Journal of Cardiovascular Electrophysiology

BACKGROUND: Multiple randomized controlled trials have demonstrated sodium-glucose cotransporter-2 inhibitors (SGLT2i) decrease the composite endpoint of cardiovascular death or heart failure hospitalizations in all heart failure patients. It is uncertain whether SGLT2i impacts the risk of sudden cardiac death in patients with heart failure. OBJECTIVE: To assess the impact of SGLT2i therapy on arrhythmic outcomes in patients with heart failure receiving optimal medical therapy...

INTRODUCTION: Cardioneuroablation may be an alternative to pacing therapy to treat carotid sinus syndrome secondary to inoperable head and neck tumors. METHODS: We performed, bi-atrial electroanatomic-mapping-guided (a fractionated electrogram-based) cardioneuroablation treatment. RESULTS: Ablation procedure led to an increase in resting sinus heart rhythm (from 54 to 81 bpm). During the follow-up period of approximately 6 months, neither any bradycardia episodes (sinus bradycardia, sinus pause, AV block, etc...

INTRODUCTION: Routine ultrasound (US)-guidance for femoral venous access to decrease vascular complications of atrial fibrillation (AF) ablation procedures has been advocated. However, the benefit has not been unequivocally demonstrated by randomized-trial data. METHODS AND RESULTS: Consecutive patients undergoing pulmonary vein isolation (PVI) on uninterrupted anticoagulant treatment were included. A quasi-random allocation to either US-guided or conventional puncture group was based on which of the two procedure rooms the patient was scheduled in, with only one of the rooms equipped with an US machine including a vascular transducer...

BACKGROUND: The Apple Watch (AW) Irregular Rhythm Notification (IRN) feature uses photoplethysmography to identify prolonged episodes of irregular rhythm suggestive of atrial fibrillation (AF). IRN is FDA cleared for those with no previous history of AF, however, these devices are increasingly being used for AF management. OBJECTIVE: To determine the accuracy of the IRN in subjects with a previous diagnosis of non-permanent AF. METHODS: Subjects with a history of non-permanent AF and either an insertable cardiac monitor (ICM) or cardiac implanted electronic device (CIED) with < 5% ventricular pacing were fitted with an AW Series 5 for 6 months...

Radiofrequency (RF) ablation uses alternating electrical current to generate heat at the catheter-tissue interface. The goal is the produce irreversible myocardial tissue injury by raising the tissue temperature above the lethal threshold, variably estimated at approximately 53.6±3.20°C to 60.6 (IQR 59.7-62.4) °C(1,2). Ideally, the tissue temperature should not exceed boiling point and the tissue surface temperature should be kept less than 80°C to avoid complications such as steam pop and coagulum or char formation, respectively...

A 50-year old man with a structurally normal heart presented with recurrent palpitations for six months. This was in spite of a recent radiofrequency ablation at another center for a presumed diagnosis of atrio-ventricular nodal reentrant tachycardia (AVNRT). Interestingly, his first radiofrequency ablation for a tachyarrhythmia was over a decade ago, but records were unavailable. The 12 lead Electrocardiogram (ECG) revealed a short RP tachycardia at rate of 170 bpm. There was no preexcitation during sinus rhythm...

Sudden cardiac death (SCD) increases with age, with the incidence among persons in their fifth and sixth decades of life reaching 50 per 100,000 patient years. 1 However, SCD and sudden cardiac arrest (SCA) in the young remains one of the most poorly understood causes of death in cardiovascular medicine, comprising a broad range of pathologic entities that encompass both genetic and structural causes. 2 Understanding the fundamental substrate is critical for effective management and prevention of future adverse events...

BACKGROUND: Incidental left atrial appendage (LAA) isolation may occur during radiofrequency ablation of persistent atrial fibrillation (AF). OBJECTIVE: The study aims to describe the mechanisms and long-term thromboembolic risk related to incidental LAA isolation. METHODS: Patients who experienced incidental LAA isolation after AF ablation were included. Culprit sites where ablation resulted in LAA isolation were identified. Thromboembolic risk despite oral anticoagulation (OAC) was compared to that in a propensity-matched control group without LAA isolation...

BACKGROUND: Structural changes in the left atrium (LA) modestly predict outcomes in patients undergoing catheter ablation for atrial fibrillation (AF). Machine learning (ML) is a promising approach to personalize AF management strategies and improve predictive risk models after catheter ablation by integrating atrial geometry from cardiac computed tomography (CT) scans and patient-specific clinical data. We hypothesized that ML approaches based on a patient's specific data can identify responders to AF ablation...

High power short duration (HPSD) radiofrequency (RF) ablation, utilizing 45-50W for durations of 5-15 seconds per lesion, is increasingly accepted as a safe and effective technique to efficiently achieve pulmonary vein isolation to prevent atrial fibrillation (AF).1 The next contender in the progression of hotter and faster RF technology is very high power short duration (vHPSD) RF ablation - 90W power for a duration of 4 seconds per lesion - using the QDOT-Micro ablation catheter (Biosense Webster, CA, USA)...

We read with great interest the article recently published in Journal of Cardiovascular Electrophysiology, "Left atrial appendage dimension predicts elevated brain natriuretic peptide in nonvalvular atrial fibrillation" by Cook JA. et al.1 The authors have studied the relation between Brain natriuretic peptide (BNP) elevations and left atrial appendage measurements in patients who referred for left atrial appendage (LAA) occlusion in patients with nonvalvular atrial fibrillation (AF) This article is protected by copyright...

PURPOSE: The QDOT-MicroTM catheter is a novel irrigated contact force (CF) sensing catheter which benefits from thermocouples for temperature monitoring, allowing temperature-flow-controlled (TFC) ablation. We compared lesion metrics at fixed ablation index (AI) value during TFC-ablation and conventional power-controlled (PC)-ablation. METHODS: A total of 480 RF-applications were performed on ex-vivo swine myocardium with predefined AI targets (400/550) or until steam-pop occurred, using the QDOT-MicroTM (TFC-ablation) and Thermocool SmartTouch SFTM (PC-ablation)...

INTRODUCTION: The benefits of cardiac resynchronization therapy (CRT) with biventricular pacing (BiV) is significantly lower when applied to heart failure (HF) patients with non-left bundle branch block (LBBB) conduction delay. We investigated clinical outcomes of conduction system pacing (CSP) for CRT in non-LBBB HF. METHODS: Consecutive HF patients with non-LBBB conduction delay undergoing CSP were propensity matched for age, sex, HF-etiology and atrial fibrillation (AF) in a 1:1 ratio to BiV from a prospective registry of CRT recipients...

AIMS: We aimed to investigate the impact of the 2021 ESC guideline changes in left bundle branch block(LBBB) definition on cardiac resynchronization therapy(CRT) patient selection and outcomes. METHODS: The MUG(Maastricht-Utrecht-Groningen) registry, consisting of consecutive patients implanted with a CRT device between 2001 and 2015 was studied. For this study, patients with baseline sinus rhythm and QRS duration >130ms were eligible. Patients were classified according to ESC 2013 and 2021 guideline LBBB definitions and QRS duration...

BACKGROUND: A quantifiable, automated standard of analysing heart rhythm has long eluded cardiologists due, in part, to the limitations in technology and the ability to analyse large electrogram datasets. In this proof-of-concept study, we propose new measures to quantify plane activity in atrial fibrillation (AF) using our RETRO-Mapping software. METHODS: We recorded 30 second segments of electrograms at the lower posterior wall of the left atrium using a 20-pole double loop catheter (AFocusII)...

INTRODUCTION: Pulmonary vein isolation (PVI) using radiofrequency (RF) and cryoballoon (Cryo) ablation are standard approaches for rhythm control in patients with symptomatic atrial fibrillation. Both strategies create scar in the left atrium (LA). There have been few studies investigating the difference in scar formation between patients undergoing RF and Cryo using cardiac magnetic resonance imaging (CMR). METHODS: The current study is a sub-analysis of the control arm of the Delayed-Enhancement MRI Determinant of Successful Catheter Ablation of Atrial Fibrillation study (DECAAF II)...

INTRODUCTION: Sacubitril/valsartan reduces all-cause mortality in heart failure (HF) patients compared to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). ACEIs/ARBs have been shown to decrease the incidence of atrial fibrillation (AF). We hypothesized sacubitril-valsartan decreases the incidence of AF compared to ACEis/ARBs. METHODS: Clinicaltrials.gov was searched for trials by terms sacubitril/valsartan, entresto, sacubitril, valsartan...

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The study by Strocchi et al. adds evidence that choosing the cardiac resynchronization therapy (CRT) according to the cardiac substrate of each patient could be beneficial. Perhaps the most appropriate approach in CRT would be to find the appropriate niche for each pacing method. It may be less about demonstrating the superiority of conduction system pacing (CSP) and more about personalizing the therapy for each particular patient. That is, a patient with septal scarring or diffuse conduction system disease could benefit more from biventricular CRT...