Efficacy and Safety of Pulsed-Field Versus High-Power Short-Duration Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis With Reconstructed Time-to-Event Data.

Background: Pulsed-field ablation (PFA) and high-power short-duration (HPSD) ablation (45-90 W) are emerging technologies in atrial fibrillation (AF) treatment, both achieving durable pulmonary vein isolation. We aim to investigate the efficacy and safety of PFA versus HPSD ablation.

Methods: We comprehensively searched PubMed, Web of Science (WOS), Scopus, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) through July 2024.

Cardioneural Ablation for Functional Bradycardia and Vasovagal Syncope: Outcomes From the U.S. Multicenter CNA Registry.

Background: Cardioneural ablation (CNA) shows promise as a viable alternative to permanent cardiac pacing and pharmacotherapy for patients with symptomatic functional bradycardia and debilitating vasovagal syncope (VVS). The evidence supporting a potential therapeutic role for CNA is limited by relatively small sample sizes from predominantly single-center reports.

Objectives: This study sought to report the feasibility, safety, and clinical efficacy of CNA from a large, first-ever multicenter US registry.

Percutaneous VT Ablation Via RA-to-LV Access in Patients With Double Mechanical Valves: A Multicenter Registry.

Background: In patients with mechanical aortic and mitral valves requiring catheter ablation of ventricular tachycardia (VT), a technique for access from the right atrium (RA) to the left ventricle (LV) via puncture of the inferoseptal process of the LV was previously described in a single-center series.

Objectives: This study sought to report the multicenter experience of VT ablation using this novel LV access approach.

Methods: We assembled a multicenter registry of patients with double mechanical valves who underwent VT ablation with RA-to-LV access.

Septal late enhancement by cardiac CT is associated with repeat ablation in nonischemic cardiomyopathy patients.

Introduction: Scar substrate in nonischemic cardiomyopathy (NICM) patients is often difficult to identify. Advances in cardiac imaging, especially using late iodine-enhanced computed tomography (LIE-CT), allow better characterization of scars giving rise to ventricular tachycardia (VT). Currently, there are limited data on clinical correlates of CT-derived scar substrates in NICM.

Pulsed Field vs Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation: Recurrent Atrial Arrhythmia Burden.

Background: The ADVENT randomized trial revealed no significant difference in 1-year freedom from atrial arrhythmias (AA) between thermal (radiofrequency/cryoballoon) and pulsed field ablation (PFA). However, recent studies indicate that the postablation AA burden is a better predictor of clinical outcomes than the dichotomous endpoint of 30-second AA recurrence.

Objectives: The goal of this study was to determine: 1) the impact of postablation AA burden on outcomes; and 2) the effect of ablation modality on AA burden.

Surpoint algorithm for improved guidance of ablation for ventricular tachycardia (SURFIRE-VT): A pilot study.

Introduction: The utility of ablation index (AI) to guide ventricular tachycardia (VT) ablation in patients with structural heart disease is unknown. The aim of this study was to assess procedural characteristics and clinical outcomes achieved using AI-guided strategy (target value 550) or conventional non-AI-guided parameters in patients undergoing scar-related VT ablation.

Methods: Consecutive patients (n = 103) undergoing initial VT ablation at a single center from 2017 to 2022 were evaluated.

SARS-CoV-2 Infection Precipitating VT Storm in Patients With Cardiac Sarcoidosis.

The authors describe 3 patients presenting with cardiac sarcoidosis (CS) flare and ventricular tachycardia (VT) storm following infection with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), the causative agent of COVID-19. COVID-19-related cardiac manifestations can vary and include arrythmias, myocarditis, and exacerbation of underlying cardiovascular disease. The exact mechanism of myocardial involvement is not clear but may include abnormal host immune response and direct myocardial injury, thereby predisposing to enhanced arrhythmic risk.

Solving the Reach Problem: A Review of Present and Future Approaches for Addressing Ventricular Arrhythmias Arising from Deep Substrate.

Ventricular tachycardia (VT) is a significant cause of morbidity and mortality in patients with ischaemic and non-ischaemic cardiomyopathies. In most patients, the primary strategy of VT catheter ablation is based on the identification of critical components of reentry circuits and modification of abnormal substrate which can initiate reentry. Despite technological advancements in catheter design and improved ability to localise abnormal substrates, putative circuits and site of origins of ventricular arrhythmias (VAs), current technologies remain inadequate and durable success may be elusive when the critical substrate is deep or near to critical structures that are at risk of collateral damage.

inHEART Models software - novel 3D cardiac modeling solution.

Introduction: Advanced cardiac imaging is an important component in pre-procedural planning for ventricular tachycardia (VT) ablations. inHEART's proprietary software, inHEART Models, and its academic version, Multimodality Platform for Specific Imaging in Cardiology (MUSIC), provide detailed characterization of anatomical structures and scars.

Areas Covered: This review highlights the current overview of the market and offers insight into inHEART Models and MUSIC and its application during VT ablations with supporting case examples.

Substrate Imaging Before Catheter Ablation of Ventricular Tachycardia: Risk Prediction for Acute Hemodynamic Decompensation.

Background: The PAINESD (Pulmonary disease, Age, Ischemic cardiomyopathy, NYHA functional class, Ejection fraction, Storm, Diabetes mellitus) risk score has been validated as a predictor of periprocedural acute hemodynamic decompensation (AHD) in patients undergoing ventricular tachycardia (VT) ablation. Whether the addition of total scar volume (TSV) determined by preprocedure computed tomography imaging provides additional risk stratification has not been previously investigated.

Objectives: The purpose of this study was to evaluate the impact of TSV on the risk of AHD and its adjunctive benefit to the PAINESD score newly modified as Pulmonary disease, Age, Ischemic cardiomyopathy, NYHA class, Ejection fraction, Storm, Scar volume, Diabetes mellitus (PAINES2D) based on the addition of scar volumes.

Coronary Venous Mapping and Ablation for Ventricular Tachycardia.

Coronary venous mapping and ablation can be an effective strategy in targeting ventricular arrhythmias that arise from intramural or epicardial sites of origin. We discuss the case of a patient with ischemic cardiomyopathy referred to our center for index ventricular tachycardia ablation after receiving multiple shocks from his implantable cardioverter-defibrillator who underwent coronary venous mapping and ablation as an adjunct to endocardial ventricular tachycardia ablation.

A systematic review and meta-analysis comparing radiofrequency catheter ablation with medical therapy for ventricular tachycardia in patients with ischemic and non-ischemic cardiomyopathies.

Background: In patients with cardiomyopathy, radiofrequency catheter ablation (CA) for ventricular tachycardia (VT) is an adjunctive and alternative treatment option to long-term anti-arrhythmic drug therapy. We sought to compare CA with medical therapy for the management of VT in patients with ischemic and non-ischemic cardiomyopathies.

Methods: MEDLINE, Cochrane, and ClinicalTrials.

Epicardial mapping and ablation of ventricular tachycardia from the coronary venous system in post-coronary bypass patients.

Background: Ventricular tachycardia (VT) ablation of mid- or epicardial substrate is difficult and requires a creative approach in patients with a history of coronary bypass that precludes percutaneous epicardial catheter manipulation. The coronary venous system (CVS) provides limited access to the epicardial surface of the heart. The objective of this study is to assess the feasibility, safety, and efficacy of epicardial mapping and ablation of VT substrates from the CVS in patients with history of coronary bypass.

Non-invasive localization of premature ventricular focus: A prospective multicenter study.

Background: Accurate localization of premature ventricular contractions (PVC) focus is a prerequisite to successful catheter ablation.

Objective: The objective was to evaluate the software View Into Ventricular Onset (VIVO) accuracy at locating the anatomical origins for premature ventricular contractions. The VIVO device noninvasively creates a model of the patient's heart and torso, with exact locations of 12‑lead ECG electrodes, and applies a mathematical algorithm from surface signals to determine the origin of the arrhythmia.

Comparison of ablation index versus time-guided radiofrequency energy dosing using normal and half-normal saline irrigation in a porcine left ventricular model.

Background: Ablation Index (AI) is a multiparametric quality marker to assess the durability of radiofrequency (RF) lesions. The comparative effectiveness and safety of AI versus time-based energy dosing for ablation of ventricular arrhythmias are unknown.

Objective: We compared AI and time-based RF dosing strategies in the left ventricles (LVs) of freshly harvested porcine hearts.