Background: The endoscopic ablation system (EAS) is an established ablation device for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). The novel X3 EAS is now equipped with a contiguous circumferential ablation mode (RAPID mode). Aim: To determine the feasibility of single-sweep ablation using X3. Methods: Consecutive patients who underwent AF ablation using X3 were enrolled. We assessed the acute procedural data focusing on “Single-sweep PVI” defined as PVI with a single energy application using RAPID mode to complete the circular lesion set, and on “first-pass isolation” defined as successful visually guided PVI after initial circular lesion set. Results: One-hundred AF patients (56% male, age 68±10 years, 66% paroxysmal AF) were analyzed. A total of 379 of 383 PVs (99%) were isolated with X3. Single-sweep isolation and first-pass-isolation were achieved in 214 PVs (56%) and in 362 PVs (95%), respectively. Single-sweep isolation rates varied across PVs with higher rates at the superior PVs (61.2% vs. inferior PVs:49.5%, P=0.0239) and at PVs with maximal ostial diameter <24mm (57.6% vs. >24mm: 36.8%, P=0.0151). The mean total procedure and fluoroscopy times were 43.0±10 and 4.0±2 mins, respectively. In none of the patients an acute thromboembolic event (stroke or transient ischemic attack) or a pericardial effusion/tamponade occurred. A single transient phrenic nerve palsy was observed. Conclusion: The new X3 EAS allows for single-sweep PVI in 56% of PVs. The new RAPID ablation mode leads to an improved rate of first-pass isolation associated with very short procedure times without compromising safety.

Backgrounds: Left atrial appendage (LAA) isolation (LAAI) has been described as an adjunctive ablation strategy for patients with recurrent atrial fibrillation (AF). Objectives: We compared the clinical impact of persistent LAAI durability between radiofrequency catheter (RF)-guided wide-area LAAI and cryoballoon (CB)-guided ostial LAAI. Methods: Consecutive patients who underwent RF- or CB-guided LAAI were retrospectively analyzed. RF-guided LAAI was performed by combining anterior, roof and mitral isthmus linear ablation. CB-guided LAAI was performed by LAA ostial ablation. After LAAI, patients underwent invasive re-mapping study. LAA closure was performed if persistent durability was confirmed. Procedural data, LAAI durability and ATa recurrence were assessed. Results: A total of 260 patients (RF:n=201, CB:n=59) undergoing LAAI were identified out of 7630 AF ablation procedures. Acute rate of procedural LAAI was significantly higher in CB group (RF: 82.6% vs. CB: 94.9%, P=0.02) and associated with a lower rate of pericardial effusion (RF: 7.5% vs. CB: 0%, P=0.03). Six-week durable LAAI was similar between two groups (RF: 78.1% vs. CB: 66.0%, P=0.103). One-year freedom from ATa recurrence was higher in the patients with durable LAAI after RF-guided wide-area LAAI irrespective of arrhythmia types (overall; RF:76.3% vs. CB:56.7%, P=0.0017, only AF; RF:81.3% vs. CB:57.5%, P=0.0013, respectively). Multivariate analysis revealed that RF-guided LAAI was a predictor of freedom from ATa recurrence (HR: 0.41, 95%CI: 0.221–0.766, P=0.0056). Conclusions: Acute LAAI can be more readily and safely achieved by CB-guided ostial ablation. In patients with confirmed LAAI, however, the freedom from ATa recurrence was higher after a RF-guided wide-area isolation.

Backgrounds: The role of non-pulmonary vein (PV) triggers ablation in persistent atrial fibrillation (PEAF) was suggested but it is still under debate. Objectives: We aimed to assess the effectiveness of non-PV trigger targeted ablation for patients with PEAF. Methods: Consecutive patients with PEAF undergoing catheter ablation (CA) between January 2015 and April 2017 were enrolled. Isoproterenol plus adenosine challenge was performed to provoke non-PV triggers. Non-PV triggers were defined as the non-PV foci inducing AF and/or frequent premature contraction (non-PV PAC) from other than PVs. Three groups were defined: group 1 (n=186) without non-PV triggers; group 2 (n=65) with non-PV triggers that could be completely eliminated with CA; group 3 (n=49) with non-PV triggers still inducible after CA. Primary endpoint was freedom from any atrial tachyarrhythmia (ATa) recurrence. Results: A total of 300 patients (230 males, age 64±10) were enrolled. Mean follow-up period was 27±10 months. Freedom from ATa recurrence at 1- and 2 years were significantly lower in group 3 compared to the other 2 groups (group 1; 74.7%, 67.2% vs. group 2; 75.8%, 68.3% vs. group 3: 52.1%, 38.6%, P=0.0005), irrespective of the type of non-PV triggers (non-PV PAC vs. non-PV foci initiating AF). On multivariate analysis, unsuccessful elimination of non-PV trigger was an independent predictor for ATa recurrence (HR 1.80 [95%CI:1.07-2.93], P=0.026). Conclusions: Successful non-PV trigger elimination can improve the ATa recurrence rate in PEAF ablation. ATa recurrence rate is higher, if non-PV foci or even non-PV PAC remains in patients with PEAF.