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.

Contact Force Increases During Radiofrequency Ablation: A Novel Catheter Assessment of Myocardial Response to Thermal Injury.

Background: Contact force (CF) changes after onset of radiofrequency (RF) delivery are not well understood and often ascribed to catheter instability.

Objectives: This study sought to characterize CF changes during RF-based pulmonary vein (PV) isolation.

Methods: Catheter-tip parameters including CF for all RF sessions were extracted from a novel catheter-mapping system from 6 patients undergoing PV isolation.

Lesion Morphometry of the Pentaspline Pulsed Field Ablation Catheter: Understanding Catheter Pose, Rotation, and Dosing.

Background: The pentaspline pulsed field ablation catheter achieves pulmonary vein isolation using 8 stacked, pose-specific applications with rotation. The morphology of pose-specific, single or double applications has not been described.

Methods: One or 2 applications were delivered to select veins and discrete atrial and ventricular sites in 9 swine.

Ten Years of Leadless Cardiac Pacing.

Leadless pacemakers (LPs) are self-contained pacemakers implanted inside the heart, providing a clinical strategy of pacing without pacemaker leads or a subcutaneous pocket. From an experimental therapy first used clinically in 2012, a decade later this technology is an established treatment option. Because of technologic advances and growing evidence, LPs are increasingly being used.

Impact of race and ethnicity on the rhythm control of newly diagnosed atrial fibrillation: Insights from the Get With the Guidelines Atrial Fibrillation Registry.

Background: An early rhythm control strategy is the preferred management for patients newly diagnosed with atrial fibrillation (AF). A rhythm control strategy, however, has been historically underused for patients from underrepresented racial and ethnic groups (UREGs).

Objective: We aimed to determine whether disparities in rhythm control are present at the initial diagnosis with AF.

Specific locations of myocardial inflammation and fibrosis are associated with higher risk of events in cardiac sarcoidosis.

Background: F-Fluorodeoxyglucose (F-FDG) positron emission tomography (PET)/magnetic resonance (MR) can identify inflammation and fibrosis, which are high-risk features in cardiac sarcoidosis.

Objective: The purpose of this study was to evaluate whether the involvement of certain myocardial segments is associated with higher risk compared to others.

Methods: One hundred twenty-four patients with suspected clinical sarcoidosis underwent F-FDG-PET/MR.

Pulsed Field Ablation to Treat Paroxysmal Atrial Fibrillation: Safety and Effectiveness in the AdmIRE Pivotal Trial.

Background: Evidence from clinical trials of early pulsed field ablation (PFA) systems in treating atrial fibrillation has demonstrated their promising potential to reduce complications associated with conventional thermal modalities while maintaining efficacy. However, the lack of a fully integrated mapping system, a staple technology of most modern electrophysiology procedures, poses limitations in lesion creation and workflow options. A novel variable-loop PFA catheter integrated with an electroanatomic mapping system has been developed that allows for real-time nonfluoroscopic procedural guidance and lesion indexing as well as feedback of tissue-to-catheter proximity.

Catheter ablation for atrial fibrillation in patients with prior left atrial appendage occlusion device.

Background: The safety and efficacy of CA for AF and left-sided atrial arrhythmias (AA) in patients with left atrial appendage occlusion (LAAO) devices are lacking.

Methods: This is a single-center retrospective registry that included all patients with prior LAAO who underwent catheter ablation for AF or left-sided atrial arrhythmia from January 2020-January 2023. The primary outcomes were procedure-related complications, device-related complications, AA recurrence, and stroke.

Novel Ablation Catheters for Atrial Fibrillation.

Various ablation technologies with different energy sources are currently being either used or being investigated for atrial fibrillation (AF) ablation. Potential complications continue to occur due to the indiscriminate thermal effects on non-targeted tissues adjacent to the myocardium that are common to all thermal ablation modalities. Pulsed field ablation (PFA) has recently gained significant attention and interest as an approach to AF ablation.

Left atrial appendage closure for stroke prevention in atrial fibrillation: current status and perspectives.

Atrial fibrillation (AF) is associated with an increased risk of stroke and systemic embolism, and the left atrial appendage (LAA) has been identified as a principal source of thromboembolism in these patients. While oral anticoagulation is the current standard of care, LAA closure (LAAC) emerges as an alternative or complementary treatment approach to reduce the risk of stroke or systemic embolism in patients with AF. Moderate-sized randomized clinical studies have provided data for the efficacy and safety of catheter-based LAAC, largely compared with vitamin K antagonists.

Short-term safety and feasibility of a practical approach to combined atrial and ventricular physiological pacing: An initial single-center experience.

Background: Traditional right atrial appendage (RAA) pacing accentuates conduction disturbances as opposed to Bachmann bundle pacing (BBP).

Objective: The purpose of this study was to evaluate the feasibility, efficacy, and safety of routine anatomically guided high right atrial septal (HRAS) pacing with activation of Bachmann bundle combined with routine left bundle branch area pacing (LBBAP).

Methods: This retrospective single-center study included 96 consecutive patients who underwent 1 of 2 strategies: physiological pacing (PP) (n = 32) with HRAS and LBBAP leads and conventional pacing (CP) (n = 64) with traditional RAA and right ventricular apical leads.

Efficacy and safety of a novel hexaspline pulsed field ablation system in patients with paroxysmal atrial fibrillation: the PLEASE-AF study.

Aims: Pulsed field ablation (PFA) is an emerging non-thermal ablative modality demonstrating considerable promise for catheter ablation of atrial fibrillation (AF). However, these PFA trials have almost universally included only Caucasian populations, with little data on its effect on other races/ethnicities. The PLEASE-AF trial sought to study the 12-month efficacy and the safety of a multi-electrode hexaspline PFA catheter in treating a predominantly Asian/Chinese population of patients with drug-refractory paroxysmal AF.

Autonomic Effects of Pulsed Field vs Thermal Ablation for Treating Atrial Fibrillation: Subanalysis of ADVENT.

Background: Autonomic denervation is an ancillary phenomenon during thermal ablation of atrial fibrillation (AF), that may have synergistic effects on symptomatic improvement and long-term freedom from AF. Pulsed field ablation (PFA), a nonthermal ablation modality, was noninferior to thermal ablation in treating AF; however, PFA's relative myocardial selectivity may minimize autonomic effects.

Objectives: This study sought to compare heart rate (HR) and heart rate variability (HRV) metrics as markers of autonomic function after ablation using PFA vs thermal ablation.

Pulsed Field vs Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation: Recurrent Atrial Arrhythmia Burden.

Background: The ADVENT randomized trial revealed no significant difference in 1-year freedom from atrial arrhythmias (AA) between thermal (radiofrequency/cryoballoon) and pulsed field ablation (PFA). However, recent studies indicate that the postablation AA burden is a better predictor of clinical outcomes than the dichotomous endpoint of 30-second AA recurrence.

Objectives: The goal of this study was to determine: 1) the impact of postablation AA burden on outcomes; and 2) the effect of ablation modality on AA burden.

Periprocedural Intravascular Hemolysis During Atrial Fibrillation Ablation: A Comparison of Pulsed Field With Radiofrequency Ablation.

Background: Hemolysis-related renal failure has been described after pulmonary vein isolation (PVI) with pulsed-field ablation (PFA).

Objectives: This study sought to compare the potential for hemolysis during PVI with PFA vs radiofrequency ablation (RFA).

Methods: In consecutive patients, PVI was performed with PFA or RFA.

Dual-energy lattice-tip ablation system for persistent atrial fibrillation: a randomized trial.

Clinical outcomes of catheter ablation for atrial fibrillation (AF) are suboptimal due, in part, to challenges in achieving durable lesions. Although focal point-by-point ablation allows for the creation of any required lesion set, this strategy necessitates the generation of contiguous lesions without gaps. A large-tip catheter, capable of creating wide-footprint ablation lesions, may increase ablation effectiveness and efficiency.