How a Topological Mindset May Offer Extra Control During Mapping and Ablation of Left-Sided Reentrant Atrial Tachycardia.

Background: Reentry (macro or localized) is historically described as multiple pathways that are separated by barriers (either anatomic or functional) and involve active and passive loops (identified by electro-anatomic and entrainment mapping, EAM/ETM). Some reentrant atrial tachycardia (AT) cases are characterized by challenging activation patterns and unexpected ablation responses. A recent translational study, focusing on topology (TOP) and the role of boundaries, suggests that thinking topology within EAM/ETM might offer extra control during mapping and ablation of reentrant AT.

Prospective Evaluation of Superior Vena Cava Isolation as an Adjunct to Pulmonary Vein Re-Isolation During Paroxysmal Atrial Fibrillation Repeat Procedures.

Background: The superior vena cava (SVC) is a prominent non-pulmonary vein trigger of atrial fibrillation (AF). Its isolation has been shown to be effective in paroxysmal AF (PAF) originating from SVC.

Objective: In this study, focusing on repeat procedures for recurrent PAF post-PVI, we aimed to evaluate the added value of empirical SVC isolation to PV antral re-isolation, when at least one PV reconnection is demonstrated.

Radiofrequency-aided venous ethanol vs optimized radiofrequency for primary and repeat ablation of left ventricular summit arrhythmias: A propensity score-matched comparison.

Background: Radiofrequency (RF) ablation of left ventricular summit arrhythmias (LVSAs) is challenging and may fail due to the anatomical inaccessibility of the substrate. Coronary venous ethanol ablation (CVEA) has been suggested as an alternative ablation strategy for drug- and RF-refractory LVSA.

Objective: This study compared venous ethanol with or without adjunctive RF (CVEA ± RF) vs optimized RF (ORF) for primary or repeat ablation of LVSA.

Atrial Tachyarrhythmias With Ultra-Rapid Ventricular Response and Sudden Death in Patients Without Structural Heart Disease.

Background: Sudden cardiac death (SCD) is generally associated with life-threatening ventricular arrhythmias. Supraventricular arrhythmias are an accepted cause of SCD in Wolff-Parkinson-White syndrome and complex congenital heart disease. However, the role of atrial tachyarrhythmias (ATAs) in SCD in patients with structurally normal hearts is unclear.

Catheter Ablation of Persistent AF-Where are We Now?

Persistent atrial fibrillation (AF) is a diverse condition that includes various subtypes and underlying causes of arrhythmia. Progress made in catheter ablation technology in recent years has significantly enhanced the durability of ablation. Despite these advances however, the effectiveness of ablation in treating persistent AF is still relatively modest.

Distinct Substrates of Idiopathic Ventricular Fibrillation Revealed by Arrhythmia Characteristics on Implantable Cardioverter-Defibrillator.

Background: Idiopathic ventricular fibrillation (IVF) can be associated with undetected distinct conditions such as microstructural cardiomyopathic alterations (MiCM) or Purkinje (Purk) activities with structurally normal hearts.

Objectives: This study sought to evaluate the characteristics of recurrent VF recorded on implantable defibrillator electrograms, associated with these substrates.

Methods: This was a multicenter collaboration study.

Risk assessment of esophageal ulceration following left atrial radiofrequency linear ablation.

Introduction: Esophageal safety following radiofrequency (RF) left atrial (LA) linear ablation has not been established. To determine the esophageal safety profile of LA linear RF lesions, we performed systematic esophagogastroduodenoscopy in all patients with intraesophageal temperature rise (ITR) ≥ 38.5°C.

Procedural performance and outcome after pulsed field ablation for pulmonary vein isolation: comparison with a reference radiofrequency database.

Aims: Pulsed field ablation (PFA) is a promising ablation technique for pulmonary vein isolation (PVI) with appealing advantages over radiofrequency (RF) including speed, tissue selectivity, and the promise of enhanced durability. In this study, we determine the procedural performance, efficacy, safety, and durability of PFA and compare its performance with a dataset of optimized RF ablation.

Methods And Results: After propensity score matching, we compared 161 patients who received optimized RF-guided PVI in the PowerPlus study (CLOSE protocol) with 161 patients undergoing PFA-guided PVI for paroxysmal or persistent atrial fibrillation (AF; pentaspline basket catheter).

Early atrial fibrillation recurrence post catheter ablation: Analysis from insertable cardiac monitor in the era of optimized radiofrequency ablation.

Background: Early recurrence of atrial tachyarrhythmia (ERAT) is associated with ablation-induced proarrhythmogenic inflammation; however, existing studies used intermittent monitoring or nonoptimized radiofrequency (RF) applications (noncontiguous or without ablation index target value).

Objective: The purpose of this study was to investigate the relationship between ERAT and late recurrence based on insertable cardiac monitor (ICM) data.

Methods: We compiled data from Close-To-Cure and Close Maze studies, which enrolled patients who underwent RF ablation for paroxysmal or persistent atrial fibrillation (AF).

No Effect of Continued Antiarrhythmic Drug Treatment on Top of Optimized Pulmonary Vein Isolation in Patients With Persistent Atrial Fibrillation: Results From the POWDER-AF2 Trial.

Background: In patients with persistent atrial fibrillation (PersAF), catheter ablation aiming for pulmonary vein isolation (PVI) is associated with moderate clinical effectiveness. We investigated the benefit of continuing previously ineffective class 1C or 3 antiarrhythmic drug therapy (ADT) in the setting of a standardized PVI-only ablation strategy.

Methods: In this multicenter, randomized controlled study, patients with PersAF (≥7 days and <12 months) despite ADT were prospectively randomized 1:1 to PVI with ADT continued versus discontinued beyond the blanking period (ADT ON versus ADT OFF).

Impact of Catheter Ablation on Arrhythmia Burden in Patients With Shock-Resistant Persistent Atrial Fibrillation.

Background: Persistent shock-resistant atrial fibrillation (AF) is a challenging entity, with modest results from catheter ablation according to conventional survival analysis.

Objectives: The aim of this study was to determine the effect of catheter ablation on atrial tachyarrhythmia (ATA) burden in persistent AF patients undergoing first-time ablation with the use of an implantable cardiac monitor (ICM).

Methods: Patients with drug-resistant ongoing persistent AF and at least 1 previous failed cardioversion were implanted with an ICM 2 months before the procedure.

Serum uric acid: a futile bystander in endothelial function?

Purpose: This study aims to investigate the relationship between serum uric acid levels and endothelial function, oxidative stress, and hemodynamic parameters, and to determine if uric acid levels provide additional insights beyond traditional factors like ageing and hypertension in volunteers with low cardiovascular risk factors. Serum uric acid is known for its antioxidant properties, but it may also contribute to cardiovascular risk.

Materials And Methods: The study enrolled 40 male participants, divided into three groups based on age and blood pressure status.

Very High-Power Ablation for Contiguous Pulmonary Vein Isolation: Results From the Randomized POWER PLUS Trial.

Background: Very high-power, short-duration (90-W/4-second) ablation for pulmonary vein isolation (PVI) may reduce procedural times. However, shorter applications with higher power may impact lesion quality.

Objectives: In this multicenter, randomized controlled trial, the authors compared procedural efficiency, efficacy, and safety of PVI using 90-W/4-second ablation to 35/50-W ablation.