Catheter Ablation of Paroxysmal Atrial Fibrillation and Disease Progression: Magnitude of the anti-progression effect and role of intervention timing.

Background: Recent randomized controlled trials(RCT) have shown that catheter ablation of paroxysmal atrial fibrillation(AF) is associated with a lower incidence of progression to persistent AF compared to the use of antiarrhythmic drug(AAD) therapy.

Objective: This meta-analysis aimed to investigate the magnitude of the anti-progression effect of catheter ablation, as well as the effect of intervention timing.

Methods: MEDLINE/EMBASE databases were searched until April 1 2024 for RCTs comparing catheter ablation and AAD therapy for the treatment of paroxysmal AF and reporting the rate of progression to persistent AF at 3 years (PROSPERO CRD42024534288).

Vagal response during radiofrequency catheter ablation initiated from right superior pulmonary vein: Incidence, risk factors, and clinical outcomes.

Background: The vagal response (VR) is unavoidable during pulmonary vein isolation (PVI) for atrial fibrillation (AF). In this study, we aimed to investigate the incidence, risk factors, and clinical outcomes of VR during PVI initiated from the right superior pulmonary vein (RSPV).

Methods: Patients with AF were consecutively enrolled.

Image quality assessment and automation in late gadolinium-enhanced MRI of the left atrium in atrial fibrillation patients.

Background: Late gadolinium-enhanced (LGE) MRI has become a widely used technique to non-invasively image the left atrium prior to catheter ablation. However, LGE-MRI images are prone to variable image quality, with quality metrics that do not necessarily correlate to the image's diagnostic quality. In this study, we aimed to define consistent clinically relevant metrics for image and diagnostic quality in 3D LGE-MRI images of the left atrium, have multiple observers assess LGE-MRI image quality to identify key features that measure quality and intra/inter-observer variabilities, and train and test a CNN to assess image quality automatically.

Atrial Tachyarrhythmias With Ultra-Rapid Ventricular Response and Sudden Death in Patients Without Structural Heart Disease.

Background: Sudden cardiac death (SCD) is generally associated with life-threatening ventricular arrhythmias. Supraventricular arrhythmias are an accepted cause of SCD in Wolff-Parkinson-White syndrome and complex congenital heart disease. However, the role of atrial tachyarrhythmias (ATAs) in SCD in patients with structurally normal hearts is unclear.

Clinical and Electrophysiological Characteristics of Marshall Bundle-Related Atrial Tachycardia: Considerations Based on a Definitive Diagnosis.

Background: Conventional endocardial mapping cannot fully elucidate Marshall bundle (MB)-related atrial tachycardia (AT).

Objectives: This study aimed to clarify the clinical and electrophysiological characteristics of MB-related AT definitively diagnosed using catheter insertion.

Methods: Forty-eight patients with AT who had previously undergone mitral isthmus ablation were enrolled in this study.

Relationship of Structural Abnormalities of Papillary Muscles to the Site of Origin of Ventricular Arrhythmias.

Background: Arrhythmias originating from papillary muscles (PAPs) can be challenging when targeted with catheter ablation. The prevalence and impact of structural abnormalities on PAPs in patients with focal PAP arrhythmias is unknown.

Objectives: The purpose of this study was to analyze, in a consecutive patient series with focal PAP arrhythmias, the impact of structural abnormalities detected by multimodality imaging.

The predictive value of monocyte count to high-density lipoprotein cholesterol ratio combined with left atrial diameter for post-radiofrequency ablation recurrence of paroxysmal atrial fibrillation in patients.

Background: Paroxysmal atrial fibrillation (PAF) usually recurs after radiofrequency ablation (RFA). This study probed the predictive value of monocyte count to high-density lipoprotein cholesterol (HDL-C) ratio (MHR) with left atrial diameter (LAD) for post-RFA recurrence in PFA patients.

Methods: Totally 210 RFA-treated PAF patients were selected and assigned into Recurrence and Non-Recurrence groups, with clinical baseline data recorded.

Vascular Cell Adhesion Molecule 1 in atrial fibrillation.

Objective: Assessing whether serum Vascular Cell Adhesion Molecule 1(VCAM-1) concentration in the left atrial appendage(LAA) and the expression of VCAM-1 in LAA tissues are associated with the risk of atrial fibrillation-related stroke.

Method: Blood samples were collected from atrial fibrillation(AF) patients scheduled for catheter ablation of AF, both from within the LAA and peripheral veins(PV). The serum concentration of VCAM-1 was quantitatively analyzed using ELISA.

Novel algorithm for non-invasive estimation of left atrial pressure in patients with atrial fibrillation.

Aims: Determining elevated left atrial (LA) pressure is crucial in patients with atrial fibrillation (AF), yet non-invasive estimation using echocardiography remains unclear. This study aimed to identify useful echocardiographic indices for identifying elevated LA pressure in patients with AF.

Methods And Results: Patients with paroxysmal or persistent AF referred for catheter ablation at two tertiary hospitals were prospectively enrolled.

Catheter ablation in rate-controlled atrial fibrillation with severely reduced ejection fraction: intervention for irregularity-mediated cardiomyopathy.

Background: Recent evidence suggests atrial fibrillation (AF) causes cardiomyopathy due to remodeling driven by both irregular rate and rhythm. Atrial fibrillation (AF) ablation in patients with reduced ejection fraction (EF) ≤ 35% has been shown to improve EF and mortality. It is unknown whether the benefits of AF ablation among patients with reduced EF are affected by the degree of pre-ablation rate control.

Concurrent assessment of time-to-isolation and temperature at 30 s as an innovative metric for predicting the persistence of pulmonary vein isolation using second-generation cryoballoons.

Background: We attempted to establish correlations between intraoperative variables such as time-to-isolation (TTI) and temperature (T) at the 30-second mark, and the sustained efficacy of pulmonary vein isolation.

Methods: One hundred patients underwent repeat procedures subsequent to their index ablation. Five time intervals were delineated based on TTI metrics of 30, 35, 40, 45, and 60 s during the initial procedure.

Predicting Early recurrence of atrial fibrilation post-catheter ablation using machine learning techniques.

Background: Catheter ablation is a common treatment for atrial fibrillation (AF), but recurrence rates remain variable. Predicting the success of catheter ablation is crucial for patient selection and management. This research seeks to create a machine learning model to forecast the early recurrence of atrial fibrillation following catheter ablation.

High Power Short Duration Atrial Fibrillation Ablation: Long-Term Predictors of Success and Recurrence - A Multivariate Analysis.

Background: Point-by-point ablation with a high-power short-duration (HPSD) technique in atrial fibrillation (AF) ablation is used worldwide. Little data is available with the HPSD and dragging technique (DT).

Objective: To perform a multivariate analysis of clinical and procedural predictors of success and recurrence in HPSD with DT.

Percutaneous radiofrequency ablation of an actively bleeding renal angiomyolipoma.

We report a case of computed tomography-guided percutaneous radiofrequency ablation of a bleeding renal angiomyolipoma. Radiofrequency ablation was performed as an alternative to partial nephrectomy and super-selective renal artery embolization for ruptured renal angiomyolipoma with slow persistent bleeding in a patient with elevated serum creatinine levels and other comorbidities. Computed tomography-guided radiofrequency ablation successfully stopped the active hemorrhage and did not affect long-term renal function during the 3-year follow period.

Pulsed Field Ablation Using Focal Contact Force-Sensing Catheters for Treatment of Atrial Fibrillation: 1-Year Outcomes of the ECLIPSE AF Study.

Background: Pulsed field ablation (PFA) is a promising treatment for atrial fibrillation. We report 1-year freedom from atrial arrhythmia outcomes using monopolar PFA delivered through 3 commercial, contact force-sensing focal catheters.

Methods: ECLIPSE AF (NCT04523545) was a prospective, single-arm, multicenter study evaluating acute and chronic safety and performance using the CENTAURI system to deliver focal PFA with TactiCath SE, StablePoint, and ThermoCool ST.

Combining computed tomography features of left atrial epicardial and pericoronary adipose tissue with the triglyceride-glucose index to predict the recurrence of atrial fibrillation after radiofrequency catheter ablation: a machine learning study.

Background: Radiofrequency catheter ablation (RFCA) represents an important treatment option for atrial fibrillation (AF); however, the recurrence rate following surgery is relatively high. This study aimed to predict the recurrence of AF after RFCA using interpretable machine learning models that combined the triglyceride-glucose (TyG) index and the quantification of left atrial epicardial and pericoronary adipose tissue.

Methods: This retrospective study included 325 patients with AF who underwent their first successful RFCA, among whom 79 had confirmed recurrence.

Dissociated rhythms between donor and recipient hearts after heart transplantation using the modified bicaval technique.

Unlabelled: The modified bicaval anastomosis technique is an orthotopic heart transplantation technique that preserves the posterior wall of the right atrium as a bridging tissue, creating a dual structure of the recipient and donor hearts between the superior and inferior venae cavae. In this report, we present a case with unique electrophysiological findings following heart transplantation using this technique. The patient, who had persistent atrial fibrillation before the procedure, achieved a maintained sinus rhythm afterward.

Feasibility of Atrial Substrate Mapping During Atrial Pacing and Its Impact on the Omnipolar Voltage and the Peak-Frequency of Electrograms.

Introduction: Atrial pacing maps are often used as substitutes for sinus rhythm (SR) maps to expedite mapping procedures. However, the impact of this method on electrophysiological parameters has not been systematically examined. This study aimed to elucidate the advantages and limitations of atrial pacing maps.

Epigenetic regulation on left atrial function and disease recurrence after catheter ablation in atrial fibrillation.

Background: Genetic variation and modifiable risk factors play a significant role in the pathogenesis of atrial fibrillation (AF). The influence of epigenetic modification on AF remains to be elucidated. We investigated the role of DNA methylation in the etiology of AF.

Comparing pulsed field ablation and thermal energy catheter ablation for paroxysmal atrial fibrillation: A cost-effectiveness analysis of the ADVENT trial.

Background: Pulsed field ablation (PFA) has emerged as an effective technology in the treatment of paroxysmal atrial fibrillation (AF).

Objective: To evaluate the cost-effectiveness of PFA vs. thermal ablation from a US healthcare payer perspective using data from a randomized trial.

Pulsed-field ablation of atrial fibrillation with a pentaspline catheter across National Health Service England centres.

Introduction: Pulsed-field ablation (PFA) is a novel modality for pulmonary vein isolation in patients with atrial fibrillation (AF). We describe the initial uptake and experience of PFA using a pentaspline catheter across selected National Health Service England (NHSE) centres.

Methods: Data collected by NHSE Specialised Services Development Programme regarding AF ablation procedures using a single-shot, pentaspline, multielectrode PFA catheter (FARAWAVE, Boston Scientific) between June 2022 and August 2024 were aggregated and analysed to examine procedural metrics, acute efficacy and safety outcomes over 3-month follow-up.

Pentaspline catheter or cryoballoon for pulmonary vein plus posterior wall isolation in persistent atrial fibrillation: 1-year outcomes.

Background: Left atrial posterior wall isolation (LAPWI) plus pulmonary vein isolation (PVI) can be performed with either radiofrequency, cryoballoon (CB-A) or, recently, with pulsed field ablation (PFA).

Objective: The aim of this study is: (1) to evaluate efficacy and safety of the pentaspline PFA catheter for PVI + LAPWI in patients with persistent AF undergoing an index ablation procedure and (2) to compare 1- year outcomes of PVI + LAPWI with PFA vs CB-A.

Methods: All consecutive patients undergoing to an index ablation for persistent atrial fibrillation (AF) at Universitair Ziekenhuis Brussel, Belgium, between 2021 and 2023, were retrospectively screened.

A Novel Focal Lattice Tip Catheter Toggling Between Pulsed Field Energy and Radiofrequency for Atrial Arrhythmia Ablation: Results from a Real-World, Multicenter Registry.

Introduction: A novel focal lattice tip catheter allowing the delivery of either pulsed field (PF) or radiofrequency (RF) energy has recently received regulatory approval. The technology features a proprietary 3D electroanatomical mapping system.

Objective: to describe the first real-world and multicentre experience.