BACKGROUND: Among patients undergoing catheter ablation for atrial fibrillation (AF), it remains uncertain whether peri- or post-ablation use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) reduces AF recurrence...BACKGROUND: Among patients undergoing catheter ablation for atrial fibrillation (AF), it remains uncertain whether peri- or post-ablation use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) reduces AF recurrence. OBJECTIVES: We conducted a meta-analysis of observational studies and randomized controlled trials comparing GLP-1 RA therapy versus no GLP-1 RA use on AF recurrence following ablation. METHODS: We systematically searched PubMed, Scopus, Web of Science, and Embase for adult randomized and observational studies. Random-effects models generated risk ratios (RRs), and heterogeneity was assessed via I. Time-to-event outcomes were synthesized using reconstructed individual patient data from Kaplan-Meier curves. RESULTS: Six studies met the inclusion criteria, with four contributing data for Kaplan-Meier curve reconstruction and five included in the hazard ratio (HR) meta-analysis. Across four studies (n = 695; GLP-1 RA = 295; control = 400), pooled Kaplan-Meier curves showed a lower risk of AF recurrence with GLP-1 RA therapy (HR 0.53, 95% confidence interval [CI]: 0.38-0.72), with a restricted mean survival time (RMST) advantage of 1.02 months. A random-effects meta-analysis of five studies confirmed this benefit (HR 0.78, 95% CI: 0.61-0.99; I = 75%). Pairwise analyses at 12 months demonstrated fewer AF recurrences with GLP-1 RAs (28.6% vs. 32.9%; RR 0.82, 95% CI: 0.76-0.90; I = 46.9%). CONCLUSION: GLP-1 RA therapy was associated with reduced AF recurrence after ablation, but methodological limitations warrant cautious interpretation. Prospective randomized trials are needed to confirm this potential benefit.
INTRODUCTION: Atrial fibrillation (AF) frequently coexists with pulmonary hypertension (PH) and is associated with clinical deterioration, right ventricular dysfunction, and increased mortality. While catheter ablation h...INTRODUCTION: Atrial fibrillation (AF) frequently coexists with pulmonary hypertension (PH) and is associated with clinical deterioration, right ventricular dysfunction, and increased mortality. While catheter ablation has demonstrated superiority over anti-arrhythmic drug (AAD) therapy in select AF populations, outcomes in patients with concurrent PH remain poorly characterized. METHODS: We performed a retrospective cohort study using the TriNetX Research Network. Adults with AF and PH were identified and stratified by treatment with catheter ablation plus AAD or AAD therapy alone. After 1:1 propensity score matching for demographics, comorbidities, and medication use, 9759 patients were included in each cohort. The primary outcomes were major adverse cardiovascular events (MACE) and right heart failure. Secondary outcomes included all-cause mortality, acute myocardial infarction (MI), and stroke. Kaplan-Meier models were used as the primary analysis, with Cox proportional hazards and E-value analysis as sensitivity. Competing risk analyses were performed using Fine-Gray models. RESULTS: Ablation was associated with a 50% reduction in MACE (HR 0.497 [0.467, 0.528], p < 0.001) and 35% reduction in right heart failure (HR 0.647 [0.573, 0.732], p < 0.001). There were also significant reductions in all-cause mortality (HR 0.469 [0.454, 0.488], p < 0.001) and stroke (HR 0.819 [0.728, 0.922], p = 0.001). There was no difference in acute MI (HR 0.982 [0.891, 1.082], p = 0.710). Findings were consistent across Cox sensitivity analyses, E-value analysis, and competing-risk models. CONCLUSION: In AF patients with PH, catheter ablation with AAD therapy was associated with substantially lower risks of adverse cardiovascular outcomes compared with AAD therapy alone. These findings suggest that catheter ablation is associated with lower risks of adverse cardiovascular outcomes in this high-risk population.
Bachmann bundle area pacing (BBp) has primarily been performed using lumenless leads delivered through dedicated atrial sheaths. With stylet-driven leads, stable positioning at the superior interatrial septum can be tech...Bachmann bundle area pacing (BBp) has primarily been performed using lumenless leads delivered through dedicated atrial sheaths. With stylet-driven leads, stable positioning at the superior interatrial septum can be technically challenging. We report two patients in whom the distal portion of a standard ventricular delivery catheter was shortened and reshaped using controlled heat molding with a heat gun. The customized sheath enabled stable placement of a stylet-driven lead at the high interatrial septum, resulting in successful BBp with favorable electrical parameters. Customized sheath modification may facilitate BBp using conventional pacing systems. Clinical Trial Registration: This study was not registered in a clinical trial registration, as it represents a retrospective case series and dose not meet the criteria for a prospective interventional clinical trial.
BACKGROUND: Clinical data about pulsed field ablation (PFA) under deep sedation among patients with obstructive sleep apnea (OSA) are limited, while the optimal periprocedural monitoring is not established. We report our...BACKGROUND: Clinical data about pulsed field ablation (PFA) under deep sedation among patients with obstructive sleep apnea (OSA) are limited, while the optimal periprocedural monitoring is not established. We report our experience in PFA among patients with atrial fibrillation (AF) and OSA, using a continuous non-invasive respiratory and hemodynamic monitoring protocol. METHODS: A total of 32 patients with AF suffering from OSA (mean age 68.5 ±9 years, 31% female) were compared with 60 consecutive patients without OSA. The monitoring protocol comprised continuous beat-to-beat blood pressure recording via an infrared light system and near-infrared spectroscopy for both cerebral and peripheral tissue oximetry. The Acumen Hypotension Prediction Index (HPI) that detects hypotensive trending was also assessed. RESULTS: Three of the patients with OSA (9%) and four of the controls (6%) developed transient decrease of cerebral saturation during induction to deep sedation, early detected and effectively managed with airway manoeuvres and supplemental oxygen up-titration. In nine patients with OSA (28%) and twenty controls (33%), increased HPI values followed by transient decrease in blood pressure were detected after induction to sedation and/or during PFA, responsive to intravenous fluids. The average time of hypotension was comparable between patients with and without OSA (2.69% vs. 3.23% of the total procedure time, respectively). No serious complications occurred. CONCLUSION: PFA under deep sedation in patients with OSA and AF was not associated with higher incidence of adverse events compared to those without OSA. This is confirmed by a sensitive continuous non-invasive monitoring protocol, which could be further evaluated by dedicated multicenter studies.
INTRODUCTION: Multipoint pacing (MPP) delivers sequential stimuli from multiple left-ventricular electrodes, potentially improving cardiac resynchronization therapy (CRT) response versus conventional biventricular pacing...INTRODUCTION: Multipoint pacing (MPP) delivers sequential stimuli from multiple left-ventricular electrodes, potentially improving cardiac resynchronization therapy (CRT) response versus conventional biventricular pacing (BiV). We performed an updated systematic review and meta-analysis to synthesize contemporary evidence. METHODS: Following PRISMA 2020 (PROSPERO CRD420261293273), MEDLINE, EMBASE, and CENTRAL were searched to January 2026 for comparative studies of MPP versus conventional BiV in adults receiving CRT. Primary outcomes were all-cause mortality and heart failure (HF)-related hospitalization. Secondary outcomes included echocardiographic response, NYHA class improvement, and absolute change in left-ventricular ejection fraction (LVEF). Random-effects models produced pooled odds ratios (OR) or mean differences (MD). RESULTS: Eight studies (n = 2430; 1190 MPP, 1240 BiV), including five randomized and three observational studies, were analyzed. All-cause mortality showed no significant difference between groups (OR = 1.46, 95% CI 0.76-2.80; p = 0.25; I = 0%). HF-related hospitalization was significantly reduced with MPP in the largest trial (5.4% vs. 8.9%; p = 0.015), corresponding to a 39% relative risk reduction. MPP was associated with significantly higher echocardiographic response (OR = 0.43, 95% CI 0.29-0.64; p < 0.0001; I = 0%), greater NYHA class improvement (OR = 0.38, 95% CI 0.20-0.73; p = 0.004; I = 3%), and greater absolute LVEF (MD = -4.67, 95% CI -6.70 to -2.64; p < 0.00001; I = 0%). CONCLUSIONS: Compared with conventional CRT, MPP was associated with improved functional and echocardiographic outcomes and reduced HF hospitalization, without a demonstrated mortality benefit. Larger prospective studies with longer follow-up are required to assess long-term prognostic effects.
BACKGROUND: Bachmann's bundle pacing (BBp) improves interatrial conduction, but its clinical impact on atrial function has not fully established. METHODS AND RESULTS: We report eight cases of attempted BBp. Three cases m...BACKGROUND: Bachmann's bundle pacing (BBp) improves interatrial conduction, but its clinical impact on atrial function has not fully established. METHODS AND RESULTS: We report eight cases of attempted BBp. Three cases met BBp electrocardiographic criteria with significant P-wave shortening and P-wave amplitude increase in the inferior leads, resulting in improved left atrial (LA) function (increased a' velocity, decreased E/e', and reduced LA diameter) and heart failure stabilization. Conversely, the remaining five cases failing to achieve significant P-wave changes showed no such improvements. CONCLUSIONS: Restoring interatrial conduction through successful BBp may optimize LA performance, potentially offering heart failure stabilization.
BACKGROUND: Subcutaneous and extravascular pacing systems represent an emerging class of cardiac rhythm management devices that deliver therapy without direct myocardial contact. Despite their clinical potential, the exc...BACKGROUND: Subcutaneous and extravascular pacing systems represent an emerging class of cardiac rhythm management devices that deliver therapy without direct myocardial contact. Despite their clinical potential, the excitability characteristics of subcutaneous stimulation are not well defined. METHODS: Acute preclinical studies were conducted in four swine (n = 4) using a coil-to-can subcutaneous pacing configuration. Monophasic and biphasic pulses ranging from 1 to 10 ms and 1 to 200 mA in amplitude were delivered asynchronously at rates 20-30 bpm above the intrinsic heart rate. Myocardial capture was confirmed via high-fidelity intra-aortic pressure. Strength-duration curves were generated, and rheobase and chronaxie values were derived using Lapicque's model. RESULTS: All subjects exhibited a hyperbolic strength-duration profile. Rheobase ranged from 19.54 to 77.58 mA, chronaxie varied from 0.70 to 2.94 ms. An inverse relationship was identified between rheobase and chronaxie, suggesting that effects of electrode geometry, tissue impedance, or lead placement may influence the excitability profile. Biphasic waveforms tended to lower capture thresholds versus monophasic stimuli; this difference did not reach statistical significance (p = 0.161). Inter-subject variability was consistent with differences in tissue impedance and electrode-myocardial distance. CONCLUSION: Subcutaneous pacing exhibits classical excitability consistent with Lapicque's theory. Thresholds follow predictable dependencies on pulse width and waveform, indicating opportunities to optimize energy delivery safety margins. These data provide a basis for programming strategies and future device designs targeting lower energy use and extended battery life in subcutaneous and extravascular pacing systems.
AIMS: As a novel technique, left bundle branch area pacing (LBBAP) can achieve excellent resynchronization in heart failure (HF) patients with left bundle branch block (LBBB). This study used cardiovascular magnetic reso...AIMS: As a novel technique, left bundle branch area pacing (LBBAP) can achieve excellent resynchronization in heart failure (HF) patients with left bundle branch block (LBBB). This study used cardiovascular magnetic resonance (CMR) to evaluate the scar burden at the lead deployment site and its ability to predict the echocardiographic response. METHODS AND RESULTS: Eighty-seven HF patients with LBBB and a left ventricular ejection fraction (LVEF)≤ 35% who underwent CMR examination and successful LBBAP implantation were retrospectively enrolled. Based on the results of the 6-month echocardiographic assessment after LBBAP, a response was defined as a reduction in the left ventricular end-systolic volume (LVESV) of ≥ 15%, and a super-response was defined as an improvement in the LVEF of ≥ 20% or greater than 50%. The myocardial scar, including global, septum, free wall, lateral and scar around lead deployment sites, was assessed by CMR. LBBAP achieved an 86.2% response rate and a 50.6% super-response rate. Compared with other LGE parameters, a superior negative linear correlation was found between the scar load around lead deployment site and LVESV reduction and improvement in LVEF, indicating that for every 1% increase in the scar burden of the lead deployment site, the delta LVESV decreased by 0.94%, and the delta LVEF decreased by 0.43%. The scar around lead deployment site can strongly predict responders and super-responders [area under the receiver operating characteristic curve (AUC: 0.87 and 0.76), respectively]. In patients with scars around deployment sites > 12.3% (cut-off values based on the Youden's index), the rates of response and super-response decreased substantially to 56.0% and 16.0%, respectively. CONCLUSION: The scar burden around lead deployment site as assessed by CMR, which is commonly located around the mid anteroseptum, can predict the echocardiographic response. Assessment of myocardial late gadolinium enhancement in the lead deployment site is recommended.
Preda A, Guarracini F, Falasconi G
… +14 more, Schiavone M, Latini AC, Cersosimo A, Villaschi A, Sabatino M, Falco R, De Luca L, Ramadan A, Penela D, Ammirati E, Carbucicchio C, Frontera A, Mazzone P, Gigli L
Advanced Heart failure (adHF) is the final common pathway of multiple cardiovascular diseases and affects over 64 million people worldwide. Ventricular arrhythmias (VAs), including electrical storm, are part of the natur...Advanced Heart failure (adHF) is the final common pathway of multiple cardiovascular diseases and affects over 64 million people worldwide. Ventricular arrhythmias (VAs), including electrical storm, are part of the natural history of adHF, being associated with morbidity, mortality, and missing of effective therapeutic options. Management often requires intensive care, deep sedation, autonomic modulation, multiple antiarrhythmic drugs, and mechanical circulatory support (MCS), while non-responders have very limited alternatives. Heart transplantation (HTx) remains the gold standard therapy, although its availability is constrained by the lack of donors and strict allocation criteria. VAs are major drivers of urgent HTx listing across allocation systems. In recent years, catheter ablation (CA) has evolved into a disease-modifying therapy for scar-related VAs, with improvements in safety, mapping resolution, and procedural efficacy. Although randomized data in adHF populations remain limited, observational studies and contemporary trials demonstrate that CA can significantly reduce arrhythmic burden, implantable cardioverter-defibrillator shocks, hospitalizations, and the need for urgent HTx, particularly when performed early in the disease course. Advances in substrate-based strategies, functional mapping, multipolar and omnipolar technologies, and integration of cardiac imaging have enhanced procedural precision, while preprocedural risk stratification tools guide the use of MCS to improve safety in high-risk patients. Emerging therapies, including pulsed-field ablation, stereotactic arrhythmia radiotherapy, and autonomic modulation, alongside multimodal imaging, are expanding treatment options for refractory VAs in end-stage cardiomyopathy. This review provides a comprehensive state-of-the-art overview of VA mechanisms, patient selection, ablation strategies, and future directions in the management of severe VAs in adHF, with a focus on patients awaiting HTx.
BACKGROUND: Achieving durable mitral isthmus (MI) block remains challenging in persistent atrial fibrillation (PeAF). Vein of Marshall ethanol infusion (VOMEI) facilitates MI block, but the impact of ethanol delivery tec...BACKGROUND: Achieving durable mitral isthmus (MI) block remains challenging in persistent atrial fibrillation (PeAF). Vein of Marshall ethanol infusion (VOMEI) facilitates MI block, but the impact of ethanol delivery technique on lesion formation and procedural outcomes is not well established. METHODS: In this prospective, single-center study, 106 patients with PeAF were assigned to three groups: RF-only (n = 57), selective VOMEI (n = 34), and double-balloon VOMEI (n = 15). Electroanatomic mapping was performed before and after ethanol infusion. The primary procedural endpoint was acute bidirectional MI block. Secondary endpoints included ethanol volume, scar area, voltage reduction, need for adjunctive radiofrequency (RF) ablation, arrhythmia recurrence, and procedural safety. RESULTS: The primary procedural endpoint, acute bidirectional MI block, was achieved in both VOMEI groups; however, the double-balloon technique delivered significantly higher ethanol volumes and produced larger bipolar and unipolar scar areas with greater voltage reduction compared with selective cannulation (all p < 0.05). It also significantly reduced the need for endocardial and epicardial RF ablation (endocardial RF need: 24.4% vs. 75.6%, p = 0.032; epicardial RF need: 3.4% vs. 96.6%, p < 0.001). Although arrhythmia recurrence rates were lower in the double-balloon group, the differences were not statistically significant (AF recurrence: 0% vs. 8.8% in the selective VOMEI group; p = 0.347). No significant procedural complications were observed. CONCLUSIONS: Double-balloon VOMEI enhances substrate modification and achieves MI block with less adjunctive RF ablation than selective cannulation in PeAF ablation. Optimizing ethanol delivery at the VOM ostium may improve procedural effectiveness. Larger randomized studies are needed to confirm long-term clinical benefits and refine patient selection. CLINICAL TRIAL REGISTRATION: This study was not registered in a clinical trials registry, as it was designed as a prospective single-center observational procedural study rather than an interventional clinical trial.
BACKGROUND: Leadless pacemakers (LPs) are developed to avoid pocket- and lead-related complications of transvenous pacing systems, but direct comparative data between two single chamber LP, namely Micra VR and Aveir VR a...BACKGROUND: Leadless pacemakers (LPs) are developed to avoid pocket- and lead-related complications of transvenous pacing systems, but direct comparative data between two single chamber LP, namely Micra VR and Aveir VR are scarce. METHODS: A systematic review and meta-analysis of studies directly comparing Micra VR and Aveir VR was performed. PubMed, Embase, and Scopus were searched through November 2025. Eligible studies reported electrical performance, procedural metrics, or periprocedural complications. RESULTS: Four observational studies, including 757 patients (363 Aveir, 394 Micra), met the inclusion criteria, with follow-up of 1-6 months. At implantation, Aveir showed slightly higher pacing thresholds (mean difference (MD) 0.18 V; 95% CI 0.09-0.26), while impedance and R-wave amplitude were similar. In follow-up, pacing thresholds showed no significant difference between devices, whereas Micra demonstrated higher R-wave amplitudes (MD -1.18 mV; 95% CI -2.29 to -0.07). Fluoroscopy time was longer with Aveir (MD 2.89 min; 95% CI 0.69-5.08), but total procedure duration did not differ significantly. Rates of device dislodgement, pericardial effusion/tamponade, and overall periprocedural complications were low and not statistically different between the two systems. CONCLUSION: Micra VR and Aveir VR demonstrate generally comparable short-term electrical performance, procedural efficacy, and safety. Minor differences in thresholds, sensing, and fluoroscopy time are likely indicative of design and workflow characteristics. Larger, well-controlled randomized studies with extended follow-up periods are necessary to establish long-term performance.
INTRODUCTION: Leadless pacemakers (LP) have significantly reduced device-related complications compared with conventional systems, yet limitations in atrial pacing and atrioventricular (AV) synchrony restrict their wides...INTRODUCTION: Leadless pacemakers (LP) have significantly reduced device-related complications compared with conventional systems, yet limitations in atrial pacing and atrioventricular (AV) synchrony restrict their widespread use. METHODS AND RESULTS: We report an 87-year-old man with a history of stage 5 CKD on haemodialysis with complete AV block and a previously implanted Micra-AV who developed symptomatic sinus node dysfunction. To restore AV synchrony and avoid transvenous implantation, an Abbott AVEIR AR atrial LP was implanted, achieving functional dual-chamber leadless pacing. The procedure had no complications, and the follow-up demonstrated 89% AV synchrony with symptomatic improvement. CONCLUSION: This case demonstrates the feasibility of achieving a hybrid dual-chamber leadless pacing system from two different manufacturers in selected patients.
BACKGROUND: Cardiac resynchronization therapy (CRT) through left bundle branch area pacing (LBBAP) has been associated with reduced arrhythmogenic risk compared to biventricular pacing (BiVP). Electromechanical window (E...BACKGROUND: Cardiac resynchronization therapy (CRT) through left bundle branch area pacing (LBBAP) has been associated with reduced arrhythmogenic risk compared to biventricular pacing (BiVP). Electromechanical window (EMW) is a marker of electromechanical instability, and a negative EMW is associated with ventricular arrhythmias. We hypothesized that LBBA-CRT increases EMW at least as much as BiVP-CRT does. METHODS: 129 CRT recipients (LBBAP: n = 63; BiVP: n = 66) were included. EMW and echocardiographic reverse remodeling were evaluated before and 6-12 months after CRT implantation in the entire cohort and in a subgroup of patients with a negative EMW at baseline. EMW is calculated by subtracting the QT interval from the time interval of QRS onset to the aortic valve closure artifact (QAoC) using CW-Doppler echocardiography. RESULTS: EMW measurements were feasible in 67% of patients (n = 86). No significant difference in ΔEMW was observed between LBBAP and BiVP. In patients with a negative EMW at baseline, both CRT strategies led to significant EMW increase (LBBAP: n = 21, ΔEMW +13 ms (IQR -1 to 70), p = 0.003; BiVP: n = 36, ΔEMW +26 ms (IQR -2 to 54), p = 0.006). There was no significant difference between CRT groups (p = 0.779). Left ventricular ejection fraction improved by 10% ± 11% and end-diastolic volume decreased by 37 ± 51 mL (<0.001), with no significant differences between LBBAP and BiVP. In multivariable analysis, a negative EMW at baseline, but not echocardiographic reverse remodeling, was the only independent predictor of EMW increase. CONCLUSION: In CRT patients with a negative EMW at baseline, LBBAP and BiVP revert EMW to a similar degree.
BACKGROUND: Biventricular pacing (BVP) and conduction system pacing (CSP) can enhance pacing-induced cardiomyopathy (PICM) patients' clinical outcomes. Although BVP is a class I recommendation in guidelines, CSP may prov...BACKGROUND: Biventricular pacing (BVP) and conduction system pacing (CSP) can enhance pacing-induced cardiomyopathy (PICM) patients' clinical outcomes. Although BVP is a class I recommendation in guidelines, CSP may provide a superior physiological alternative to BVP. This meta-analysis compares the efficacy and safety of CSP and BVP in PICM patients. METHODS: Databases including PubMed, Cochrane Library, Web of Science, and Embase were searched from their establishment to June 2025. Data analysis was performed using Stata 17. RESULTS: Twenty observational studies involving 821 patients with PICM were included, among which 360 patients were treated with BVP and 461 patients with CSP. Results showed CSP had a greater QRS duration (QRSd) reduction than BVP (MD = -53.26 ms, 95% CI: -58.13, -48.39 vs. MD = -30.69 ms, 95% CI: -35.79, -25.59) (p < 0.001). After 15.6 months' follow-up, CSP had a higher response rate (84.7% vs. 67.6%) (RR = 1.25, 95% CI: 1.14, 1.38) (p < 0.001) and lower incidences of adverse outcomes and device-related complications (14.0% vs. 20.1%) (RR = 0.7, 95% CI: 0.5, 0.98) (p < 0.001) than BVP. Subgroup analysis showed His bundle pacing (HBP) was associated with greater QRSd shortening, while left bundle branch area pacing (LBBAP) had lower thresholds. CONCLUSIONS: The results indicate that upgrading to CSP in PICM patients significantly improves electrical synchrony, and correlates with higher response rates and lower adverse outcomes, suggesting CSP as a promising alternative pacing strategy.
INTRODUCTION: Bachmann's bundle pacing (BBP) is associated with shorter p-wave duration (PWD) and reduced atrial fibrillation (AF) recurrence compared to right atrial appendage pacing (RAAP). We investigated the differen...INTRODUCTION: Bachmann's bundle pacing (BBP) is associated with shorter p-wave duration (PWD) and reduced atrial fibrillation (AF) recurrence compared to right atrial appendage pacing (RAAP). We investigated the differences in acute left atrial pressure (LAP) measured invasively between sinus rhythm, BBP and RAAP. METHODS AND RESULTS: Acute LAP and PWD were measured in subjects undergoing left atrial catheter ablation in sinus rhythm, during BBP and RAAP at the end of ablation. Differences in PWD and LAP were determined by paired t-tests. Among 26 subjects (age 56.6 ± 14.2years, 27% female, 11% left-sided accessory pathway ablation, 54% pulmonary vein isolation[PVI], 35% PVI+additional LA ablation), BBP was successful in 24 subjects. Adjusted for age, only PWD was significantly associated with LAP in sinus rhythm (ß 0.12, p = 0.039). Compared to sinus rhythm and RAAP, BBP was associated with significantly shorter PWD (p < 0.05), but LAP was not significantly different (p > 0.05). In subgroup analyses, BBP remained associated with significantly shorter PWD, but was also associated with lower acute LAP compared to RAAP (16.7 ± 5.5 mmHg vs. 17.0 ± 6.0 mmHg, p = 0.010), among patients with interatrial conduction delay, defined as PWD>120 ms during sinus rhythm. Acute LAP was similar between BBP, sinus rhythm and RAAP in other subgroups (paroxysmal vs. persistent AF, PVI vs. PVI+additional LA ablation, left ventricular ejection fraction <50% vs. ≥50%; all p > 0.05). CONCLUSION: Reductions in PWD during BBP did not correspond with uniform reductions with acute LAP. Acute LAP was lower in BBP than RAAP, but its clinical significance in reducing AF requires further study.
BACKGROUND: Catheter ablation of premature ventricular contractions (PVCs) is an effective treatment modality, but traditionally involves fluoroscopy, which poses radiation risks. Recently, zero-fluoroscopy (ZF) techniqu...BACKGROUND: Catheter ablation of premature ventricular contractions (PVCs) is an effective treatment modality, but traditionally involves fluoroscopy, which poses radiation risks. Recently, zero-fluoroscopy (ZF) techniques have emerged as a safer alternative, especially in young patients and those requiring multiple procedures. METHODS: This retrospective, single-center study evaluated 150 patients who underwent PVC ablation between January 2023 and March 2025. Patients were divided into two groups: those treated with ZF (n = 75) and conventional fluoroscopy (CF) (n = 75). Procedural characteristics, procedure time, success rates, and complications were compared. RESULTS: Acute procedural success was achieved in 79.3% overall, with comparable rates between ZF and CF groups (78.7% vs. 80.0%, p = 0.84). The median procedure time was similar (88 vs. 90 min, p = 0.14), and no significant differences were observed in complication rates (4.0% vs. 4.0%, p = 1.00). Stratified analysis revealed longer procedure times in anatomically complex PVC origins, particularly in LV-superior and summit regions (p < 0.001), whereas RV-inferior PVCs showed the highest success (90%) and shortest duration (p < 0.05). Univariate logistic regression identified a higher PVC burden and a longer procedure time as predictors of procedural failure. No coronary or atrioventricular conduction injury occurred in either group. CONCLUSION: Zero-fluoroscopy PVC ablation is a safe and effective alternative to conventional methods. Despite longer durations in anatomically complex cases, the ZF approach avoids radiation without compromising outcomes.
Left bundle branch area pacing (LBBAP) is an effective strategy for restoring electro mechanical synchrony; however, its potential to suppress a high burden of concomitant atrial and ventricular ectopy remains to be full...Left bundle branch area pacing (LBBAP) is an effective strategy for restoring electro mechanical synchrony; however, its potential to suppress a high burden of concomitant atrial and ventricular ectopy remains to be fully elucidated. We present a 57-year-old male patient with left bundle branch block (LBBB)-induced cardiomyopathy who experienced significant improvement in left ventricular ejection fraction (LVEF) and marked suppression of both premature ventricular contractions (PVCs) and supraventricular extrasystoles (SVEs) after LBBAP. At 6 months of follow-up, LVEF increased to 58%, PVCs decreased to 200 per day, and SVEs disappeared. LBBAP can reverse mechanical dyssynchrony and suppress a high burden of ectopy.
BACKGROUND: The variable loop circular catheter (VLCC) called VARIPULSE is a novel device designed for catheter ablation of atrial fibrillation (AFib) and electro-anatomical mapping via 3D intracardiac echocardiography (...BACKGROUND: The variable loop circular catheter (VLCC) called VARIPULSE is a novel device designed for catheter ablation of atrial fibrillation (AFib) and electro-anatomical mapping via 3D intracardiac echocardiography (ICE). Described herein is a streamlined workflow for AFib ablation and reported feasibility, procedural efficiency, and early safety signals of the first 34 consecutive patients. The technical details of step-by-step techniques are described to serve as a practical guide for clinicians and investigators. METHODS: A retrospective, single-center review of procedural parameters was done on 34 paroxysmal and/or persistent AFib patients who were treated with a VLCC for both mapping and ablating between January 1, 2025 and May 15, 2025. The workflow of all procedures was comprised of general anesthesia administration, placement of 2 sheaths via ultrasound guided access, administration of a heparin bolus, 3D anatomical mapping of the pulmonary veins with CARTOSOUND FAM, a transeptal puncture, VLCC ablation, and then closure. Figures illustrating key procedural steps, including catheter maneuvering, are included. RESULTS: All 34 cases were done without fluoroscopy, with a median procedural time of 40.5 [IQR 19] min. After 10 procedures per operator, consistently shorter procedure times (<45min) were achieved. No major acute or 30-day complications were observed. CONCLUSION: This review of the initial 34 patients undergoing ICE and cardiac ablation using the VLCC catheter, exhibits a fluoroless, streamlined workflow that is feasible and operationally efficient, with early safety signals that require validation in larger, prospective studies. Notably, this approach did not require multiple transvenous access sites, pre-procedural cross-sectional imaging, right atrial matrix, or additional multielectrode catheters that would necessitate frequent catheter-cable switching.