The Electrophysiology Lab of the Future.

Electrophysiology (EP) labs are fundamental in cardiovascular medicine, especially for the diagnosis and treatment of cardiac arrhythmias. Nowadays, continuous advances in technology have led to significant improvements in the design and functioning of EP labs, including the development of more sensitive and accurate sensors and algorithms as well as three- and four-dimensional imaging and guidance systems. However, there are still significant challenges related to the reduction of radiation exposure, space constraints, and the integration and compatibility between the different EP systems.

Cardiac implantable electronic device implantation and function after transcatheter tricuspid valve replacement.

Background: Transcatheter tricuspid valve replacement (TTVR) has been introduced as a minimally invasive treatment for tricuspid regurgitation. Cardiac implantable electronic devices (CIEDs) commonly coexist with tricuspid regurgitation, and TTVR may cause bradyarrhythmias necessitating pacing.

Objective: The purpose of this study was to describe CIED outcomes after TTVR, including the incidence of bradyarrhythmias and pacemaker implantation, as well as outcomes in patients with preexisting CIEDs.

Incomplete Cancer Surgery Correlates With Loss of Immune Surveillance and Hyper-Progression of Disease.

Background: Surgery is potentially curative for solid cancers; however, in cases of incomplete surgery, the impact of surgery on immune surveillance in the residual tumor microenvironment is not known. We sought to understand how surgery impacts immune populations in a residual tumor and correlates with overall survival in patients with primary pleomorphic liposarcoma.

Methods: This retrospective cohort study was conducted by searching the UCLA Sarcoma Program database for all patients with a histologic diagnosis of primary pleomorphic liposarcoma from 1995 to 2015.

Predictive Parameters for Impending Steam Pops During High-Power Short-Duration Ablation for Atrial Fibrillation.

Background: High-power short-duration (HPSD) radiofrequency ablation (RFA) for atrial fibrillation (AF) treatment carries the risk of steam pops (SPs) due to rapid tissue heating. However, methods to predict impending SP during HPSD-RFA remain undefined.

Objective: This study aims to establish a quantitative criterion for predicting SPs during HPSD-RFA.

A Novel Electrocardiographic Approach for Accurate Diagnosis of Prior Inferior Myocardial Infarction.

Background: The accuracy of diagnosing prior inferior wall myocardial infarction (IMI) on the 12-lead electrocardiogram (ECG) remains limited.

Objectives: The aim of the study was to use predictive model building to select the optimal ECG criteria specific to the diagnoses of true-IMI.

Methods: From an ongoing health system-based cohort study (n = 382,121), all consecutive subjects with ECG-based diagnoses of prior IMI (n = 9,676; 2019-2023) were assessed.

Complex Fractionated Atrial Electrograms, Dispersion, and Voltage in Persistent Atrial Fibrillation: Implications for Electrogram-Guided Ablation.

Background: Various methods have been used to identify substrate of persistent atrial fibrillation (PeAF) including complex fractionated atrial electrograms (CFAEs), electrogram dispersion, and low-voltage areas (LVAs). This study aims to investigate their relationship and changes following ablation.

Methods And Results: Consecutive patients with PeAF undergoing catheter ablation were prospectively recruited.

Insights from the use of multipolar mapping during ablation of supraventricular and ventricular arrhythmias.

Background: Multipolar mapping, a novel method of electrogram acquisition and annotation distinct from unipolar and bipolar acquisitions, provides orientation-independent near-field signal acquisition with enhanced spatial precision. Multipolar mapping use in humans has not been described.

Objective: This study aimed to present findings on the use of multipolar mapping in a variety of different arrhythmia types and mechanisms.

Pulsed Field Ablation for Persistent Atrial Fibrillation: 1-Year Results of ADVANTAGE AF.

Background: Pulsed field ablation (PFA) has gained prominence for pulmonary vein isolation (PVI) to treat atrial fibrillation, but there are limited outcome data on PFA to treat persistent atrial fibrillation (PerAF).

Objectives: This study sought to determine the safety and efficacy of PVI + posterior wall ablation (PWA) with PFA in PerAF.

Methods: ADVANTAGE AF (A Prospective Single Arm Open Label Study of the FARAPULSE Pulsed Field Ablation System in Subjects with Persistent Atrial Fibrillation) is a prospective, single-arm, multicenter pivotal investigational device exemption study of PerAF patients undergoing PVI+PWA with the pentaspline PFA catheter.

Pulsed Field Ablation of Persistent Atrial Fibrillation With Continuous Electrocardiographic Monitoring Follow-Up: ADVANTAGE AF Phase 2.

Background: There are sparse high-quality safety and effectiveness data for pulsed field ablation (PFA) of persistent atrial fibrillation (PerAF), in which lesions beyond pulmonary vein isolation (PVI) are often placed. In addition, no large trials have used insertable cardiac monitors for continuous rhythm monitoring after ablation in patients with PerAF or after PFA in any atrial fibrillation population. In Phase 2 of the ADVANTAGE AF study (A Prospective Single Arm Open Label Study of the FARAPULSE Pulsed Field Ablation System in Subjects With Persistent Atrial Fibrillation), patients with PerAF underwent PFA for PVI and posterior wall ablation (PWA) and, in a subcohort, cavotricuspid isthmus ablation for typical atrial flutter.

Interscalene Block Catheter Knotting in Brachial Plexus Following Elective Reverse Total Shoulder Arthroplasty: A Case Report.

Case: A male patient in his late 50s had attempted removal of an interscalene block catheter after reverse total shoulder arthroplasty. Atypical pain and resistance raised concern for entrapment in the brachial plexus, requiring surgical exploration. It was found to have knotted in the anterior and posterior divisions of the upper trunk of the brachial plexus.

Does Stem Design Affect the Incidence of Periprosthetic Femoral Fractures in Arthroplasty for Femoral Neck Fractures? A Secondary Analysis of the HEALTH Trial.

Background: The aim of this study was to evaluate how stem design influences the risk of periprosthetic femoral fractures (PFFs) after hemiarthroplasty (HA) and total hip arthroplasty for femoral neck fractures.

Methods: We performed a secondary analysis of the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty trial, a multicenter, prospective, randomized control trial that assessed total hip arthroplasty versus hemiarthroplasty for low-energy femoral neck fractures. Between 1,374 patients (414 men, 960 women) that were assessed, 72 sustained PFFs (5.

Spatial analysis and characteristics of persistent late potentials after ablation of scar-related VT substrate: Implications for late potential elimination as a procedural endpoint with high-resolution mapping.

Background: Late potential (LP) elimination has been proposed as a surrogate endpoint for scar-related ventricular tachycardia (VT) ablation procedures. The characteristics, distribution, and predictors of persistent late potentials (pLPs) after ablation have not been studied.

Objective: The purpose of this study was to characterize the spatial distribution and features of pLP after catheter ablation of VT substrate with high-resolution mapping.

Sympathetic toggled paroxysmal atrial fibrillation and recurrent premature atrial contractions in ambulatory patients.

Background: Autonomic nerve activity is important in the mechanisms of paroxysmal atrial fibrillation (PAF).

Objective: The purpose of this study was to test the hypothesis that a single burst of skin sympathetic nerve activity (SKNA) can toggle on and off PAF or premature atrial contraction (PAC) clusters.

Methods: Simultaneous recording of SKNA and electrocardiogram (neuECG) recording was performed over 7 days in patients with PAF.

Respiratory control minimizes diaphragmatic contraction and dry cough during pulsed-field ablation of atrial fibrillation.

Aims: Pulsed-field ablation (PFA) is a promising new ablation modality to treat atrial fibrillation. However, PFA can cause varying degrees of diaphragmatic contraction and dry cough, especially under conscious sedation. This prospective study presents a method to minimize the impact of PFA on diaphragmatic contraction and dry cough during the procedure.

Sarcoma in patients with Lynch syndrome and response to immunotherapy.

Background: Lynch syndrome (LS) is an autosomal dominant genetic predisposition to multiple malignancies and is characterized by deficient DNA mismatch repair. Increased incidence of sarcomas is not formally ascribed to LS; however, increasing evidence suggests a preponderance of these malignancies in affected families. Sarcomas typically possess a low tumor mutational burden and incite a poor immune infiltrate, thereby rendering them poorly responsive to immunotherapy.

False Tendons in the Left Ventricle: Implications for Successful Ablation of Left Posterior Fascicular Tachycardias.

Background: The anatomical substrate for left posterior fascicular ventricular tachycardia (LPF-VT) is still unclear.

Objectives: The purpose of this study is to describe the endocavitary substrate of the re-entrant loop of LPF-VT.

Methods: A total of 26 consecutive patients with LPF-VT underwent an electrophysiology study and radiofrequency ablation.

Novel algorithms improve arrhythmia detection accuracy in insertable cardiac monitors.

Introduction: Insertable cardiac monitors (ICMs) are commonly used to diagnose cardiac arrhythmias. False detections in the latest ICM systems remain an issue, primarily due to inaccurate R-wave sensing. New discrimination algorithms were developed and tested to reduce false detections of atrial fibrillation (AF), pause, and tachycardia episodes in ICMs.

Cancer-Associated B Cells in Sarcoma.

Despite being one of the first types of cancers studied that hinted at a major role of the immune system in pro- and anti-tumor biology, little is known about the immune microenvironment in sarcoma. Few types of sarcoma have shown major responses to immunotherapy, and its rarity and heterogeneity makes it challenging to study. With limited systemic treatment options, further understanding of the underlying mechanisms in sarcoma immunity may prove crucial in advancing sarcoma care.

Catheter ablation of idiopathic left fascicular ventricular tachycardia: Implications of false tendons for mapping and ablation.

Introduction: The anatomical substrate for idiopathic left ventricular tachycardia (ILVT) remains speculative. Purkinje networks surrounding false tendons (FTs) might be involved in the reentrant circuit of ILVT. The objective was to evaluate the anatomical and electrophysiological features of false tendons FTs in relation to ILVT.

Reduction of opioid use after orthopedic surgery: a scoping review.

Background: The opioid epidemic is one of the biggest public health crises of our time, and overprescribing of opioids after surgery has the potential to lead to long-term use. The purpose of this review was to identify and summarize the available evidence on interventions aimed at reducing opioid use after orthopedic surgery.

Methods: We searched CENTRAL, Embase and Medline from inception until August 2019 for studies comparing interventions aimed at reducing opioid use after orthopedic surgery to a control group.

A Systematic Review of Outcome Measures in Orthopaedic Trauma Trials: What Are We Measuring?

Purpose: The objectives of this study are to describe the outcome measures used in orthopaedic fracture care trials, with a particular focus on patient-reported outcome measures (PROMs), and to determine which study characteristics are associated with number of citations.

Methods: We retrieved randomized clinical trials on fracture care between 2012 and 2017 from Embase, Medline and CENTRAL databases. Data collected included study characteristics (e.

The Prevalence and Outcomes of Unexpected Positive Intraoperative Cultures in Presumed Aseptic Revision Knee Arthroplasty.

Background: The prevalence and outcomes of unexpected positive intraoperative cultures (UPC) in presumed aseptic revision total knee arthroplasty (TKA) are unclear. The purpose of this study was to determine the prevalence of UPC and infection-free implant survival in this patient population. Secondly, we aimed to compare the infection-free implant survival between cohorts based on number of UPCs and antibiotic treatment.