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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EThe characteristics, benefits, and uses of a number of new technologies in cardiac electrophysiology (EP) technologies were reviewed. These technologies and devices included 3D mapping technologies, high-density MRI-guided mapping, focal impulse and rotor modulation, body surface mapping, and a left atrial appendage closure device called the Watchman.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Earrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiac electrophysiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eatrial fibrillation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecatheter ablation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecerebrovascular disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EMohammad Shenasa, MD, PhD, O\u0027Connor Hospital, San Jose, California, USA, reviewed a few of the new cardiac electrophysiology technologies that are being used in clinical practice.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThree-dimensional mapping technologies, used to facilitate spatial orientation within complex cardiac anatomies, are now being integrated with conventional fluoroscopy imaging. With the use of prerecorded fluoroscopy cine-loops, stored real-time catheter location data can be visualized nonfluoroscopically within a radiographic environment. The speed of the cine-loop is matched to the real-time electrocardiogram signal. Atrial fibrillation (AF) ablation based on this technology reduces radiation exposure and may have a lower complication rate when compared to ablation based on conventional technology [Sommer P et al. \u003Cem\u003ECirc Arrhythm Electrophysiol.\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EAnother new technology, high-density magnetic resonance imaging (MRI)\u2013guided mapping, is particularly useful for mapping sinus node activation. Ablation with MRI-guided mapping has already been done at several institutions and appears safe. MRI interventional suites for mapping and ablation are now available for the specific use of this technique [Eitel C et al. \u003Cem\u003EEur Heart J.\u003C\/em\u003E 2012; Piorkowski C et al. \u003Cem\u003ECirc Arrhythm Electrophysiol\u003C\/em\u003E. 2013].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EElimination of patient-specific localized sources of AF by focal impulse and rotor modulation (FIRM) ablation can also terminate or slow the AF while improving outcomes. For instance, FIRM at the inferior left atrial rotor terminates AF to sinus in \u0026lt; 1 minute [Narayan SM et al. \u003Cem\u003EJ Am Coll Cardiol.\u003C\/em\u003E 2012]. FIRM ablation promotes freedom from AF for up to 3 years when compared with conventional ablation (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Narayan SM et al. \u003Cem\u003EJ Am Coll Cardiol.\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/16\/23\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Freedom From AF\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1127443670\u0022 data-figure-caption=\u0022Freedom From AF\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/16\/23\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/16\/23\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/16\/23\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16913\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EFreedom From AF\u003C\/p\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EAF, atrial fibrillation; FIRM, focal impulse and rotor modulation.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EAdapted from the \u003Cem\u003EJournal of the American College of Cardiology\u003C\/em\u003E, 63, Narayan SM et al, Ablation of Rotor and Focal Sources Reduces Late Recurrence of Atrial Fibrillation Compared With Trigger Ablation Alone: Extended Follow-up of the CONFIRM Trial (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation), 1761\u20131768, Copyright (2014), with permission from American College of Cardiology Foundation.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EBody surface mapping provides accurate maps of localized arrhythmias, which may shorten procedural time [Haissaguerre M et al. \u003Cem\u003EJ Cardiovasc Electrophysiol.\u003C\/em\u003E 2013]. For patients with AF, it allows unprecedented 3D vision of individual clusters of AF drivers, allowing a high rate of AF termination with significantly less radiofrequency delivery. Additional studies are evaluating ways to improve signaling in damaged tissue and integrate other imaging modalities (eg, MRI).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003ENew and smaller pacemakers are being developed as well. The leadless pacer, \u0026lt; 10% of the size of a conventional pacemaker, is implanted via a catheter inside the heart. It attaches to the wall of the right ventricular apex with a screw-in active fixation mechanism. Battery longevity is comparable to conventional pacemakers, with an average life span of 8.4 years at 100% pacing. The device is fully retrievable for repositioning, if necessary.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThe first-generation subcutaneous implantable cardioverter defibrillator detects and terminates induced and spontaneous ventricular fibrillation (VF) and is suitable for a broad range of indications, including ischemic and idiopathic VF and channelopathy-related ventricular tachyarrhythmias. It is also an option for candidates who do not require pacing for bradycardia, cardiac resynchronization, or antitachycardia [Crozier I et al. \u003Cem\u003ECard Electrophysiol Clin.\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EIn patients with paroxysmal and persistent AF, strategies for rhythm control often include antiarrhythmic drug treatment (eg, beta-blockers, diltiazem, verapamil, amiodarone) along with catheter ablation. Studies have reported that catheter ablation is superior to antiarrhythmic drug therapy for the maintenance of sinus rhythm in patients with persistent AF (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E) [Mont L et al. \u003Cem\u003EEur Heart J.\u003C\/em\u003E 2014] and paroxysmal AF [Morillo CA et al. \u003Cem\u003EJAMA.\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/16\/23\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Sinus Rhythm Better Maintained With Ablation Compared With Antiarrhythmic Drugs\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1127443670\u0022 data-figure-caption=\u0022Sinus Rhythm Better Maintained With Ablation Compared With Antiarrhythmic Drugs\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/16\/23\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/16\/23\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/16\/23\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16914\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \u003Cp id=\u0022p-11\u0022 class=\u0022first-child\u0022\u003ESinus Rhythm Better Maintained With Ablation Compared With Antiarrhythmic Drugs\u003C\/p\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EShading indicates standard deviation.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-4\u0022\u003EAdapted from Mont L et al. Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study). \u003Cem\u003EEur Heart J.\u003C\/em\u003E 2014;35:501\u2013507. By permission from European Society of Cardiology.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-12\u0022\u003EHowever, another study reported no significant difference (\u003Cem\u003EP\u003C\/em\u003E = .10) in the cumulative burden of AF over a 2-year period when comparing radiofrequency ablation with antiarrhythmic drug therapy as a first-line treatment in patients with paroxysmal AF (\u003Ca id=\u0022xref-fig-3-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F3\u0022\u003EFigure 3\u003C\/a\u003E) [Cosedis Nielsen J et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2012]. Nevertheless, more patients in the ablation group were free from any AF (85% vs 71%; \u003Cem\u003EP\u003C\/em\u003E = .004) and symptomatic AF (93% vs 84%; \u003Cem\u003EP\u003C\/em\u003E = .01).\u003C\/p\u003E\u003Cdiv id=\u0022F3\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/16\/23\/F3.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022No Difference in Cumulative Burden of AF Between Ablation and Drug Therapy\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1127443670\u0022 data-figure-caption=\u0022No Difference in Cumulative Burden of AF Between Ablation and Drug Therapy\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 3.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/16\/23\/F3.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/16\/23\/F3.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 3.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/16\/23\/F3.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16915\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 3.\u003C\/span\u003E \u003Cp id=\u0022p-13\u0022 class=\u0022first-child\u0022\u003ENo Difference in Cumulative Burden of AF Between Ablation and Drug Therapy\u003C\/p\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-5\u0022\u003EAF, atrial fibrillation.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-6\u0022\u003EAdapted from N Engl J Med. Cosedis Nielsen J et al, Radiofrequency Ablation as Initial Therapy in Paroxysmal Atrial Fibrillation, 367, 1587\u20131595. Copyright \u00a9 (2012) Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-14\u0022\u003EIn patients with mild heart failure, left ventricular dysfunction, and left bundle branch block, early intervention with cardiac resynchronization therapy and a defibrillator is associated with significant long-term survival (7 years). This benefit was not seen in patients without left bundle branch block [Goldenberg I et al. \u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EThe final technology that Prof Shenasa discussed was the Watchman, a left atrial appendage closure device that was evaluated in the PROTECT AF trial [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00129545\u0026amp;atom=%2Fspmdc%2F14%2F16%2F23.atom\u0022\u003ENCT00129545\u003C\/a\u003E] and found to be noninferior to warfarin in patients with nonvalvular AF for prevention of stroke [Holmes DR et al. \u003Cem\u003ELancet.\u003C\/em\u003E 2009]. In a subsequent analysis, the Watchman was associated with a significant improvement in quality of life on the Short-Form 12 Health Survey for total physical score, physical function, and physical role limitation as compared with the warfarin-treated patients [Alli O et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E. 2013].\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/16\/23.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlkq1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlkq1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}