Catheter Ablation to Prevent Malignant Ventricular Arrhythmias in Symptomatic Brugada Syndrome: A systematic review and meta-analysis.

Background: Brugada syndrome (BrS) is a cardiac channelopathy predisposing individuals to malignant ventricular arrhythmias (VA) and sudden cardiac death (SCD). Substrate modification with catheter ablation (CA) has emerged as an interesting option to prevent recurrence of VA.

Objective: This systematic review and meta-analysis aimed to assess the efficacy and safety of CA in patients with high-risk symptomatic BrS.

Assessment of activation delay in the right ventricular outflow tract as a potential complementary diagnostic tool for Brugada Syndrome.

Aims: In patients with Brugada syndrome (BrS), diagnosis relies primarily on the presence of the characteristic type 1 electrocardiographic (ECG) pattern. The aim of this study was to propose an alternative diagnostic method in situations where ECG alone is uncertain.

Methods And Results: This study was conducted in two phases: (i) Phase 1: cut-off determination.

Efficacy and Drug-Related Complications of Anticholinergic Drugs for Vagal Reaction Prevention During Pulsed Field Ablation.

Background: Vagal responses (VR) are frequently observed during pulmonary vein isolation (PVI) with pulsed field ablation (PFA).

Objectives: The aim of this study was to compare the effectiveness of 2 different anticholinergic (AC) medications, namely glycopyrrolate (GLY) or atropine (ATP), for VR prophylaxis in patients undergoing PVI via a pentaspline PFA catheter.

Methods: Consecutive patients with atrial fibrillation undergoing first-time PVI with PFA were prospectively enrolled at 4 centers between April 2023 and March 2024.

PVI With CF-Sensing Large-Tip Focal PFA Catheter With 3D Mapping for Paroxysmal AF: Omny-IRE 3-Month Results.

Background: Omny-IRE (A Study For Treatment of Paroxysmal Atrial Fibrillation [PAF] With the OMNYPULSE Catheter and the TRUPULSE Generator) evaluated safety and effectiveness of a novel large-tip focal, multielectrode, contact force-sensing, pulsed field ablation catheter with electroanatomic mapping integration.

Objectives: This study sought to assess 3-month safety and effectiveness of the platform for treating symptomatic paroxysmal atrial fibrillation.

Methods: Pulmonary vein isolation (PVI) was performed using the OMNYPULSE Platform.

Pulmonary vein isolation durability with fluoroscopy or 3D mapping-guided radiofrequency balloon ablation: a mandated remap study.

Background: Effective balloon positionnking during pulmonary vein isolation (PVI) with a radiofrequency balloon (RFB) is crucial for optimal energy delivery, maximising lesion formation, and preventing gaps. Traditionally, fluoroscopy is used to guide pulmonary vein (PV) occlusion, however, this method exposes patients to radiation. Recently, RFBs equipped with 3D electroanatomical mapping (EAM) offer an alternative approach, potentially achieving the same results with reduced radiation exposure.

Cryoballoon Ablation With the POLARx FIT or the Arctic Front Advance Pro for Paroxysmal Atrial Fibrillation: A Health Economic Analysis.

Pulmonary vein isolation (PVI) is the main ablation strategy for the treatment of paroxysmal atrial fibrillation. Different technologies are available for PVI, including various cryoballoon catheters (CB-A). Compared with the Arctic Front Advance Pro™, the novel POLARx FIT™ CB-A might reduce costs for atrial fibrillation ablation.

Feasibility of reversible electroporation mapping in human atrial flutter.

Background: Reversible pulsed field ablation (PF) can temporarily block conduction and may emerge as a novel clinical mapping tool to accurately identify critical isthmuses before permanent lesions are created.

Objective: We aimed to assess the feasibility and performance of PF as a mapping tool in humans.

Methods: PF pulses were delivered with a 9-mm lattice-tip ablation catheter in 24 atrial flutters, targeting sites in and outside the circuit.

Spontaneous type 1 ECG and arrhythmic risk in Brugada syndrome: A meta-analysis of adjusted time-to-event data.

Background: Brugada syndrome (BrS) is associated with an increased risk of major arrhythmic events (MAEs), particularly in patients with a spontaneous type 1 electrocardiographic (ECG) pattern.

Objective: Because previous meta-analyses used mainly crude or unadjusted data from observational studies, we conducted an updated meta-analysis on the prognostic role of spontaneous type 1 ECG in BrS patients combining adjusted and unadjusted data separately.

Methods: We conducted a systematic search of PubMed and Cochrane Central Register of Controlled Trials from inception to May 2024.

Noninvasive electrocardiographic imaging assessment of conduction system pacing: A novel algorithm to assess intraventricular synchrony.

Background: Left bundle branch area pacing (LBBAP) has become the procedure of choice for various indications including atrioventricular block and considered to be physiologic modality of pacing compared with right ventricular apex pacing.

Objective: The purpose of this study was to assess ventricular activation and synchrony in patients with an LBBAP device using electrocardiographic imaging (ECGI).

Methods: A total of 25 consecutive patients underwent an LBBAP device implantation were included in the study.

2D speckle-tracking echocardiography assessment of left atrial and left ventricular mechanics: outcomes in patients with atrial fibrillation treated with hybrid ablation and left atrial appendage surgical closure.

Background And Aims: Hybrid atrial fibrillation (AF) ablation is a therapeutic option in non-paroxysmal AF. Our study examines cardiac mechanics changes after hybrid AF ablation plus epicardial closure of left atrial appendage (LAA).

Methods: All consecutive patients undergoing hybrid AF ablation at UZ Brussel were evaluated.

Endo-epicardial mapping of human sinus node in vivo: Novel electrophysiologic findings and anatomic correlations.

Background: The human sinoatrial node (SAN) pacemaker is a complex structure located at the right atrium (RA)-superior vena cava (SVC) junction.

Objective: This study aimed to perform in vivo endocardial and epicardial electroanatomic mapping of human SAN in inappropriate sinus node tachycardia (IST) and to correlate electrical findings with anatomic observations from thoracoscopy during hybrid SAN-sparing IST ablation.

Methods: All consecutive patients with diagnosis of symptomatic IST, refractory to or intolerant of drugs, and endocardial and epicardial mapping of SAN during hybrid ablation were included.

Implantable Cardioverter-Defibrillator Therapy in Brugada Syndrome: A 30-Year Single-Center Experience.

Background: Brugada syndrome (BrS) continues to pose clinical challenges, despite 3 decades of dedicated research and therapeutic advancements. The pivotal role of implantable cardioverter-defibrillator (ICD) therapy in safeguarding high-risk BrS patients from sudden cardiac death due to ventricular arrhythmias is undeniable. However, the debate on risk stratification and the use of ICDs for primary prevention remains ongoing.

Redo ablation procedures to treat recurrent atrial arrhythmias via a pentaspline pulsed field ablation catheter: a prospective, multicenter experience.

Background: Patients undergoing atrial fibrillation (AF) catheter ablation may require redo procedures involving pulmonary vein (PV) re-isolation and/or ablation of extra-PV sites. Pulsed field ablation (PFA) offers a highly selective energy source for cardiac tissue, with the potential to reduce collateral damage to adjacent structures. This study aimed to evaluate the feasibility and efficacy of redo ablation using a pentaspline PFA system.

Pulsed field ablation in the elderly by a pentaspline multielectrode catheter: Safety, efficacy, and comparison with cryoballoon and radiofrequency devices.

Background: Catheter ablation is an effective treatment of atrial fibrillation. Pulsed field ablation (PFA) has emerged as a novel energy modality that relies on high-voltage electric fields to achieve cardiac tissue ablation. Data on its efficacy in the elderly are scarce.

Pentaspline catheter or cryoballoon for pulmonary vein plus posterior wall isolation in persistent atrial fibrillation: 1-Year outcomes.

Background: Left atrial posterior wall isolation (LAPWI) plus pulmonary vein isolation (PVI) can be performed with radiofrequency ablation, cryoballoon ablation (CB-A), or, recently, pulsed field ablation (PFA).

Objective: The aims of this study were to evaluate efficacy and safety of the pentaspline PFA catheter for PVI + LAPWI in patients with persistent AF undergoing an index ablation procedure and to compare 1-year outcomes of PVI + LAPWI with PFA vs CB-A.

Methods: All consecutive patients undergoing an index ablation for persistent atrial fibrillation (AF) at Universitair Ziekenhuis Brussel, Belgium, between 2021 and 2023 were retrospectively screened.

A novel focal lattice-tip catheter toggling between pulsed field energy and radiofrequency for atrial arrhythmia ablation: Results from a real-world, multicenter registry.

Background: A novel focal lattice-tip catheter allowing the delivery of either pulsed field (PF) or radiofrequency (RF) energy has recently received regulatory approval. The technology features a proprietary 3-dimensional electroanatomic mapping system.

Objective: We describe the first real-world and multicenter experience.

Ultrasound-guided versus fluoroscopy-guided axillary vein puncture for cardiac implantable electronic device implantation: a meta-analysis enrolling 1257 patients.

Introduction: Ultrasound-guided (Echo-AVP) and Fluoroscopy-guided Axillary Vein Puncture (Fluoro-AVP) are both acknowledged as safe and effective techniques for transvenous implantation of leads for cardiac implantable electronic devices (CIEDs). Nonetheless, it is still debated which of the two techniques has a better safety and efficacy profile. Therefore, we performed a meta-analysis to evaluate the efficacy and safety of Echo-AVP versus Fluoro-AVP for CIEDs implantation.

Multielectrode catheter-based pulsed field ablation of persistent and long-standing persistent atrial fibrillation.

Aims: Rhythm control of non-paroxysmal atrial fibrillation (AF) is significantly more challenging, as a result of arrhythmia perpetuation promoting atrial substrate changes and AF maintenance. We describe a tailored ablation strategy targeting multiple left atrial (LA) sites via a pentaspline pulsed field ablation (PFA) catheter in persistent AF sustained beyond 6 months (PerAF > 6 m) and long-standing persistent AF (LSPAF).

Methods And Results: The ablation protocol included the following stages: pulmonary vein antral and posterior wall isolation plus anterior roof line ablation (Stage 1); electrogram-guided substrate ablation (Stage 2); atrial tachyarrhythmia regionalization and ablation (Stage 3).