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.

Correlation Between CRT Response and Patient-Regret Scores in Patients With Heart Failure With Reduced Ejection Fraction.

Background: The correlation between CRT response and patient perception of the procedure is uncertain.

Objective: To identify whether patient-reported outcomes correlate with CRT response through a decision regret scale (DRS) in patients with heart failure with reduced ejection fraction (HFrEF).

Methods: We included 150 patients with HFrEF who underwent CRT implantation at the Cleveland Clinic from 2020 to 2022.

Incidence and Predictors of Pacing-Induced Cardiomyopathy in Paced Patients Undergoing Attempted Left Bundle Branch Area Pacing.

Background: The incidence and predictors of pacing-induced cardiomyopathy (PICM) in patients undergoing attempted left bundle branch area pacing (LBBAP) are unknown.

Objective: To examine the incidence and predictors of PICM in patients with preserved left ventricular ejection fraction (LVEF) and atrioventricular block (AVB) undergoing attempted LBBAP.

Methods: The study cohort included consecutive patients undergoing an attempt at LBBAP at the Cleveland Clinic from 2018 until 2022 with preserved LVEF and AVB.

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.

Variability in implantable cardioverter-defibrillator battery longevity.

Background: Implantable cardioverter-defibrillator (ICD) battery longevity impacts the need for generator replacement, with the accompanying risk of complications and cost.

Objective: We sought to identify factors associated with ICD battery longevity and compare manufacturers.

Methods: We used a nationwide, multicenter remote monitoring dataset (PaceMate) to evaluate ICDs implanted between 2003 and 2023, assessing time from implant to replacement interval (RI).

Impact of Hospital VT Ablation Volume on Postprocedural Complications: Argument for Selective Referral to High-Volume Centers.

Background: Existing studies have shown a relationship between hospital case volume and outcomes of various cardiovascular procedures. The impact of hospital procedure volume on complications of catheter ablation of ventricular tachycardia (VT) and the potential benefit of selective referral to high-volume centers have not been previously evaluated.

Objectives: This study sought to assess the associations between hospital procedure volume of VT catheter ablation and postprocedural morbidity and mortality.

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.

Late-gadolinium enhancement predicts appropriate device therapies in nonischemic recipients of primary prevention implantable cardioverter-defibrillators.

Background: Better risk stratification is needed to evaluate patients with nonischemic cardiomyopathy (NICM) for prophylactic implantable cardioverter-defibrillators (ICDs). Growing evidence suggests that cardiac magnetic resonance (CMR) imaging may be useful in this regard.

Objective: We aimed to determine if late gadolinium enhancement (LGE) seen on CMR (dichotomized as none or minimal <2% vs significant ≥2%) predicts appropriate ICD therapies (primary endpoint) or all-cause mortality/transplant/left-ventricular assist device (LVAD) implantation (secondary endpoint) in patients with NICM.

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.

Temporal changes in device-derived daily activity related to ventricular arrhythmias from the CERTITUDE registry.

Background: There have been limited data examining the temporal relationship between device-derived daily activity and ventricular arrhythmias (VAs).

Objective: We aimed to assess whether activity predicted VAs or VAs predicted changes in activity.

Methods: The CERTITUDE registry includes over 55,000 implanted devices active on Home Monitoring.

Bridging the Gap: Remote Evaluation and Programming of Cardiac Implantable Devices in Medically Underserved Areas.

Background: Delivering care in medically underserved areas (MUA) is a public health challenge.

Objectives: The purpose of this study was to evaluate the advantages of a noncommercial multivendor solution for remote interrogation and programming of cardiac implantable electronic devices (CIEDs) among inhabitants of MUAs.

Methods: This prospective comparative study evaluated benefits and safety of remote CIEDs evaluation in patients living >100 km from the Bordeaux University Hospital.

Impact of a universal monitoring system ("third party") on outcomes of ICD patients: A nationwide study.

Background: Adherence to recommended follow-up schedules for remote monitoring (RM) of patients with implantable cardioverter-defibrillators (ICDs) is inconsistent, which may influence clinical outcomes. Systematic organization through a "third-party" universal monitoring system (UMS) may be beneficial.

Objective: We aimed to evaluate the clinical impact of RM and any incremental benefit of UMS vs conventional RM.

State of the art of mobile health technologies use in clinical arrhythmia care.

The rapid growth in consumer-facing mobile and sensor technologies has created tremendous opportunities for patient-driven personalized health management. The diagnosis and management of cardiac arrhythmias are particularly well suited to benefit from these easily accessible consumer health technologies. In particular, smartphone-based and wrist-worn wearable electrocardiogram (ECG) and photoplethysmography (PPG) technology can facilitate relatively inexpensive, long-term rhythm monitoring.

Left ventricular mass as a modulator of ventricular arrhythmia risk and sex differences after CRT for nonischemic cardiomyopathy and LBBB.

Background: The risk of ventricular arrhythmias (VAs) after cardiac resynchronization therapy (CRT) has been associated with ischemic disease/scar, sex, and possibly left ventricular mass (LVM).

Objective: The purpose of this study was to evaluate sex differences and baseline/postimplant change in LVM on VA risk after CRT implantation in patients with nonischemic cardiomyopathy and left bundle branch block.

Methods: In patients meeting the criteria, baseline and follow-up echocardiographic images were obtained for LVM assessment.

Wearable Devices, Health Care Use, and Psychological Well-Being in Patients With Atrial Fibrillation.

Background: Wearables are increasingly used by patients with atrial fibrillation (AF) for symptom monitoring and health management, but their impact on patient health care use and psychological well-being is not well understood.

Methods And Results: In this retrospective, propensity-matched study of patients with AF, survey and electronic health record data were merged to compare AF-specific health care use (outpatient/inpatient visits, rhythm-related testing, and procedures) and informal health care use (telephone calls and patient portal messages) over a 9-month period between wearable users and nonusers. We also examined the effects of wearable cardiac monitoring features (eg, heart rate alerts, irregular rhythm notification, and ECG) on patient behavior and well-being.

Heart Size Difference Drives Sex-Specific Response to Cardiac Resynchronization Therapy: A Post Hoc Analysis of the MORE-MPP CRT Trial.

Background: Studies have reported that female sex predicts superior cardiac resynchronization therapy (CRT) response. One theory is that this association is related to smaller female heart size, thus increased relative dyssynchrony at a given QRS duration (QRSd). Our objective was to investigate the mechanisms of sex-specific CRT response relating to heart size, relative dyssynchrony, cardiomyopathy type, QRS morphology, and other patient characteristics.