Concomitant cryoballoon pulmonary vein and posterior wall isolation in persistent atrial fibrillation: Results from the Left Atrial Posterior Wall Isolation in Conjunction With Pulmonary Vein Isolation Using the Cryoballoon for Treatment of Persistent Atrial Fibrillation (PIVoTAL) IDE trial.

Background: Pulmonary vein isolation (PVI) remains the cornerstone of atrial fibrillation (AF) ablation, but its efficacy in patients with persistent AF (PersAF) remains suboptimal compared with those with paroxysmal AF.

Objective: This study investigated the outcomes of cryoballoon PVI with concomitant "direct" posterior wall isolation (PWI) vs PVI alone in patients with symptomatic PersAF.

Methods: The PIVoTAL IDE was a prospective, multicenter trial (NCT04505163) that randomized patients with symptomatic antiarrhythmic drug-refractory PersAF to cryoballoon PVI vs PVI + PWI.

Effect of electrical posterior wall isolation on left atrial mechanical function.

Background: Pulmonary vein isolation (PVI) is a cornerstone of AF ablation. Posterior wall isolation (PWI) has become a frequently used adjunct to PVI. While there is data to suggest that PVI alone does not negatively impact left atrial function, the effect of PWI on left atrial mechanical function has not been definitively determined.

Outcomes of adjunct posterior wall isolation in atrial fibrillation patients with cardiac implantable electronic devices.

Background: Although pulmonary vein isolation (PVI) remains the cornerstone of catheter ablation of atrial fibrillation (AF), several studies have illustrated clinical benefits associated with PVI with posterior wall isolation (PWI).

Methods: This retrospective study investigated the outcomes of PVI alone versus PVI+PWI performed using the cryoballoon in patients with cardiac implantable electronic devices (CIEDs) and paroxysmal AF (PAF) or persistent AF (PersAF).

Results: Acute PVI was achieved in all patients using cryoballoon ablation.

Pulmonary Vein Isolation With and Without Posterior Wall Isolation in Paroxysmal Atrial Fibrillation: IMPPROVE-PAF Trial.

Background: Prior studies have demonstrated clinical benefits associated with cryoballoon pulmonary vein isolation (PVI) and concomitant posterior wall isolation (PWI) in patients with persistent atrial fibrillation (AF). However, the role for this approach in patients with paroxysmal atrial fibrillation (PAF) remains unclear.

Objectives: This study investigated the acute and long-term outcomes of PVI vs PVI+PWI using cryoballoon in patients with symptomatic PAF.

Painful left bundle branch block syndrome: Clinical and electrocardiographic features and further directions for evaluation and treatment.

Background: Painful left bundle branch block (LBBB) is a rarely diagnosed chest pain syndrome caused by intermittent LBBB in the absence of myocardial ischemia. Its prevalence, mechanism, detailed electrocardiographic (ECG) features, and effective treatments are not well described.

Objectives: The purpose of this study was to characterize clinical and ECG features of patients with painful LBBB syndrome with respect to the LBBB ECG morphology (in particular QRS axis and the precordial S/T wave ratio), clarify diagnostic criteria and possible mechanisms, and provide directions for further evaluation and treatment.

Nonreentrant ventricular arrhythmias in patients with structural heart disease unrelated to abnormal myocardial substrate.

Background: Ventricular arrhythmias in the absence of structural heart disease are commonly referred to as "idiopathic." Patients with structural heart disease have ventricular arrhythmias with the same mechanisms and sites of origin as idiopathic ventricular arrhythmias, but the prevalence of such arrhythmias is not well defined.

Objectives: To identify the prevalence of nonreentrant ventricular arrhythmias unrelated to abnormal myocardial substrate in patients with structural heart disease and to compare these arrhythmias to ventricular arrhythmias in patients with structurally normal hearts.

What About Tachycardia-induced Cardiomyopathy?

Long-standing tachycardia is a well-recognised cause of heart failure and left ventricular dysfunction, and has led to the nomenclature, tachycardia-induced cardiomyopathy (TIC). TIC is generally a reversible cardiomyopathy if the causative tachycardia can be treated effectively, either with medications, surgery or catheter ablation. The diagnosis is usually made after demonstrating recovery of left ventricular function with normalisation of heart rate in the absence of other identifiable aetiologies.

The importance of atrial fibrillation burden and the origin of device-tailored anticoagulation.

The current paradigm for anticoagulation in patients with atrial fibrillation is based upon clinical risk factors for stroke without reference to the frequency or duration (i.e., burden) of atrial fibrillation episodes.

Heart failure and tachycardia-induced cardiomyopathy.

Congestive heart failure is a major health care concern affecting almost six million Americans and an estimated 23 million people worldwide, and its prevalence is increasing with time. Long-standing tachycardia is a well-recognized cause of heart failure and left ventricular dysfunction and has led to the nomenclature, tachycardia-induced cardiomyopathy. Tachycardia-induced cardiomyopathy is generally a reversible cardiomyopathy with effective treatment of the causative arrhythmia, either with medications, surgery, or catheter ablation.

Body Mass Index, Quality of Life, and Catheter Ablation in Patients with Atrial Fibrillation.

Atrial fibrillation and obesity are interlinked epidemics and both impair quality of life. As the prevalence of both conditions in the US continues to rise, so will the number of obese patients with atrial fibrillation referred for catheter ablation. Catheter ablation has already been shown to significantly improve quality of life in patients with atrial fibrillation.

Death and near death from cardiac arrest during the Boston Marathon.

The Boston Marathon has been run for 115 years during which there were three sudden cardiac arrests. The most recent was a near death avoided by rapid cardiopulmonary resuscitation (CPR) and defibrillation. Awareness of the dangers of participating in a marathon, the risk factors associated with sudden death during competition, and the life-saving importance of rapid CPR and defibrillation are essential for participants and event organizers.

Trends in utilization and complications of catheter ablation for atrial fibrillation in Medicare beneficiaries.

Background: Utilization of radiofrequency catheter ablation (RFA) for treatment of atrial fibrillation (AF) is increasing. Data regarding the safety of RFA for AF outside of selected centers of excellence and in older patients are limited.

Objective: The purpose of this study was to quantify utilization of RFA for treatment of AF and rates of adverse events over time in unselected U.

Sleep associated gas exchange abnormalities in children and adolescents with habitual snoring.

Study Objectives: The purpose of this study was to describe the prevalence of polysomnographically diagnosed OSAS and to describe the severity of sleep associated gas exchange abnormalities (SAGEA) in habitually snoring children. We hypothesized that there would be a high prevalence of OSAS in obese children with habitual snoring and that the most overweight children would have the most significant SAGEA.

Design: Retrospective chart review.