The Role of Imaging in Ventricular Tachycardia Ablation.

Ventricular tachycardia (VT) remains a major cause of morbidity and mortality in patients with structural heart disease. While catheter ablation has become a cornerstone in VT management, recurrence rates remain substantial due to limitations in electroanatomic mapping (EAM), particularly in cases of deep or heterogeneous arrhythmogenic substrates. Cardiac imaging, especially when multimodal and integrated with mapping systems, has emerged as a critical adjunct to enhance procedural efficacy, safety, and individualized strategy.

Termination of atrial arrhythmia and restoration of sinus rhythm during pulsed field ablation with a pentaspline catheter in patients with persistent atrial fibrillation.

Advanced TecHnologies For SuccEssful AblatioN of AF in Clinical Practice (ATHENA). URL: http://clinicaltrials.gov/Identifier: NCT05617456.

Optimizing C-Type Natriuretic Peptide and Receptor Expression Analysis with Droplet Digital™ PCR: Advancing Biomarker Discovery for Brugada Syndrome?

Brugada syndrome (BrS) is a cardiac disease associated with characteristic ECG abnormalities and a heightened risk of sudden cardiac death, especially in young individuals with structurally normal hearts. The primary aim of this study was to highlight, for the first time, the potential of using droplet digital PCR (ddPCR), a highly sensitive method, to detect () and its receptors, and , expression in BrS. Whole-blood samples from 12 subjects with type 1 BrS and 12 controls were analyzed.

[Management of arrhythmias during pregnancy: a literature review in light of the Heart Rhythm Society consensus document].

Maternal mortality represents a crucial indicator of the quality of care, as stated by the World Health Organization. Non-obstetric mortality in Italy is equally derived from cardiovascular and hypertensive problems with an upward trend. The increased incidence of cardiovascular risk factors, the rise in maternal age, and the use of assisted reproduction suggest a growing impact of arrhythmias on maternal morbidity and mortality.

Optimizing Imaging Techniques for Left Atrial Appendage Closure: Insights and Emerging Directions.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults and is associated with significant morbidity and mortality, including an increased risk of stroke, heart failure, dementia, and recurrent hospitalizations. As life expectancy rises, both the incidence and prevalence of AF continue to grow. Stroke prevention remains a cornerstone of AF management, with oral anticoagulation being the primary strategy to reduce thromboembolic risk.

Outcomes of Micra Leadless Pacemaker Implants in Centers With and Without Cardiac Surgery.

Background: Micra leadless pacemaker offers an alternative to traditional transvenous pacemakers by eliminating the risks associated with leads and device pockets. Due to the technical demands of a leadless transcatheter pacemaker, concerns initially limited the procedure to centers with on-site cardiac surgery (CS) capabilities. However, growing evidence supports its safe implementation in noncardiac surgical centers, though data comparing outcomes in these settings remain limited.

Does Age Impact Safety and Efficacy During Pulse-Field Ablation for Atrial Fibrillation?

Background: There is no evidence evaluating efficiency, effectiveness, and safety outcomes in older patients in the context of pulsed-field ablation technology for the ablation of atrial fibrillation. We aimed to compare safety, efficacy, and acute and long-term outcomes of pulsed-field ablation in older patients (≥75 years) with younger ones.

Methods: We enrolled consecutive patients who had undergone atrial fibrillation ablation with the pulsed-field ablation FARAPULSE system (Boston Scientific) at 15 centers.

Insight Into Early Recurrences After Pulsed-Field Ablation for Atrial Fibrillation: Results From a Multicenter Experience.

Background: Factors contributing to early recurrence after atrial fibrillation (AF) ablation, particularly with pulsed-field ablation (PFA), are poorly understood.

Purpose: This study aimed to evaluate the significance of early recurrence and identify factors associated with its occurrence, focusing on predicting late recurrence in AF patients treated with PFA.

Methods: A total of 620 consecutive patients referred for their first paroxysmal or early persistent AF ablation underwent the procedure using the FARAPULSE PFA system (Boston Scientific) across 10 centers.

Epicardial ventricular arrhythmia ablation: a clinical consensus statement of the European Heart Rhythm Association of the European Society of Cardiology and the Heart Rhythm Society, the Asian Pacific Heart Rhythm Society, the Latin American Heart Rhythm Society, and the Canadian Heart Rhythm Society.

Epicardial access during electrophysiology procedures offers valuable insights and therapeutic options for managing ventricular arrhythmias (VAs). The current clinical consensus statement on epicardial VA ablation aims to provide clinicians with a comprehensive understanding of this complex clinical scenario. It offers structured advice and a systematic approach to patient management.

Outcomes of ventricular tachycardia ablation facilitated by pre-procedural cardiac imaging-derived scar characterization: a prospective multi-centre international registry.

Aims: Pre-procedural imaging can facilitate scar-related ventricular tachycardia (VT) ablation, although only limited data have been reported. This prospective registry aimed to analyse procedural data and outcomes in a multi-centre setting of a pre-defined VT ablation strategy facilitated by the integration of pre-procedural imaging into the navigation system.

Methods And Results: Consecutive patients referred for scar-related left-sided VT ablation were prospectively enrolled at five European tertiary hospitals.

The Diagnostic Yield of Implantable Loop Recorders Stratified by Indication: A "Real-World" Single-Center Experience.

Implantable loop recorders (ILRs) are widely used for the diagnosis of unexplained syncope, palpitations, and cryptogenic stroke. While ILRs demonstrate clinical utility, data on their diagnostic yield and value in real-world settings remain limited. This study evaluates ILR performance, diagnostic yield, and clinical impact across multiple indications.

Leadless Micra pacemakers: Estimating long-term longevity. A real word data analysis.

Background: Although leadless pacemakers have demonstrated satisfactory safety and efficacy, there is limited published data regarding the estimated lifespan in real word clinical scenarios.

Methods: Between May 2015 and September 2023, all consecutive patients who underwent implantation of a single-chamber leadless Micra pacemaker were included in the One Hospital ClinicalService project and systematically tracked through remote monitoring at 15 Italian cardiology sites. Data on procedures, complications, electrical parameters, and estimated battery longevity were collected at baseline and annually during follow-up (FU).

One-year Impact of Clinical and Echocardiographic Parameters in Cardiac Implantable Electronic Device Infection after Transvenous Extraction.

Introduction: Cardiac implantable electronic device infection (CIEDi) represents a serious complication with a poor prognosis. Many studies have underlined the importance of comorbidities on prognosis, but less is known about the impact of echocardiographic parameters. The aim of our study was to evaluate the clinical and echocardiographic characteristics of patients hospitalized for CIEDi submitted to transvenous extraction and their impact on 1-year follow-up.

Leadless Pacemaker Implantation Following Lead Extraction in a Patient With Recent Percutaneous Tricuspid Valve Repair.

This case details the successful implantation of a leadless pacemaker following the extraction of transvenous leads in a 72-year-old female patient with a complex cardiovascular history. The patient had undergone a series of cardiac interventions, including a recent percutaneous tricuspid valve repair with a metal clip implant due to severe regurgitation. After presenting with an infection at the pacemaker site, methicillin-resistant Staphylococcus hominis was identified, necessitating the removal of the entire pacing system.

Ventricular lead malfunction in a patient with complete atrioventricular block and corrected transposition of the great arteries: Is leadless pacemaker the best solution?

Unlabelled: Corrected transposition of the great arteries (c-TGA) is a congenital abnormality characterized by atrioventricular (AV) and ventriculoarterial discordance, associated with early and late-onset conduction disturbances. We report the case of a c-TGA patient affected by congenital complete AV block, with right ventricular lead malfunction with prolonged dwell time and two abandoned leads. He underwent leadless VDD pacemaker implantation at an unusual site (i.

A Matlab Toolbox for cardiac electrophysiology simulations on patient-specific geometries.

In this paper, we present CardioMat, a Matlab toolbox for cardiac electrophysiology simulation based on patient-specific anatomies. The strength of CardioMat is the easy and fast construction of electrophysiology cardiac digital twins from segmented anatomical images in a general-purpose software such as Matlab. CardioMat implements a quasi-automatic pipeline that guides the user toward the construction of anatomically detailed cardiac electrophysiology models.

A Long Atrial Electromechanical Interval is Associated with Arrhythmic Recurrence after Catheter Ablation: How to Find What Has Been Lost.

Background: Atrial fibrillation (AF) results in electrical and structural remodeling of the atria, which extent is known to be associated with a higher AF recurrence rate after catheter ablation (CA). Recently, a novel echocardiographic parameter derived from tissue Doppler imaging (TDI) [PA-TDI] has been introduced to assess the total atrial activation time, as a noninvasive surrogate of fibrosis and remodeling. The aim of the study is to investigate the role of PA-TDI interval as a predictor of AF ablation efficacy.

Approaching Ventricular Tachycardia Ablation in 2024: An Update on Mapping and Ablation Strategies, Timing, and Future Directions.

This review provides insights into mapping and ablation strategies for VT, offering a comprehensive overview of contemporary approaches and future perspectives in the field. The strengths and limitations of classical mapping strategies, namely activation mapping, pace mapping, entrainment mapping, and substrate mapping, are deeply discussed. The increasing pivotal relevance of CMR and MDCT in substrate definition is highlighted, particularly in defining the border zone, tissue channels, and fat.

Ranolazine Unveiled: Rediscovering an Old Solution in a New Light.

Ranolazine is an anti-anginal medication that has demonstrated antiarrhythmic properties by inhibiting both late sodium and potassium currents. Studies have shown promising results for ranolazine in treating both atrial fibrillation and ventricular arrhythmias, particularly when used in combination with other medications. This review explores ranolazine's mechanisms of action and its potential role in cardiac arrhythmias treatment in light of previous clinical studies.

The Ablate-by-LAWT multicentre prospective study: Personalized paroxysmal atrial fibrillation ablation with ablation index adapted to local left atrial wall thickness.

Background: Personalized radiofrequency (RF) ablation for paroxysmal atrial fibrillation (PAF), adapting the ablation index (AI) to local left atrial wall thickness (LAWT), proved to be highly efficient maintaining high arrhythmia-free survival rates. However, multicentre data are lacking. This multicentre, prospective, non-randomized study was conducted at 5 tertiary hospitals and sought to assess the safety, efficacy, and reproducibility of the LAWT-guided ablation for PAF.

Contact-force local impedance algorithm to guide effective pulmonary vein isolation in AF patients: 1-year outcome from an international multicenter clinical setting.

Background: The combination of highly localized impedance (LI) and contact force (CF) may improve tissue characterization and lesion prediction during radiofrequency (RF) pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF).

Objective: We report the outcomes of our acute and long-term clinical evaluation of CF-LI-guided PVI in consecutive AF ablation cases from an international multicenter clinical setting.

Methods: Three hundred twenty-four consecutive patients from 20 European centers undergoing RF catheter ablation with the Stablepoint™ catheter were enrolled in the CHARISMA registry.