Comparative Effects of Pulsed Field and Radiofrequency Ablation on Blood Cell Parameters During Pulmonary Vein Isolation.

Pulsed field ablation (PFA) is a novel non-thermal modality for pulmonary vein isolation (PVI) in atrial fibrillation (AF), offering myocardial selectivity through irreversible electroporation while sparing surrounding structures. However, concerns have emerged regarding potential subclinical hemolysis, reflected by alterations in biochemical markers such as lactate dehydrogenase (LDH). We conducted a retrospective, single-center study involving 249 patients undergoing PVI: 121 treated with PFA (PulseSelect or FARAPULSE) and 128 with radiofrequency (RF) ablation (PVAC catheter).

Optimising implantable loop recorder alerts with artificial intelligence: role of R-wave amplitude and workload reduction.

Background: False-positive (FP) alerts from implantable loop recorders increase clinical workload and may delay appropriate intervention. AccuRhythm AI, a cloud-based filtering algorithm, is designed to reduce these alerts in Reveal LINQ and LINQ II devices. This study assessed the algorithm's effect on FP and clinician burden reduction, with a focus on the influence of R-wave sensing amplitude.

Integrated Severity Staging of Paravalvular Regurgitation After Transcatheter Aortic Valve Implantation Using Echocardiographic and Hemodynamic Assessment.

Evidence suggests that even mild-to-moderate paravalvular regurgitation (PVR) following transcatheter aortic valve implantation (TAVI) is associated with adverse outcomes. We directly compared the diagnostic performance and predictive value of invasive (hemodynamic) versus noninvasive (echocardiographic) assessments of PVR. Additionally, we explored the effectiveness of a comprehensive integrated approach that combines both methodologies to accurately identify and predict the clinical consequences of PVR.

Not Afraid to Go Beyond: Innovative Management of Intermuscular S-ICD Infection.

Background: Subcutaneous implantable cardioverter-defibrillator (S-ICD) infection can be managed conservatively, shifting the generator from the submuscular to intermuscular pocket.

Case Summary: A 50-year-old man with hypertrophic cardiomyopathy and an S-ICD implanted as primary prevention with the intermuscular pocket technique was admitted to the cardiology department for a check-up owing to evidence of a pseudonodular skin lesion over the catheter sleeve that developed after having shaved the chest. Positron emission tomography/computed tomography scan was performed and revealed an active infection both over the S-ICD generator and along the lead.

Endocardial Ablation of Atrial Flutter with Involvement of the Vein of Marshall: A Case Report.

Atypical atrial flutter (AFL) is a complex clinical challenge, particularly in patients with prior atrial fibrillation (AF) treated with pulmonary vein isolation (PVI). Arrhythmias involving the vein of Marshall (VOM) often require extensive lesion sets, including ethanol infusion, to effectively target the epicardial substrate. To minimize tissue damage, an alternative strategy has been proposed, emphasizing advanced electroanatomical mapping, entrainment maneuvers, and highly targeted ablation techniques.

Myocardial work parameters in left bundle branch area pacing versus other pacing techniques: a systematic review and aggregate comparative analysis.

Cardiac conduction disease often necessitates permanent pacemaker implantation. While right ventricular pacing (RVP) effectively treats bradycardia, it may lead to adverse cardiac remodeling and heart failure. Left bundle branch area pacing (LBBAP) has emerged as an alternative, potentially preserving myocardial function.

Novel Right Ventricular Function Parameters can Identify Short-Term Nonresponders to Transcatheter Edge-to-Edge Repair for Mitral Regurgitation.

Mitral regurgitation (MR) is a common valvular disease associated with poor prognosis. Percutaneous mitral valve repair (PMVR) combined with guideline-directed medical therapy has shown prognostic benefits, yet a substantial proportion of patients experience major adverse cardiovascular events (MACE), including death and heart failure hospitalization, within the first year. Identifying short-term nonresponders remains a clinical priority.

Durability of Ultra-Low Temperature Cryoablation Lesions in Atrial Fibrillation: Insights From Repeat Ablation Procedures.

Background: Ultra-low temperature cryoablation (ULTC) is a technique designed to rapidly cool cardiac tissue to extremely low temperatures, enabling the creation of ablation lesions for the treatment of atrial fibrillation (AF). Prior studies have demonstrated low rates of arrhythmia recurrence, but little is known about ablation lesion durability.

Methods: Patients undergoing repeat ablation were selected from the CryoCure2 (NCT02839304) and iCLAS PMCF(NCT05416086) studies.

Patient with Vulnerable Coronary Plaque and Treatment with Evolocumab: A Clinical Case.

Vulnerable coronary plaques are strongly associated with acute coronary events, posing significant therapeutic challenges despite statin therapy. This case report evaluates the impact of Evolocumab, a PCSK-9 inhibitor, on stabilizing high-risk plaques and promoting phenotypic transformation, assessed through coronary CT angiography (CCTA). A 50-year-old male with chronic coronary syndrome and a history of myocardial infarction underwent a CCTA, revealing a high-risk plaque (approximately 50%) in the proximal LAD.

Ex vivo efficacy assessment of ultralow temperature cryoablation versus standard RF ablation applied to surgical ventricular patches: implications for ventricular ablation in patients with repaired congenital heart disease.

Background: Clinical experience during trans-patch ventricular ablations shows difficult lesion formation when using standard RF ablation technology. The aim of this exploratory study is to test if ultralow temperature cryoblation (ULTC) technology could be suitable for trans-patch ventricular ablations.

Materials And Methods: Ex vivo ablations were performed on 16 porcine tenderloin specimens of 5 × 7 × 3 cm, eight with and eight without pericardial patch (Supple Peri-Guard Repair Patch, Baxter, USA).

Catheter-Based Renal Denervation for Resistant Arterial Hypertension: 10-Year Real-World Follow-Up Data.

This analysis of real-world data examines the efficacy, safety, and long-term outcomes of renal denervation in hypertensive patients for up to 10 years. Sixty-five consecutive patients underwent renal denervation (RDN) (single operator) for uncontrolled resistant hypertension. Efficacy was defined as the interindividual change of office (OBPM) and ambulatory blood pressure monitoring (ABPM) at 1, 6, 12 months, 2-4 and 5-10 years after RDN.

Cardiomyopathy and Sudden Cardiac Death: Bridging Clinical Practice with Cutting-Edge Research.

Sudden cardiac death (SCD) prevention in cardiomyopathies such as hypertrophic (HCM), dilated (DCM), non-dilated left ventricular (NDLCM), and arrhythmogenic right ventricular cardiomyopathy (ARVC) remains a crucial but complex clinical challenge, especially among younger populations. Accurate risk stratification is hampered by the variability in phenotypic expression and genetic heterogeneity inherent in these conditions. This article explores the multifaceted strategies for preventing SCD across a spectrum of cardiomyopathies and emphasizes the integration of clinical evaluations, genetic insights, and advanced imaging techniques such as cardiac magnetic resonance (CMR) in assessing SCD risks.

High efficiency single-catheter workflow for radiofrequency atrial fibrillation ablation in the QDOT catheter era.

Background: High-power short-duration (HPSD) ablation may improve the consistency and efficiency of pulmonary vein isolation (PVI). The novel QDOT Micro™ catheter (Biosense Webster, Inc.) with temperature feedback and microelectrodes aims to enhance PVI efficiency and safety.

Combined Cardiac Damage Staging by Echocardiography and Cardiac Catheterization in Patients With Clinically Significant Aortic Stenosis.

Background: Cardiac damage (CD) staging enhances risk stratification in patients with clinically significant aortic stenosis (AS). We aimed to assess the prognostic value and reclassification rate of right heart catheterization (RHC) compared with transthoracic echocardiography (TTE) in characterising CD staging at 3-year follow-up in patients with clinically significant AS, to identify patients that would benefit from RHC for prognostic stratification, and to test the prognostic value of combined CD staging.

Methods: An observational cohort study of 432 AS patients undergoing TTE and RHC were divided into moderate or asymptomatic severe (m/asAS) and symptomatic severe (ssAS) AS.

Appropriate ICD Interventions for Ventricular Arrhythmias Are Predicted by Higher Syntax Scores I and II in Patients with Ischemic Heart Disease.

Aims: The occurrence of ventricular arrhythmias (VAs) in ischemic heart disease (IHD) patients is related to the presence and extent of fibrotic/scar tissue. As coronary atherosclerosis is the underlying cause of myocardial ischemia and fibrosis, in IHD patients implanted with an implantable cardioverter defibrillator (ICD) we investigated the relation between the VA burden and the complexity of coronary atherosclerotic lesions.

Methods And Results: In IHD patients who underwent coronary angiography and ICD implant, the Syntax scores I and II (SSI-II), as index of the severity of the coronary atherosclerotic disease, and the occurrence of VA were assessed.

Does the Age Affect the Outcomes of Cardiac Resynchronization Therapy in Elderly Patients?

Background: More and more heart failure (HF) patients aged ≥ 75 years undergo cardiac resynchronization therapy (CRT) device implantation, however the data regarding the outcomes and their predictors are scant. We investigated the mid- to long-term outcomes and their predictors in CRT patients aged ≥ 75 years.

Methods: Patients in the Cardiac Resynchronization Therapy Modular (CRT MORE) Registry were divided into three age-groups: <65 (group A), 65-74 (group B) and ≥75 years (group C).