“Non-invasive” portable laser ablation sampling for lead isotope analysis of archaeological silver: a comparison with bulk and in situ laser ablation techniques

Portable laser ablation is tested for Pb isotope analysis of silver, yielding results comparable to bulk analyses. This low impact method removes the need for invasive sampling, opening the way for analysis of archaeological silver worldwide.

Irrigated Needle Ablation Compared to Other Advanced Ablation Techniques for Failed Endocardial Ventricular Arrhythmia Ablation

Background - Options when endocardial ventricular arrhythmia (VA) ablation fails include epicardial, simultaneous two site unipolar radiofrequency (SURF) and transcoronary ethanol (TCE) ablation. Recently, investigational needle ablation has also been used, but how it compares to other advanced methods is not clear. This study sought to compare outcomes and complications for needle ablation versus other advanced ablation techniques in patients with structural heart disease, VA, and failed endocardial ablation. Methods - We retrospectively reviewed 136 procedures in 119 consecutive patients with structural heart disease (excluding arrhythmogenic right ventricular cardiomyopathy) who failed endocardial ablation and underwent ablation with either an investigational needle catheter (27 gauge, single end hole) or with other advanced techniques including epicardial, SURF or TCE ablation. Results - Of 136 procedures, needle ablation was performed in 58 procedures. In the remaining 78 procedures, 65 were epicardial ablation including 10 with SURF ablation from endocardial and epicardial sites, seven with SURF from both sides of the septum, one SURF and TCE ablation, and five TCE ablation procedures. Acute outcomes, 6-month VA recurrence, and mortality rates were not different between the two groups (49% vs 55%, P=0.54, 45% vs 46%, P=1.00, and 4% vs 3%, P=1.00, respectively). There were 22 major complications observed in 22 procedures with pericardial bleeding occurring less frequently with needle ablation (1.7% vs 12.8%, P=0.02). Conclusions - Ablation with an irrigated needle catheter compares favorably to other advanced ablation techniques.

Catheter ablation of long-standing persistent atrial fibrillation: the ugly type of AF?

Funding Acknowledgements Type of funding sources: None. Introduction In atrial fibrillation (AF) patients (pts), catheter ablation (CA) by isolating pulmonary veins (PVI) is the most effective therapeutic option in order to maintain sinus rhythm. The success rate of CA relies on type and duration of AF, being more successful in pts with paroxysmal AF and presenting suboptimal success in pts with long-standing persistent AF (LSPAF, >12 months). Purpose To evaluate the success of AF ablation, particularly in LSPAF. Methods Single-center prospective study of pts submitted to CA between 2004 and 2020. The strategy, regardless of the type of AF, was based on PVI, complemented by cavo-tricuspid isthmus line (CTI) in pts with history of flutter. Additional CA strategies were selectively considered in pts with stable atypical flutter conversion, persistent triggers or no electrograms in the VPs. Pts were monitored with Holter/7-day event loop recorder (3, 6, 12 months and annually up to 5 years). Success was assessed from the 90th day after ablation, with the absence of recurrences of any sustained atrial arrhythmias (> 30 sec). Cox regression and Kaplan-Meier survival were used to compare the success of ablation as a function of the clinical type of AF. Results 862 pts were submitted to AF ablation (67.3% male, mean age of 58 ± 0.41 years), including 130 pts (15.1%) with LSPAF, 63.3% with paroxysmal AF and 21.6% with short-duration persistent AF (SDPAF). In LSPAF, PVI was performed with irrigated catheter in 26.4%, PVAC in 39.5% and cryoablation in 34.1%. With a mean follow up period of 838 (IQ 159-1469) days, the 3-year success rate after a single procedure was 54.1% in LSPAF, compared to 72.4% in paroxysmal AF and 61.6% in SDPAF (LogRank - p < 0.0001 - figure 1). The risk of arrhythmic recurrence was 37% higher in patients with LSPAF comparing with other groups (HR 0.63 CI 95% 0.43-0.92, p 0.016). However after a mean of 1.17 procedures/patients, the success difference between groups was not detect (LogRank – p = 0.112 – figure 2). With additional ablation procedures (REDO), the success rate at 3 years was 82.9% LSPAF pts, compared 88.2% in paroxysmal AF pts and 83.6% in SDPAF pts. In LSPAF pts, different ablation techniques did not predict arrhythmic recurrence. Regarding comorbidities, higher prevalence of peripheral arterial disease (PAD, p = 0.005) a higher NT-proBNP (p = 0.006) and left auricular volume (p = 0.045) were associated with arrhythmic relapse. Conclusions AF ablation is more effective when performed earlier in the natural history of the disease. However, even in LSPAF pts, with additional procedures an acceptable rate of success can be achieve, independently from the ablation techniques. Abstract Figures 1 and 2: Success of AF ablation

Aortic Regurgitation as a Complication of Electrophysiologic Ablation Techniques: A narrative review

Background: Radiofrequency catheter ablation is a well-established treatment for several cardiac arrhythmias. Arrhythmias originating from the left side of the heart including ventricular and supraventricular tachycardia and ectopy can be successfully ablated through either transseptal or retrograde aortic approach. Although these techniques have a generally low rate of complications, aortic valve injury is a potential complication of ablation at the left cardiac side that warrants more investigation. Objective: The purpose of this review is to evaluate the incidence of iatrogenic aortic valve regurgitation and explore the potential mechanisms and risk factors that might contribute to aortic valve injury during radiofrequency ablation. Additionally, the course and progression of aortic regurgitation in the reported cases will be described. Methods and results: Authors searched PubMed for articles using the keywords “ablation” AND "aortic insufficiency" OR "aortic valve injury" OR "aortic regurgitation". Case reports and series, as well as retrospective and prospective studies were included and relevant review articles and editorial comments were used as a supplementary source of data. A total of 19 references were used and a detailed description of patient characteristics, procedural techniques, and incidence, predictors, and fate of aortic regurgitation was reported by 11 clinical studies. Conclusion: There is a small risk of significant iatrogenic aortic regurgitation after radiofrequency ablation of left-sided cardiac arrhythmias especially techniques performed via a retrograde aortic approach. Although the risk is not confined to procedures applying direct energy to the aortic cusp region, a more aggressive ablation applied in the vicinity of the valvular complex seems to be associated with a higher risk. Routine post-procedural surveillance should be adopted to detect de novo aortic valve injury following radiofrequency ablation techniques.

Alcohol Ablation for Ventricular Tachycardia

Catheter-based radiofrequency (RF) ablation is an effective, well-established therapy for ventricular tachycardia (VT). However, a large number of patients still have recurrences, particularly those with substrates arising from intramural locations that are inaccessible through endo- or epicardial catheter approaches. Several unconventional ablation techniques have been proposed to treat RF-refractory VT, including transarterial coronary ethanol ablation and retrograde coronary venous ethanol ablation. We review the evidence regarding the mechanisms, procedural aspects, and alcohol ablation outcomes for ventricular arrhythmias.