Aldo Bonso - Academia.edu (original) (raw)

Papers by Aldo Bonso

Research paper thumbnail of Ablation of Perimitral Flutter Following Catheter Ablation of Atrial Fibrillation: Impact on Outcomes from a Randomized Study (PROPOSE)

Patients with previous ablation for atrial fibrillation (AF) may experience recurrence of perimit... more Patients with previous ablation for atrial fibrillation (AF) may experience recurrence of perimitral flutter (PMFL). These arrhythmias are usually triggered from sources that may also induce AF. This study aims at determining whether ablation of triggers or completing mitral valve isthmus (MVI) block prevents more arrhythmia recurrences. Sixty-five patients with recurrent PMFL after initial ablation of long standing persistent AF were included in this study. Thirty-two patients were randomized to MVI ablation only (Group 1) and 33 were randomized to cardioversion and repeat pulmonary vein (PV) isolation plus ablation of non-PV triggers (Group 2). MVI bidirectional block was achieved in all but 1 patient from Group 1. In Group 2, reconnection of 17 PVs was detected in 14 patients (42%). With isoproterenol challenge, 44 non-PV trigger sites were identified in 28 patients (85%, 1.57 sites per patient). At 18-month follow-up, 27 patients (84%) from Group 1 had recurrent atrial tachyarrhythmias, of whom 15 remained on antiarrhythmic drug (AAD); however, 28 patients from Group 2 (85%, P < 0.0001 vs Group 1) were free from arrhythmia off AAD. The ablation strategy used in Group 2 was associated with a lower risk of recurrence (hazard ratio = 0.10, 95% CI 0.04-0.28, P < 0.001) and an improved arrhythmia-free survival (log rank P < 0.0001). In patients presenting with PMFL after ablation for longstanding persistent AF, MVI block had limited impact on arrhythmia recurrence. On the other hand, elimination of all PV and non-PV triggers achieved higher freedom from atrial arrhythmias at follow-up.

Research paper thumbnail of Visually-Guided Balloon Catheter Ablation of Atrial Fibrillation Experimental Feasibility and First-in-Human Multicenter Clinical Outcome

Background—Electric isolation of the pulmonary veins (PVs) can successfully treat patients with p... more Background—Electric isolation of the pulmonary veins (PVs) can successfully treat patients with paroxysmal atrial fibrillation. However, it remains technically challenging to identify the left atrial-PV junction and sequentially position the ablation catheter in a point-by-point contiguous fashion to isolate the PVs. In this study, a novel endoscopic ablation system was used to directly visualize and ablate tissue at the left

Research paper thumbnail of Visually-Guided Balloon Catheter Ablation of Atrial Fibrillation Experimental Feasibility and First-in-Human Multicenter Clinical Outcome

Background—Electric isolation of the pulmonary veins (PVs) can successfully treat patients with p... more Background—Electric isolation of the pulmonary veins (PVs) can successfully treat patients with paroxysmal atrial fibrillation. However, it remains technically challenging to identify the left atrial-PV junction and sequentially position the ablation catheter in a point-by-point contiguous fashion to isolate the PVs. In this study, a novel endoscopic ablation system was used to directly visualize and ablate tissue at the left

Research paper thumbnail of Ablation of Perimitral Flutter Following Catheter Ablation of Atrial Fibrillation: Impact on Outcomes from a Randomized Study (PROPOSE)

Patients with previous ablation for atrial fibrillation (AF) may experience recurrence of perimit... more Patients with previous ablation for atrial fibrillation (AF) may experience recurrence of perimitral flutter (PMFL). These arrhythmias are usually triggered from sources that may also induce AF. This study aims at determining whether ablation of triggers or completing mitral valve isthmus (MVI) block prevents more arrhythmia recurrences. Sixty-five patients with recurrent PMFL after initial ablation of long standing persistent AF were included in this study. Thirty-two patients were randomized to MVI ablation only (Group 1) and 33 were randomized to cardioversion and repeat pulmonary vein (PV) isolation plus ablation of non-PV triggers (Group 2). MVI bidirectional block was achieved in all but 1 patient from Group 1. In Group 2, reconnection of 17 PVs was detected in 14 patients (42%). With isoproterenol challenge, 44 non-PV trigger sites were identified in 28 patients (85%, 1.57 sites per patient). At 18-month follow-up, 27 patients (84%) from Group 1 had recurrent atrial tachyarrhythmias, of whom 15 remained on antiarrhythmic drug (AAD); however, 28 patients from Group 2 (85%, P < 0.0001 vs Group 1) were free from arrhythmia off AAD. The ablation strategy used in Group 2 was associated with a lower risk of recurrence (hazard ratio = 0.10, 95% CI 0.04-0.28, P < 0.001) and an improved arrhythmia-free survival (log rank P < 0.0001). In patients presenting with PMFL after ablation for longstanding persistent AF, MVI block had limited impact on arrhythmia recurrence. On the other hand, elimination of all PV and non-PV triggers achieved higher freedom from atrial arrhythmias at follow-up.

Research paper thumbnail of Ablation of Perimitral Flutter Following Catheter Ablation of Atrial Fibrillation: Impact on Outcomes from a Randomized Study (PROPOSE)

Patients with previous ablation for atrial fibrillation (AF) may experience recurrence of perimit... more Patients with previous ablation for atrial fibrillation (AF) may experience recurrence of perimitral flutter (PMFL). These arrhythmias are usually triggered from sources that may also induce AF. This study aims at determining whether ablation of triggers or completing mitral valve isthmus (MVI) block prevents more arrhythmia recurrences. Sixty-five patients with recurrent PMFL after initial ablation of long standing persistent AF were included in this study. Thirty-two patients were randomized to MVI ablation only (Group 1) and 33 were randomized to cardioversion and repeat pulmonary vein (PV) isolation plus ablation of non-PV triggers (Group 2). MVI bidirectional block was achieved in all but 1 patient from Group 1. In Group 2, reconnection of 17 PVs was detected in 14 patients (42%). With isoproterenol challenge, 44 non-PV trigger sites were identified in 28 patients (85%, 1.57 sites per patient). At 18-month follow-up, 27 patients (84%) from Group 1 had recurrent atrial tachyarrhythmias, of whom 15 remained on antiarrhythmic drug (AAD); however, 28 patients from Group 2 (85%, P < 0.0001 vs Group 1) were free from arrhythmia off AAD. The ablation strategy used in Group 2 was associated with a lower risk of recurrence (hazard ratio = 0.10, 95% CI 0.04-0.28, P < 0.001) and an improved arrhythmia-free survival (log rank P < 0.0001). In patients presenting with PMFL after ablation for longstanding persistent AF, MVI block had limited impact on arrhythmia recurrence. On the other hand, elimination of all PV and non-PV triggers achieved higher freedom from atrial arrhythmias at follow-up.

Research paper thumbnail of Atrial fibrillation ablation strategies for paroxysmal patients: randomized comparison between different techniques

Circulation. Arrhythmia and electrophysiology, 2009

Whether different ablation strategies affect paroxysmal atrial fibrillation (AF) long-term freedo... more Whether different ablation strategies affect paroxysmal atrial fibrillation (AF) long-term freedom from AF/atrial tachyarrhythmia is unclear. We sought to compare the effect of 3 different ablation approaches on the long-term success in patients with paroxysmal AF. One hundred three consecutive patients with paroxysmal AF scheduled for ablation and presenting in the electrophysiology laboratory in AF were selected for this study. Patients were randomized to pulmonary vein antrum isolation (PVAI; n=35) versus biatrial ablation of the complex fractionated atrial electrograms (CFAEs; n=34) versus PVAI followed by CFAEs (n=34). Patients were given event recorders and followed up at 3, 6, 9, 12, and 15 months postablation. There was no statistical significant difference between the groups in term of sex, age, AF duration, left atrial size, and ejection fraction. At 1 year follow-up, freedom from AF/atrial tachyarrhythmia was documented in 89% of patients in the PVAI group, 91% in the PVA...

Research paper thumbnail of Pacemapping of the Triangle of Koch: A Simple Method to Reduce the Risk of Atrioventricular Block During Radiofrequency Ablation of Atrioventricular Node Reentrant Tachycardia

Pacing and Clinical Electrophysiology, 2001

Slow pathway ablation in common AVNRT can be complicated by total AV block. When radiofrequency e... more Slow pathway ablation in common AVNRT can be complicated by total AV block. When radiofrequency energy is delivered to the posterior aspect of the triangle of Koch, total AV block may be the consequence of the absence of anterograde conduction along the fast pathway or of inadvertent damage to a fast pathway abnormally located close to the slow pathway. To localize the anterogradely conducting fast pathway, the triangle of Koch was pacemapped in 72 patients who underwent the ablation of common AVNRT. In all cases, before ablation the St-H interval was calculated by stimulating the anteroseptal (AS), mid-septal (MS), and posteroseptal (PS) aspect of the triangle of Koch at a rate slightly faster than the sinus rate. In all patients, common AVNRT was induced. In 64 (89%) of 72 patients (group A) the shortest St-H interval was recorded on stimulating the AS region. In six (8%) patients (group B) the shortest St-H interval was recorded on stimulating the MS region. Finally, in two (3%) patients (group C) the shortest St-H interval was recorded stimulating in the PS region. In group C, AH interval, calculated on stimulating in the AS region, was significantly longer than in patients of groups A and B (200 +/- 99 ms vs 64 +/- 18 and 62 +/- 3, respectively). In group A, on stimulating in the AS, MS, and PS regions, the AH interval remained constant in all patients. In contrast, in groups B and C on stimulation in the MS and PS regions, AH interval shortened (in group B from 56 +/- 8 to 27 +/- 37 and 37 +/- 14, respectively; in group C from 200 +/- 99 to 170 +/- 100 and to 137 +/- 109, respectively). In groups A and B, a posteroseptal slow pathway, and in group C, an anteroseptal retrograde fast pathway were successfully ablated without AV block. Pacemapping of the triangle of Koch can help to recognize patients in whom the anterograde conducting fast pathway is abnormally located far from the anteroseptal region or in whom anterograde conduction of the fast pathway is absent. In these cases the risk of AV block can be reduced by performing slow pathway ablation in a site sufficiently far from the site of the anterograde fast pathway or ablating the retrogradely conducting fast pathway.

Research paper thumbnail of Pacemapping of the Triangle of Koch: A Simple Method to Reduce the Risk of Atrioventricular Block During Radiofrequency Ablation of Atrioventricular Node Reentrant Tachycardia

Pacing and Clinical Electrophysiology, 2001

Slow pathway ablation in common AVNRT can be complicated by total AV block. When radiofrequency e... more Slow pathway ablation in common AVNRT can be complicated by total AV block. When radiofrequency energy is delivered to the posterior aspect of the triangle of Koch, total AV block may be the consequence of the absence of anterograde conduction along the fast pathway or of inadvertent damage to a fast pathway abnormally located close to the slow pathway. To localize the anterogradely conducting fast pathway, the triangle of Koch was pacemapped in 72 patients who underwent the ablation of common AVNRT. In all cases, before ablation the St-H interval was calculated by stimulating the anteroseptal (AS), mid-septal (MS), and posteroseptal (PS) aspect of the triangle of Koch at a rate slightly faster than the sinus rate. In all patients, common AVNRT was induced. In 64 (89%) of 72 patients (group A) the shortest St-H interval was recorded on stimulating the AS region. In six (8%) patients (group B) the shortest St-H interval was recorded on stimulating the MS region. Finally, in two (3%) patients (group C) the shortest St-H interval was recorded stimulating in the PS region. In group C, AH interval, calculated on stimulating in the AS region, was significantly longer than in patients of groups A and B (200 +/- 99 ms vs 64 +/- 18 and 62 +/- 3, respectively). In group A, on stimulating in the AS, MS, and PS regions, the AH interval remained constant in all patients. In contrast, in groups B and C on stimulation in the MS and PS regions, AH interval shortened (in group B from 56 +/- 8 to 27 +/- 37 and 37 +/- 14, respectively; in group C from 200 +/- 99 to 170 +/- 100 and to 137 +/- 109, respectively). In groups A and B, a posteroseptal slow pathway, and in group C, an anteroseptal retrograde fast pathway were successfully ablated without AV block. Pacemapping of the triangle of Koch can help to recognize patients in whom the anterograde conducting fast pathway is abnormally located far from the anteroseptal region or in whom anterograde conduction of the fast pathway is absent. In these cases the risk of AV block can be reduced by performing slow pathway ablation in a site sufficiently far from the site of the anterograde fast pathway or ablating the retrogradely conducting fast pathway.

Research paper thumbnail of Pacemapping of the Triangle of Koch: A Simple Method to Reduce the Risk of Atrioventricular Block During Radiofrequency Ablation of Atrioventricular Node Reentrant Tachycardia

Pacing and Clinical Electrophysiology, 2001

Slow pathway ablation in common AVNRT can be complicated by total AV block. When radiofrequency e... more Slow pathway ablation in common AVNRT can be complicated by total AV block. When radiofrequency energy is delivered to the posterior aspect of the triangle of Koch, total AV block may be the consequence of the absence of anterograde conduction along the fast pathway or of inadvertent damage to a fast pathway abnormally located close to the slow pathway. To localize the anterogradely conducting fast pathway, the triangle of Koch was pacemapped in 72 patients who underwent the ablation of common AVNRT. In all cases, before ablation the St-H interval was calculated by stimulating the anteroseptal (AS), mid-septal (MS), and posteroseptal (PS) aspect of the triangle of Koch at a rate slightly faster than the sinus rate. In all patients, common AVNRT was induced. In 64 (89%) of 72 patients (group A) the shortest St-H interval was recorded on stimulating the AS region. In six (8%) patients (group B) the shortest St-H interval was recorded on stimulating the MS region. Finally, in two (3%) patients (group C) the shortest St-H interval was recorded stimulating in the PS region. In group C, AH interval, calculated on stimulating in the AS region, was significantly longer than in patients of groups A and B (200 +/- 99 ms vs 64 +/- 18 and 62 +/- 3, respectively). In group A, on stimulating in the AS, MS, and PS regions, the AH interval remained constant in all patients. In contrast, in groups B and C on stimulation in the MS and PS regions, AH interval shortened (in group B from 56 +/- 8 to 27 +/- 37 and 37 +/- 14, respectively; in group C from 200 +/- 99 to 170 +/- 100 and to 137 +/- 109, respectively). In groups A and B, a posteroseptal slow pathway, and in group C, an anteroseptal retrograde fast pathway were successfully ablated without AV block. Pacemapping of the triangle of Koch can help to recognize patients in whom the anterograde conducting fast pathway is abnormally located far from the anteroseptal region or in whom anterograde conduction of the fast pathway is absent. In these cases the risk of AV block can be reduced by performing slow pathway ablation in a site sufficiently far from the site of the anterograde fast pathway or ablating the retrogradely conducting fast pathway.

Research paper thumbnail of Different Clinical Courses and Predictors of Atrial Fibrillation Occurrence After Transisthmic Ablation in Patients with Preablation Lone Atrial Flutter, Coexistent Atrial Fibrillation, and Drug Induced Atrial Flutter

Pacing and Clinical Electrophysiology, 2004

The aim of this prospective study was to compare the long-term follow-up after transisthmic ablat... more The aim of this prospective study was to compare the long-term follow-up after transisthmic ablation of patients with preablation lone atrial flutter, coexistent AF, and drug induced atrial flutter to determine if postablation AF followed a different clinical course and displayed different predictors in these groups. The study evaluated 357 patients who underwent transisthmic ablation for typical atrial flutter. These were divided into four groups according to their preablation history. Group A included patients with typical atrial flutter and without preablation AF (n=120, 33.6%). Group B included patients with preablation AF and spontaneous atrial flutter (n=132, 37.0%). Group C patients had preablation AF and atrial flutter induced by treatment with IC drugs (propafenone or flecainide) (n=63, 17.6%) Group D included patients with preablation AF and atrial flutter induced by treatment with amiodarone (n=42, 11.8%). During a mean follow-up of 15.2 double dagger 10.6 months (range 6-55 months) AF occurred more frequently in groups B (56.1%) and C (57.1%) patients than in groups A (20.8%, P <0.0001) and D (31.0%, P <0.0001) patients. The results of multivariate analysis revealed that different clinical and echocardiographical variables were correlated with postablation AF occurrence in the different groups. Patients with atrial flutter induced by amiodarone have a significantly lower risk of postablation AF than patients with spontaneous atrial flutter and AF, and those with atrial flutter induced by IC drugs. Different clinical and echocardiographical variables predict postablation AF occurrence in different subgroups of patients.

Research paper thumbnail of Different Clinical Courses and Predictors of Atrial Fibrillation Occurrence After Transisthmic Ablation in Patients with Preablation Lone Atrial Flutter, Coexistent Atrial Fibrillation, and Drug Induced Atrial Flutter

Pacing and Clinical Electrophysiology, 2004

The aim of this prospective study was to compare the long-term follow-up after transisthmic ablat... more The aim of this prospective study was to compare the long-term follow-up after transisthmic ablation of patients with preablation lone atrial flutter, coexistent AF, and drug induced atrial flutter to determine if postablation AF followed a different clinical course and displayed different predictors in these groups. The study evaluated 357 patients who underwent transisthmic ablation for typical atrial flutter. These were divided into four groups according to their preablation history. Group A included patients with typical atrial flutter and without preablation AF (n=120, 33.6%). Group B included patients with preablation AF and spontaneous atrial flutter (n=132, 37.0%). Group C patients had preablation AF and atrial flutter induced by treatment with IC drugs (propafenone or flecainide) (n=63, 17.6%) Group D included patients with preablation AF and atrial flutter induced by treatment with amiodarone (n=42, 11.8%). During a mean follow-up of 15.2 double dagger 10.6 months (range 6-55 months) AF occurred more frequently in groups B (56.1%) and C (57.1%) patients than in groups A (20.8%, P <0.0001) and D (31.0%, P <0.0001) patients. The results of multivariate analysis revealed that different clinical and echocardiographical variables were correlated with postablation AF occurrence in the different groups. Patients with atrial flutter induced by amiodarone have a significantly lower risk of postablation AF than patients with spontaneous atrial flutter and AF, and those with atrial flutter induced by IC drugs. Different clinical and echocardiographical variables predict postablation AF occurrence in different subgroups of patients.

Research paper thumbnail of Different Clinical Courses and Predictors of Atrial Fibrillation Occurrence After Transisthmic Ablation in Patients with Preablation Lone Atrial Flutter, Coexistent Atrial Fibrillation, and Drug Induced Atrial Flutter

Pacing and Clinical Electrophysiology, 2004

The aim of this prospective study was to compare the long-term follow-up after transisthmic ablat... more The aim of this prospective study was to compare the long-term follow-up after transisthmic ablation of patients with preablation lone atrial flutter, coexistent AF, and drug induced atrial flutter to determine if postablation AF followed a different clinical course and displayed different predictors in these groups. The study evaluated 357 patients who underwent transisthmic ablation for typical atrial flutter. These were divided into four groups according to their preablation history. Group A included patients with typical atrial flutter and without preablation AF (n=120, 33.6%). Group B included patients with preablation AF and spontaneous atrial flutter (n=132, 37.0%). Group C patients had preablation AF and atrial flutter induced by treatment with IC drugs (propafenone or flecainide) (n=63, 17.6%) Group D included patients with preablation AF and atrial flutter induced by treatment with amiodarone (n=42, 11.8%). During a mean follow-up of 15.2 double dagger 10.6 months (range 6-55 months) AF occurred more frequently in groups B (56.1%) and C (57.1%) patients than in groups A (20.8%, P <0.0001) and D (31.0%, P <0.0001) patients. The results of multivariate analysis revealed that different clinical and echocardiographical variables were correlated with postablation AF occurrence in the different groups. Patients with atrial flutter induced by amiodarone have a significantly lower risk of postablation AF than patients with spontaneous atrial flutter and AF, and those with atrial flutter induced by IC drugs. Different clinical and echocardiographical variables predict postablation AF occurrence in different subgroups of patients.

Research paper thumbnail of Modification of Antegrade Slow Pathway is not Crucial for Successful Catheter Ablation of Common Atrioventricular Nodal Reentrant Tachycardia

Pacing and Clinical Electrophysiology, 1999

Ablation of Common Atrioventricular Nodal Reentrant Tachycardia./w^e tested the hypothesis that i... more Ablation of Common Atrioventricular Nodal Reentrant Tachycardia./w^e tested the hypothesis that in some patients affected by typical AVNRT, successful catheter ablation treatment may be achieved independently of specific measurable electrophysiological modifications of antegrade AV node conducting properties. Standard electrophysiological parameters and comparable antegrade AV node function curves were obtained, before and after successful ablation, in 104 patients (mean age 52 ± 16 years; 69 women and 35 men) affected by the common form of AVNRT. The end point ofthe ablation procedure was noninducibility of AVNRT and of no more than one echo beat. For the purpose of this study, AVnode duality was defined as an increase of ^ 50 ms in the A2H2 interval in response to a 10 ms decrease ofthe A1A2 coupling interval. Refore ablation, AV node duality was present in 65 patients (62%) and absent in 39 patients (37%). Ablation caused measurable modifications of electrophysiological properties oftheAV node in most patients with elicited AV node duality, but not in most patients without demonstrable AV node duality. After ablation, AV node duality persisted in 20 patients who had it before, whereas a new duality that could not be elicited before appeared in 5 patients. During 19 ± 6 months of follow-up, clinical AVNRT recurred in 1 of 45 patients who had disappearance of AVnode duality after ablation, in 1 of 34 patients who did not show AV node duality before and after ablation, and in 1 of 20 patients who had persistence of AVnode duality after ablation. In conclusion, modifications of antegrade conduction properties of the AVnode are not crucial for the cure of AVNRT in many patients/ (PACE 1999; 22:263-267) AV nodal reentrant tachycardia, slow pathways, catheter ablation, electrophysiological study

Research paper thumbnail of Modification of Antegrade Slow Pathway is not Crucial for Successful Catheter Ablation of Common Atrioventricular Nodal Reentrant Tachycardia

Pacing and Clinical Electrophysiology, 1999

Ablation of Common Atrioventricular Nodal Reentrant Tachycardia./w^e tested the hypothesis that i... more Ablation of Common Atrioventricular Nodal Reentrant Tachycardia./w^e tested the hypothesis that in some patients affected by typical AVNRT, successful catheter ablation treatment may be achieved independently of specific measurable electrophysiological modifications of antegrade AV node conducting properties. Standard electrophysiological parameters and comparable antegrade AV node function curves were obtained, before and after successful ablation, in 104 patients (mean age 52 ± 16 years; 69 women and 35 men) affected by the common form of AVNRT. The end point ofthe ablation procedure was noninducibility of AVNRT and of no more than one echo beat. For the purpose of this study, AVnode duality was defined as an increase of ^ 50 ms in the A2H2 interval in response to a 10 ms decrease ofthe A1A2 coupling interval. Refore ablation, AV node duality was present in 65 patients (62%) and absent in 39 patients (37%). Ablation caused measurable modifications of electrophysiological properties oftheAV node in most patients with elicited AV node duality, but not in most patients without demonstrable AV node duality. After ablation, AV node duality persisted in 20 patients who had it before, whereas a new duality that could not be elicited before appeared in 5 patients. During 19 ± 6 months of follow-up, clinical AVNRT recurred in 1 of 45 patients who had disappearance of AVnode duality after ablation, in 1 of 34 patients who did not show AV node duality before and after ablation, and in 1 of 20 patients who had persistence of AVnode duality after ablation. In conclusion, modifications of antegrade conduction properties of the AVnode are not crucial for the cure of AVNRT in many patients/ (PACE 1999; 22:263-267) AV nodal reentrant tachycardia, slow pathways, catheter ablation, electrophysiological study

Research paper thumbnail of Modification of Antegrade Slow Pathway is not Crucial for Successful Catheter Ablation of Common Atrioventricular Nodal Reentrant Tachycardia

Pacing and Clinical Electrophysiology, 1999

Ablation of Common Atrioventricular Nodal Reentrant Tachycardia./w^e tested the hypothesis that i... more Ablation of Common Atrioventricular Nodal Reentrant Tachycardia./w^e tested the hypothesis that in some patients affected by typical AVNRT, successful catheter ablation treatment may be achieved independently of specific measurable electrophysiological modifications of antegrade AV node conducting properties. Standard electrophysiological parameters and comparable antegrade AV node function curves were obtained, before and after successful ablation, in 104 patients (mean age 52 ± 16 years; 69 women and 35 men) affected by the common form of AVNRT. The end point ofthe ablation procedure was noninducibility of AVNRT and of no more than one echo beat. For the purpose of this study, AVnode duality was defined as an increase of ^ 50 ms in the A2H2 interval in response to a 10 ms decrease ofthe A1A2 coupling interval. Refore ablation, AV node duality was present in 65 patients (62%) and absent in 39 patients (37%). Ablation caused measurable modifications of electrophysiological properties oftheAV node in most patients with elicited AV node duality, but not in most patients without demonstrable AV node duality. After ablation, AV node duality persisted in 20 patients who had it before, whereas a new duality that could not be elicited before appeared in 5 patients. During 19 ± 6 months of follow-up, clinical AVNRT recurred in 1 of 45 patients who had disappearance of AVnode duality after ablation, in 1 of 34 patients who did not show AV node duality before and after ablation, and in 1 of 20 patients who had persistence of AVnode duality after ablation. In conclusion, modifications of antegrade conduction properties of the AVnode are not crucial for the cure of AVNRT in many patients/ (PACE 1999; 22:263-267) AV nodal reentrant tachycardia, slow pathways, catheter ablation, electrophysiological study

Research paper thumbnail of Pulmonary-Vein Isolation for Atrial Fibrillation in Patients with Heart Failure

Research paper thumbnail of The Risk of Thromboembolism and Need for Oral Anticoagulation After Successful Atrial Fibrillation Ablation

Journal of the American College of Cardiology, 2010

The aim of this multicenter study was to evaluate the safety of discontinuing oral anticoagulatio... more The aim of this multicenter study was to evaluate the safety of discontinuing oral anticoagulation therapy (OAT) after apparently successful pulmonary vein isolation.

Research paper thumbnail of The Risk of Thromboembolism and Need for Oral Anticoagulation After Successful Atrial Fibrillation Ablation

Journal of the American College of Cardiology, 2010

The aim of this multicenter study was to evaluate the safety of discontinuing oral anticoagulatio... more The aim of this multicenter study was to evaluate the safety of discontinuing oral anticoagulation therapy (OAT) after apparently successful pulmonary vein isolation.

Research paper thumbnail of Ablation of Peri-Mitral Flutter After Ablation of Long Standing Persistent Af: Results from the Propose Multicenter Study

Journal of the American College of Cardiology, 2011

Patients with previous ablation for atrial fibrillation (AF) may experience recurrence of peri-mi... more Patients with previous ablation for atrial fibrillation (AF) may experience recurrence of peri-mitral flutter (PMFL). We sought to determine whether ablation of triggers or completing mitral valve isthmus (MVI) block prevents more arrhythmia recurrences.

Research paper thumbnail of Use of ibutilide in cardioversion of patients with atrial fibrillation or atrial flutter treated with class IC agents

Journal of the American College of Cardiology, 2004

We sought to assess the efficacy and safety of ibutilide cardioversion for those with atrial fibr... more We sought to assess the efficacy and safety of ibutilide cardioversion for those with atrial fibrillation (AF) or atrial flutter (AFL) receiving long-term treatment with class IC agents. BACKGROUND Attenuation of ibutilide-induced QT prolongation has been observed in a small number of patients pretreated with class IC agents. The clinical significance of the interaction between ibutilide and class IC agents is unknown.

Research paper thumbnail of Ablation of Perimitral Flutter Following Catheter Ablation of Atrial Fibrillation: Impact on Outcomes from a Randomized Study (PROPOSE)

Patients with previous ablation for atrial fibrillation (AF) may experience recurrence of perimit... more Patients with previous ablation for atrial fibrillation (AF) may experience recurrence of perimitral flutter (PMFL). These arrhythmias are usually triggered from sources that may also induce AF. This study aims at determining whether ablation of triggers or completing mitral valve isthmus (MVI) block prevents more arrhythmia recurrences. Sixty-five patients with recurrent PMFL after initial ablation of long standing persistent AF were included in this study. Thirty-two patients were randomized to MVI ablation only (Group 1) and 33 were randomized to cardioversion and repeat pulmonary vein (PV) isolation plus ablation of non-PV triggers (Group 2). MVI bidirectional block was achieved in all but 1 patient from Group 1. In Group 2, reconnection of 17 PVs was detected in 14 patients (42%). With isoproterenol challenge, 44 non-PV trigger sites were identified in 28 patients (85%, 1.57 sites per patient). At 18-month follow-up, 27 patients (84%) from Group 1 had recurrent atrial tachyarrhythmias, of whom 15 remained on antiarrhythmic drug (AAD); however, 28 patients from Group 2 (85%, P < 0.0001 vs Group 1) were free from arrhythmia off AAD. The ablation strategy used in Group 2 was associated with a lower risk of recurrence (hazard ratio = 0.10, 95% CI 0.04-0.28, P < 0.001) and an improved arrhythmia-free survival (log rank P < 0.0001). In patients presenting with PMFL after ablation for longstanding persistent AF, MVI block had limited impact on arrhythmia recurrence. On the other hand, elimination of all PV and non-PV triggers achieved higher freedom from atrial arrhythmias at follow-up.

Research paper thumbnail of Visually-Guided Balloon Catheter Ablation of Atrial Fibrillation Experimental Feasibility and First-in-Human Multicenter Clinical Outcome

Background—Electric isolation of the pulmonary veins (PVs) can successfully treat patients with p... more Background—Electric isolation of the pulmonary veins (PVs) can successfully treat patients with paroxysmal atrial fibrillation. However, it remains technically challenging to identify the left atrial-PV junction and sequentially position the ablation catheter in a point-by-point contiguous fashion to isolate the PVs. In this study, a novel endoscopic ablation system was used to directly visualize and ablate tissue at the left

Research paper thumbnail of Visually-Guided Balloon Catheter Ablation of Atrial Fibrillation Experimental Feasibility and First-in-Human Multicenter Clinical Outcome

Background—Electric isolation of the pulmonary veins (PVs) can successfully treat patients with p... more Background—Electric isolation of the pulmonary veins (PVs) can successfully treat patients with paroxysmal atrial fibrillation. However, it remains technically challenging to identify the left atrial-PV junction and sequentially position the ablation catheter in a point-by-point contiguous fashion to isolate the PVs. In this study, a novel endoscopic ablation system was used to directly visualize and ablate tissue at the left

Research paper thumbnail of Ablation of Perimitral Flutter Following Catheter Ablation of Atrial Fibrillation: Impact on Outcomes from a Randomized Study (PROPOSE)

Patients with previous ablation for atrial fibrillation (AF) may experience recurrence of perimit... more Patients with previous ablation for atrial fibrillation (AF) may experience recurrence of perimitral flutter (PMFL). These arrhythmias are usually triggered from sources that may also induce AF. This study aims at determining whether ablation of triggers or completing mitral valve isthmus (MVI) block prevents more arrhythmia recurrences. Sixty-five patients with recurrent PMFL after initial ablation of long standing persistent AF were included in this study. Thirty-two patients were randomized to MVI ablation only (Group 1) and 33 were randomized to cardioversion and repeat pulmonary vein (PV) isolation plus ablation of non-PV triggers (Group 2). MVI bidirectional block was achieved in all but 1 patient from Group 1. In Group 2, reconnection of 17 PVs was detected in 14 patients (42%). With isoproterenol challenge, 44 non-PV trigger sites were identified in 28 patients (85%, 1.57 sites per patient). At 18-month follow-up, 27 patients (84%) from Group 1 had recurrent atrial tachyarrhythmias, of whom 15 remained on antiarrhythmic drug (AAD); however, 28 patients from Group 2 (85%, P < 0.0001 vs Group 1) were free from arrhythmia off AAD. The ablation strategy used in Group 2 was associated with a lower risk of recurrence (hazard ratio = 0.10, 95% CI 0.04-0.28, P < 0.001) and an improved arrhythmia-free survival (log rank P < 0.0001). In patients presenting with PMFL after ablation for longstanding persistent AF, MVI block had limited impact on arrhythmia recurrence. On the other hand, elimination of all PV and non-PV triggers achieved higher freedom from atrial arrhythmias at follow-up.

Research paper thumbnail of Ablation of Perimitral Flutter Following Catheter Ablation of Atrial Fibrillation: Impact on Outcomes from a Randomized Study (PROPOSE)

Patients with previous ablation for atrial fibrillation (AF) may experience recurrence of perimit... more Patients with previous ablation for atrial fibrillation (AF) may experience recurrence of perimitral flutter (PMFL). These arrhythmias are usually triggered from sources that may also induce AF. This study aims at determining whether ablation of triggers or completing mitral valve isthmus (MVI) block prevents more arrhythmia recurrences. Sixty-five patients with recurrent PMFL after initial ablation of long standing persistent AF were included in this study. Thirty-two patients were randomized to MVI ablation only (Group 1) and 33 were randomized to cardioversion and repeat pulmonary vein (PV) isolation plus ablation of non-PV triggers (Group 2). MVI bidirectional block was achieved in all but 1 patient from Group 1. In Group 2, reconnection of 17 PVs was detected in 14 patients (42%). With isoproterenol challenge, 44 non-PV trigger sites were identified in 28 patients (85%, 1.57 sites per patient). At 18-month follow-up, 27 patients (84%) from Group 1 had recurrent atrial tachyarrhythmias, of whom 15 remained on antiarrhythmic drug (AAD); however, 28 patients from Group 2 (85%, P < 0.0001 vs Group 1) were free from arrhythmia off AAD. The ablation strategy used in Group 2 was associated with a lower risk of recurrence (hazard ratio = 0.10, 95% CI 0.04-0.28, P < 0.001) and an improved arrhythmia-free survival (log rank P < 0.0001). In patients presenting with PMFL after ablation for longstanding persistent AF, MVI block had limited impact on arrhythmia recurrence. On the other hand, elimination of all PV and non-PV triggers achieved higher freedom from atrial arrhythmias at follow-up.

Research paper thumbnail of Atrial fibrillation ablation strategies for paroxysmal patients: randomized comparison between different techniques

Circulation. Arrhythmia and electrophysiology, 2009

Whether different ablation strategies affect paroxysmal atrial fibrillation (AF) long-term freedo... more Whether different ablation strategies affect paroxysmal atrial fibrillation (AF) long-term freedom from AF/atrial tachyarrhythmia is unclear. We sought to compare the effect of 3 different ablation approaches on the long-term success in patients with paroxysmal AF. One hundred three consecutive patients with paroxysmal AF scheduled for ablation and presenting in the electrophysiology laboratory in AF were selected for this study. Patients were randomized to pulmonary vein antrum isolation (PVAI; n=35) versus biatrial ablation of the complex fractionated atrial electrograms (CFAEs; n=34) versus PVAI followed by CFAEs (n=34). Patients were given event recorders and followed up at 3, 6, 9, 12, and 15 months postablation. There was no statistical significant difference between the groups in term of sex, age, AF duration, left atrial size, and ejection fraction. At 1 year follow-up, freedom from AF/atrial tachyarrhythmia was documented in 89% of patients in the PVAI group, 91% in the PVA...

Research paper thumbnail of Pacemapping of the Triangle of Koch: A Simple Method to Reduce the Risk of Atrioventricular Block During Radiofrequency Ablation of Atrioventricular Node Reentrant Tachycardia

Pacing and Clinical Electrophysiology, 2001

Slow pathway ablation in common AVNRT can be complicated by total AV block. When radiofrequency e... more Slow pathway ablation in common AVNRT can be complicated by total AV block. When radiofrequency energy is delivered to the posterior aspect of the triangle of Koch, total AV block may be the consequence of the absence of anterograde conduction along the fast pathway or of inadvertent damage to a fast pathway abnormally located close to the slow pathway. To localize the anterogradely conducting fast pathway, the triangle of Koch was pacemapped in 72 patients who underwent the ablation of common AVNRT. In all cases, before ablation the St-H interval was calculated by stimulating the anteroseptal (AS), mid-septal (MS), and posteroseptal (PS) aspect of the triangle of Koch at a rate slightly faster than the sinus rate. In all patients, common AVNRT was induced. In 64 (89%) of 72 patients (group A) the shortest St-H interval was recorded on stimulating the AS region. In six (8%) patients (group B) the shortest St-H interval was recorded on stimulating the MS region. Finally, in two (3%) patients (group C) the shortest St-H interval was recorded stimulating in the PS region. In group C, AH interval, calculated on stimulating in the AS region, was significantly longer than in patients of groups A and B (200 +/- 99 ms vs 64 +/- 18 and 62 +/- 3, respectively). In group A, on stimulating in the AS, MS, and PS regions, the AH interval remained constant in all patients. In contrast, in groups B and C on stimulation in the MS and PS regions, AH interval shortened (in group B from 56 +/- 8 to 27 +/- 37 and 37 +/- 14, respectively; in group C from 200 +/- 99 to 170 +/- 100 and to 137 +/- 109, respectively). In groups A and B, a posteroseptal slow pathway, and in group C, an anteroseptal retrograde fast pathway were successfully ablated without AV block. Pacemapping of the triangle of Koch can help to recognize patients in whom the anterograde conducting fast pathway is abnormally located far from the anteroseptal region or in whom anterograde conduction of the fast pathway is absent. In these cases the risk of AV block can be reduced by performing slow pathway ablation in a site sufficiently far from the site of the anterograde fast pathway or ablating the retrogradely conducting fast pathway.

Research paper thumbnail of Pacemapping of the Triangle of Koch: A Simple Method to Reduce the Risk of Atrioventricular Block During Radiofrequency Ablation of Atrioventricular Node Reentrant Tachycardia

Pacing and Clinical Electrophysiology, 2001

Slow pathway ablation in common AVNRT can be complicated by total AV block. When radiofrequency e... more Slow pathway ablation in common AVNRT can be complicated by total AV block. When radiofrequency energy is delivered to the posterior aspect of the triangle of Koch, total AV block may be the consequence of the absence of anterograde conduction along the fast pathway or of inadvertent damage to a fast pathway abnormally located close to the slow pathway. To localize the anterogradely conducting fast pathway, the triangle of Koch was pacemapped in 72 patients who underwent the ablation of common AVNRT. In all cases, before ablation the St-H interval was calculated by stimulating the anteroseptal (AS), mid-septal (MS), and posteroseptal (PS) aspect of the triangle of Koch at a rate slightly faster than the sinus rate. In all patients, common AVNRT was induced. In 64 (89%) of 72 patients (group A) the shortest St-H interval was recorded on stimulating the AS region. In six (8%) patients (group B) the shortest St-H interval was recorded on stimulating the MS region. Finally, in two (3%) patients (group C) the shortest St-H interval was recorded stimulating in the PS region. In group C, AH interval, calculated on stimulating in the AS region, was significantly longer than in patients of groups A and B (200 +/- 99 ms vs 64 +/- 18 and 62 +/- 3, respectively). In group A, on stimulating in the AS, MS, and PS regions, the AH interval remained constant in all patients. In contrast, in groups B and C on stimulation in the MS and PS regions, AH interval shortened (in group B from 56 +/- 8 to 27 +/- 37 and 37 +/- 14, respectively; in group C from 200 +/- 99 to 170 +/- 100 and to 137 +/- 109, respectively). In groups A and B, a posteroseptal slow pathway, and in group C, an anteroseptal retrograde fast pathway were successfully ablated without AV block. Pacemapping of the triangle of Koch can help to recognize patients in whom the anterograde conducting fast pathway is abnormally located far from the anteroseptal region or in whom anterograde conduction of the fast pathway is absent. In these cases the risk of AV block can be reduced by performing slow pathway ablation in a site sufficiently far from the site of the anterograde fast pathway or ablating the retrogradely conducting fast pathway.

Research paper thumbnail of Pacemapping of the Triangle of Koch: A Simple Method to Reduce the Risk of Atrioventricular Block During Radiofrequency Ablation of Atrioventricular Node Reentrant Tachycardia

Pacing and Clinical Electrophysiology, 2001

Slow pathway ablation in common AVNRT can be complicated by total AV block. When radiofrequency e... more Slow pathway ablation in common AVNRT can be complicated by total AV block. When radiofrequency energy is delivered to the posterior aspect of the triangle of Koch, total AV block may be the consequence of the absence of anterograde conduction along the fast pathway or of inadvertent damage to a fast pathway abnormally located close to the slow pathway. To localize the anterogradely conducting fast pathway, the triangle of Koch was pacemapped in 72 patients who underwent the ablation of common AVNRT. In all cases, before ablation the St-H interval was calculated by stimulating the anteroseptal (AS), mid-septal (MS), and posteroseptal (PS) aspect of the triangle of Koch at a rate slightly faster than the sinus rate. In all patients, common AVNRT was induced. In 64 (89%) of 72 patients (group A) the shortest St-H interval was recorded on stimulating the AS region. In six (8%) patients (group B) the shortest St-H interval was recorded on stimulating the MS region. Finally, in two (3%) patients (group C) the shortest St-H interval was recorded stimulating in the PS region. In group C, AH interval, calculated on stimulating in the AS region, was significantly longer than in patients of groups A and B (200 +/- 99 ms vs 64 +/- 18 and 62 +/- 3, respectively). In group A, on stimulating in the AS, MS, and PS regions, the AH interval remained constant in all patients. In contrast, in groups B and C on stimulation in the MS and PS regions, AH interval shortened (in group B from 56 +/- 8 to 27 +/- 37 and 37 +/- 14, respectively; in group C from 200 +/- 99 to 170 +/- 100 and to 137 +/- 109, respectively). In groups A and B, a posteroseptal slow pathway, and in group C, an anteroseptal retrograde fast pathway were successfully ablated without AV block. Pacemapping of the triangle of Koch can help to recognize patients in whom the anterograde conducting fast pathway is abnormally located far from the anteroseptal region or in whom anterograde conduction of the fast pathway is absent. In these cases the risk of AV block can be reduced by performing slow pathway ablation in a site sufficiently far from the site of the anterograde fast pathway or ablating the retrogradely conducting fast pathway.

Research paper thumbnail of Different Clinical Courses and Predictors of Atrial Fibrillation Occurrence After Transisthmic Ablation in Patients with Preablation Lone Atrial Flutter, Coexistent Atrial Fibrillation, and Drug Induced Atrial Flutter

Pacing and Clinical Electrophysiology, 2004

The aim of this prospective study was to compare the long-term follow-up after transisthmic ablat... more The aim of this prospective study was to compare the long-term follow-up after transisthmic ablation of patients with preablation lone atrial flutter, coexistent AF, and drug induced atrial flutter to determine if postablation AF followed a different clinical course and displayed different predictors in these groups. The study evaluated 357 patients who underwent transisthmic ablation for typical atrial flutter. These were divided into four groups according to their preablation history. Group A included patients with typical atrial flutter and without preablation AF (n=120, 33.6%). Group B included patients with preablation AF and spontaneous atrial flutter (n=132, 37.0%). Group C patients had preablation AF and atrial flutter induced by treatment with IC drugs (propafenone or flecainide) (n=63, 17.6%) Group D included patients with preablation AF and atrial flutter induced by treatment with amiodarone (n=42, 11.8%). During a mean follow-up of 15.2 double dagger 10.6 months (range 6-55 months) AF occurred more frequently in groups B (56.1%) and C (57.1%) patients than in groups A (20.8%, P <0.0001) and D (31.0%, P <0.0001) patients. The results of multivariate analysis revealed that different clinical and echocardiographical variables were correlated with postablation AF occurrence in the different groups. Patients with atrial flutter induced by amiodarone have a significantly lower risk of postablation AF than patients with spontaneous atrial flutter and AF, and those with atrial flutter induced by IC drugs. Different clinical and echocardiographical variables predict postablation AF occurrence in different subgroups of patients.

Research paper thumbnail of Different Clinical Courses and Predictors of Atrial Fibrillation Occurrence After Transisthmic Ablation in Patients with Preablation Lone Atrial Flutter, Coexistent Atrial Fibrillation, and Drug Induced Atrial Flutter

Pacing and Clinical Electrophysiology, 2004

The aim of this prospective study was to compare the long-term follow-up after transisthmic ablat... more The aim of this prospective study was to compare the long-term follow-up after transisthmic ablation of patients with preablation lone atrial flutter, coexistent AF, and drug induced atrial flutter to determine if postablation AF followed a different clinical course and displayed different predictors in these groups. The study evaluated 357 patients who underwent transisthmic ablation for typical atrial flutter. These were divided into four groups according to their preablation history. Group A included patients with typical atrial flutter and without preablation AF (n=120, 33.6%). Group B included patients with preablation AF and spontaneous atrial flutter (n=132, 37.0%). Group C patients had preablation AF and atrial flutter induced by treatment with IC drugs (propafenone or flecainide) (n=63, 17.6%) Group D included patients with preablation AF and atrial flutter induced by treatment with amiodarone (n=42, 11.8%). During a mean follow-up of 15.2 double dagger 10.6 months (range 6-55 months) AF occurred more frequently in groups B (56.1%) and C (57.1%) patients than in groups A (20.8%, P <0.0001) and D (31.0%, P <0.0001) patients. The results of multivariate analysis revealed that different clinical and echocardiographical variables were correlated with postablation AF occurrence in the different groups. Patients with atrial flutter induced by amiodarone have a significantly lower risk of postablation AF than patients with spontaneous atrial flutter and AF, and those with atrial flutter induced by IC drugs. Different clinical and echocardiographical variables predict postablation AF occurrence in different subgroups of patients.

Research paper thumbnail of Different Clinical Courses and Predictors of Atrial Fibrillation Occurrence After Transisthmic Ablation in Patients with Preablation Lone Atrial Flutter, Coexistent Atrial Fibrillation, and Drug Induced Atrial Flutter

Pacing and Clinical Electrophysiology, 2004

The aim of this prospective study was to compare the long-term follow-up after transisthmic ablat... more The aim of this prospective study was to compare the long-term follow-up after transisthmic ablation of patients with preablation lone atrial flutter, coexistent AF, and drug induced atrial flutter to determine if postablation AF followed a different clinical course and displayed different predictors in these groups. The study evaluated 357 patients who underwent transisthmic ablation for typical atrial flutter. These were divided into four groups according to their preablation history. Group A included patients with typical atrial flutter and without preablation AF (n=120, 33.6%). Group B included patients with preablation AF and spontaneous atrial flutter (n=132, 37.0%). Group C patients had preablation AF and atrial flutter induced by treatment with IC drugs (propafenone or flecainide) (n=63, 17.6%) Group D included patients with preablation AF and atrial flutter induced by treatment with amiodarone (n=42, 11.8%). During a mean follow-up of 15.2 double dagger 10.6 months (range 6-55 months) AF occurred more frequently in groups B (56.1%) and C (57.1%) patients than in groups A (20.8%, P <0.0001) and D (31.0%, P <0.0001) patients. The results of multivariate analysis revealed that different clinical and echocardiographical variables were correlated with postablation AF occurrence in the different groups. Patients with atrial flutter induced by amiodarone have a significantly lower risk of postablation AF than patients with spontaneous atrial flutter and AF, and those with atrial flutter induced by IC drugs. Different clinical and echocardiographical variables predict postablation AF occurrence in different subgroups of patients.

Research paper thumbnail of Modification of Antegrade Slow Pathway is not Crucial for Successful Catheter Ablation of Common Atrioventricular Nodal Reentrant Tachycardia

Pacing and Clinical Electrophysiology, 1999

Ablation of Common Atrioventricular Nodal Reentrant Tachycardia./w^e tested the hypothesis that i... more Ablation of Common Atrioventricular Nodal Reentrant Tachycardia./w^e tested the hypothesis that in some patients affected by typical AVNRT, successful catheter ablation treatment may be achieved independently of specific measurable electrophysiological modifications of antegrade AV node conducting properties. Standard electrophysiological parameters and comparable antegrade AV node function curves were obtained, before and after successful ablation, in 104 patients (mean age 52 ± 16 years; 69 women and 35 men) affected by the common form of AVNRT. The end point ofthe ablation procedure was noninducibility of AVNRT and of no more than one echo beat. For the purpose of this study, AVnode duality was defined as an increase of ^ 50 ms in the A2H2 interval in response to a 10 ms decrease ofthe A1A2 coupling interval. Refore ablation, AV node duality was present in 65 patients (62%) and absent in 39 patients (37%). Ablation caused measurable modifications of electrophysiological properties oftheAV node in most patients with elicited AV node duality, but not in most patients without demonstrable AV node duality. After ablation, AV node duality persisted in 20 patients who had it before, whereas a new duality that could not be elicited before appeared in 5 patients. During 19 ± 6 months of follow-up, clinical AVNRT recurred in 1 of 45 patients who had disappearance of AVnode duality after ablation, in 1 of 34 patients who did not show AV node duality before and after ablation, and in 1 of 20 patients who had persistence of AVnode duality after ablation. In conclusion, modifications of antegrade conduction properties of the AVnode are not crucial for the cure of AVNRT in many patients/ (PACE 1999; 22:263-267) AV nodal reentrant tachycardia, slow pathways, catheter ablation, electrophysiological study

Research paper thumbnail of Modification of Antegrade Slow Pathway is not Crucial for Successful Catheter Ablation of Common Atrioventricular Nodal Reentrant Tachycardia

Pacing and Clinical Electrophysiology, 1999

Ablation of Common Atrioventricular Nodal Reentrant Tachycardia./w^e tested the hypothesis that i... more Ablation of Common Atrioventricular Nodal Reentrant Tachycardia./w^e tested the hypothesis that in some patients affected by typical AVNRT, successful catheter ablation treatment may be achieved independently of specific measurable electrophysiological modifications of antegrade AV node conducting properties. Standard electrophysiological parameters and comparable antegrade AV node function curves were obtained, before and after successful ablation, in 104 patients (mean age 52 ± 16 years; 69 women and 35 men) affected by the common form of AVNRT. The end point ofthe ablation procedure was noninducibility of AVNRT and of no more than one echo beat. For the purpose of this study, AVnode duality was defined as an increase of ^ 50 ms in the A2H2 interval in response to a 10 ms decrease ofthe A1A2 coupling interval. Refore ablation, AV node duality was present in 65 patients (62%) and absent in 39 patients (37%). Ablation caused measurable modifications of electrophysiological properties oftheAV node in most patients with elicited AV node duality, but not in most patients without demonstrable AV node duality. After ablation, AV node duality persisted in 20 patients who had it before, whereas a new duality that could not be elicited before appeared in 5 patients. During 19 ± 6 months of follow-up, clinical AVNRT recurred in 1 of 45 patients who had disappearance of AVnode duality after ablation, in 1 of 34 patients who did not show AV node duality before and after ablation, and in 1 of 20 patients who had persistence of AVnode duality after ablation. In conclusion, modifications of antegrade conduction properties of the AVnode are not crucial for the cure of AVNRT in many patients/ (PACE 1999; 22:263-267) AV nodal reentrant tachycardia, slow pathways, catheter ablation, electrophysiological study

Research paper thumbnail of Modification of Antegrade Slow Pathway is not Crucial for Successful Catheter Ablation of Common Atrioventricular Nodal Reentrant Tachycardia

Pacing and Clinical Electrophysiology, 1999

Ablation of Common Atrioventricular Nodal Reentrant Tachycardia./w^e tested the hypothesis that i... more Ablation of Common Atrioventricular Nodal Reentrant Tachycardia./w^e tested the hypothesis that in some patients affected by typical AVNRT, successful catheter ablation treatment may be achieved independently of specific measurable electrophysiological modifications of antegrade AV node conducting properties. Standard electrophysiological parameters and comparable antegrade AV node function curves were obtained, before and after successful ablation, in 104 patients (mean age 52 ± 16 years; 69 women and 35 men) affected by the common form of AVNRT. The end point ofthe ablation procedure was noninducibility of AVNRT and of no more than one echo beat. For the purpose of this study, AVnode duality was defined as an increase of ^ 50 ms in the A2H2 interval in response to a 10 ms decrease ofthe A1A2 coupling interval. Refore ablation, AV node duality was present in 65 patients (62%) and absent in 39 patients (37%). Ablation caused measurable modifications of electrophysiological properties oftheAV node in most patients with elicited AV node duality, but not in most patients without demonstrable AV node duality. After ablation, AV node duality persisted in 20 patients who had it before, whereas a new duality that could not be elicited before appeared in 5 patients. During 19 ± 6 months of follow-up, clinical AVNRT recurred in 1 of 45 patients who had disappearance of AVnode duality after ablation, in 1 of 34 patients who did not show AV node duality before and after ablation, and in 1 of 20 patients who had persistence of AVnode duality after ablation. In conclusion, modifications of antegrade conduction properties of the AVnode are not crucial for the cure of AVNRT in many patients/ (PACE 1999; 22:263-267) AV nodal reentrant tachycardia, slow pathways, catheter ablation, electrophysiological study

Research paper thumbnail of Pulmonary-Vein Isolation for Atrial Fibrillation in Patients with Heart Failure

Research paper thumbnail of The Risk of Thromboembolism and Need for Oral Anticoagulation After Successful Atrial Fibrillation Ablation

Journal of the American College of Cardiology, 2010

The aim of this multicenter study was to evaluate the safety of discontinuing oral anticoagulatio... more The aim of this multicenter study was to evaluate the safety of discontinuing oral anticoagulation therapy (OAT) after apparently successful pulmonary vein isolation.

Research paper thumbnail of The Risk of Thromboembolism and Need for Oral Anticoagulation After Successful Atrial Fibrillation Ablation

Journal of the American College of Cardiology, 2010

The aim of this multicenter study was to evaluate the safety of discontinuing oral anticoagulatio... more The aim of this multicenter study was to evaluate the safety of discontinuing oral anticoagulation therapy (OAT) after apparently successful pulmonary vein isolation.

Research paper thumbnail of Ablation of Peri-Mitral Flutter After Ablation of Long Standing Persistent Af: Results from the Propose Multicenter Study

Journal of the American College of Cardiology, 2011

Patients with previous ablation for atrial fibrillation (AF) may experience recurrence of peri-mi... more Patients with previous ablation for atrial fibrillation (AF) may experience recurrence of peri-mitral flutter (PMFL). We sought to determine whether ablation of triggers or completing mitral valve isthmus (MVI) block prevents more arrhythmia recurrences.

Research paper thumbnail of Use of ibutilide in cardioversion of patients with atrial fibrillation or atrial flutter treated with class IC agents

Journal of the American College of Cardiology, 2004

We sought to assess the efficacy and safety of ibutilide cardioversion for those with atrial fibr... more We sought to assess the efficacy and safety of ibutilide cardioversion for those with atrial fibrillation (AF) or atrial flutter (AFL) receiving long-term treatment with class IC agents. BACKGROUND Attenuation of ibutilide-induced QT prolongation has been observed in a small number of patients pretreated with class IC agents. The clinical significance of the interaction between ibutilide and class IC agents is unknown.