The Clinical Significance of Atrial Fibrillation in Non-High-Risk Brugada Syndrome: The BruFib Study.

Background: Atrial fibrillation (AF) occurs in up to 20% of patients with Brugada syndrome (BrS), yet its risk factors and prognostic implications remain uncertain.

Objectives: This study sought to identify risk factors for AF in patients with non-high-risk BrS and to evaluate the impact of AF on ventricular arrhythmias (VAs), sick sinus syndrome (SSS), and stroke in non-high-risk BrS.

Methods: This was a multicenter, retrospective study conducted across 20 international centers.

Prognostic Role of Myocarditis-Like Episodes and Their Treatment in Patients With Pathogenic Desmoplakin Variants.

Background: Inflammatory, myocarditis-like episodes precede and are associated with higher risk of sustained ventricular arrhythmias and heart failure in patients with pathogenic or likely pathogenic desmoplakin (DSP) variants. Whether the recurrence and treatment of myocarditis-like episodes influence the outcomes in this population is unknown. This study aimed to assess the prognostic impact of the recurrence and treatment of myocarditis-like episodes in patients with pathogenic or likely pathogenic DSP variants.

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.

Major arrhythmias in non-dilated left ventricular cardiomyopathy: a novel prediction score.

Background And Aims: The prediction of the first major arrhythmic event (MAE) is still an unmet need in the recently defined scenario of non-dilated left ventricular cardiomyopathy (NDLVC).

Methods: A cohort of 337 patients with NDLVC and no history of MAE was retrospectively identified at two large centres. Patient-tailored diagnostic workup included cardiac magnetic resonance (CMR), endomyocardial biopsy, and genetic testing.

Diagnostic Criteria and Disease Staging for Desmoplakin Cardiomyopathy.

Background: Desmoplakin (DSP) cardiomyopathy, caused by variants in the gene , is a unique subtype of cardiomyopathy distinct from typical dilated or arrhythmogenic right ventricular cardiomyopathies. Specific diagnostic and disease staging criteria have yet to be developed for DSP cardiomyopathy.

Objective: Utilizing a large cohort of DSP cardiomyopathy patients and their genotype-positive family members, this study aims to develop diagnostic and disease staging criteria for DSP cardiomyopathy.

Long-Term Risk Assessment in Athletes With Complex Ventricular Arrhythmias.

Background: Ventricular arrhythmias (VAs) are a major concern in athletes. We sought to determine the prognostic role of noninvasive and invasive assessments in athletes with complex VAs.

Methods: One-hundred-ninety athletes (82% men; 28 [19-43] years; 148 [78%] competitive athletes) with frequent or exercise-induced premature ventricular complexes or nonsustained ventricular tachycardia were included in a multicenter cohort study and categorized based on VA ECG morphology into common (n=99) and uncommon (n=91) VA groups.

Ensuring catheter-tissue contact with intracardiac echocardiography during pulsed-field ablation improves procedure outcome in patients with atrial fibrillation.

Background: Catheter-tissue contact is critical in creating durable lesions during pulsed-field ablation (PFA) of atrial fibrillation (AF).

Objective: This study aimed to compare the reconnection rate of previously ablated targets using PFA with vs without intracardiac echocardiography (ICE) guidance for confirmation of tissue contact.

Methods: This multicenter prospective study included consecutive patients with paroxysmal and persistent AF undergoing their first procedure using the PFA system.

The Diagnostic and Prognostic Value of the 12-Lead ECG in Arrhythmogenic Left Ventricular Cardiomyopathy.

Background: Electrocardiographic findings in arrhythmogenic left ventricular cardiomyopathy (ALVC) have been limited to small studies.

Objectives: The authors aimed to analyze the electrocardiogram (ECG) characteristics of ALVC, to correlate ECG with cardiac magnetic resonance and genetic data, and to evaluate its prognostic value.

Methods: We reviewed data of 125 consecutive patients with ALVC (81.

Expert consensus document on artificial intelligence of the Italian Society of Cardiology.

Artificial intelligence (AI), a branch of computer science focused on developing algorithms that replicate intelligent behaviour, has recently been used in patients management by enhancing diagnostic and prognostic capabilities of various resources such as hospital datasets, electrocardiograms and echocardiographic acquisitions. Machine learning (ML) and deep learning (DL) models, both key subsets of AI, have demonstrated robust applications across several cardiovascular diseases, from the most diffuse like hypertension and ischemic heart disease to the rare infiltrative cardiomyopathies, as well as to estimation of LDL cholesterol which can be achieved with better accuracy through AI. Additional emerging applications are encountered when unsupervised ML methodology shows promising results in identifying distinct clusters or phenotypes of patients with atrial fibrillation that may have different risks of stroke and response to therapy.

Does Age Impact Safety and Efficacy During Pulse-Field Ablation for Atrial Fibrillation?

Background: There is no evidence evaluating efficiency, effectiveness, and safety outcomes in older patients in the context of pulsed-field ablation technology for the ablation of atrial fibrillation. We aimed to compare safety, efficacy, and acute and long-term outcomes of pulsed-field ablation in older patients (≥75 years) with younger ones.

Methods: We enrolled consecutive patients who had undergone atrial fibrillation ablation with the pulsed-field ablation FARAPULSE system (Boston Scientific) at 15 centers.

Long-Term Follow-Up Data on Flecainide Use as an Antiarrhythmic in Arrhythmogenic Right Ventricular Cardiomyopathy: A Multicenter Study.

Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy associated with a high risk of ventricular arrhythmia (VA). Several animal models have been used to postulate a therapeutic role of the inhibition of the ryanodine 2 receptor via the use of flecainide for this disease. Clinical data describing its use are scarce, however, especially in patients without implantable cardioverter-defibrillators or with left ventricular (LV) involvement.

Insight Into Early Recurrences After Pulsed-Field Ablation for Atrial Fibrillation: Results From a Multicenter Experience.

Background: Factors contributing to early recurrence after atrial fibrillation (AF) ablation, particularly with pulsed-field ablation (PFA), are poorly understood.

Purpose: This study aimed to evaluate the significance of early recurrence and identify factors associated with its occurrence, focusing on predicting late recurrence in AF patients treated with PFA.

Methods: A total of 620 consecutive patients referred for their first paroxysmal or early persistent AF ablation underwent the procedure using the FARAPULSE PFA system (Boston Scientific) across 10 centers.

Leadless pacemaker implantation in real-world clinical practice: An Italian survey promoted by the AIAC (Italian Association of Arrhythmology and Cardiac Pacing).

Backgrounds: After a decade since the introduction of leadless pacemaker (L-PM), its use is still limited. The aim of this survey is to evaluate how this technology is perceived by electrophysiologist members of a National scientific society in clinical practice.

Methods: A questionnaire with 22 questions was posted in the reserved area of the society website.

Catheter Ablation of Atrial Fibrillation in Patients With Psoriasis: A Multicenter Study.

Background: Psoriasis is linked to an increased risk of atrial fibrillation (AF). However, data on the electrophysiological substrate and outcomes of AF ablation in patients with psoriasis are lacking.

Methods: We conducted a retrospective, multicenter study involving 48 patients with psoriasis (median age, 66 years [56-72]; 79% male) and paroxysmal (n=25.

Brugada Syndrome in Sports Cardiology: An Expert Opinion Statement of the Italian Society of Sports Cardiology (SICSport).

Brugada syndrome (BrS) is a genetic disorder marked by a characteristic electrocardiogram (ECG) pattern of ST-segment elevation and T-wave inversion in right precordial leads, which is associated with an increased risk of ventricular fibrillation in the absence of structural heart disease. Despite advancements in understanding its epidemiology, pathophysiology, and treatment, there is considerable variability in how sports cardiologists approach BrS. This expert opinion by the Italian Society of Sports Cardiology (SICSPORT) aim to review the current definition, diagnosis, epidemiology, genetics, risk stratification, and treatment of BrS and provide guidance for sport eligibility provides guidance for sports doctors and cardiologists in assessing competitive sports eligibility in athletes with BrS.

How to Approach Left Ventricular Hypertrabeculation: A Practical Guide and Literature Review.

Left ventricular hypertrabeculation is one of the most debated conditions in modern cardiology. Many studies have tried to characterise this disease by addressing the various clinical risks and diagnostic tools, but its very nosological existence is currently being challenged. The latest ESC guidelines on cardiomyopathies state that it should be addressed as a morphologic trait rather than an intrinsic disease of the cardiac muscle.

Temporal trends of characteristics and management of patients with suspected MINOCA.

Background: Myocardial infarction without obstructive coronary artery disease (MINOCA) is a challenging condition which requires appropriate management and therapy. Although specific guidelines and recommendations for this condition have been introduced, there are few data about management implementation over time. The aim of this study is to compare two cohorts of patients affected by suspected MINOCA to assess the temporal trends change in the clinical characteristics and management.

Different Approaches to Atrial Fibrillation Ablation in Heart Failure Patients: Temporal Trends and Clinical Outcomes.

Background: Catheter ablation of atrial fibrillation has been proven beneficial in patients with heart failure and reduced ejection fraction (HFrEF). On top of pulmonary vein isolation (PVI), additional ablation strategies such as empirical lines/posterior box/low voltage ablation (PVI+L/LVA) are often used. Whether PVI+L/LVA provides additional benefits in this population has never been systematically investigated.

Results of ICE-Guided Isolation of the Superior Vena Cava With Pulsed Field Ablation.

Background: Earlier studies have documented the risk for sinoatrial node injury and phrenic nerve paralysis as complications following radiofrequency catheter ablation for electrical isolation of the superior vena cava (SVCI).

Objectives: The aim of this study was to assess the safety and feasibility of SVCI in patients with atrial fibrillation undergoing pulsed field ablation (PFA) METHODS: A total of 1,600 consecutive patients undergoing PFA for pulmonary vein isolation plus SVCI were included in this multicenter analysis. Superior vena cava (SVC) ablation was performed under the continuous guidance of intracardiac echocardiography.

Multimodality Imaging for Transcatheter Tricuspid Regurgitation Interventions: Novel Approaches to the Forgotten Valve.

Tricuspid regurgitation (TR) poses a significant healthcare burden and is a major concern for patients who experience debilitating symptoms and face a poorer prognosis. Cardiologists are showing renewed interest in TR, as the previous belief that it was merely a bystander of left-sided heart disease has evolved. As a result, more transcatheter techniques addressing TR are emerging.

Electrophysiological Phenotype-Genotype Study of Sustained Monomorphic Ventricular Tachycardia in Inherited, High Arrhythmic Risk, Left Ventricular Cardiomyopathy.

Background: Among inherited cardiomyopathies involving the left ventricle, whether dilated or not, certain genotypes carry a well-established arrhythmic risk, notably manifested as sustained monomorphic ventricular tachycardia (SMVT). Nonetheless, the precise localization and electrophysiological profile of this substrate remain undisclosed across different genotypes.

Methods: Patients diagnosed with cardiomyopathy and left ventricle involvement due to high-risk genetic variants and SMVT treated by electrophysiological study were recruited from 18 European/US centers.

Differentiating sensor changes in a composite heart failure ICD monitoring index: Clinical correlates and implications.

Background: The HeartLogic algorithm (Boston Scientific, St Paul, MN) integrates data from implantable cardioverter-defibrillator (ICD) sensors to predict heart failure (HF) decompensation: first (S1) and third (S3) heart sounds, intrathoracic impedance, respiration rate, ratio of respiration rate to tidal volume (RSBI), and night heart rate.

Objective: This study assessed the relative changes in ICD sensors at the onset of HeartLogic alerts, their association with patient characteristics, and outcomes.

Methods: The study included 568 patients with HF carrying ICDs (CRT-D, n = 410) across 26 centers, with a median follow-up of 26 months.