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Despite the global COVID-19 pandemic, during the past 2 years, there have been numerous advances in our understanding of arrhythmia mechanisms and diagnosis and in new therapies. We increased our understanding of risk factors and mechanisms of atrial arrhythmias, the prediction of atrial arrhythmias, response to treatment, and outcomes using machine learning and artificial intelligence. There have been new technologies and techniques for atrial fibrillation ablation, including pulsed field ablation. There have been new randomized trials in atrial fibrillation ablation, giving insight about rhythm control, and long-term outcomes. There have been advances in our understanding of treatment of inherited disorders such as catecholaminergic polymorphic ventricular tachycardia. We have gained new insights into the recurrence of ventricular arrhythmias in the setting of various conditions such as myocarditis and inherited cardiomyopathic disorders. Novel computational approaches may help predict occurrence of ventricular arrhythmias and localize arrhythmias to guide ablation. There are further advances in our understanding of noninvasive radiotherapy. We have increased our understanding of the role of His bundle pacing and left bundle branch area pacing to maintain synchronous ventricular activation. There have also been significant advances in the defibrillators, cardiac resynchronization therapy, remote monitoring, and infection prevention. There have been advances in our understanding of the pathways and mechanisms involved in atrial and ventricular arrhythmogenesis.

Ventricular arrhythmias (VAs) originating from the anterosuperior left ventricular outflow tract (LVOT) represent a challenging location for catheter ablation. This study investigates mapping and ablation of VA from anterosuperior LVOT via a transseptal approach.

The use of second-generation cryoballoon for pulmonary vein isolation in patients with paroxysmal atrial fibrillation has demonstrated encouraging acute and mid-term results. Long-term outcome data are not yet available.

The aim of this study was to evaluate in vivo contact force (CF) and the correlation of CF with impedance during left atrial 3-dimensional electroanatomical mapping and ablation.

Pulmonary vein isolation is an established treatment option for atrial fibrillation. To date, the incidence and quality of ablation-induced esophageal thermal lesions (ETLs) using the recently introduced second-generation cryoballoon (CB, ArcticFront Advance, Medtronic) is unknown.

Pulmonary vein isolation is the most prevalent approach for catheter ablation of paroxysmal atrial fibrillation. Long-term success of the procedure is diminished by arrhythmia recurrences occurring predominantly because of reconnections in previously isolated pulmonary veins. The aim of the EFFICAS I multicenter study was to demonstrate the correlation between contact force (CF) parameters during initial procedure and the incidence of isolation gaps (gap) at 3-month follow-up.

Los servicios de arritmias y electrofisiología cardiaca son una rama innovadora y en rápido crecimiento de la cardiología clínica. La puesta en marcha de una unidad de arritmias comporta una selección adecuada del personal, así como exigencias técnicas, estructurales y organizativas. La selección adecuada del personal especializado y bien formado incluye la de médicos, personal de enfermería y técnicos médicos en los laboratorios de electrofisiología y las salas hospitalarias. Los laboratorios de electrofisiología estándar deben hacer posible toda la gama de diagnósticos y tratamientos percutáneos de las arritmias cardiacas. Ello incluye los métodos más modernos de fluoroscopia y sistemas de determinación de mapas tridimensionales utilizados en intervenciones complejas como la ablación percutánea de la fibrilación auricular o la taquicardia ventricular. Además, las disponibilidades técnicas deben permitir la implantación de marcapasos y desfibriladores como una de las tareas clave de una unidad de arritmias especializada. Las clínicas ambulatorias deben disponer de las capacidades técnicas necesarias para realizar una amplia variedad de técnicas diagnósticas previas y posteriores a las intervenciones, para garantizar un seguimiento adecuado del paciente. Los requisitos estructurales deben centrarse en la integración física próxima de unidades funcionales que permita un flujo de trabajo efectivo y seguro. Por último, los requisitos organizativos, como la creación de redes de conexión entre los especialistas en arritmias y los médicos y los hospitales que remiten a los pacientes, son esenciales para el reclutamiento de los pacientes y para una asistencia de alta calidad tras el alta. Los programas de formación regulares para médicos, enfermeras y técnicos son esenciales en un campo de la cardiología innovador y en rápido crecimiento.

Lack of an irrigated-tip magnetic catheter has limited the role of remote-controlled magnetic navigation Niobe II, Stereotaxis for catheter ablation of atrial fibrillation AF.

Pulmonary vein isolation PVI is an established treatment option for patients with drug refractory paroxysmal atrial fibrillation. A novel compliant endoscopic ablation system housing a 980-nm-diode laser allows for discrete point-by-point ablation enabling a true circumferential ablation line design. We sought to determine the feasibility and safety of a circumferential ablation using endoscopic ablation system.

Introduction:Catheter ablation (CA) is now an established therapy for symptomatic atrial fibrillation (AF). Although the procedural success rate is high, the role of race-ethnicity and clinical predictors in preventing recurrence of AF remains unclear.Methods:Patients prospectively enrolled in an AF clinical-DNA biorepository and treated with CA for AF were included in the study. Recurrence of AF was assessed with symptom assessment, ECG, Holter, and event recorder evaluations in all patients during follow-up visits and Holter recordings were done when appropriate. Recurrence of AF was defined as AF detected <12 months after CA.Results:Of the 238 enrolled, 84 (35.3%) were European American (EAs), 106 (44.5%) were African American (AA) and 48 (20.2%) were Hispanic American (HA). Baseline clinical characteristics were similar across the groups. Eighty-eight (37%) patients had AF recurrence within 12 months of CA. Multivariate analysis showed that compared to EAs, AAs (odds ratio [OR] 0.48, 95% confidence interval [CI]: 0.24-0.96, P+0.048) and HAs (OR 0.42, 95% CI: 0.18 - 0.94, P+0.048) are less likely to experience AF recurrence after CA (Table 1). Other clinical predictors included left atrial dilatation (OR 1.88, 95% 1.04 - 3.44, P+0.036), persistent AF (OR] 1.94, 95% [CI]: 1.04-3.64, P+0.074), valvular heart disease (VHD) (OR 2.66, 95% CI: 1.02-7.20; P=0.046) and history of smoking (OR 2.16, 95% CI: 1.18-3.99; P=0.012).Conclusion:We showed that clinical predictors of recurrence of AF after CA included left atrial dilatation, VHD, persistent AF and a history of smoking. Surprisingly, we found that AAs and HAs were less likely to experience AF recurrence than EAs and reasons for this differential response remains unclear.

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