Optimizing hypertension treatment: Evidence-based approaches and new drugs.

Despite advances, poor blood pressure control remains common. Through a series of cases, this review presents contemporary evidence-based approaches to managing hypertension. Additionally, it highlights treatment strategies that offer new hope in optimizing blood pressure control and reducing the incidence of cardiovascular disease.

Safety of Same-Day Discharge Following Pulsed-Field Ablation Versus Radiofrequency Ablation: A Comparative Analysis.

Background: Same-day discharge (SDD) after catheter ablation is increasingly adopted to improve patient convenience and reduce healthcare costs. While SDD following radiofrequency ablation (RFA) is well-documented, no data exist on SDD in patients undergoing pulsed-field ablation (PFA) for atrial fibrillation (AF).

Objective: To evaluate the safety of SDD in patients undergoing PFA and RFA for AF, with an exploratory comparison of practice patterns and outcomes.

Catheter ablation of atrial fibrillation in antiarrhythmic drug-naïve patients.

Background: Catheter ablation has become the standard of care for atrial fibrillation (AF) and is increasingly performed as first-line therapy.

Objective: We aimed to assess freedom from AF after AF ablation in antiarrhythmic drug (AAD)-naïve patients compared with those previously treated with AADs.

Methods: Patients undergoing AF ablation at the Cleveland Clinic were enrolled in a prospective registry for procedural and clinical outcomes (2013-2022).

Incidence and Predictors of Pacing-Induced Cardiomyopathy in Paced Patients Undergoing Attempted Left Bundle Branch Area Pacing.

Background: The incidence and predictors of pacing-induced cardiomyopathy (PICM) in patients undergoing attempted left bundle branch area pacing (LBBAP) are unknown.

Objective: To examine the incidence and predictors of PICM in patients with preserved left ventricular ejection fraction (LVEF) and atrioventricular block (AVB) undergoing attempted LBBAP.

Methods: The study cohort included consecutive patients undergoing an attempt at LBBAP at the Cleveland Clinic from 2018 until 2022 with preserved LVEF and AVB.

Role of the Bridge balloon in improving the safety of transvenous lead extraction procedures.

Background: Transvenous lead extraction (TLE) procedures are complex and carry an increased risk of superior vena cava (SVC) tears. Approved by the US Food and Drug Administration in February 2016, the Bridge balloon was designed to temporarily occlude the SVC in cases of SVC tears and facilitate surgical repair.

Objective: The purpose of this study was to evaluate the impact of introducing the Bridge balloon into clinical practice on reducing periprocedural mortality during TLE.

Radiation-Induced Cardiac Disease: Dilemma of Transcatheter Aortic Valve Replacement vs Surgical Aortic Valve Replacement and Pericardiectomy.

Background: Radiation-induced cardiovascular disease, a complication of mediastinal radiation, often results in valvular and pericardial disease. Management is challenging, especially in high-risk patients.

Case Summary: A 59-year-old man with a history of total body radiation presented with fatigue and dyspnea.

Procedural outcomes and predictors of lead extraction requiring a bailout femoral approach from a prospective registry at a large volume US center.

Background: Transvenous lead extraction (TLE) remains a complex procedure most commonly performed via the superior approach using the initial implant vein. The femoral approach is typically used as a "bailout" strategy aiming to increase success rate.

Objective: The study aimed to evaluate the procedural outcomes and factors associated with the "bailout" femoral approach in TLE.

Tissue Selectivity of Pulsed Field Ablation.

Over the last 2 decades, thermal-based catheter ablation has remained the mainstay treatment of cardiac arrhythmias. Although rare, thermal ablation can extend beyond the myocardium resulting in serious adverse events namely pulmonary vein stenosis, esophagus and phrenic nerve injury. In contrast, pulsed field ablation (PFA) has emerged as a promising technique that creates nonthermal lesions in cardiac tissue through the mechanism of irreversible electroporation (IRE).

Lesion Characteristics of Pulsed Field Ablation.

Pulsed field ablation (PFA) has emerged as a promising, nonthermal technique for arrhythmia ablation, leveraging high-voltage electrical fields to induce electroporation and create precise ablation lesions. Unlike traditional thermal methods such as radiofrequency ablation (RFA) and cryoablation, PFA selectively targets myocardial cells while sparing surrounding tissues, reducing the risk of collateral damage. This review focuses on the key characteristics of PFA lesion formation, drawing comparisons with RFA and cryoablation based on histopathology, imaging, and electroanatomical mapping.

Outcomes of Concomitant Atrial Fibrillation Ablation and Left Atrial Appendage Closure: A Retrospective Single-Center Experience.

Background: Catheter ablation is an effective therapy in the management of atrial fibrillation (AF). Left atrial appendage closure (LAAC) is an alternative to anticoagulation for stroke prevention in patients with bleeding risks.

Objectives: The purpose of this study was to assess the safety and efficacy of combining AF ablation and LAAC in a single procedure.

Outcomes of Atrial Fibrillation Ablation in Heart Failure Subtypes.

Background: Catheter ablation (CA) improves clinical outcomes in patients with atrial fibrillation (AF) and heart failure (HF) with reduced ejection fraction (HFrEF). We aimed to evaluate the impact of CA on clinical and quality-of-life outcomes across HF subtypes.

Methods: All patients undergoing AF ablation at a tertiary center were enrolled in a prospective registry and included in this study (2013-2021).

Blood Pressure Time in Target Range and its Impact on Clinical Outcomes.

Purpose Of Review: To examine the concept of time in target range for blood pressure (BP) management, exploring its calculation methods, implications for patient outcomes, and potential use in patient care.

Recent Findings: Recent post-hoc analyses of clinical trials and observational studies highlight the importance of BP time in target range in predicting cardiovascular outcomes. Higher time in target range correlates with reduced risks of major adverse cardiovascular events including heart failure, stroke, myocardial infarction and all-cause mortality.

Comparative Efficacy and Safety of Pulsed Field Ablation Versus Radiofrequency Ablation of Idiopathic LV Arrhythmias.

Background: Comparative efficacy and safety data on radiofrequency ablation (RFA) versus pulsed field ablation (PFA) for common idiopathic left ventricular arrhythmia (LV-VAs) locations are lacking.

Objectives: This study sough to compare RFA with PFA of common idiopathic LV-VAs locations.

Methods: Ten swine were randomized to PFA or RFA of LV interventricular septum, papillary muscle, LV summit via distal coronary sinus, and LV epicardium via subxiphoid approach.

Comparison of outcomes and required tools between transvenous extraction of pacemaker and implantable cardioverter defibrillator leads: Insight from single high-volume center experience.

Introduction: Reports of comparison with procedural outcomes for implantable cardioverter defibrillator (ICD) and pacemaker (PM) transvenous lead extraction (TLE) are old and limited. We sought to compare the safety, efficacy, and procedural properties of ICD and PM TLE and assess the impact of lead age.

Methods: The study cohort included all consecutive patients with ICD and PM TLE in the Cleveland Clinic Prospective TLE Registry between 2013 and 2022.

Impact of Contact Force on Pulsed Field Ablation Outcomes Using Focal Point Catheter.

Background: Conventional focal radiofrequency catheters may be modified to enable multiple energy modalities (radiofrequency or pulsed field [PF]) with the benefit of contact force (CF) feedback, providing greater flexibility in the treatment of arrhythmias. Information on the impact of CF on lesion formation in PF ablations remains limited.

Methods: An in vivo study was performed with 8 swine using an investigational dual-energy CF focal catheter with local impedance.

Association of device detected atrial and ventricular tachyarrhythmia with adverse events in patients with an implantable cardioverter-defibrillator.

Introduction: Heart failure patients with a history of atrial fibrillation (AF) and ventricular tachycardia/ventricular fibrillation (VT/VF) are known to have worse outcomes. However, there are limited data on the temporal relationship between development of these arrhythmias and the risk of subsequent congestive heart failure (CHF) exacerbation and death.

Methods: The study cohort comprised 5511 patients implanted with an implantable cardioverter-defibrillator (ICD) in landmark clinical trials (MADIT-II, MADIT-RISK, MADIT-CRT, MADIT-RIT, and RAID) who were in sinus rhythm at enrollment.

Cryoballoon pulmonary vein isolation versus radiofrequency ablation of the pulmonary veins and left atrial posterior wall: Patient-reported outcomes.

Background: Data are lacking on patient-reported outcomes (PRO) following cryoballoon ablation (CBA) versus radiofrequency ablation (RFA). We sought to evaluate QoL and clinical outcomes of cryoballoon pulmonary vein isolation only (CRYO-PVI-ONLY) versus RFA with PVI and posterior wall isolation (RF-PVI+PWI) in a large prospective PRO registry.

Methods: Patients who underwent AF ablation (2013-2016) at our institution were enrolled in an automated, prospectively maintained PRO registry.

Extraction outcomes of implantable cardioverter-defibrillator leads vary by manufacturer and model family.

Aims: Transvenous lead extraction (TLE) of implantable cardioverter-defibrillator (ICD) leads is considered challenging. The structure of each ICD leads is variable between manufacturer and model families. The net impact of lead family on the safety and effectiveness of TLE is poorly characterized.

Efficacy of Pulsed Field vs Radiofrequency for the Reablation of Chronic Radiofrequency Ablation Substrate: Redo Pulsed Field Ablation.

Background: The efficacy of pulsed field ablation (PFA) for redo procedures is unknown.

Objectives: In this study, the authors aimed to evaluate the effectiveness of PFA when performing PFA over chronic RFA (redo environment).

Methods: This was a 3-step in vivo study.