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Arrhythmias are among the most frequent and serious complications in patients with adult congenital heart disease. The arrhythmogenic substrate is specific for different congenital heart diseases, either due to congenital anatomical malformations or as a result of surgical repair. Given the often borderline haemodynamic status, rhythm-control therapy is preferred, including the use of interventional methods (catheter ablation, pacemaker/cardioverter implantation, resynchronisation therapy). Periodic and thorough risk stratification is essential in the prophylaxis of sudden cardiac death. Patients with arrhythmias and severe congenital heart disease should be managed and treated in superspecialised expert centres. The aim of this article is to review the recent knowledge and guidelines for the care of these patients. [ABSTRACT FROM AUTHOR]

Catheter ablation of atrial fibrillation using radiofrequency energy has been the gold standard until these days. Nevertheless, there are limitations associated with the application of thermal energy such as damage to collateral structures, time-consuming nature, and, in particular, frequent recurrences of both atrial fibrillation and atrial tachycardias. Therefore, it was essential to find a brand new method with a better safety and efficiency profile. Promising results have been obtained with methods using pulsed field based on the principles of irreversible electroporation which, in comparison with the methods used so far that have a thermal effect and induce coagulation necrosis, predominantly cause disintegration of the cell membrane. This article deals with the principle of electroporation, pathophysiological background, and technical specification of the development of ablation systems using pulsed field energy. Also presented are the results of initial clinical trials with ablation treatment of all types of atrial fibrillation using the pulsed field method as well as the initial experience from the practice. [ABSTRACT FROM AUTHOR]

The EAST-AFNET 4 trial has brought a major paradigm shift in the treatment of atrial fibrillation (AF). The results of the trial have confirmed the findings of previous observational studies that have demonstrated that in patients with recently diagnosed AF, early rhythm control improves prognosis compared to usual care (mostly aimed at rate control). The sub-analyses have shown that the observed benefit is dependent on the presence of sinus rhythm. Thus, in patients with recently diagnosed AF, the treatment should aim at restoration and maintenance of sinus rhythm. This applies to patients with both paroxysmal and persistent AF regardless of the presence of AF symptoms or heart failure. It is conceivable that the next guidelines from the European Society of Cardiology will no lon‑ ger be focused on the treatment of symptomatic AF, but rather support rhythm control strategy for most patients with this arrhythmia. [ABSTRACT FROM AUTHOR]

Vertebral fracture is a common trauma can occur at any age group. Unstable fractures are treated surgically to restore the basic spinal functionality. In most cases, stable fractures are treated conservatively or by minimally invasive techniques. Pain is the most common symptom and can be a limiting factor for an early return to ones daily activities. Among the minimally invasive procedures for pain management are analgesis blockades, oxygenozone therapy, radiofrequency ablation or augmentation. This paper presents the current view of evidence-based medicine (EBM) on individual methods of pain treatment of which basic principles and aspects are discussed. Furthermore, the practical experiences of the author's workplace are presented. Over the past 8 years, more than 8,800 back pain treatments under CT guidance and 253 augmentation procedures have been performed at the authors' workplace. No clinically significant complication was observed. [ABSTRACT FROM AUTHOR]

Congestive heart failure (HF) is a progressive disease defined as the inability of the heart to maintain adequate blood flow. Ventricular arrhythmias (VAs) are common in patients with HF. Moreover, an advanced HF increases the risk of VAs. The management of VAs in patients with HF requires a systematic, multimodal approach consisting of an optimized medical therapy, use of ICD and/or cardiac resynchronization therapy. Another possibility is catheter ablation (CA), which is the method of choice for arrhythmia-induced cardiomyopathy and may represent a life-saving procedure for patients with electric storm. Novel approaches in the treatment of refractory VAs include modulation of the autonomic nervous system and stereotactic radiotherapy. In patients with end-stage HF with VAs, implantation of mechanical cardiac support or heart transplantation can be considered. The purpose of this review is to provide an overview of strategies used for the treatment of VAs in patients with HF with an emphasis on interventional options. [ABSTRACT FROM AUTHOR]

Catheter ablation is an effective method for the treatment of cardiac arrhythmias. In some patients, the arrhythmogenic substrate can be located on the epicardial aspect of the cardiac chambers and may be inaccessible from the endocardium. Therefore, percutaneous epicardial access to the pericardium has been introduced. Currently, it is used for patients in whom endocardial ablation has failed or in whom imaging studies or ECG characteristics suggest the presence of an epicardial substrate. Other indications include specific myocardial diseases, such as arrhythmogenic cardiomyopathy and Brugada syndrome. The aim of our paper is to review current techniques and potential complications associated with percutaneous epicardial mapping and ablation. Additionally, a brief analysis of a patient cohort from our center is presented. [ABSTRACT FROM AUTHOR]

Aim: Non-invasive imaging of the left atrium is a routine part of management before catheter radiofrequency ablation in patients suffering from atrial fibrillation. The aim of the study was to verify the degree of agreement in left atrial volume (LAV) calculated from echocardiography and computed tomography (CT) images. Further, we tried to verify whether the use of electrocardiography (ECG) gated CT protocol affects the degree of agreement between echocardiographic and CT volumetry. Methods: Totally, 62 patients with atrial fibrillation met the inclusion criteria. They all underwent routine transthoracic echocardiography. Furthermore, the group was prospectively randomized into two groups. Group A underwent a contrast-enhanced CT scan of the pulmonary veins and left atrium using ECG-gated protocol. For group B, a helical CT protocol without ECG synchronization was used. Left atrial volumetry was performed using CT data. Left atrial volume was calculated using Simpson's biplane discs summation method based on 2D echocardiographic images. In both imaging methods, the resulting volume was indexed to the body surface area. The indexed left atrial volume (LAVi) in echocardiography and CT scan between group A and group B was statistically compared. We also calculated correlation between echo LAVi and CT LAVi in both subgroups and in the whole study group. Results: LAVi measured by echocardiography was statistically significantly lower by 31.8-36.6% (p < 0.001). The CT LAVi value did not differ significantly between groups A and B (50.71 vs. 54.57 ml/m2; p = 0.34). Similarly, the echo LAVi value did not differ significantly between groups A and B (34.58 vs. 34.60 ml/m2; p = 0.94). The correlation coefficient rho between echo LAVi and CT LAVi in group A reached 0.429, in group B 0.527 and in the whole group 0.482. Conclusion: The estimation of left atrium volume in a routine transthoracic echocardiography was significantly underestimated and achieved only moderate correlation in comparison with CT volumetry, therefore this estimation should be interpreted with caution. The use of ECG-gated protocol during the CT data acquisition did not affect the degree of agreement between echocardiographic and CT volumetry. [ABSTRACT FROM AUTHOR]

Recent years in arrhythmology have been characterized by a number of interesting articles with potential impact in daily practice. Most of the space is devoted to atrial fibrillation, which is the most common rhythm disorder in humans. We better understand the pathophysiology and discover new potential for pharmacological treatment. Non-pharmacological treatment, in particular catheter ablation, is unstoppably developing. In a large number of arrhythmias, catheter ablation is curative in nature and should be preferred over antiarrhythmic therapy. In recent years, new anticoagulants have become the preferred therapy for stroke prevention in atrial fibrillation patients. Their use is effective and safe for both atrial fibrillation ablation and cardiac device implantation. Innovations have also been reported in cardiac device therapy, where permanent His bundle pacing is a promising method and a possible alternative to biventricular stimulation. [ABSTRACT FROM AUTHOR]

The first part of the a article summarises the mechanisms, diagnostic techniques, and management of the most common arrhythmias in children. In the second part, current topics in paediatric arrhythmology are discussed: catheter ablation, arrhythmias in patients with congenital heart disease, implantable devices, foetal arrhythmias, inherited primary arrhythmia syndromes, and genetic testing. [ABSTRACT FROM AUTHOR]

As in other arrhythmias, the strategies for ablation of ventricular tachycardias (VTs) in patients with structural heart disease are evolving. The current dominant strategy is substrate ablation, because it is associated with better outcomes than conventional approach and activation mapping during VT. The progress in imaging has enabled a more detailed characterization of the arrhythmogenic substrate in these patients. Likewise, novel techniques of ablation have been proposed that allow modification of the substrate in previously inaccessible sites. Despite the improvements, treatment of these patients still represents a challenge. For patients with an arrhythmic storm, successful ablation may be a life-saving procedure. Our aim is to review the current perspectives of catheter ablation of VT in patients with structural heart disease. [ABSTRACT FROM AUTHOR]

Prevention of thromboembolic complications represents a fundamental component of treatment in patients with atrial fibrillation (AF). Successful AF catheter ablation, via restoration of sinus rhythm and recovery of normal left atrial appendage contractions, has the potential to reverse the risk of ischemic stroke to the level in population without AF. In addition, the ablation effects include reversal of hemodynamic and functional impairment hidden behind the cardiovascular mortality, specifically in patients with persistent AF. Deeper understanding of causal links between AF and the risk of thromboembolic event would help better stratification of patients who can safely terminate anticoagulation after ablation. [ABSTRACT FROM AUTHOR]

Atrial fibrillation is an underappreciated reversible cause of left ventricular systolic dysfunction despite adequate rate control. The restoration of sinus rhythm with catheter ablation results in an improvement in the ventricular function and is associated with lower rates of death and hospital admission for heart failure. These outcomes challenge the current treatment paradigm that rate control is the appropriate strategy in patients with atrial fibrillation and heart failure. [ABSTRACT FROM AUTHOR]