Beyond the Learning Curve: How Operator Experience Affects Pulsed-Field Ablation Outcomes.

Background: The learning curve for pulmonary vein isolation (PVI) using "single-shot" pulsed-field ablation (PFA) is thought to be short. 3D electro-anatomical mapping (3D-EAM) might provide adjunctive information to shorten the learning curve and improve lesion durability.

Objective: To analyze procedural performance markers over time for PVI using PFA and 3D-EAM.

External Validation of the REACT-HF Score for Predicting Heart Failure in Patients With Atrial Fibrillation.

Background: Validated risk prediction scores for incident heart failure (HF) in patients with atrial fibrillation are lacking. We aimed to externally validate the the HF prediction risk score derived from three large control randomized trials RE-LY, AVERROES, and ACTIVE-A (REACT-HF) score and assess potential improvements by incorporating biomarkers.

Methods: We included 2599 patients with atrial fibrillation without prior HF from the Swiss-AF (Swiss Atrial Fibrillation) and BEAT-AF (Basel Atrial Fibrillation) cohorts.

Atrial fibrillation and atherosclerosis cause different vascular brain lesions on magnetic resonance imaging.

Background And Aims: Atrial fibrillation (AF) and atherosclerosis pre-dispose to the occurrence of vascular brain lesions compared with the general population, yet direct comparisons of brain lesion patterns between these two cardiovascular patient groups are lacking. This study sought to compare the prevalence and distribution of vascular brain lesions on cerebral magnetic resonance imaging (MRI) between patients with AF and those with atherosclerosis.

Methods: Baseline clinical data and standardized brain MRI scans from the Swiss Atrial Fibrillation cohort study (Swiss-AF; representing patients with AF) and the COMPASS MRI sub-study (COMPASS MIND; representing patients with atherosclerosis without AF) were used to compare the prevalence of lacunar and non-lacunar infarcts, periventricular and deep white matter hyperintensities (WMH), and cerebral micro-bleeds (CMB) between groups.

Hemolysis Induced by Pulsed-Field Ablation of Atrial Arrhythmias: A Comparative Analysis of Current Systems.

Introduction: Pulsed-field ablation (PFA) is an emerging technology associated with dose-dependent hemolysis as a recently recognized side effect. This study aimed to compare hemolysis levels and assess dose-dependency across three PFA systems: a pentaspline catheter (PSC), a lattice-tip focal catheter (LTFC), and a variable loop circular catheter (VLCC).

Methods: Patients treated for atrial arrhythmias with the LTFC (n = 29) or the VLCC (n = 30) were included from a prospective registry.

Biomarker panels for improved risk prediction and enhanced biological insights in patients with atrial fibrillation.

Atrial fibrillation (AF) increases the risk of adverse cardiovascular events, yet the underlying biological mechanisms remain unclear. We evaluate a panel of 12 circulating biomarkers representing diverse pathophysiological pathways in 3817 AF patients to assess their association with adverse cardiovascular outcomes. We identify 5 biomarkers including D-dimer, growth differentiation factor 15 (GDF-15), interleukin-6 (IL-6), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity troponin T (hsTropT) that independently predict cardiovascular death, stroke, myocardial infarction, and systemic embolism, significantly enhancing predictive accuracy.

Are there pulmonary vein geometrical features associated with reconnection after pulsed field ablation of atrial fibrillation?

Background: Pulmonary vein (PV) isolation (PVI) using pulsed field ablation (PFA) is an emerging technique for the treatment of atrial fibrillation (AF). However, the recurrence rate of AF remains significant, and the durability of PVI is insufficient.

Objective: This study aimed to assess the impact of anatomical and geometrical features of the PV ostia on the PVI durability.

Behavioural insights in the underuse of cardiac resynchronisation therapy in heart failure: a pilot survey on incentive perceptions among referring cardiologists.

Aims: Heart failure is a leading cause of hospitalisation in patients over 50, significantly impacting both quality of life and survival. Despite the well-established benefits of Cardiac Resynchronisation Therapy (CRT), its utilisation in clinical practice remains suboptimal. Traditional incentives, have shown limited effectiveness in increasing CRT referrals.

Colchicine in patients with aortic stenosis undergoing transcatheter aortic valve replacement: a double-blind randomized trial.

An inflammatory process may increase the risk of arrhythmias after transcatheter aortic valve replacement (TAVR). In this single-centre, double-blind, placebo-controlled, randomized trial we investigated the efficacy of colchicine to reduce a composite of new-onset atrial fibrillation or atrioventricular conduction disturbances requiring the implantation of a permanent pacemaker at 30 days after TAVR. Between September 21, 2021 and April 25, 2024, 120 patients with aortic stenosis undergoing TAVR (mean age 80.

Safety and efficacy of a lattice-tip catheter for ventricular arrhythmia ablation: the Affera Ventricular Arrhythmia Ablation (AVAAR) Registry.

Background: The feasibility and safety of the lattice-tip catheter for ventricular arrhythmia (VA) ablation in humans remain largely unknown. This study aimed to assess feasibility, safety profile as well as patient outcomes after VA ablation with a lattice-tip catheter in a multicenter European registry.

Methods: All 18 European centers using the AFFERA system on September 2024 agreed to participate.

Voltage threshold adjustments for a novel pulsed-field ablation catheter with integrated mapping capabilities: lessons from a case series.

Background: Accurate electroanatomical mapping relies on voltage thresholds to differentiate electrically inactive areas, fibrotic scar, and healthy myocardium. These thresholds have been well established for high-density mapping catheters with small, closely spaced electrodes. However, the optimal voltage thresholds for a novel pulsed-field ablation catheter with integrated mapping capabilities remain unclear.

Long-Term Outcomes of Patients Requiring Pacemaker Implantation After Transcatheter Aortic Valve Replacement: The SwissTAVI Registry.

Background: The impact of pacemaker (PM) implantation on outcomes following transcatheter aortic valve replacement (TAVR) remains controversial, especially as TAVR indications expand to low-risk patients.

Objectives: This study sought to evaluate the all-cause and cardiovascular mortality of patients undergoing PM implantation after TAVR.

Methods: In this prospective, observational, nationwide TAVR cohort study, the outcomes of patients undergoing permanent PM implantation were investigated.

Biomarker and cognitive decline in atrial fibrillation: a prospective cohort study.

We investigated associations of a broad biomarker panel with cognitive decline in atrial fibrillation (AF) patients to characterize possible mechanisms. We enrolled 1440 AF patients with available baseline biomarkers and cognitive testing by the Montreal Cognitive assessment (MoCA) score at inclusion and at ≥ 2 yearly follow-ups. We investigated the associations of biomarkers with cognitive decline in univariate logistic regression models, LASSO regression analysis and built a combined model.

Novel vs established cryoballoon ablation system for atrial fibrillation: A systematic review and meta-analysis.

Background: Recently, a novel cryoballoon ablation system (POLARx) for the treatment of atrial fibrillation has been introduced.

Objective: We aimed at systematically reviewing the efficacy and safety of the POLARx compared with the ArcticFront system.

Methods: Structured systematic database search for articles published between 2021 and 2024 reporting the efficacy and/or safety of the POLARx system for atrial fibrillation ablation.

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.

Pulsed Field or Cryoballoon Ablation for Paroxysmal Atrial Fibrillation.

Background: Pulmonary-vein isolation is an effective treatment for paroxysmal atrial fibrillation. Pulsed field ablation (PFA) is a nonthermal ablation method with few adverse effects beyond the myocardium. Data are lacking on outcomes after PFA as compared with cryoballoon ablation as assessed with continuous rhythm monitoring.

The Association of Heart Failure and Liver T1 Mapping in Cardiac Magnetic Resonance Imaging.

The objective of this study was to investigate the association between congestive heart failure (CHF) and T1 mapping in both liver lobes using cardiac MRI. This retrospective study included patients who underwent cardiac MRI with T1 mapping sequences on a 1.5 T scanner.

Characterization of ventricular tachycardia ablation in end-stage heart failure patients with left ventricular assist device (CHANNELED registry).

Aims: Patients with left ventricular assist devices (LVADs) are at high risk for ventricular tachycardia (VT), and data on VT ablation in patients with LVAD are scarce. This multicentre registry assessed the mechanism of VT, procedural parameters, and outcome of VT ablation in patients with LVAD (NCT06063811).

Methods And Results: Data of patients with LVAD referred for VT ablation at nine tertiary care centres were collected retrospectively.

Pulsed-Field vs Thermal Catheter Ablation of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy.

Background: Pulsed-field ablation (PFA) may be beneficial for the treatment of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM).

Objectives: The goal of this study was to compare the safety and efficacy of PFA and thermal ablation in patients with HCM and AF.

Methods: From 2016 to 2024, patients with HCM undergoing a first AF ablation using PFA or thermal ablation (cryoballoon or radiofrequency) were retrospectively included from 3 French and Swiss centers.

Dose-dependent ventricular lesion formation using a novel large-area pulsed field ablation catheter: A preclinical feasibility study.

Background: Pulsed field ablation (PFA) has shown promising data in terms of safety and procedural efficiency for pulmonary vein isolation. Large-area focal PFA catheter designs might be suitable to deliver deep and durable lesions in ventricular myocardium.

Objective: We aimed to investigate the dose-response of a novel large-area focal 3-dimensional (3D)-enabled map-and-ablate PFA catheter for ventricular ablation in a chronic preclinical swine model.

Comparison of a Novel Temperature-Controlled Diamond-Tip Catheter and a Power-Controlled Gold-Tip Catheter for the Irrigated Ablation of Cavotricuspid Isthmus-Dependent Atrial Flutter.

: Radiofrequency (RF) ablation of the cavotricuspid isthmus (CTI) is a recommended treatment option for typical atrial flutter (AFL). While power-controlled ablation has been the current standard, a novel temperature-controlled ablation system has been introduced. We aimed to compare the procedural efficacy and one-year outcome of a temperature-controlled diamond-tip catheter with an established power-controlled gold-tip catheter.