Pulsed-Field Ablation of Atrial Flutter: Insights From a Large Volume U.S. Center.

Background: Pulsed-field ablation (PFA) is increasingly used in clinical practice for atrial fibrillation, but its utility in atrial flutter (AFL) ablation is not yet established.

Objectives: This study sought to evaluate the safety, effectiveness, and procedural outcomes of PFA in treating AFL across different subtypes.

Methods: This study included 311 consecutive patients undergoing ablation of 368 AFLs using PFA.

Safety of Same-Day Discharge Following Pulsed-Field Ablation Versus Radiofrequency Ablation: A Comparative Analysis.

Background: Same-day discharge (SDD) after catheter ablation is increasingly adopted to improve patient convenience and reduce healthcare costs. While SDD following radiofrequency ablation (RFA) is well-documented, no data exist on SDD in patients undergoing pulsed-field ablation (PFA) for atrial fibrillation (AF).

Objective: To evaluate the safety of SDD in patients undergoing PFA and RFA for AF, with an exploratory comparison of practice patterns and outcomes.

Access to digital health technologies: personalized framework and global perspectives.

The emergence and rapid adoption of digital health technologies (DHT) present unprecedented opportunities to democratize and reduce disparities in health care by monitoring health and disease at the point of care in all patients. However, limited access to DHT is becoming a major obstacle to realizing these goals. Access to DHT is influenced not only by well-recognized social determinants of health, but also by digital determinants of health, such as digital literacy and the need for broad access to digital infrastructure, as well as commercial and economic factors.

Strategies for optimizing efficacy of electrical cardioversion of atrial fibrillation.

Direct current cardioversion (DCCV) is a cornerstone in the management of atrial fibrillation (AF) and is the quickest way to convert AF to sinus rhythm. Overall, the procedure is effective and safe, but the efficacy of DCCV can be reduced due to modifiable and non-modifiable patient characteristics, or procedural factors. Additionally, inadequate preparation, such as a lack of QRS-synchronization or omitting preprocedural imaging of the left atrial appendage (LAA), could lead to significant harm.

Genomics in atrial fibrillation: Predicting recurrence of AF after treatment using genetics.

With the demonstration that AF is highly hereditable and strongly associated with over 100 genetic loci, one step towards personalized treatment of AF is the potential use of genetic testing to predict response to therapy. Although various clinical models have been developed to predict recurrence, none have shown a consistent ability to predict treatment outcomes. This highlights a need for additional patient information to increase predictive value.

Sudden cardiac arrest: Limitations in risk-stratification and treatment, and the potential for digital technologies and artificial intelligence to improve prediction and outcomes.

Sudden cardiac death (SCD) remains a pervasive public health challenge, accounting for a significant proportion of cardiac and all-cause mortality worldwide. Despite notable advancements in cardiovascular therapies and reductions in overall cardiac mortality, survival following sudden cardiac arrest (SCA) remains dismally low, and prediction strategies remain inadequate. This comprehensive review examines the current landscape of SCD etiologies and the latest guidelines for primary and secondary prevention of SCD with implantable cardioverter defibrillators (ICDs).

Is it safe to use class 1C antiarrhythmic drugs in patients with coronary artery disease and/or cardiomyopathy?

Class 1C antiarrhythmic drugs (AADs) are a key treatment option for effective rhythm control in several common arrhythmias. Here, we review the relevant background on Class 1C AADs, these drugs' indications and contraindications, and potential safe ways to use them. The safety profile of 1C AADs, and related restrictions on their use, has been largely based on the decades-old CAST trial, but more recent evidence may favor re-evaluating previously excluded populations.

Prolonged hospitalization after catheter ablation of ventricular tachycardia: Predictors and outcomes.

Background: In patients with structural heart disease undergoing catheter ablation of ventricular tachycardia (VT), prolonged postablation hospitalization may be a predictor of poor outcomes.

Objective: This study sought to identify predictors of prolonged hospitalization after VT ablation and their impact on subsequent outcomes.

Methods: This retrospective cohort study analyzed 318 patient cases undergoing VT ablation from January 2022 to October 2024.

Cardiovascular imaging techniques for electrophysiologists.

Rapid technological advancements in noninvasive and invasive imaging including echocardiography, computed tomography, magnetic resonance imaging and positron emission tomography have allowed for improved anatomical visualization and precise measurement of cardiac structure and function. These imaging modalities allow for evaluation of how cardiac substrate changes, such as myocardial wall thickness, fibrosis, scarring and chamber enlargement and/or dilation, have an important role in arrhythmia initiation and perpetuation. Here, we review the various imaging techniques and modalities used by clinical and basic electrophysiologists to study cardiac arrhythmia mechanisms, periprocedural planning, risk stratification and precise delivery of ablation therapy.

Data Interoperability and Harmonization in Cardiovascular Genomic and Precision Medicine.

Despite advances in cardiovascular care and improved outcomes, fragmented healthcare systems, nonequitable access to health care, and nonuniform and unbiased collection and access to healthcare data have exacerbated disparities in healthcare provision and further delayed the technological-enabled implementation of precision medicine. Precision medicine relies on a foundation of accurate and valid omics and phenomics that can be harnessed at scale from electronic health records. Big data approaches in noncardiovascular healthcare domains have helped improve efficiency and expedite the development of novel therapeutics; therefore, applying such an approach to cardiovascular precision medicine is an opportunity to further advance the field.

Actigraphy-based sleep disruption and diurnal biomarkers of autonomic function in paroxysmal atrial fibrillation.

Introduction: Sleep architectural disruption is associated with atrial fibrillation (AF); however, associated autonomic influences remain unclear and it is unknown if this detriment persists during wakefulness. We hypothesize sleep disruption and autonomic dysfunction have diurnal patterning in patients with paroxysmal AF.

Methods: We analyzed data from the Sleep Apnea and Atrial Fibrillation Biomarkers and Electrophysiologic Atrial Triggers (SAFEBEAT) study designed to examine paroxysmal AF and sleep apnea, including simultaneous collection of continuous electrocardiogram monitoring (Heartrak Telemetry) and actigraphy (Actiwatch GTX) for 7-21 days.

European Society of Cardiology (ESC) clinical consensus statement on indications for conduction system pacing, with special contribution of the European Heart Rhythm Association of the ESC and endorsed by the Asia Pacific Heart Rhythm Society, the Canadian Heart Rhythm Society, the Heart Rhythm Society, and the Latin American Heart Rhythm Society.

Conduction system pacing (CSP) is being increasingly adopted as a more physiological alternative to right ventricular and biventricular pacing. Since the 2021 European Society of Cardiology pacing guidelines, there has been growing evidence that this therapy is safe and effective. Furthermore, left bundle branch area pacing was not covered in these guidelines due to limited evidence at that time.

Correlating Left Atrial Enlargement and Left Ventricular Hypertrophy on ECG With Echocardiography and Cardiac Magnetic Resonance Imaging.

Background: ECGs are a primary assessment of cardiac structure and function. Alignment of their findings with cardiac imaging is not well defined. This study investigates the correlation of left atrial enlargement and left ventricular hypertrophy (LVH) found on ECG with transthoracic echocardiogram and cardiac magnetic resonance imaging (CMR) findings.

Direct-to-Consumer Genetic Testing for Cardiovascular Disease: A Scientific Statement From the American Heart Association.

Despite insufficient evidence to support direct-to-consumer genetic testing in routine clinical care, cardiovascular clinicians increasingly face questions about its utility and interpretation because individuals can purchase these tests directly from laboratories. A burgeoning marketplace offers an expanding array of testing options. In many cases, direct-to-consumer genetic testing advertises information that could inform one's risk of heritable disease, including insight into having a genetic predisposition to cardiovascular disease or data about gene-drug interactions that could affect response to cardiovascular medications.

Sequencing in over 50,000 cases identifies coding and structural variation underlying atrial fibrillation risk.

Atrial fibrillation (AF) is a prevalent and morbid abnormality of the heart rhythm with a strong genetic component. Here, we meta-analyzed genome and exome sequencing data from 36 studies that included 52,416 AF cases and 277,762 controls. In burden tests of rare coding variation, we identified novel associations between AF and the genes MYBPC3, LMNA, PKP2, FAM189A2 and KDM5B.

Meta-analysis of genome-wide associations and polygenic risk prediction for atrial fibrillation in more than 180,000 cases.

Atrial fibrillation (AF) is the most common heart rhythm abnormality and is a leading cause of heart failure and stroke. This large-scale meta-analysis of genome-wide association studies increased the power to detect single-nucleotide variant associations and found more than 350 AF-associated genetic loci. We identified candidate genes related to muscle contractility, cardiac muscle development and cell-cell communication at 139 loci.

Polysomnographic sleep architectural disruption associated with atrial fibrillation development.

Study Objectives: To examine the unclear, inconsistent role of sleep architectural disruption in atrial fibrillation (AF) development.

Methods: Patients (age ≥ 18 years) who underwent in-laboratory sleep studies at Cleveland Clinic 2000-2015 were examined (follow-up: 7.8 ± 3.

A call for transparency, improved reporting, and interpretation of trials using surrogate end points in cardiac electrophysiology.

In this call for transparency, we aim to disseminate knowledge about recent CONSORT-Surrogate and SPIRIT-Surrogate checklists. SPIRIT-Surrogate is an extension of the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist, developed as a consensus document and designed as a reporting guideline for randomized controlled trial (RCT) protocols using surrogate end points as the primary end points. CONSORT-Surrogate is an extension of the Consolidated Standards of Reporting Trials (CONSORT) checklist, a consensus-driven reporting guideline for RCTs using surrogate end points as the primary end points.

Discovery of plasma proteins and metabolites associated with left ventricular cardiac dysfunction in pan-cancer patients.

Background: Cancer-therapy related cardiac dysfunction (CTRCD) remains a significant cause of morbidity and mortality in cancer survivors. In this study, we aimed to identify differential plasma proteins and metabolites associated with left ventricular dysfunction (LVD) in cancer patients.

Methods: We analyzed data from 50 patients referred to the Cleveland Clinic Cardio-Oncology Center for echocardiograph assessment, integrating electronic health records, proteomic, and metabolomic profiles.

ACC/AHA/ASE/HFSA/HRS/SCAI/SCCT/SCMR 2025 Appropriate Use Criteria for Implantable Cardioverter-Defibrillators, Cardiac Resynchronization Therapy, and Pacing.

This appropriate use criteria (AUC) document is developed by the American College of Cardiology along with key specialty and subspecialty societies. It provides a comprehensive review of common clinical scenarios where implantable cardioverter-defibrillator (ICD), cardiac resynchronization therapy (CRT), cardiac contractility modulation, leadless pacing, and conduction system pacing therapies are frequently considered. The 335 clinical scenarios covered in this document address ICD indications including those related to secondary prevention, primary prevention, comorbidities, generator replacement at elective replacement indicator, dual-chamber, and totally subcutaneous ICDs, as well as device indications related to CRT, conduction system pacing, leadless pacing, cardiac contractility modulation, and ICD therapy in the setting of left ventricular assist devices (LVADs).

Atrial Fibrillation: A Review.

Importance: In the US, approximately 10.55 million adults have atrial fibrillation (AF). AF is associated with significantly increased risk of stroke, heart failure, myocardial infarction, dementia, chronic kidney disease, and mortality.

Upstream targeting for the prevention of atrial fibrillation: Targeting Risk Interventions and Metformin for Atrial Fibrillation (TRIM-AF)-rationale and study design.

Background: Despite advances in ablation and other therapies for AF, progression of atrial fibrillation (AF) remains a significant clinical problem, associated with worse prognosis and worse treatment outcomes. Upstream therapies targeting inflammatory or antifibrotic mechanisms have been disappointing in preventing AF progression, but more recently genetic and genomic studies in AF suggest novel cellular and metabolic stress targets, supporting prior studies of lifestyle and risk factor modification (LRFM) for AF. However, while obesity is a significant risk factor, weight loss and risk factor modification have not been successfully applied in a US population with AF.