Feasibility and Safety of Pulsed Field Ablation for Coronary Sinus and Left Atrial Appendage Isolation and Mitral Isthmus Ablation: Acute and Chronic Findings.

Background: The safety and efficacy of pulsed field ablation for pulmonary vein and posterior wall isolation in atrial fibrillation ablation are well established; however, evidence regarding its use in extra-pulmonary vein areas remains limited. The aim of this study was to assess the feasibility and durability of pulsed field ablation for coronary sinus (CS) and left atrial appendage (LAA) isolation and mitral isthmus (MI) ablation.

Methods: We analyzed data from consecutive patients who underwent repeat atrial fibrillation ablation with pulsed field ablation between February and October 2024.

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: PVI remains the cornerstone of AF ablation, but its efficacy in patients with persistent AF (PersAF) remains suboptimal compared to those with paroxysmal AF.

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

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

Ablation Index-Guided Radiofrequency Ablation for Atrial Fibrillation: An Updated Meta-Analysis on Its Procedural Efficacy and Safety Profiles.

Atrial fibrillation (AF) is the most common sustained arrhythmia, with radiofrequency ablation (RFA) being a key treatment strategy. Despite its success, AF recurrence postablation is significant, and the ablation index (AI) was introduced to improve lesion quality and clinical outcomes. The aim of this study was to provide updated safety and efficacy data regarding AI-guided ablation strategy.

Management of oral anticoagulation after pulsed field ablation for atrial fibrillation: Insights from a multicenter study.

Background: The endothelial injury that can promote thrombus formation during radiofrequency ablation (RFA) of atrial fibrillation does not occur with pulsed field ablation (PFA).

Objective: The purpose of this study was to evaluate different strategies for oral anticoagulation (OAC) management following PFA and RFA.

Methods: Consecutive patients undergoing PFA were propensity score matched with consecutive patients undergoing RFA during the same time period (1:1) and prospectively followed up for 15 months.

Contemporary medical therapy, sex-specific characteristics, and outcomes of patients with non-ischemic cardiomyopathy: a prespecified interim analysis of the BIO-LIBRA study.

Background: Contemporary data on characteristics, medical therapy, and outcomes in non-ischemic cardiomyopathy (NICM) with implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) are lacking, and the role of sex remains unexplored due to historical low enrollment of females in device trials. The purpose of this pre-specified interim analysis of the BIO-LIBRA study was to assess characteristics, medical therapy, and ventricular tachyarrhythmias (VT/VF) or mortality at 12 months in NICM patients with ICD or CRT-D, by sex.

Methods: In this multicenter, prospective, registry study, we recruited patients with primary prevention ICD or CRT-Ds with Home Monitoring®, aiming for 40% female enrollment, utilizing specific recruitment tools.

Impact of contact force and pulsed field ablation parameters on myocardial lesion formation during pulsed field ablation: A systematic review of pre-clinical studies.

Pulsed field ablation (PFA) is a novel and minimally thermal energy source that exploits the biophysics of irreversible electroporation (IRE) to cause cell death. Differently from radiofrequency ablation (RFA) where adequate catheter-tissue contact proved paramount in lesion formation, the additional role of contact force (CF) during PFA is under debate due to the inherent myocardial selectivity and the customizable nature of IRE. In fact, it is not clear whether the amount of contact exerted during PFA delivery is as pivotal in achieving optimal lesion size as during RFA.

Caveolin 3 Variant T78M in a Large Family With Brugada Syndrome: Clinical Features and Coexistence of ADRB1 and GRK5 Gene Mutation.

Aims: Genetic mutations involving sodium channel Nav 1.5 have been linked with Brugada Syndrome (BrS). Caveolin-3(CAV-3) is a protein that could modulate Nav1.

Impact of the first-pass pulmonary vein isolation on ablation outcomes in persistent atrial fibrillation.

Background: The achievement of first-pass isolation (FPI) during pulmonary vein isolation (PVI) generally serves as a reliable marker of lesion quality in initial radiofrequency encirclement and predicts favorable procedural outcomes. This study sought to evaluate the impact of the FPI on the long-term clinical outcomes in persistent atrial fibrillation (PeAF) patients undergoing radiofrequency ablation.

Methods: We conducted a retrospective analysis of 346 patients with PeAF who were divided into three groups: patients with FPI in bilateral PVs (BOTH group,  = 197), those with FPI in either ipsilateral PVs (EITHER group,  = 92), and those without FPI in bilateral PVs (NEITHER group,  = 57).

Optimal Thromboembolism Prevention for Patients With Atrial Fibrillation on Long-Term Dialysis.

Background: Optimal strategies for thromboembolism prevention, including vitamin K antagonists (VKA), direct oral anticoagulants (DOAC), and left atrial appendage occlusion (LAAO), for patients with atrial fibrillation (AF) and on dialysis have not been fully investigated. We aimed to investigate the efficacy and safety of thromboembolism prevention strategies in AF patients on dialysis through a network meta-analysis.

Methods: Multiple databases were searched through January 2024.

HRS Scientific Documents Methodology Manual: Executive summary.

The Heart Rhythm Society (HRS) Scientific Documents Pathway was established to support the development of high-quality, evidence-informed scientific statements that advance the field of electrophysiology through the synthesis and communication of foundational knowledge, translational insights, and emerging trends. Unlike clinical practice guidelines, scientific documents are not designed to offer practice recommendations. Instead, they provide a framework for understanding scientific domains that impact the arrhythmia care community.

Premature Ventricular Complexes After Ablation for Paroxysmal Atrial Fibrillation and Recurrent Atrial Arrhythmias: The admIRE Subanalysis.

Background: Premature ventricular complexes (PVCs) have been reported to independently predict incident atrial fibrillation in the general population. The prognostic importance of PVCs after catheter ablation for paroxysmal atrial fibrillation (PAF) is unknown.

Objectives: In patients undergoing catheter ablation for PAF, we assessed whether postablation PVCs influence the risk for recurrence.

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.

Role of Catheter-Tissue Contact in Pulsed Field Ablation.

Pulsed electrical field energy is a highly customizable, minimally thermal energy source associated with a myriad of potential ablation recipes that would hypothetically limit the importance of catheter-tissue contact on lesion formation. However, recent preclinical studies conducted on ventricular swine models suggest that contact force is pivotal in achieving adequate lesion formation even during pulsed field ablation. Despite the accruing preclinical evidence, clinical data on ablation targets beyond pulmonary veins are lacking and vast, and prospective human studies are required to better explore the clinical outcome of patients undergoing contact-force-guided pulsed field ablation for cardiac arrhythmias.

NEMESIS-PFA: Investigating Collateral Tissue Injury Associated With Pulsed Field Ablation.

Background: Early evidence showed reduced complications with pulsed field ablation (PFA), but non-target tissue collateral damage created by electroporation effects is poorly understood and may significantly differ between systems.

Objectives: In this study, the authors evaluated the collateral effects of PFA.

Methods: NEMESIS-PFA is a multicenter, observational registry of patients who underwent AF ablation from March 2024 onwards with any approved PFA systems-either a circular multielectrode array, spherical, pentaspline, or variable loop catheter-or radiofrequency ablation (RFA).

Current state of arrhythmia care in Latin America: A statement from the Latin American Heart Rhythm Society.

Background: On May 18, 2023, the Latin American Heart Rhythm Society and the Heart Rhythm Society convened a meeting of leaders committed to arrhythmia care in Latin America to discuss clinical and health care policy issues and the barriers to delivering world-class standards in electrophysiology (EP) services, discuss potential future solutions, and share experiences and best practices.

Methods: A questionnaire on clinical arrhythmia problems, access to EP procedures, annual numbers of arrhythmia and device implantation procedures, and the largest medical issues that face each country was sent to 15 Latin American Heart Rhythm Society representatives from 15 different countries of the 20 that make up Latin America and was completed by all of them before the meeting. The event was organized as a series of individual reports, provided by the representatives as well as 11 regional leaders, followed by open discussion among the chair and meeting participants.