Use of pulse field ablation in the treatment of an atrial tachycardia: A case report.

This case illustrates the safety and efficacy of pulse field ablation (PFA) in the short and medium term. It could be used to isolate extra pulmonary sites including the posterior wall. PFA could be used in the treatment of atrial tachycardias both focal and reentrant in combination with ultrahigh density electroanatomic mapping. It is also important to understand that different catheter shapes are available and their use can be tailored to the targeted anatomical site.

UBLED AF (Uninterrupted BLackpool EDoxaban vs Warfarin vs Rivaroxaban in Atrial Fibrillation/Flutter ablation) Study.

AIM: Catheter ablation in patients with atrial fibrillation (AF)/atrial flutter carries a risk of thromboembolism and major bleeding. In light of recent prospective trial data on the safety and efficacy of uninterrupted edoxaban in patients undergoing AF/flutter ablation, real-world Data was aimed for validation. METHODS: A total of 228 patients who underwent AF/atrial flutter ablation over 14 months at our centre were retrospectively analyzed. All patients received uninterrupted oral anticoagulation for at least 4 weeks prior to ablation and 3 months post-ablation. Both bleeding and thromboembolic events were assessed at 24 hours comparing patients on warfarin, rivaroxaban and edoxaban. RESULTS: Mean age of patients were 68.5 +/- 8 years in the warfarin group ( N =86), 63.4 +/- 10.6 years; in the edoxaban group ( N =63) and 62.3 +/- 11.6 years in the rivaroxaban group ( N =79). CHADSVASc scores were 2.43 +/- 1.34, 1.68 +/- 1.34 and 1.64 +/- 1.38 respectively. The mean left atrial sizes were 42.7 +/- 6.8 mm, 42.0 +/- 6 mm and 41.1 +/- 6.5 mm respectively. The study endpoint was death, acute thromboembolism or major bleeding. There was 1 pericardial effusion (1.2%) in the warfarin group, 1 pericardial effusion and 1 transient ischaemic attack (2.5%) in the rivaroxaban group and 1 pericardial effusion needing drainage (1.6%) in the edoxaban group. There were no significant differences in the study endpoints between groups. CONCLUSION: This real-world study demonstrated no significant difference in safety and efficacy between uninterrupted edoxaban, warfarin and rivaroxaban in patients undergoing AF/flutter ablation.

Bradyarrhythmias for the Internist.

In this article, the authors review the different types of sinus node and atrioventricular node diseases that lead to bradyarrhythmias with their associated symptoms, the diagnostic investigations needed to assess the degree of disease, and the therapeutic management, including the indications for permanent pacing.