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The article looks at a study led by J.W. Dukes and colleagues on access to alcohol and heart disease among patients in a hospital in Texas. Study highlights include prevalence and incidence of alcohol misuse and alcoholic liver disease in residents of wet counties, public health impact of laws limiting alcohol sales, and the reason why the problem of former alcoholic drinkers is largely mitigated.

Background: Cardioneuroablation has been emerging as a potential treatment alternative in appropriately selected patients with cardioinhibitory vasovagal syncope (VVS) and functional AV block (AVB). However the majority of available evidence has been derived from retrospective cohort studies performed by experienced operators., Methods: The Cardioneuroablation for the Management of Patients with Recurrent Vasovagal Syncope and Symptomatic Bradyarrhythmias (CNA-FWRD) Registry is a multicenter prospective registry with cross-over design evaluating acute and long-term outcomes of VVS and AVB patients treated by conservative therapy and CNA., Results: The study is a prospective observational registry with cross-over design for analysis of outcomes between a control group (i.e., behavioral and medical therapy only) and intervention group (Cardioneuroablation). Primary and secondary outcomes will only be assessed after enrollment in the registry. The follow-up period will be 3 years after enrollment., Conclusions: There remains a lack of prospective multicentered data for long-term outcomes comparing conservative therapy to radiofrequency CNA procedures particularly for key outcomes including recurrence of syncope, AV block, durable impact of disruption of the autonomic nervous system, and long-term complications after CNA. The CNA-FWRD registry has the potential to help fill this information gap., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Active esophageal cooling reduces the incidence of endoscopically identified severe esophageal lesions during radiofrequency (RF) catheter ablation of the left atrium for the treatment of atrial fibrillation. A formal analysis of the atrioesophageal fistula (AEF) rate with active esophageal cooling has not previously been performed., Objectives: The authors aimed to compare AEF rates before and after the adoption of active esophageal cooling., Methods: This institutional review board (IRB)-approved study was a prospective analysis of retrospective data, designed before collecting and analyzing the real-world data. The number of AEFs occurring in equivalent time frames before and after adoption of cooling using a dedicated esophageal cooling device (ensoETM, Attune Medical) were quantified across 25 prespecified hospital systems. AEF rates were then compared using generalized estimating equations robust to cluster correlation., Results: A total of 14,224 patients received active esophageal cooling during RF ablation across the 25 hospital systems, which included a total of 30 separate hospitals. In the time frames before adoption of active cooling, a total of 10,962 patients received primarily luminal esophageal temperature (LET) monitoring during their RF ablations. In the preadoption cohort, a total of 16 AEFs occurred, for an AEF rate of 0.146%, in line with other published estimates for procedures using LET monitoring. In the postadoption cohort, no AEFs were found in the prespecified sites, yielding an AEF rate of 0% (P < 0.0001)., Conclusions: Adoption of active esophageal cooling during RF ablation of the left atrium for the treatment of atrial fibrillation was associated with a significant reduction in AEF rate., Competing Interests: Funding Support and Author Disclosures No specific funding for this research was provided. Some authors are supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health, under Award Number R44HL158375 for the evaluation of esophageal cooling (the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health). Academic advisors to—and representatives of—Attune Medical participated in the study design, data collection, analysis, and interpretation and participated in the preparation, review, and approval of the manuscript. Dr Woods has received consulting fees from Abbott and research funding from Biosense Webster; and has equity in Inheart Medical and intellectual property with Attune Medical. Dr Zagrodzky has received consulting fees from Biosense Webster and Attune Medical. Dr Singleton has received consulting fees from Biosense Webster. Dr Brumback has received consulting fees from Attune Medical. Dr Athill has received consultant fees from Abbott, Boston Scientific, Biosense Webster, and Acutus; and speaker fees from Zoll Medical. Dr Joseph has served an internship with Attune Medical. Dr Shah has received consulting fees from Abbott and Janssen Pharmaceuticals. Dr Kulstad holds equity in and has had employment in Attune Medical. Dr Upadhyay has received consulting fees from Abbott, Biotronik, Boston Scientific, Medtronic, Philips BioTel, and Zoll Medical. Dr Cogan has received consulting fees from Abbott and Biosense Webster. Dr Cooper has received support for data acquisition from Attune Medical. Dr Tamirisa has received speaking fees from Abbott and Medtronic; and consultant fees from Sanofi. Dr Patel has received consulting fees from Biosense Webster. Dr Greet has received consulting fees from Medtronic. Dr MacGregor has received research fees from Boston Scientific. Dr Percell has served on Speaker Bureau for Abbott and Janssen. Dr Hao has received consultant fees from Rampart IC. Dr Dewland has received consulting fees from Adagio Medical. Dr Gerstenfeld has received lecture honoraria from Medtronic, Boston Scientific, and Abbott; research funding, scientific advisory board, and compensation from Biosense Webster; has served on a scientific advisory board for Farapulse; and Data and Safety Monitoring Board for trials sponsored by Thermedical Inc and Abbott. Dr Panico has received consulting fees from Abbott and Impulse Dynamics. Dr Mickelsen has received consulting fees from Field Medical, Atraverse Medical, and Attune Medical. Dr Metzl has received consulting fees from Abbott, Biosense Webster, Attune Medical, Medtronic, Sanofi Aventis, and Philips. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: This study sought to characterize the presentations, electrophysiological features and diagnostic maneuvers for a series of unique arrhythmias involving the HPS., Background: By virtue of its unique anatomy and ion channel composition, the His-Purkinje system (HPS) is prone to a variety of arrhythmic perturbations., Methods: The authors present a collaborative multicenter case series of 6 patients with HPS-related arrhythmias. All patients underwent electrophysiological studies using standard multipolar catheters., Results: In 3 patients, both typical and reverse bundle branch re-entry were seen, with 1 patient demonstrating "figure of 8" re-entry likely involving the septal fascicle. One patient presented with systolic dysfunction associated with a high premature ventricular complex burden, with the mechanism being bundle-to-bundle re-entrant beats masquerading as dual response to a single sinus impulse. Two patients were diagnosed with interfascicular re-entry. Diagnosis was aided by careful assessment of HV interval in sinus rhythm and ventricular tachycardia, multipolar catheters to assess the activation sequence of the His-right bundle branch, and fascicles and entrainment of different components of the HPS. Cure of the arrhythmia was achieved by ablation of the right bundle branch block in 3 patients, the left septal fascicle in 2 patients, and the left posterior fascicle in 1 patient., Conclusions: Proper diagnosis of re-entrant arrhythmias involving the HPS may prove challenging. We emphasize a structured approach for diagnosis and effective therapy., Competing Interests: Author Relationship With Industry The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Mapping and ablation of fractionated electrograms is a common treatment for scar-based ventricular tachycardia (VT). An automated algorithm has been developed for rapid "fractionation mapping.", Methods: Electroanatomic maps from 21 ablation procedures (14 scar-based VT and seven control idiopathic VT/premature ventricular contractions with normal voltage) were retrospectively analyzed using the Ensite Precision fractionation map (fMap; Abbott Laboratories; Abbott Park, IL, USA) algorithm. For each study, voltage maps and 30 fMaps were generated using combinations of parameters: width (5, 10, 20 ms), refractory time (15, 30 ms), sensitivity (0.1, 0.2 mV), and fractionation threshold (2, 3, 5). Parameter sensitivity was assessed by overlap of fractionated areas (fArea) with successful VT ablation sites (defined by entrainment and/or pace mapping). Specificity was assessed by presence of fractionated areas in control patients., Results: Of the 30 fMap parameter sets tested, seven identified >50% of scar-based VT ablation sites, and 26 contained <5 cm 2 fractionation on control fMaps. Three combinations of fMap width/refractory/sensitivity/threshold parameters met both of the above criteria, and 20/30/0.1/2 identified the most VT ablation sites (79%) and generated 42.3 ± 28.2 cm 2 of fArea on scar-based VT maps compared with 4.9 ± 3.2 cm 2 on control maps (P = .001). None of the control patients and 23% of the scar-based VT patients had VT recurrence at mean 15 month follow-up., Conclusion: Careful selection of signal processing parameters optimizes sensitivity and specificity of automated fractionation mapping for scar-based VT. Real-time use of fMap algorithms may reduce VT ablation procedure time and improve substrate modification, which may improve outcomes., (© 2019 Wiley Periodicals, Inc.)

Background: Many nonischemic cardiomyopathy (NICMP) patients referred for catheter ablation of ventricular tachycardia (VT) undergo an initial epicardial approach under general anesthesia (GA). However, GA may suppress inducibility and decrease tolerance of induced VT, leaving substrate modification as the sole ablation method., Objectives: Determine the utility of a strategy of initial programmed electrical stimulation (PES) under light sedation in patients referred for epicardial ablation of VT., Methods: Of 68 NICMP patients referred for VT ablation, 25 were referred specifically for epicardial ablation. All patients underwent PES under conscious sedation, with conversion to GA and epicardial access only if VT morphology and/or endocardial mapping suggested an epicardial substrate., Results: VT was induced with PES in 24 of 25 patients (mean age 52 years; 76% male; ejection fraction 38 ± 18%). VT was hemodynamically tolerated in 63% and unstable in 38% of patients. The noninducible/unstable VT patients underwent substrate modification based on voltage and pace mapping. Of the patients with stable VT, 73% were mapped and ablated endocardially (six right ventricle, three left ventricle, one left coronary cusp, one middle cardiac vein), and 33% were successfully ablated in areas of normal endocardial voltage. After ablation, the clinical VT was noninducible in all patients. After mean follow-up of 10 months, 80% were free of implantable cardioverter defibrillator shocks or sustained VT., Conclusions: An initial approach of PES and entrainment mapping under conscious sedation is critically important for patients with NICMP referred for epicardial ablation. Empiric ablation of endocardial/epicardial scar would have missed the clinical VT in 20% of patients., (© 2015 Wiley Periodicals, Inc.)