Patient Comfort and Response Pattern Following Pulsed-Field Ablation Compared to Radiofrequency Ablation for Atrial Fibrillation.

Background: Pulsed-field ablation (PFA) for atrial fibrillation (AF) offers several advantages compared to thermal ablation, however direct comparisons of patient-reported outcomes after PFA and radiofrequency ablation (RFA) are limited. This study aimed to assess patient experience following PFA or RFA in AF ablation performed under general anesthesia.

Methods: A retrospective study across a single integrated health system was conducted on consecutive patients who underwent PFA or RFA for AF under general anesthesia from March 2024 to December 2024.

Immediate Leg Mobilization is Feasible After Catheter Ablation of Atrial Fibrillation Using Large Vascular Access Sheaths (Pulsed Field and Cryoballoon Ablation).

Background: Vascular recovery from catheter ablation (CA) has traditionally required a period of leg immobilization which can lead to discomfort and prolonged time to discharge.

Objective: The objective of this study was to compare a strategy of immediate leg mobilization (IM) using suture-mediated closure devices against traditional vascular recovery consisting of figure-of-eight suture and 4 h bed rest (BR) after CA of atrial fibrillation (AF) using large vascular access sheaths for cryoballoon ablation (CBA) and pulsed field ablation (PFA).

Methods: Two hundred subjects were retrospectively analyzed: 100 IM and 100 BR.

Characterization of acute residual pulmonary vein connections using electroanatomic mapping during pulsed-field ablation of atrial fibrillation.

Background: Single-shot pulsed-field ablation (PFA) catheters show promising safety and efficacy for achieving pulmonary vein isolation (PVI) in atrial fibrillation (AF). However, additional PFA applications are sometimes required after standard PFA delivery to achieve PVI.

Objective: This study aimed to evaluate the real-world frequency and location of acute residual pulmonary vein (PV) connections using 3-dimensional electroanatomic mapping (3D-EAM) during index PFA.

Feasibility of deep sedation for catheter ablation of atrial fibrillation using pulsed field ablation.

Introduction: Pulsed field ablation (PFA) is a non-thermal energy source for catheter ablation associated with shorter procedure time, less risk of esophageal injury, and less dependence on absolute catheter stability compared with radiofrequency ablation. Limited data are available on performing the procedure with deep sedation (DS) as an alternative to general anesthesia (GA) utilizing endotracheal intubation.

Methods: Patients who underwent PFA using DS between March and August 2024 were retrospectively included.

Imaging evaluation of a persistent left superior vena cava and its importance in electrophysiologic procedures.

Accurate characterization of thoracic vascular structures is essential to safe, efficient, and successful cardiac electrophysiologic procedures. Here we describe a case of persistent left superior vena cava incidentally discovered during an elective cryoablation of atrial fibrillation procedure to illustrate possible diagnostic modalities to identify vascular abnormalities.

The Advanced Application of Intracardiac Echocardiography for Cardiac Electrophysiology Ablation Procedures.

Purpose Of Review: The advanced use of intracardiac echocardiography (ICE) is both a significant leap forward and an underutilized and unrealized innovation for electrophysiological (EP) procedures [1]. ICE can inform operators of complex anatomic heterogeneity as well as close anatomic relationships beyond fluoroscopy and even electroanatomic mapping. We will review the myriad advantages of advanced ICE application to EP ablation procedures.

Fluoroless left atrial access for radiofrequency and cryoballoon ablations using a novel radiofrequency transseptal wire.

Purpose: Conventional catheter ablation for atrial fibrillation requires fluoroscopy, which has inherent risks of radiation exposure to patients and medical staff. Optimization of fluoroscopy parameters and use of three-dimensional electroanatomic mapping (EAM) and intracardiac echocardiography (ICE) have helped to reduce radiation exposure; however, despite growing evidence, there are still concerns about safety and added procedure time associated with fluoroless procedures, particularly in left-sided ablations, due to the potential risk of complications. Herein, we report our initial experience using a radiofrequency (RF) wire for completely fluoroless radiofrequency ablation (RFA) and cryoballoon ablation (CBA).

Fluoroless Catheter Ablation of Cardiac Arrhythmias.

Fluoroless catheter ablation of all endocardial cardiac arrhythmias is feasible using current, and often standard, electrophysiology laboratory equipment. This article lays out a road map for performing fluoroless ablations, safely and efficaciously. We outline optimizing intracardiac echocardiography, performing complex ablations with radiofrequency and cryoballoon technology.

Late perforation of a passively fixated pacemaker lead through the right ventricle. A report and review of literature.

Lead perforation is one of the serious complications associated with cardiac pacemakers and implantable cardiac defibrillators. Late perforations - occurring more than one month after placement - are exceedingly rare and are usually more associated with actively fixed leads rather than passively fixed tined leads. We present a case of blunt ended tined lead perforation after 4 months of implantation managed by a two-step hybrid minimally invasive approach consisting of mini-thoracotomy and lead tip transection, followed by trans-venous lead extraction.

Fluoroless Catheter Ablation of Cardiac Arrhythmias: A 5-Year Experience.

Background: Catheter ablations have been traditionally performed with the use of fluoroscopic guidance, which exposes the patient and staff to the inherent risks of radiation. We have developed techniques to eliminate the use of fluoroscopy during cardiac ablations and have been performing completely fluoroless catheter ablations on our patients for over 5 years.

Methods: We present a retrospective analysis of the safety, efficacy, and feasibility data from 500 consecutive patients who underwent nonfluoroscopic catheter ablation, targeting a total of 639 arrhythmias, including atrioventricular reciprocating tachycardia (AVRT), atrioventricular nodal reentrant tachycardia (AVNRT), atrial tachycardia (AT), atrial fibrillation (AF), premature ventricular contractions (PVCs), and ventricular tachycardia (VT).

Nonfluoroscopic Ablation of Atrial Fibrillation Using Cryoballoon.

Background: The conventional method of cryoballoon ablation of atrial fibrillation involves the use of fluoroscopy for visual guidance. The use of fluoroscopy is accompanied by significant radiation risks to the patient and the medical staff. Herein, we report our experience in performing successful nonfluoroscopic pulmonary vein isolation using cryoballoon ablation in 5 consecutive patients with paroxysmal atrial fibrillation.

Dissemination of a simulation-based mastery learning intervention reduces central line-associated bloodstream infections.

Background: Approximately 41,000 central line-associated bloodstream infections (CLABSI) occur annually in US hospitals. We previously developed a simulation-based mastery learning (SBML) curriculum in central venous catheter (CVC) insertion that significantly reduced CLABSI rates. In this study, we evaluated the effect of dissemination of the SBML curriculum on trainee skills and CLABSI rates at a community hospital.