (n  =  55; age: 63.9 ± 10.7; 39% women); ALARA + MVG (n  =  36; age: 64.2 ± 9.6; 39% women); and ALARA + PBT (n  =  205; age: 64.7 ± 9.1; 30% women) were compared, respectively. All groups were simplified with a 2-catheter femoral approach using 8-mm gold tip catheters (Osypka AG, Germany or Biotronik, Germany) with 15 min of observation. The MVG technique was performed using step-by-step application by mapping the largest atrial signals within the CTI.Bidirectional block in CTI was achieved in 99% of all patients (P  =  NS, between groups). In NXR + MVG and NXR + PBT groups, the procedure time decreased (45.4 ± 17.6 and 47.2 ± 15.7 min vs. 52.6 ± 23.7 and 59.8 ± 24.0 min, P < .01) as compared to ALARA + MVG and ALARA + PBT subgroups. In NXR + MVG and NXR + PBT groups, 91% and 98% of the procedures were performed with complete elimination of fluoroscopy. The NXR approach was associated with a significant reduction in fluoroscopy exposure (from 0.2 ± 1.1 [NXR + PBT] and 0.3 ± 1.6 [NXR + MVG] to 7.7 ± 6.0 min [ALARA + MVG] and 9.1 ± 7.2 min [ALARA + PBT], P < .001). The total application time significantly decreased in the MVG technique subgroup both in NXR and ALARA (P < .01). No major complications were observed in either groups.Complete elimination of fluoroscopy is feasible, safe, and effective during RFCA of CTI in almost all AFL patients without cardiac implanted electronic devices. The most optimal method for RFCA of CTI-dependent AFL seems to be MVG; however, it required validation of optimal RFCA's parameters with clinical follow-up.

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Atrioventricular nodal reentry tachycardia (AVNRT) is one of the most common types of regular supraventricular tachycardia (SVT) in patients referred for catheter ablation (CA). This is the first study to determine the frequency of familial form of atrioventricular nodal reentry tachycardia (FAVNRT) in Poland. In this study we revealed relationship between the geographical region of families origin, with diagnosed FAVNRT. The closer distance the family is to Subcarpathia Province, the highest the risk of FAVNRT. We also found the biggest number of patients and families with diagnosed FAVNRT so far reported.