LI recorded from miniature electrodes provides a valuable measure of catheter-tissue coupling, and ΔLI is predictive of lesion formation during radiofrequency ablation.

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Aims The aim of the study was to determine the incidence of oesophageal lesions after radiofrequency ablation (RFA) of atrial fibrillation (AF) with or without the use of oesophageal temperature probes. Methods and results Two hundred patients were prospectively randomized into two groups: the OPERA+ group underwent RFA using oesophageal probes (SensiTherm™); the OPERA− group received RFA using fixed energy levels of 25 W at the posterior wall without an oesophageal probe. All patients underwent post-interventional endoscopy and Holter-electrocardiogram after 6 months. (Clinical.Trials.gov: NCT03246594). One hundred patients were randomized in OPERA+ and 100 patients in OPERA−. The drop-out rate was 10%. In total, 18/180 (10%) patients developed endoscopically diagnosed oesophageal lesions (EDEL). There was no difference between the groups with 10/90 (11%) EDEL in OPERA+ vs. 8/90 (9%) in OPERA− (P = 0.62). Despite the higher power delivered at the posterior wall in OPERA+ [28 ± 4 vs. 25 ± 2 W (P = 0.001)], the average EDEL size was equal [5.7 ± 2.6 vs. 4.5 ± 1.7 mm (P = 0.38)]. The peak temperature did not correlate with EDEL size. During follow-up, no patient died. Only one patient in OPERA− required a specific therapy for treatment of the lesion. Cumulative AF recurrence after 6 (3–13) months was 28/87 (32%) vs. 34/88 (39%), P = 0.541. Conclusion This first randomized study demonstrates that intraoesophageal temperature monitoring using the SensiTherm™ probe does not affect the probability of developing EDEL. The peak temperature measured by the thermoprobe seems not to correlate with the incidence of EDEL. Empiric energy reduction at the posterior wall did not affect the efficacy of the procedure.

The combination of active catheter tracking and passive real-time visualization in CMR-guided electrophysiologic (EP) studies using advanced interventional hardware and software was safe and enabled efficient navigation, mapping, and ablation. These cases demonstrate significant progress in the development of MR-guided EP procedures.

This study demonstrates significantly better outcomes in terms of restenosis after stent implantation versus PTA only, with comparable complication rates for these 2 options of interventional treatment of radiofrequency-induced PVS. In summary, despite the lack of randomized studies, the present data and currently available published studies seem to favor stent implantation as a first-line therapy in patients with radiofrequency-induced severe PVS.

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AimsImplantable loop recorders (ILRs) with specific atrial fibrillation (AF) detection algorithms (ILR-AF) have been developed for continuous AF monitoring. We sought to analyse the clinical value of a new AF monitoring device and to compare it to serial 7-day Holter.Methods and resultsSixty-four consecutive patients suffering from paroxysmal AF were included in this prospective analysis and received an ILR-AF. Manual electrogram analysis was performed for each automatically detected episode and each was categorized into one of three possible diagnoses: ‘no AF', ‘definite AF', and ‘possible AF' (non-diagnostic). Analysis was performed separately before and after a software upgrade that was introduced during the course of the study. A subgroup of patients (51 of 64) underwent AF catheter ablation with subsequent serial 7-day Holter in comparison with the ILR-AF. A total of 333 interrogations were performed (203 before and 130 after software upgrade). The number of patients with AF misdetection was significantly reduced from 72 to 44% following the software upgrade (P= 0.001). The number of patients with non-diagnostic interrogations went from 38 to 16% (P= 0.001). Compared with serial 7-day Holter, the ILR-AF had a tendency to detect a higher number of patients with AF recurrences (31 vs. 24%; P = 0.125).ConclusionsThe rate of AF detection on ILR-AF may be higher compared with standard AF monitoring. However, false-positive AF recordings hamper the clinical value. Developements in device technology and device handling are necessary to minimize non-diagnostic interrogations.

Device type and location constitute the main independent predictors of CMR image quality and thus, need to be considered during protocol adaptation. Most notably, post-contrast SGE cine imaging proved superior to conventionally used SSFP sequences. Thus, following the proposed device-dependent CMR imaging strategy, diagnostic image quality can be achieved in the majority of device patients.