Long-Term Outcomes of Cryoballoon Pulmonary Vein Isolation Freeze Using a Modified ICE-T Protocol With a Double 120 s Applications (ICE-T 2 × 2).

Background: Cryoballoon (CB) pulmonary vein isolation (PVI) is a well-established treatment for symptomatic atrial fibrillation (AF). Most centers use application durations of 180 or 240 s. Since freezing-related complications tend to occur later during the application, empirically shortening the duration may reduce procedural risks.

The Olive Strategy: Improved Pulmonary Vein Isolation Durability With the Pentaspline Pulsed Field Catheter.

Background: The pentaspline pulsed field ablation (PFA) catheter is rapidly gaining popularity as a tool for pulmonary vein isolation (PVI). Its standard ablation protocol recommends applying 8 applications per pulmonary vein (PV) with 2 different catheter configurations: the flower and the basket shape. Using this protocol, the rate of durably isolated PVs during repeat procedures is not superior to that after conventional thermal PVI.

Pulsed-Field Ablation for Persistent Atrial Fibrillation in EU-PORIA Registry.

Background: Real-life data on efficacy and safety of pulsed-field ablation (PFA) using the pentaspline multi-electrode catheter in symptomatic atrial fibrillation (AF) patients is still scarce.

Objective: This study aims to assess the efficacy and safety of PFA in patients with persistent AF.

Methods: Data from early commercial use across seven European centers were collected in a registry.

Safety and efficacy of a light antithrombotic regimen after left atrial appendage occlusion: Insights from the LOGIC (left atrial appendage occlusion in patients with gastrointestinal or IntraCranial bleeding) international multicenter registry.

Background: Antithrombotic therapy (AT) after left atrial appendage occlusion (LAAO) in patients with non-valvular atrial fibrillation (NVAF) has the purpose of preventing device related thrombosis (DRT), avoiding embolic events; nevertheless, the correct antithrombotic regimen after LAAO is still under debate.

Aims: Aim of this substudy of the observational LOGIC registry was to describe the efficacy and safety of a light antithrombotic regimen, comprising single antiplatelet therapy or none, compared to a standard antithrombotic regimen, after a successful LAAO.

Methods: Patients with NVAF that underwent LAAO were previously included in the LOGIC registry.

Pulsed Field Ablation as First-Line Therapy for Atrial Fibrillation: A Substudy of the EU-PORIA Registry.

Background: Recent studies have demonstrated the benefit of early ablation in preventing the progression of atrial fibrillation (AF). Clinical practice has reflected this shift in AF management and no longer requires patients to fail antiarrhythmic drugs (AADs) before receiving ablation. However, there is limited evidence on outcomes with pulsed field ablation (PFA) as a first-line therapy.

Left atrial appendage occlusion in patients with non-valvular atrial fibrillation and cerebral amyloid angiopathy: insights from the LOGIC (Left atrial appendage Occlusion in patients with Gastrointestinal or IntraCranial bleeding) international multicenter registry.

Objectives: Oral anticoagulation therapy (OAC) is often contraindicated in patients with atrial fibrillation (AF) and cerebral amyloid angiopathy (CAA) because of the high hemorrhagic risk. Left atrial appendage occlusion (LAAO) can prevent thromboembolic events while avoiding long-term anticoagulation. However, a short period of antithrombotic therapy (AT) is still recommended after LAAO, and, therefore, it is unclear whether patients with CAA can be candidates for LAAO.

Radiofrequency balloon ablation: 1-year outcomes of the AURORA study.

Background: A novel irrigated radiofrequency balloon (RFB) for pulmonary vein isolation (PVI) integrated into a 3D mapping platform was recently launched.

Methods: Patients undergoing a first atrial fibrillation (AF) ablation at two German high-volume EP centers were included into the prospective AURORA registry. All patients underwent clinical follow-up (FU) at 90, 180, and 360 days following ablation including 48-h Holter ECGs.

Ablation Strategies for Repeat Procedures in Atrial Fibrillation Recurrences Despite Durable Pulmonary Vein Isolation: The Prospective Randomized ASTRO AF Multicenter Trial.

Background: Ablation strategies for patients with symptomatic atrial fibrillation and isolated pulmonary veins vary and their effects on arrhythmia recurrence remain unclear. A prospective randomized German multicenter trial sought to compare 2 ablation strategies in this patient cohort.

Methods: Patients with atrial fibrillation despite durable pulmonary vein isolation were randomly assigned at 7 centers to undergo low-voltage area ablation using 3-dimensional mapping and irrigated radiofrequency current ablation (group A) or empirical left atrial appendage isolation (LAAI) using the cryoballoon followed by staged interventional left atrial appendage closure (group B).

Safety and efficacy of pulsed-field ablation for atrial fibrillation in the elderly: A EU-PORIA sub-analysis.

Background: The role of catheter ablation in elderly patients with atrial fibrillation (AF) is unclear. Pulsed field ablation (PFA) demonstrates a favorable clinical profile, however, data on elderly patients are lacking.

Aims: We aimed to assess the safety and efficacy of PFA in the elderly, using data from the EU-PORIA registry.

Long-term follow-up of patients treated with laser balloon for atrial fibrillation: A high volume center experience with the first- and second-generation laser balloon.

Background: Laser balloon (LB) pulmonary vein isolation (PVI) is an established ablation technique for atrial fibrillation (AF). We report long-term follow-up and procedural data of LB-PVI and we compare the first and second LB generation.

Methods: Patients undergoing LB ablation with first- (LB1) or second-generation LB (LB2) for AF were retrospectively enrolled and divided into two groups.

Durable LAA isolation combining pulsed field ablation and radiofrequency linear lesions in a patient with a therapy refractory left atrial appendage tachycardia.

Background: Treating atrial tachycardia (AT) originating from left atrial appendage (LAA) needs sometimes electrical isolation of LAA. We report a case of AT originating from LAA successfully treated with electrical isolation using the novel lattice-tip pulsed-field/radiofrequency ablation (PFA/RFA) catheter. A 55-year-old female patient with a history of three focal ablative attempts for a highly symptomatic AT originating from the LAA in different centers was admitted to our department for the recurrence of the clinical tachycardia.

Initial real-world data on catheter ablation in patients with persistent atrial fibrillation using the novel lattice-tip focal pulsed-field ablation catheter.

Aims: Technological advancements have contributed to the enhanced precision and lesion flexibility in pulsed-field ablation (PFA) by integrating a three-dimensional mapping system combined with a point-by-point ablation strategy. Data regarding the feasibility of this technology remain limited to some clinical trials. This study aims to elucidate initial real-world data on catheter ablation utilizing a lattice-tip focal PFA/radiofrequency ablation (RFA) catheter in patients with persistent atrial fibrillation (AF).

State-of-the-art pulsed field ablation for cardiac arrhythmias: ongoing evolution and future perspective.

Pulsed field ablation (PFA) is an innovative approach in the field of cardiac electrophysiology aimed at treating cardiac arrhythmias. Unlike traditional catheter ablation energies, which use radiofrequency or cryothermal energy to create lesions in the heart, PFA utilizes pulsed electric fields to induce irreversible electroporation, leading to targeted tissue destruction. This state-of-the-art review summarizes biophysical principles and clinical applications of PFA, highlighting its potential advantages over conventional ablation methods.

Ventricular tachycardia due to left ventricular metastasis: A case report.

We present the case of a 60-year-old male patient who was admitted to our hospital after experiencing a syncopal episode. First ECGs showed sinus rhythm with polymorphic premature ventricular complexes and later ventricular tachycardia with a left bundle branch block morphology were recorded. Imaging with TEE and MRI revealed a space-occupying lesion in the left ventricle, which was ultimately identified as a rare cardiac metastasis of renal cell carcinoma.

Severe ST-segment elevation and AV block during pulsed-field ablation due to vasospastic angina - a novel observation.

Catheter ablation of atrial fibrillation using non-thermal electroporation represents a promising ablation modality due to its believed superior safety profile. Still, if electroporation is delivered in proximity to a coronary artery, vasospasms can occur. We report the first case of severe right coronary artery vasospasm resulting in ST-segment elevation and AV block despite a remote distance from the ablation site to the right coronary artery, indicating a different mechanism.

The impact of ultrasound-guided vascular access for catheter ablation of left atrial arrhythmias in a high-volume centre.

Background: Vascular complications are a common occurrence during atrial fibrillation ablation. Observational studies indicate that the utilization of ultrasound (US)-guided puncture may decrease the incidence of vascular complications; however, its routine use is not established in many centres.

Methods: Patients undergoing catheter ablation for atrial fibrillation were included sequentially.

Durability of Pulmonary Vein Isolation Using Pulsed-Field Ablation: Results From the Multicenter EU-PORIA Registry.

Background: Pulsed-field ablation (PFA) is a novel nonthermal ablation technology with high procedural safety and efficiency for pulmonary vein isolation (PVI). Premarket data showed high PVI durability during mandatory remapping studies. Data on lesion durability in real-world patients with clinically indicated redo procedures are scarce.

Early recurrences predict late therapy failure after pulsed field ablation of atrial fibrillation.

Introduction: Pulsed field ablation (PFA) is a new ablation technology for atrial fibrillation (AF). Data regarding early recurrences of atrial tachyarrhythmia (ERAT) after PFA-pulmonary vein isolation (PVI) are sparse.

Methods: Consecutive patients with symptomatic AF were enrolled to undergo PFA-PVI.