Bipolar radiofrequency ablation for refractory scar-related interatrial septal tachycardias: a multicenter study.

Background: Catheter ablation of scar-related interatrial septal atrial tachycardias (IAS-ATs) is challenging and can be refractory to conventional unipolar radiofrequency catheter ablation (RFCA).

Aim: This multicenter study investigated the safety and efficacy of bipolar radiofrequency catheter ablation (Bi-RFCA) in patients with IAS-AT refractory to conventional unipolar RFCA.

Methods: Consecutive patients with scar-related IAS-AT refractory to conventional unipolar RFA across three electrophysiological centers were included in the study.

Comparison of a guidewire with an uninsulated tip versus dedicated radiofrequency wire with discrete electrode for energy-based transseptal puncture: a pre-clinical study.

Background: Dedicated radiofrequency (RF) needles and wires for transseptal puncture (TSP) achieve better outcomes vs. electrified open-ended needles and guidewires due to optimized electrode design and energy delivery. This study benchmarked TSP performance between the dedicated VersaCross wire system (VC; Boston Scientific) and an electrified guidewire with an alternative electrode configuration similar to commercially available devices.

Left Atrial Appendage Occlusion in Patients with End-Stage Renal Disease: An Individual Patient-Level Meta-Analysis.

Background: Patients with end-stage renal disease (ESRD) and atrial fibrillation (AF) present a challenge for thromboembolic prevention, given their elevated risks of both thromboembolism and bleeding. Anticoagulants carry a higher bleeding risk in this population without clear evidence of thromboembolic benefit. This study aims to define the role of left atrial appendage occlusion (LAAO) as a preventive strategy for patients with ESRD.

Feasibility and Safety of Pulsed Field Ablation for Coronary Sinus and Left Atrial Appendage Isolation and Mitral Isthmus Ablation: Acute and Chronic Findings.

Background: The safety and efficacy of pulsed field ablation for pulmonary vein and posterior wall isolation in atrial fibrillation ablation are well established; however, evidence regarding its use in extra-pulmonary vein areas remains limited. The aim of this study was to assess the feasibility and durability of pulsed field ablation for coronary sinus (CS) and left atrial appendage (LAA) isolation and mitral isthmus (MI) ablation.

Methods: We analyzed data from consecutive patients who underwent repeat atrial fibrillation ablation with pulsed field ablation between February and October 2024.

Percutaneous Aspiration Thrombectomy in Patients With Persistent Left Atrial Appendage Thrombus: A Case Series.

Background: Persistent left atrial appendage (LAA) thrombosis in patents with contraindications or who are refractory to intensive antithrombotic therapy remains a clinical challenge. Although LAA closure with limited manipulation is performed in patients with small distal nonmobile thrombi, larger more proximal mobile thrombi are usually deemed a contraindication to percutaneous LAA closure due to the inherent risk of iatrogenic thromboembolism. In this population, percutaneous aspiration thrombectomy (AT) is a potential treatment modality.

Artificial intelligence and natural language processing for automated coding of cervical and lumbar spine surgery.

Objective: Artificial intelligence (AI) in healthcare offers substantial opportunities to enhance efficiencies, reduce costs, and improve clinical outcomes. AI is primed to disrupt legacy healthcare processes such as coding and billing, where there is an estimated $11-$54 billion in challenged revenue annually due to billing complexities and claim denials. The purpose of this study was to assess the accuracy of a novel natural language processing algorithm (NNLPA) in coding spine operative reports, according to Current Procedural Terminology (CPT) codes, as compared to the authors' institutional human coders (IHCs).

Cardiac rehabilitation in patients with atrial fibrillation.

Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality worldwide, accounting for significant public health and economic burdens. Cardiac rehabilitation (CR) is a comprehensive, multidisciplinary program designed to aid patients in recovering from cardiac events and to prevent further complications. The aim of CR is to improve their quality of life and prognosis.

Characterization of reflex syncope in Brugada syndrome: a literature review.

In Brugada syndrome (BrS), syncope is considered a sign of increased risk for sudden cardiac death (SCD) due to ventricular tachycardia/ventricular fibrillation (VT/VF) episodes. However, arrhythmic syncope in BrS is extremely rare, while nonarrhythmic syncope may occur as in the general active population, mostly from reflex events. Symptomatic patients with BrS show a higher risk profile, requiring a watchful risk stratification.

Pulsed field ablation-related hemoglobinuria and acute kidney injury: Insights and strategies for effective management.

Background: Pulsed field ablation has emerged as a novel technique for atrial fibrillation ablation, offering myocardial preferential ablation and safety advantages over traditional thermal energy methods. Complications such as hemolysis, hemoglobinuria, and acute kidney injury have been reported, particularly with high-energy delivery and excessive applications.

Objective: To understand the underlying mechanisms and potential preventative strategies, and identifying at-risk populations, to optimize procedural safety and ensure consistent outcomes.

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.

Atrial fibrillation: economic burden and impact of catheter ablation.

Atrial fibrillation (AF) is a prevalent and significant health concern, imposing a substantial economic burden on healthcare systems worldwide. The condition is associated with an increased risk of stroke, heart failure and other comorbidities, contributing to heightened morbidity and mortality rates amongst those affected. Healthcare resource utilization and costs associated with the treatment and management of AF have become a pressing concern, particularly in the context of recurrent episodes.

Atrial cardiomyopathy: new pathophysiological and clinical aspects.

Atrial cardiomyopathy (ACM) is increasingly recognized as a key contributor to the development and perpetuation of atrial fibrillation (AF), a prevalent cardiac arrhythmia with significant clinical implications. ACM involves complex structural, electrical, and functional remodeling of the atrial myocardium, driven by various pathological conditions such as hypertension, heart failure, and obesity. Key mechanisms include atrial fibrosis, inflammation, and oxidative stress, which collectively contribute to the pro-arrhythmic and pro-thrombotic state associated with AF.

Concealed Wenckebach Phenomenon in Left Bundle Branch Associated With Chest Pain.

Background: Painful left bundle branch block (LBBB) syndrome is a rare cause of chest pain associated with intermittent LBBB.

Case Summary: We report the case of a 68-year-old man who experienced chest pain during a treadmill test. The temporal relationship between chest pain and the concealed Wenckebach phenomenon in the left bundle branch, along with the absence of documented myocardial ischemia, strongly suggested a diagnosis of painful LBBB syndrome.

Current utilization and impact of AI LVO detection tools in acute stroke triage: a multicenter survey analysis.

Background: Artificial intelligence (AI) tools for large vessel occlusion (LVO) detection are increasingly used in acute stroke triage to expedite diagnosis and intervention. However, variability in access and workflow integration limits their potential impact. This study assessed current usage patterns, access disparities, and integration levels across U.

Efficacy and Safety of Pulsed-Field Versus High-Power Short-Duration Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis With Reconstructed Time-to-Event Data.

Background: Pulsed-field ablation (PFA) and high-power short-duration (HPSD) ablation (45-90 W) are emerging technologies in atrial fibrillation (AF) treatment, both achieving durable pulmonary vein isolation. We aim to investigate the efficacy and safety of PFA versus HPSD ablation.

Methods: We comprehensively searched PubMed, Web of Science (WOS), Scopus, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) through July 2024.

A Talk with ChatGPT: The Role of Artificial Intelligence in Shaping the Future of Cardiology and Electrophysiology.

: Artificial intelligence (AI) is poised to significantly impact the future of cardiology and electrophysiology, offering new tools to interpret complex datasets, improve diagnosis, optimize clinical workflows, and personalize therapy. ChatGPT-4o, a leading AI-based language model, exemplifies the transformative potential of AI in clinical research, medical education, and patient care. : In this paper, we present an exploratory dialogue with ChatGPT to assess the role of AI in shaping the future of cardiology, with a particular focus on arrhythmia management and cardiac electrophysiology.

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.

Extrapulmonary Vein Areas with Pulsed Field Ablation: Is the Transition Completed?

Pulsed field ablation (PFA) is an innovative technology for the ablation of atrial fibrillation (AF), characterized by its ability to create tissue-selective lesions while minimizing collateral damage to surrounding structures. Isolation of the pulmonary veins (PVs) remains the cornerstone of AF ablation; however, recent evidence underscores the significance of extra-PV triggers, such as those from the posterior wall of the left atrium, the superior vena cava, the coronary sinus, and the left atrial appendage. While preliminary data suggest that PFA may enhance safety outcomes compared to traditional thermal techniques, further studies needed to validate its efficacy in non-PV areas.

Efficacy and Drug-Related Complications of Anticholinergic Drugs for Vagal Reaction Prevention During Pulsed Field Ablation.

Background: Vagal responses (VR) are frequently observed during pulmonary vein isolation (PVI) with pulsed field ablation (PFA).

Objectives: The aim of this study was to compare the effectiveness of 2 different anticholinergic (AC) medications, namely glycopyrrolate (GLY) or atropine (ATP), for VR prophylaxis in patients undergoing PVI via a pentaspline PFA catheter.

Methods: Consecutive patients with atrial fibrillation undergoing first-time PVI with PFA were prospectively enrolled at 4 centers between April 2023 and March 2024.

Outcomes of Mothers and Infants Affected by COVID-19.

The long-term effects of the novel coronavirus disease 2019 (COVID-19) infection during pregnancy are poorly characterized in mothers and their infants. The aim of this study was to assess the physical, mental, and emotional well-being of mothers and infants in the first year postpartum who were exposed to and/or diagnosed with COVID-19 infection.This direct-to-participant cohort study recruited 96 mother-infant pairs delivering at Pediatrix Medical Group sites, where mothers tested positive for COVID-19 during their pregnancy or birth hospitalization and/or infants tested positive for COVID-19 prior to hospital discharge.

Comparison of left atrial appendage closure and oral anti-coagulation after catheter ablation for atrial fibrillation: Concomitant and sequential cohorts of the OPTION randomized controlled trial.

Background: Left atrial appendage closure (LAAC) can be performed in separate procedures with cardiac ablation (sequentially) or concomitantly in the same operative session.

Objective: The OPTION trial aims to compare the efficacy and safety of LAAC with oral anticoagulation (OAC) in patients who have undergone catheter ablation for atrial fibrillation (AF). The objective of this sub-analysis is to evaluate LAAC vs OAC within concomitant and sequential ablation timings.