IIntroduction: Atrial fibrillation (AF) ablation requires a precise reconstruction of the left atrium (LA) and pulmonary veins (PV). Model-based FAM (m-FAM) is a novel module recently developed for the CARTO system which applies machine-learning techniques to LA reconstruction. We aimed to evaluate the feasibility and safety of a m-FAM guided AF ablation as well as the accuracy of LA reconstruction using the cardiac computed tomography angiography (CTA) of the same patient LA as gold standard, in 32 patients referred for AF ablation. Methods: Consecutive patients undergoing AF ablation. The m-FAM reconstruction was performed with the ablation catheter (Group 1) or a Pentaray catheter (Group 2). The reconstruction accuracy was confirmed prior to the ablation by verification of pre-specified landmarks of the LA and PVs by intracardiac echocardiogram (ICE) visualization and fluoroscopy. A cardiac CTA performed before the ablation was used as gold standard of LA anatomy. For each patient, the m-FAM reconstruction was compared to his/her cardiac CTA. Results: The m-FAM reconstruction was accurate in all patients regardless the catheter used for mapping. In 12% re acquisition of the LA landmarks was necessary to improve the accuracy. m-FAM time was shorter in group 2 while the M-Fam fluoroscopy time was similar. Pulmonary vein isolation was achieved in 100% of patients without major complications. The m-FAM reconstructions accurately resemble the cardiac CTA of the same patients. Conclusions: The m-FAM module allows for rapid and precise reconstruction of the LA and PV anatomy, which can be safely used to guide AF ablation.

Background. Pulmonary veins (PV) reconnection is the most common reason for atrial fibrillation (AF) recurrence. The ablation-index is a marker of ablation lesion quality which use achieves high percentages of first pass isolation and improved results of AF ablation. Most operators use a double trans-septal approach with confirmation of PV isolation with a circular mapping catheter. In the present study we aimed to show that an ablation-index guided procedure using a single trans-septal approach and ablation catheter only would achieve adequate PV isolation while demonstrating the critical role of the carina in PV isolation. Methods. 76 consecutive patients with paroxysmal AF: 34 patients underwent WACA, 32 patients underwent WACA+ (including empiric carina isolation) and 10 patients underwent a staged procedure of WACA followed by WACA+ in case of lack of first pass isolation. All procedures were performed via single trans-septal. Results. Compared to WACA-only, WACA+ increased the odds of PV isolation from 65% to 91%, p=0.012. In WACA-only, ablation of the carina was needed to achieve PV isolation. The role of the carina was confirmed in 10 patients with sequential ablation. PV isolation was confirmed by inserting a circular mapping catheter through the single trans-septal sheath. At 18 months of follow-up [IQR 15.2-20.8 months], freedom from AF was 84% for the entire cohort. Conclusion. Our study confirms the high success rate of PV isolation using ablation index and shows that this can be achieved via single trans-septal crossing. Our study confirms the role of the carina in PV isolation.

Background: Tricuspid regurgitation (TR) is associated with adverse prognosis in various patient populations but currently no data is available about the prevalence and prognostic implication of TR in ST-segment elevation myocardial infarction (STEMI) patients. We investigated the possible implication of TR among STEMI patients. Methods: We conducted a retrospective study of STEMI patients undergoing primary percutaneous coronary intervention (PCI), and its relation to major clinical and echocardiographic parameters. Patients records were assessed for the prevalence and severity of TR, its relation to the clinical profile, key echocardiographic parameters, in-hospital outcomes, and long-term mortality. Patients with previous myocardial infarction or known previous TR were excluded. Results: The study included 1071 STEMI patients admitted between September 2011 and May 2016 (age 61 ± 13 years; predominantly male). A total of 205 patients (19%) had mild TR while another 32 (3%) had moderate or greater TR was 3% (n = 32). Patients with significant TR demonstrated worse echocardiographic parameters, more likely to have in-hospital complications and had higher long-term mortality (28% vs. 6%; p<0.001). Following adjustment for significant clinical and echocardiographic parameters, mortality hazard ratio (HR) of at least moderate to severe TR remained significant (2.44; 95% CI, 1.06-5.6; P = .036) for patients with moderate-severe TR. Conclusions: Among STEMI patients after primary PCI, the presence of moderate-severe TR was independently associated with adverse outcomes and significantly lower survival rate. Keywords: Tricuspid Regurgitation; ST-segment elevation myocardial infarction; percutaneous coronary intervention; cardiac intensive care unit; cardiac intensive care unit; echocardiography; valvular regurgitation.

Background: Although diastolic dysfunction is common among patients treated with cancer therapy, no clear evidence has been shown that it predicts systolic dysfunction. This study evaluated the correlation of longitudinal diastolic strain time (Dst) with the routine echocardiography diastolic parameters and to estimated its role in the early detection of cardiotoxicity among patients with active breast cancer. Methods: Data were collected as part of the Israel Cardio-Oncology Registry (ICOR), a prospective registry enrolling all adult patients referred to the cardio-oncology clinic. All patients with breast cancer, planned for Doxorubicin therapy were included. Echocardiography, including Global longitudinal systolic strain (GLS) and Dst, was assessed at baseline before chemotherapy (T1), during Doxorubicin therapy (T2) and after the completion of Doxorubicin therapy (T3). Cardiotoxicity were determined by GLS relative reduction of ≥15%. Dst was assessed as the time measured (ms) of the myocardium lengthening during diastole. =diastolic time (ms) measured. Results: Among 69 patients, 67 (97.1%) were females with a mean age 52±13years. Diastolic strain timeDst measurement was significantly associated with the standard routine diastolic parameters. Significant GLS reduction was observed in 10 (20%) patients at T3 . Both in a univariate and a multivariate analyses the change in Ds basal time from T1 to T2 emerged to be significantly associated with GLS reduction at T3 (p<0.04). Conclusions: Among breast cancer patients, Dst time showed high correlation to standard the routine diastolic echocardiography parameters. Relative reductionChange in Ds basal time emerged associated with clinically significant systolic dysfunction as measured by GLS reduction.

Background: Although diastolic dysfunction is common among patients treated with cancer therapy, no clear evidence has been shown that it predicts systolic dysfunction. This study evaluated the correlation of longitudinal diastolic strain (Ds) with echocardiography diastolic parameters and to estimate its role in the early detection of cardiotoxicity among patients with active breast cancer. Methods: Data were collected as part of the Israel Cardio-Oncology Registry (ICOR), a prospective registry enrolling all adult patients referred to the cardio-oncology clinic. All patients with breast cancer, planned for Doxorubicin therapy were included. Echocardiography, including Global longitudinal systolic strain (GLS) and Ds, was assessed at baseline before chemotherapy (T1), during Doxorubicin therapy (T2) and after the completion of Doxorubicin therapy (T3). Cardiotoxicity were determined by GLS relative reduction of ≥15%. Ds was assessed as the time of lengthening =diastolic time (ms) measured. Results: Among 69 patients, 67 (97.1%) were females with a mean age 52±13years. Diastolic strain time measurement was significantly associated with the standard diastolic parameters. Significant GLS reduction was observed in 10 (20%) patients at T3 . Both in a univariate and a multivariate analyses the change in Ds basal time from T1 to T2 emerged to be significantly associated with GLS reduction at T3 (p<0.04). Conclusions: Among breast cancer patients, Ds time showed high correlation to standard diastolic echocardiography parameters. Relative reduction in Ds basal time emerged associated with clinically significant systolic dysfunction as measured by GLS reduction.