A tailored substrate-based approach using focal pulsed field catheter ablation in patients with atrial fibrillation and advanced atrial substrate: Procedural data and 6-months success rates.

Background: Focal pulsed-field ablation (F-PFA) integrated in electroanatomical mapping (EAM) systems allows tailored lesion sets in patients with atrial fibrillation (AF).

Objective: To determine feasibility, safety and 6-months outcome of F-PFA for a tailored substrate-based catheter ablation (CA) approach in patients with AF and advanced atrial substrate.

Methods: Consecutive patients with AF and advanced atrial substrate treated by a F-PFA system (Cardiofocus) through contact-force sensing catheters integrated in EAM systems were prospectively enrolled.

Quest for the ideal assessment of electrical ventricular dyssynchrony in cardiac resynchronization therapy.

This paper reviews the literature on assessing electrical dyssynchrony for patient selection in cardiac resynchronization therapy (CRT). The guideline-recommended electrocardiographic (ECG) criteria for CRT are QRS duration and morphology, established through inclusion criteria in large CRT trials. However, both QRS duration and LBBB morphology have their shortcomings.

Selecting repetitive focal and rotational activation patterns with the highest probability of being a source of atrial fibrillation.

Introduction: Repetitive focal and rotational activation patterns are currently used as additional ablation targets for atrial fibrillation (AF). However, there is no evidence that all these detected targets are actual sources of AF. In this paper, we present an approach that detects and ranks AF activation patterns not only based on the degree of pattern repetitiveness but also on the extent to which they are able to entrain their vicinity.

Reverse electrical remodelling after cardiac resynchronization therapy in a patient undergoing left bundle branch area pacing: a case report.

Background: Left bundle branch area pacing (LBBAP) has been introduced as an alternative to biventricular pacing in cardiac resynchronization therapy (CRT). Several studies describe echocardiographic reverse remodelling after LBBAP. Reverse electrical remodelling after LBBAP has not yet been described.

Local atrial bipolar electrogram voltage drops during cardiac magnetic resonance guided catheter ablation of typical atrial flutter: Associations with delivered radiofrequency energy and peri-procedural imaging.

Background: Cardiac magnetic resonance (CMR)-guided catheter ablation of the cavotricuspid isthmus (CTI) has been proven feasible, but determinants of local electrogram (EGM) voltage drops during radiofrequency (RF) applications are unknown.

Objective: The purpose of this study was to investigate local atrial bipolar EGM voltage drops and the association with delivered RF energy and anatomical information derived from peri-procedural CMR imaging.

Methods: In consecutive patients undergoing CMR-guided CTI ablation procedures, relative EGM voltage drops for RF applications ≥20 seconds were calculated.

Raw photoplethysmogram waveforms versus peak-to-peak intervals for machine learning detection of atrial fibrillation: Does waveform matter?

Background: Machine learning-based analysis can accurately detect atrial fibrillation (AF) from photoplethysmograms (PPGs), however the computational requirements for analyzing raw PPG waveforms can be significant. The analysis of PPG-derived peak-to-peak intervals may offer a more feasible solution for smartphone deployment, provided the diagnostic utility is comparable.

Aims: To compare raw PPG waveforms and PPG-derived peak-to-peak intervals as input signals for machine learning detection of AF.

Accelerated atrial pacing reduces left-heart filling pressure: a combined clinical-computational study.

Background And Aims: Accelerated atrial pacing offers potential benefits for patients with heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF), compared with standard lower-rate pacing. The study investigates the relationship between atrial pacing rate and left-heart filling pressure.

Methods: Seventy-five consecutive patients undergoing catheter ablation for AF underwent assessment of mean left atrial pressure (mLAP) and atrioventricular (AV) conduction delay (PR interval) in sinus rhythm and accelerated atrial pacing with 10 bpm increments up to Wenckebach block.

Conduction system pacing compared with biventricular pacing for cardiac resynchronization therapy in patients with heart failure and mildly reduced left ventricular ejection fraction: Results from International Collaborative LBBAP Study (I-CLAS) Group.

Background: Cardiac resynchronization therapy (CRT) is a guideline-recommended therapy in patients with heart failure with mildly reduced ejection fraction (HFmrEF, 36%-50%) and left bundle branch block or indication for ventricular pacing. Conduction system pacing (CSP) using left bundle branch area pacing or His bundle pacing has been shown to be a safe and physiologic alternative to biventricular pacing (BVP).

Objective: The aim of this study was to compare the clinical outcomes between BVP and CSP for patients with HFmrEF undergoing CRT.

Assessment of ventricular electrical heterogeneity in left bundle branch pacing and left ventricular septal pacing by using various electrophysiological methods.

Introduction: Left bundle branch area pacing (LBBAP) comprises pacing at the left ventricular septum (LVSP) or left bundle branch (LBBP). The aim of the present study was to investigate the differences in ventricular electrical heterogeneity between LVSP, LBBP, right ventricular pacing (RVP) and intrinsic conduction with different dyssynchrony measures using the ECG, vectorcardiograpy, ECG belt, and Ultrahigh frequency (UHF-)ECG.

Methods: Thirty-seven patients with a pacemaker indication for bradycardia or cardiac resynchronization therapy underwent LBBAP implantation.

Monitoring of myocardial injury by serial measurements of QRS area and T area: The MaastrICCht cohort.

Background: Manually derived electrocardiographic (ECG) parameters were not associated with mortality in mechanically ventilated COVID-19 patients in earlier studies, while increased high-sensitivity cardiac troponin-T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were. To provide evidence for vectorcardiography (VCG) measures as potential cardiac monitoring tool, we investigated VCG trajectories during critical illness.

Methods: All mechanically ventilated COVID-19 patients were included in the Maastricht Intensive Care Covid Cohort between March 2020 and October 2021.

Outcomes of Mitral Valve Regurgitation Management after Expert Multidisciplinary Valve Team Evaluation.

: Mitral regurgitation (MR) affects millions worldwide, necessitating timely intervention. There are significant clinical challenges in the conservative management of MR, leaving a knowledge gap regarding the impact of multidisciplinary decision-making on treatment outcomes. This study aimed to provide insights into the impact of multidisciplinary decision-making on the survival outcomes of MR patients, focusing on conservative approaches.

Parameter subset reduction for imaging-based digital twin generation of patients with left ventricular mechanical discoordination.

Background: Integration of a patient's non-invasive imaging data in a digital twin (DT) of the heart can provide valuable insight into the myocardial disease substrates underlying left ventricular (LV) mechanical discoordination. However, when generating a DT, model parameters should be identifiable to obtain robust parameter estimations. In this study, we used the CircAdapt model of the human heart and circulation to find a subset of parameters which were identifiable from LV cavity volume and regional strain measurements of patients with different substrates of left bundle branch block (LBBB) and myocardial infarction (MI).

Assessment of ICD eligibility in non-ischaemic cardiomyopathy patients: a position statement by the Task Force of the Dutch Society of Cardiology.

International guidelines recommend implantation of an implantable cardioverter-defibrillator (ICD) in non-ischaemic cardiomyopathy (NICM) patients with a left ventricular ejection fraction (LVEF) below 35% despite optimal medical therapy and a life expectancy of more than 1 year with good functional status. We propose refinement of these recommendations in patients with NICM, with careful consideration of additional risk parameters for both arrhythmic and non-arrhythmic death. These additional parameters include late gadolinium enhancement on cardiac magnetic resonance imaging and genetic testing for high-risk genetic variants to further assess arrhythmic risk, and age, comorbidities and sex for assessment of non-arrhythmic mortality risk.

Longer and better lives for patients with atrial fibrillation: the 9th AFNET/EHRA consensus conference.

Aims: Recent trial data demonstrate beneficial effects of active rhythm management in patients with atrial fibrillation (AF) and support the concept that a low arrhythmia burden is associated with a low risk of AF-related complications. The aim of this document is to summarize the key outcomes of the 9th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA).

Methods And Results: Eighty-three international experts met in Münster for 2 days in September 2023.

Impact of a Chronic Total Coronary Occlusion on the Incidence of Appropriate Implantable Cardioverter-Defibrillator Shocks and Mortality: A Substudy of the Dutch Outcome in ICD Therapy (DO-IT)) Registry.

Background: Chronic total coronary occlusions (CTO) substantially increase the risk for sudden cardiac death. Among patients with chronic ischemic heart disease at risk for sudden cardiac death, an implantable cardioverter defibrillator (ICD) is the favored therapy for primary prevention of sudden cardiac death. This study sought to investigate the impact of CTOs on the risk for appropriate ICD shocks and mortality within a nationwide prospective cohort.

Ultra-High-Frequency ECG in Cardiac Pacing and Cardiac Resynchronization Therapy: From Technical Concept to Clinical Application.

Identifying electrical dyssynchrony is crucial for cardiac pacing and cardiac resynchronization therapy (CRT). The ultra-high-frequency electrocardiography (UHF-ECG) technique allows instantaneous dyssynchrony analyses with real-time visualization. This review explores the physiological background of higher frequencies in ventricular conduction and the translational evolution of UHF-ECG in cardiac pacing and CRT.

The association between coronary artery calcification and vectorcardiography in mechanically ventilated COVID-19 patients: the Maastricht Intensive Care COVID cohort.

Background: Coronary artery calcification (CAC) is associated with poor outcome in critically ill patients. A deterioration in cardiac conduction and loss of myocardial tissue could be an underlying cause. Vectorcardiography (VCG) and cardiac biomarkers provide insight into these underlying causes.