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Safe and efficient radiofrequency catheter ablation depends significantly on the proper placement of dispersive patch electrodes (DPEs), on the skin. This viewpoint describes the role of DPE positioning in optimizing lesion creation and reducing the risk of complications. Incorrect DPE placement can lead to suboptimal energy delivery, prolonging the procedure and/or increasing the risk of adverse events, such as steam pops and potentially fatal atrio-oesophageal fistula. Despite its importance, there is no consensus on the optimal positioning of DPE, and current studies require further improvement in predictive modelling. [ABSTRACT FROM AUTHOR]

Aims Advanced ablation strategies are needed to treat ventricular tachycardia (VT) and premature ventricular complexes (PVC) refractory to standard unipolar radiofrequency ablation (Uni-RFA). Bipolar radiofrequency catheter ablation (Bi-RFA) has emerged as a treatment option for refractory VT and PVC. Multicentre registry data on the use of Bi-RFA in the setting of refractory VT and PVC are lacking. The aim of this Bi-RFA registry is to determine its real-world safety, feasibility, and efficacy in patients with refractory VT/PVC. Methods and results Consecutive patients undergoing Bi-RFA at 16 European centres for recurring VT/PVC after at least one standard Uni-RFA were included. Second ablation catheter was used instead of a dispersive patch and was positioned at the opposite site of the ablation target. Between March 2021 and August 2024, 91 patients underwent 94 Bi-RFA procedures (74 males, age 62 ± 13, and prior Uni-RFA range 1–8). Indications were recurrence of PVC (n = 56), VT (n = 20), electrical storm (n = 13), or PVC-triggered ventricular fibrillation (n = 2). Procedural time was 160 ± 73 min, Bi-RFA time 426 ± 286 s, and mean Uni-RFA time 819 ± 697 s. Elimination of clinical VT/PVC was achieved in 67 (74%) patients and suppression of VT/PVC in a further 10 (11%) patients. In the remaining 14 patients (15%), no effect on VT/PVC was observed. Three major complications occurred: coronary artery occlusion, atrioventricular block, and arteriovenous fistula. Follow-up lasted 7 ± 8 months. Nineteen patients (61%) remained VT free. ≥80% PVC burden reduction was achieved in 45 (78%). Conclusion These real-world registry data indicate that Bi-RFA appears safe, is feasible, and is effective in the majority of patients with VT/PVC. [ABSTRACT FROM AUTHOR]

Introduction and purpose: Gaucher's Disease (GD), a rare genetic disorder, is a difficult challenge in genetic and metabolic disorders. The aim of this review is to provide an exploration of GD, spanning its pathophysiology to the latest advancements in diagnostic and therapeutic innovations. In this review we aimed to underscore the challenges it presents and the ongoing efforts to overcome them. State of knowledge: GD, characterized by the accumulation of glucocerebroside, involves molecular, cellular, and systemic dysfunctions. At the molecular level, mutations in the GBA gene give rise to diverse manifestations, influencing disease severity. Cellular disruptions lead to lysosomal dysfunction, altered calcium homeostasis, and chronic inflammation, impacting various organ systems. Diagnostic approaches involve biomarkers, genetic testing, and imaging studies, each playing a crucial role in confirming the disease type and assessing its grade. Summary: Management and treatment strategies for GD have evolved, with enzyme replacement therapy and substrate reduction therapy serving as the basics. However, challenges persist, including limited efficacy in treating neurological symptoms and the high cost of treatments. The review highlights ongoing research and future perspectives in GD therapy. [ABSTRACT FROM AUTHOR]

Introduction: Precise electrocardiographic localization of accessory pathways (AP) can be challenging. Seminal AP localization studies were limited by complexity of algorithms and sample size. We aimed to create a nonalgorithmic method for AP localization based on color‐coded maps of AP distribution generated by a web‐based application. Methods: APs were categorized into 19 regions/types based on invasive electrophysiologic mapping. Preexcited QRS complexes were categorized into 6 types based on polarity and notch/slur. For each QRS type in each lead the distribution of APs was visualized on a gradient map. The principle of common set was used to combine the single lead maps to create the distribution map for AP with any combination of QRS types in several leads. For the validation phase, a separate cohort of APs was obtained. Results: A total of 800 patients with overt APs were studied. The application used the exploratory data set of 553 consecutive APs and the corresponding QRS complexes to generate AP localization maps for any possible combination of QRS types in 12 leads. Optimized approach (on average 3 steps) for evaluation of preexcited electrcardiogram was developed. The area of maximum probability of AP localization was pinpointed by providing the QRS type for the subsequent leads. The exploratory data set was validated with the separate cohort of APs (n = 256); p =.23 for difference in AP distribution. Conclusions: In the largest data set of APs to‐date, a novel probabilistic and semi‐automatic approach to electrocardiographic localization of APs was highly predictive for anatomic localization. [ABSTRACT FROM AUTHOR]

Introduction and aim. Bacterial infections are raising serious concern across the globe. The effectiveness of the conventional antibiotics is decreasing due to global emergence of multi-drug-resistant (MDR) bacterial pathogens. Researchers currently focus on searching for the next generation of safe and effective antibiotics compounds including antimicrobial peptides, phage therapy, phytochemicals, metal-based antimicrobial compounds, lipopolysaccharide and efflux pump inhibitors to control the infections caused by MDR pathogens. The aim of this work was to summarize the latest research in the field of new therapies against MDR pathogens. Material and methods. The review was performed accordingto the up to date literature. Thorough analysis of the scientific data from PubMed database has been conducted. Analysis of literature. There are few novel therapeutic options. First of them are antimicrobial peptides. They have been demonstrated to kill Gram negative and Gram positive bacteria, enveloped viruses, fungi and even transformed or cancerous cells. Unlike the majority of conventional antibiotics it appears that antimicrobial peptides frequently destabilize biological membranes, can form transmembrane channels and may also have the ability to enhance immunity by functioning as immunomodulators. Second promising therapeutic option are bacteriophages, which are viruses that act as pathogens against bacteria, infecting and replicating inside them. They show the ability of attacking and killing only specific bacterial cells. Next promising alternative to traditional antibiotics are nanoparticles. They have been studied extensively for their antimicrobial properties in order to fight MDR bacteria. Several characteristics in particular make nanoparticles strong candidates as a traditional antibiotic drug alternative. Firstly, they have a high surface area to volume ratio, which increases contact area with target organisms. Secondly, they may be synthesized from polymers, lipids, and metals. Last but not least, a multitude of chemical structures, such as fullerenes and metal oxides, allow for a diverse set of chemical and biological functionalities. Conclusion. Antibiotic resistance is an alarming phenomenon. New classes of antibiotics with different actions against MDR pathogens need to be developed urgently. However, until it is successfully brought into existence, following the principles of rational antibiotic therapy is crucial. [ABSTRACT FROM AUTHOR]

Safe and efficient radiofrequency catheter ablation depends significantly on the proper placement of dispersive patch electrodes (DPEs), on the skin. This viewpoint describes the role of DPE positioning in optimizing lesion creation and reducing the risk of complications. Incorrect DPE placement can lead to suboptimal energy delivery, prolonging the procedure and/or increasing the risk of adverse events, such as steam pops and potentially fatal atrio-oesophageal fistula. Despite its importance, there is no consensus on the optimal positioning of DPE, and current studies require further improvement in predictive modelling., Competing Interests: Conflict of interest: P.F. reports patents related with bipolar ablation and high-voltage ablation and that he has equity in CorSystem. Other authors report no conflict relevant to the content of the article., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Aims: Advanced ablation strategies are needed to treat ventricular tachycardia (VT) and premature ventricular complexes (PVC) refractory to standard unipolar radiofrequency ablation (Uni-RFA). Bipolar radiofrequency catheter ablation (Bi-RFA) has emerged as a treatment option for refractory VT and PVC. Multicentre registry data on the use of Bi-RFA in the setting of refractory VT and PVC are lacking. The aim of this Bi-RFA registry is to determine its real-world safety, feasibility, and efficacy in patients with refractory VT/PVC., Methods and Results: Consecutive patients undergoing Bi-RFA at 16 European centres for recurring VT/PVC after at least one standard Uni-RFA were included. Second ablation catheter was used instead of a dispersive patch and was positioned at the opposite site of the ablation target. Between March 2021 and August 2024, 91 patients underwent 94 Bi-RFA procedures (74 males, age 62 ± 13, and prior Uni-RFA range 1-8). Indications were recurrence of PVC (n = 56), VT (n = 20), electrical storm (n = 13), or PVC-triggered ventricular fibrillation (n = 2). Procedural time was 160 ± 73 min, Bi-RFA time 426 ± 286 s, and mean Uni-RFA time 819 ± 697 s. Elimination of clinical VT/PVC was achieved in 67 (74%) patients and suppression of VT/PVC in a further 10 (11%) patients. In the remaining 14 patients (15%), no effect on VT/PVC was observed. Three major complications occurred: coronary artery occlusion, atrioventricular block, and arteriovenous fistula. Follow-up lasted 7 ± 8 months. Nineteen patients (61%) remained VT free. ≥80% PVC burden reduction was achieved in 45 (78%)., Conclusion: These real-world registry data indicate that Bi-RFA appears safe, is feasible, and is effective in the majority of patients with VT/PVC., Competing Interests: Conflict of interest: P.F. reports patents related to high-voltage and bipolar ablation and has equity in CorSystem. J.K. reports personal fees from Biosense Webster, Boston Scientific, GE Healthcare, Medtronic, and St. Jude Medical (Abbott) for participation in scientific advisory boards and has received speaker honoraria from Biosense Webster, Biotronik, Boston Scientific, Medtronic, ProMed CS, St. Jude Medical (Abbott), and Viatris. 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.)