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Aims: Atrial fibrillation (AF) patients frequently require active rhythm control therapy to maintain sinus rhythm and reduce symptom burden. Our study assessed whether antiarrhythmic therapies (AATs) are used disproportionately between men and women after new-onset AF., Methods and Results: The nationwide Finnish anticoagulation in AF registry-based linkage study covers all patients with new-onset AF in Finland during 2007-2018. Study outcomes included initiation of AATs in the form of antiarrhythmic drugs (AADs), cardioversion, or catheter ablation. The study population constituted of 229 565 patients (50% females). Women were older than men (76.6 ± 11.8 vs. 68.9 ± 13.4 years) and had higher prevalence of hypertension or hyperthyroidism, but lower prevalence of vascular disease, diabetes, renal disease, and cardiomyopathies than men. Overall, 17.6% of women and 25.1% of men were treated with any AAT. Women were treated with AADs more often than men in all age groups [adjusted subdistribution hazard ratio (aSHR) 1.223, 95% confidence interval (CI) 1.187-1.261]. Cardioversions were also performed less often on women than on men aged <65 years (aSHR 0.722, 95% CI 0.695-0.749), more often in patients ≥ 75 years (aSHR 1.166, 95% CI 1.108-1.227), while no difference between the sexes existed in patients aged 65-74 years. Ablations were performed less often in women aged <65 years (aSHR 0.908, 95% CI 0.826-0.998) and ≥75 years (aSHR 0.521, 95% CI 0.354-0.766), whereas there was no difference in patients aged 65-74 years., Conclusion: Women used more AAD than men in all age groups but underwent fewer cardioversion and ablation procedures when aged <65 years., Competing Interests: Conflict of interest: B.S.: speaker—BMS-Pfizer Alliance and Boehringer Ingelheim; member of advisory board—Pfizer; educational grants—Medtronic and Abbott. K.K.: Finnish Foundation for Cardiovascular Research. J.I.: speaker—Boehringer Ingelheim, BMS-Pfizer Alliance, and Boston Scientific; educational grants—Boston Scientific, Johnson & Johnson, and Medtronic. A.L.A.: research grants—Finnish Foundation for Cardiovascular Research and Sigrid Juselius Foundation; speaker—Abbott, Johnson & Johnson, Sanofi, Bayer, and Boehringer Ingelheim. K.T.: research grants—the Finnish Foundation for Cardiovascular Research, Aarne and Aili Turunen Foundation, and Finnish State Research funding. T.P.: BMS-Pfizer Alliance and Boehringer Ingelheim. J.P.: speaker—Bayer, Boehringer Ingelheim, BMS-Pfizer Alliance, and Abbott; advisory board—Portola, Novo Nordisk, and Herantis Pharma; visiting editor—Terve Media; stock ownership—VitalSignum. M.Li.: speaker—BMS-Pfizer Alliance, Bayer, and Boehringer Ingelheim. P.M.: consultant—Roche, BMS-Pfizer Alliance, Novartis Finland, Boehringer Ingelheim, and MSD Finland. J.H.: research grants—the Finnish Foundation for Cardiovascular Research; advisory board member—BMS-Pfizer Alliance, Novo Nordisk, and Amgen; speaker—Cardiome and Bayer. K.E.J.A.: research grants—the Finnish Foundation for Cardiovascular Research; speaker—Bayer, Pfizer, and Boehringer Ingelheim; advisory board member—Bayer, Pfizer, and AstraZeneca. M.Le.: consultant—BMS-Pfizer Alliance, Bayer, Boehringer Ingelheim, and MSD; speaker—BMS-Pfizer Alliance, Bayer, Boehringer Ingelheim, MSD, Terve Media, and Orion Pharma; research grants—Aarne Koskelo Foundation, the Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund. All remaining authors have declared no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Pulsed field ablation (PFA) is an emerging technology for the treatment of atrial fibrillation (AF), for which pre-clinical and early-stage clinical data are suggestive of some degree of preferentiality to myocardial tissue ablation without damage to adjacent structures. Here in the MANIFEST-17K study we assessed the safety of PFA by studying the post-approval use of this treatment modality. Of the 116 centers performing post-approval PFA with a pentaspline catheter, data were received from 106 centers (91.4% participation) regarding 17,642 patients undergoing PFA (mean age 64, 34.7% female, 57.8% paroxysmal AF and 35.2% persistent AF). No esophageal complications, pulmonary vein stenosis or persistent phrenic palsy was reported (transient palsy was reported in 0.06% of patients; 11 of 17,642). Major complications, reported for ~1% of patients (173 of 17,642), were pericardial tamponade (0.36%; 63 of 17,642) and vascular events (0.30%; 53 of 17,642). Stroke was rare (0.12%; 22 of 17,642) and death was even rarer (0.03%; 5 of 17,642). Unexpected complications of PFA were coronary arterial spasm in 0.14% of patients (25 of 17,642) and hemolysis-related acute renal failure necessitating hemodialysis in 0.03% of patients (5 of 17,642). Taken together, these data indicate that PFA demonstrates a favorable safety profile by avoiding much of the collateral damage seen with conventional thermal ablation. PFA has the potential to be transformative for the management of patients with AF., (© 2024. The Author(s).)

Background: Ventricular extrasystoles (VESs) are common and often harmless in a healthy heart, but they can significantly affect the quality of life. If changes in lifestyle and antiarrhythmic medication are not enough, invasive and often curative catheter ablation can be considered. Better understanding of the conformation of VESs with a 12-lead ECG, as well as their precise localization, have increased their treatment with catheter ablation. Our goal was to determine whether the anatomical site of VES had an effect on procedure success. We also analyzed the safety of the procedure and patient-related factors affecting the results., Materials and Methods: In this retrospective study, we analyzed the medical records of 63 consecutive patients with multiple idiopathic VESs treated by catheter ablation at Heart Hospital, Tampere University Hospital, during 2017 and 2018. Patients with structural heart disease were excluded. Ablation success was estimated with two endpoints, primary and follow-up success., Results: The majority of the patients received treatment on the right ventricular outflow tract (66.7%), others on the left ventricle (17.5%), or the aortic cusp (9.5%). The site of origin remained unknown in four procedures (6.3% of patients). Primary success was observed in 48 procedures (76.2%). During the follow-up period of three months, the procedure was successful in 70.3% of the cases. The anatomical site of VES had no significant effect on either primary or follow-up success. Those with a successful follow-up result had a lower body mass index (BMI = 26.4) than those who had an unsuccessful result (BMI = 28.7; p =0.069); this did not reach statistical significance, potentially due to the small study population size. Complications were observed in three patients (4.5%). All of them were related to the catheter insertion site., Conclusions: For a symptomatic patient, catheter ablation is an effective and often fully curative treatment. The success rate was similar regardless of the site of VESs. This suggests that catheter ablation should also be assessed early on for other cases besides classic right ventricular outflow tract VESs. A high BMI was the only factor associated with a poor procedure success rate. The procedure itself is safe, and adverse effects are rare. The radiation dose is also low partly due to the current magnetic navigation method., Competing Interests: All the authors declare that they have no conflicts of interest., (Copyright © 2023 Aliisa Lönnrot et al.)