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Close theclinics.com Home Articles & Issues Back Articles in Press Buy Back Issues Current Issue Future Issues Past Issues Case Reports Back Abnormalities of Impulse Formation and Conduction Atrial Fibrillation/Atrial Flutter Supraventricular Tachycardia Ventricular Tachycardia For Authors Back Author Information Researcher Academy Series Information Back About Contact Information Media Information Pricing Information Subscribe Go search All Content Article Title, Abstract, Keywords Authors Article Title Abstract Advanced Search Log in Register Subscribe Claim On the Cover Subscribe to Journal June 2020 Volume 12, Issue 2 Consulting Editors: Ranjan K. Thakur, MD, MPH, FHRS and Andrea Natale, MD, FACC, FHRS New Content Alerts Publishing Information Cardiac Electrophysiology Clinics is published by Elsevier. Current Issue June 2020 Volume 12, Issue 2 Current Topic Advances in Atrial Fibrillation Ablation Luigi Di Biase, Francis Marchlinski, Andrea Natale, Editors The COVID-19 pandemic forces us to reevaluate what is truly important to us as individuals and as a collective. As the tragedy unfolds before us, we are forced to pause and examine our behaviors; we are invited to think of new ways to solve this problem for our own and future generations. May we all persevere and fight for our collective well-being. Despite all the immediate turmoil and peril, life keeps going and the electrophysiology community still needs guidance and education. This issue, finalized during the COVID-19 pandemic, focuses on the treatment of atrial fibrillation (AF), from lifestyle modification to catheter ablation. Specifically, it focuses on different energy sources and balloon approaches to isolate the pulmonary veins. In addition, the issue provides guidance on what to do in patients with recurrent AF and already isolated pulmonary veins and highlights alternative technique and targets for ablation. Extensive narration of non-pulmonary vein triggers approaches is presented. Finally, as atrioesophageal fistula represents the most worrisome complication of AF ablation procedures, techniques for esophageal protection are presented. Recent Issues Articles in Press Past Issues Most Read 2020 - Volume 12 December 2019 Advances in Cardiac Mapping and Catheter Ablation: Part II Mohammad Shenasa, Amin Al-Ahmad, Editors September 2019 Advances in Cardiac Mapping and Catheter Ablation: Part I Mohammad Shenasa, Amin Al-Ahmad, Editors June 2019 Interpreting Complex Arrhythmias: Part III Giuseppe Bagliani, Roberto De Ponti, Fabio M. Leonelli, EditorsMarch 2020 Left Atrial Appendage Dhanunjaya Lakkireddy, David R. Holmes, Saibal Kar, Editors Epicardial Ablation in Nonischemic Ventricular Tachyardia Mouhannad M. Sadek, Daniele Muser, Pasquale Santangeli, Francis E. Marchlinski DOI: https://doi.org/10.1016/j.ccep.2020.05.004 Publication stage: In Press Corrected Proof Preview Full-Text HTML PDF x In patients with nonischemic cardiomyopathy, epicardial ablation is critical in targeting epicardial paravalvular substrate. Epicardial access and ablation can be performed safely with attention to epicardial structures, such as the coronary arteries, phrenic nerve, and epicardial fat. This review explores the indications, techniques, complications, and outcomes of epicardial ablation in patients with nonischemic cardiomyopathy. Although epicardial ablation adds to the complexity and risk of the ablation procedure, it is a vital tool that, combined with endocardial mapping and ablation, improves outcomes in patients with nonischemic cardiomyopathy suffering from ventricular arrhythmias. Epicardial Ablation via Arterial and Venous Systems Venkatakrishna N. Tholakanahalli DOI: https://doi.org/10.1016/j.ccep.2020.06.006 Publication stage: In Press Corrected Proof Preview Full-Text HTML PDF x The intracoronary artery and venous routes provide unique roadmaps for mapping and interventions for ventricular arrhythmias and certain atrial arrhythmias. The unique anatomic location of these vessels on the epicardial surface enables mapping/interventions without the need to access the pericardial space. These anatomic routes also track deep into certain intramural regions, with interventions that are not accessible from either epicardial or endocardial routes. To map smaller vessels, multipolar catheters and wires are used to record local electrograms. Endocardial/epicardial ablation at adjacent sites is sometimes required to enhance successful outcomes. This article describes tools, techniques, and site-specific mapping and interventions. Epicardial Ablation of Ventricular Tachycardia in Arrhythmogenic Right Ventricular Cardiomyopathy Fabrizio R. Assis, Harikrishna Tandri DOI: https://doi.org/10.1016/j.ccep.2020.05.005 Publication stage: In Press Corrected Proof Preview Full-Text HTML PDF Supplemental Materials x Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart muscle disease characterized by progressive fibrofatty replacement of the myocardium, right ventricular enlargement, and malignant ventricular arrhythmias. Ventricular tachycardia (VT) may be seen in all stages of the disease and is associated with sudden cardiac death. In patients who failed anti-arrhythmic medical therapy, catheter ablation has become an attractive therapeutic option to reduce VT burden and implantable cardioverter-defibrillator interventions. In this article, the authors aim to address the overall concepts of epicardial catheter ablation in ARVC, focusing on substrate characterization and ablation strategies. Epicardial Ablation of Ventricular Tachycardia in Ischemic Cardiomyopathy Travis D. Richardson, Arvindh N. Kanagasundram, William G. Stevenson DOI: https://doi.org/10.1016/j.ccep.2020.05.003 Publication stage: In Press Corrected Proof Preview Full-Text HTML PDF x Catheter ablation can effectively reduce the frequency of ventricular tachycardia in ischemic cardiomyopathy by ablating sites of reentry within complex regions of myocardial scar. In cases of near transmural infarction, this arrhythmia substrate may be nearer the epicardium than the endocardium, and epicardial ablation may be necessary. An epicardial substrate location can potentially be predicted by imaging that suggests transmural infarction. Percutaneous epicardial ablation improves outcomes in selected patients, but is higher risk and avoided in patients with prior coronary artery bypass grafting. Percutaneous Epicardial Ablation of Atrial Fibrillation Roderick Tung DOI: https://doi.org/10.1016/j.ccep.2020.06.005 Publication stage: In Press Corrected Proof Preview Full-Text HTML PDF x The observations afforded by epicardial mapping have not only increased the appreciation of distinct epicardial structures in the left atrium but also underscore the need to address the substrate transmurally. Although epicardial access and ablation have attendant risks, comparative studies with hybrid surgical approaches are lacking. In the search to find unifying mechanisms of atrial fibrillation, a conceptual shift that emphasizes the substrate in 3 dimensions, with the epicardium distinct from the endocardium, holds promise for future investigation and evolving therapeutic tools. View More Articles in Press 2019 - Volume 11 December 2019 Advances in Cardiac Mapping and Catheter Ablation: Part II Mohammad Shenasa, Amin Al-Ahmad, Editors September 2019 Advances in Cardiac Mapping and Catheter Ablation: Part I Mohammad Shenasa, Amin Al-Ahmad, Editors June 2019 Interpreting Complex Arrhythmias: Part III Giuseppe Bagliani, Roberto De Ponti, Fabio M. Leonelli, Editors March 2019 Cardiac Resynchronization - A Reappraisal Jagmeet P. Singh, Gopi Dandamudi, Editors 2018 - Volume 10 December 2018 Lead Management for Electrophysiologists Noel G. Boyle, Bruce L. Wilkoff, Editors September 2018 His Bundle Pacing Pramod Deshmukh, Kenneth A. Ellenbogen, Editors June 2018 Bradycardias, Complex Tachycardias and Clinical Arrhythmias:...