Cryoablation versus hybrid radiofrequency with high- and very-high-power short-duration catheter ablation for the treatment of paroxysmal atrial fibrillation.

BACKGROUND: High-power short-duration (HPSD) and very-high-power short-duration (vHPSD-90 W/4 s) radiofrequency (RF) technology has reduced the procedure time of pulmonary vein isolation (PVI) using RF without compromising the efficacy of the technique. The current study compares the novel technology of HPSD/vHPSD with cryoablation (CRYO) in terms of efficacy, safety, and procedure time in a cohort of symptomatic patients with paroxysmal atrial fibrillation (pAF). METHODS: This is a prospective, non-randomized trial. Patients with pAF received either CRYO or HPSD/vHPSD RF PVI. The primary endpoint of the study was arrhythmia recurrence in a 12 month follow-up period. Secondary endpoints included procedure time, fluoroscopy time, and safety. RESULTS: 104 patients were included (45 in HPSD/vHPSD and 59 in CRYO), with comparable characteristics between groups. The follow-up was 12.4 ± 0.5 months. There was no significant difference regarding arrhythmia recurrences during the early post-procedural period of the first 3 months (8.9% recurrences in HPSD/vHPSD versus 5.1% in CRYO-p 0.463) and in the mid-term follow-up of 12 months (17.8% recurrences in HPSD/vHPSD versus 10.2% in CRYO-p 0.385). Safety was excellent for both procedures. CRYO was a procedure of significantly shorter duration (64.64 ± 8.94 min versus 75.29 ± 18.30 min, p = 0.0001) at the expense of longer fluoroscopy time (HPSD/vHPSD 5.34 ± 1.83 versus 7.89 ± 3.70 min CRYO, p 0.001). CONCLUSIONS: HPSD/vHPSD and CRYO in pAF were comparable regarding the arrhythmia recurrence rates in a 12-month follow-up with excellent safety. The hybrid approach of HPSD/vHPSD has accelerated RF-PVI compared to conventional RF, but CRYO remains a procedure of significantly shorter duration at the expense of longer fluoroscopy time.

An inappropriately-appropriate ICD therapy: What is the mechanism and what interventions can be done?

Key Clinical Message: R-wave double counting is a rare cause of ventricular oversensing that can lead to inappropriate shocks. Optimizing device programming is essential for the avoidance of subsequent inappropriate therapies. Abstract: R-wave double counting is a rare cause of ventricular oversensing that can lead to inappropriate shocks. We present the case of a female patient, 52-years-old with a history of end-stage hypertrophic cardiomyopathy. The patient suffered an implantable cardioverter-defibrillator (ICD) shock. Cardiac device interrogation revealed ventricular tachycardia (VT) with a cycle length of 420 ms that was misclassified in the ventricular fibrillation (VF) zone owing to R-wave double counting. Optimizing device programming is essential for the avoidance of subsequent inappropriate therapies. Possible therapeutic options are briefly presented in the case.

Cardioneuroablation for neurally-mediated syncope: Initial experience.

Cardioneuroablation is an emerging alternative therapeutic modality for young patients with severe neurally-mediated syncope. We present two images of cardioneuroablation performed in young patients who suffered from recurrent neurally-mediated syncope with asystole and functional atrioventricular block. The patients remain syncope-free during follow-ups.

Electrocardiographic changes after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: Data from the Hellenic Registry.

BACKGROUND: Balloon pulmonary angioplasty (BPA) has provided an effective invasive treatment for inoperable patients with chronic thromboembolic pulmonary hypertension (CTEPH). The hemodynamic improvement achieved by BPA has significantly increased the long-term prognosis of these patients, mostly by reversing the negative remodeling of the right ventricle (RV). MATERIALS AND METHODS: In a cohort of 17 patients with symptomatic CTEPH hemodynamic data were collected before and after the completion of BPA sessions. After the confirmation of statistically significant hemodynamic improvement, we examined the changes in certain prespecified electrocardiographic (ECG) parameters (PR interval duration, QRS duration, QTc interval duration, R wave and S wave amplitude in lead I, R wave and S wave amplitude in precordial leads V1, V5 and V6) before the initiation and one month after the completion of BPA sessions. In addition, ECGs were qualitatively assessed before and after treatment for the presence of ECG abnormalities related to PH, proposed by the guidelines of the European Society of Cardiology (ESC). The term ESC criteria 1-6 was used for their description. RESULTS: Statistically significant correlation (p < 0.05) was found between the reduction in mean pulmonary artery pressure (mPAP) and the decrease of the depth of the S wave in leads I (p 0.0069), V5 (p 0.0003), V6 (p 0.0011) and in the R wave amplitude in leads V5 (p 0.0122) and V6 (p 0.0185). From the ESC criteria, RV strain pattern was the commonest in the initial cohort, with significant improvement after therapies. CONCLUSION: Hemodynamic improvement after BPA therapies is correlated with improved ECG amplitude parameters in leads I, V5 and V6. RV strain pattern is common among untreated patients with significant improvement after therapies.

Radiofrequency versus cryoballoon catheter ablation in patients with persistent atrial fibrillation: A randomized trial.

INTRODUCTION: Patients with persistent atrial fibrillation (AF) represent a challenging population for rhythm control therapies. Catheter ablation (CA) with pulmonary vein isolation (PVI) is an effective treatment option for the reduction of the arrhythmic burden. Data regarding the comparability between radiofrequency (RF) and cryoballoon ablation (CRYO) in persistent AF are limited. METHODS: This is a prospective, randomized, single-center study designed to compare the efficacy in terms of rhythm control between RF and CRYO in persistent AF. Eligible participants were randomized 2:1 in two arms: RF and CRYO. The primary endpoint of the study was arrhythmia relapse in the early postprocedural period (first 3 months) and in the middle term follow-up (3 months to 12 months). Secondary endpoints included procedure duration, fluoroscopy time, and complications. RESULTS: A total of 199 patients participated in the study (133 patients in the RF arm, 66 in the CRYO arm). No statistically significant difference occurred between the two groups regarding the primary endpoint (recurrences ≤3 months: 35.5% RF vs. 37.9% CRYO, p .755, recurrences >3 months: 26.3% RF vs. 27.3% CRYO, p .999). From the secondary endpoints, CRYO was a procedure of significantly shorter duration (75.15 ± 17.21 in CRYO vs. 136.6 ± 43.33 in RF group, p < .05). CONCLUSION: CRYO and RF ablation appear to be equally effective for rhythm control in patients with persistent AF. CRYO ablation is advantageous in terms of procedure duration.

Atrial fibrillation in hypertrophic cardiomyopathy - A contemporary mini-review.

Hypertrophic cardiomyopathy (HCM) represents the most common genetically inherited cardiovascular disorder and a leading cause of heart failure and sudden cardiac death. Atrial fibrillation (AF) is the most common arrhythmia encountered in HCM patients, primarily due to the process of left atrium dilatation and remodeling. Its presence typically leads to progressive functional decline, increased frequency of heart failure hospitalizations, and increased thromboembolic risk. In this mini-review, we summarize the contemporary data on AF pathophysiology, risk factors, and management in HCM patients suffering from AF.