Search Results (157)

Hemopericardium is a rare but serious complication of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). While prompt pericardial drainage is effective, the long-term clinical course and the role of adjunctive anti-inflammatory therapy remain unclear. In this prospective single-center cohort study, we included patients who developed hemopericardium requiring pericardiocentesis during RFCA for AF. All patients underwent immediate percutaneous drainage. Colchicine (0.6 mg twice daily for 14 days) was prescribed at the operator’s discretion. The primary outcome was freedom from AF or atrial tachycardia (AT) at 12 months after a 3-month blanking period. Among 2133 patients undergoing RFCA, 75 (3.5%) developed hemopericardium. Of these, 21 received colchicine and 54 received usual care. During a median follow-up of 367 days, freedom from AF/AT did not differ between groups (76.2% vs. 74.1%, log-rank p = 0.93). Residual pericardial effusion was infrequent and resolved in all patients by 3 months. Although colchicine was not associated with a reduction in atrial arrhythmia recurrence, patients receiving colchicine had lower CRP levels at 3 months than those receiving usual care (p = 0.021). However, treatment-limiting adverse events occurred in 6 of 21 patients (28.6%) receiving colchicine. No cases of constrictive pericarditis were observed. In patients with procedural hemopericardium during AF ablation, prompt pericardial drainage was associated with favorable clinical outcomes and absence of long-term pericardial sequelae. Adjunctive colchicine therapy was not associated with a significant reduction in arrhythmia recurrence; however, given the small sample size and limited number of events, a clinically meaningful treatment effect cannot be excluded. Full article

Atrial fibrillation (AF) and heart failure (HF) frequently coexist, but the clinical relevance of AF may differ according to whether it appears to be a potentially reversible contributor, an aggravating factor in established HF, or a marker of advanced substrate. The driver–modifier–marker lens used in this review is a provisional, nonvalidated aid to clinical reasoning and should not be interpreted as a treatment score. This narrative review was informed by dated searches of PubMed/MEDLINE, the Cochrane Library, and OpenAlex through 29 July 2026, followed by a targeted update on 30 July 2026. It considers HF with reduced, mildly reduced, and preserved ejection fraction together with AF timing, burden, ventricular-rate exposure, myocardial substrate, and reversibility. Early rhythm control may be particularly relevant when AF is recent or temporally associated with ventricular dysfunction, symptoms, decompensation, or inadequate cardiac resynchronization therapy delivery. Evidence supporting catheter ablation is most direct in suspected AF-mediated cardiomyopathy and selected HFrEF populations, whereas evidence in HFpEF more consistently supports symptom relief, improved exercise hemodynamics, and AF-burden reduction than mortality reduction. Pulmonary vein isolation remains the procedural foundation. Radiofrequency, cryoballoon, and pulsed-field ablation are effective in broad AF populations, but HF phenotype-specific prognostic superiority has not been established for any energy source. Clinical decisions should reflect the design and directness of the evidence together with expected benefit, rhythm durability, procedural risk, patient-reported outcomes, stroke prevention, guideline-directed HF therapy, risk-factor management, and patient preference. Full article

Background: Catheter ablation (CA) with pulmonary vein isolation is an established treatment for atrial fibrillation (AF). Epicardial adipose tissue (EAT) has been implicated in AF pathophysiology, but data on periatrial EAT and cardiac structural changes after CA in patients with heart failure with preserved ejection fraction (HFpEF) remain limited. Methods: We prospectively included 43 patients with paroxysmal AF and HFpEF undergoing radiofrequency CA. Cardiac magnetic resonance (CMR) was performed before ablation and after 6 months to quantify periatrial EAT volume and left ventricular mass (LVM) as prespecified primary endpoints, alongside secondary exploratory structural and functional parameters. Results: The study included 43 patients (74.4% male; mean age 60.5 ± 10.4 years). At 6-month follow-up, both primary endpoints improved significantly: periatrial EAT volume decreased from 28.8 ± 6.3 to 20.3 ± 5.9 mL (p < 0.001), and LVM decreased from 102 (95–115) to 97 (89–104) g/m² (p = 0.003). Exploratory analyses demonstrated favorable reverse cardiac remodeling, including reductions in left atrial area (LAA), left ventricular end-diastolic and end-systolic volumes, right ventricular end-systolic volume, and an increase in left ventricular stroke volume. Greater reduction in periatrial EAT volume correlated with more pronounced reverse cardiac remodeling, particularly with reductions in LVM (ρ = 0.48; p < 0.001) and LAA (ρ = 0.44; p = 0.003), with similar associations observed across other left ventricular remodeling parameters. Conclusions: In patients with paroxysmal AF and HFpEF, CA was associated with significant reductions in periatrial EAT volume and LVM, accompanied by favorable structural changes on CMR. These findings are consistent with reverse cardiac remodeling following CA and support further investigation of its structural effects in this patient population. Full article

Radiofrequency catheter ablation is a minimally invasive electrophysiological procedure that utilizes radiofrequency energy to induce targeted thermal injury within arrhythmogenic myocardial tissue, thereby eliminating the substrate responsible for rapid and irregular cardiac rhythm disturbances. Radiofrequency ablation is a method widely used in human medicine for the permanent treatment of arrhythmias. In veterinary medicine, there are only a few centers worldwide that use this treatment method in dogs. This article presents the experiences of a Polish center in treating supraventricular and ventricular arrhythmias using this method. The first electrophysiological study and ablation were performed using an analog electrophysiological system; subsequent procedures were performed with the aid of a computerized system, and the last three procedures were performed using a 3D electroanatomical system. A total of 14 radiofrequency ablation procedures were performed on dogs weighing 10 to 33 kg, aged 9 months to 9 years, of various sexes and breeds. Fifty percent of the dogs that underwent ablation had both clinical and echocardiographic signs of tachycardia-induced cardiomyopathy. Three dogs required a re-ablation procedure. Complete elimination of clinically significant arrhythmias was achieved in 13 of 14 dogs, while one dog showed partial procedural success. No significant or permanent complications were observed in any of the dogs. Radiofrequency ablation procedures for arrhythmias are effective and safe. Full article

Background: Obesity is a major independent risk factor for atrial fibrillation (AF), contributing to adverse outcomes and complicating rhythm control. While lifestyle modification is recommended, catheter ablation remains central to management. Conventional thermal ablation techniques often yield suboptimal results in obese patients due to anatomical and biophysical challenges. Pulsed field ablation (PFA), a novel non-thermal modality, may overcome these limitations. Methods: A systematic search of PubMed, Scopus, and Embase identified observational cohort studies (2017–2026) evaluating PFA outcomes in obese AF patients or across BMI categories. Four cohort studies met the inclusion criteria. Results: Findings on AF recurrence were heterogeneous. Recurrence rates appeared lower with PFA compared to radiofrequency ablation (RFA), though differences were not statistically significant. In a PFA-only study, freedom from arrhythmia recurrence did not vary across BMI categories. Compared with cryoballoon ablation (CBA), one matched-cohort study demonstrated significantly higher one-year freedom from AF with PFA-PVI, whereas another reported no difference. Left atrial epicardial adipose tissue (LA EAT) emerged as the only independent predictor of recurrence in PFA patients, suggesting electrical field perturbation by fat tissue. Radiation exposure was lower with PFA than CBA, while fluoroscopy time and periprocedural complications were comparable across groups. Conclusions: Current observational evidence suggests that PFA may be a feasible and safe option for AF ablation in overweight and obese patients, with outcomes comparable to conventional ablation techniques. However, comparative efficacy and long-term safety remain uncertain. Obesity-related adipose hypertrophy, systemic inflammation, and atrial remodeling may alter electric field distribution, contributing to variable recurrence outcomes. Larger prospective and randomized trials are warranted to define the long-term role of PFA in this high-risk population. Full article

Assessment of left atrial remodeling in atrial fibrillation (AF) has traditionally relied on anteroposterior diameter, left atrial volume (LAV), and indexed left atrial volume (LAVI). Although these measures remain clinically useful, they reduce a complex, asymmetric, and anatomically constrained chamber to scalar descriptors and therefore cannot fully capture the spatial substrate that underlies AF persistence, thromboembolic risk, or arrhythmia recurrence after catheter ablation. Three-dimensional left atrial reconstruction provides a more refined framework by preserving chamber shape, regional deformation, pulmonary vein (PV) orientation, left atrial appendage (LAA) geometry, posterior wall and roof configuration, left lateral ridge anatomy, wall-thickness heterogeneity, and computational surface features. In this review, we examine how three-dimensional left atrial geometry can extend conventional remodeling assessment from measurement of atrial size toward imaging-based substrate characterization. We discuss the relative strengths and limitations of computed tomography (CT), cardiovascular magnetic resonance (CMR), three-dimensional echocardiography, and electroanatomic mapping (EAM), and summarize key geometry-derived metrics, including LAV, LAVI, left atrial sphericity, asymmetry index, atrial eccentricity index, PV anatomy, LAA morphology, posterior wall geometry, wall thickness, radiomics, and artificial intelligence (AI)-derived shape descriptors. We further synthesize evidence linking geometric remodeling with atrial cardiomyopathy, mechanical dysfunction, fibrosis, low-voltage substrate, and catheter ablation outcomes. The clinical relevance of three-dimensional left atrial geometry may be further redefined by pulsed field ablation (PFA), whose non-thermal lesion biology and tissue selectivity may modify predictors of recurrence established in radiofrequency and cryoballoon cohorts. Finally, we outline the need for standardized segmentation, harmonized metric definitions, prospective multicenter validation, and integration with AI, digital twin modeling, biomarkers, EAM data, and wearable-derived AF burden. Three-dimensional left atrial geometry is not yet a standalone determinant of ablation strategy, but it may become a central component of individualized atrial phenotyping and rhythm-control decision-making. Full article

Electrical storm (ES) is a life-threatening clinical condition characterized by recurrent ventricular arrhythmias within a 24 h period, carrying a high mortality rate. Despite conventional therapies, including hemodynamic optimization, antiarrhythmic drugs, implantable cardioverter-defibrillator (ICD) reprogramming, and catheter ablation, a subset of patients develop refractory ventricular arrhythmias. In this setting, cardiac sympathetic neuromodulation can interrupt arrhythmic circuits by reducing efferent sympathetic outflow to the myocardium. Stellate ganglion block (SGB) with local anaesthetic (LA) is a temporary pharmacological blockade used as rescue therapy; in the largest prospective series (the STAR study), 92% of treated patients achieved at least a 50% reduction in arrhythmic events in the 12 h following the procedure. Because the effect of anaesthetic blockade is transient, more durable interventions have been explored, including percutaneous radiofrequency or chemical neurolysis and surgical cardiac sympathetic denervation (CSD), although current evidence is largely confined to small, uncontrolled case series. This narrative review synthesizes the available evidence on cardiac sympathetic neuromodulation—spanning SGB, percutaneous neurolysis, and surgical CSD—in refractory ES, positioning these interventions primarily as a means of stabilizing patients and bridging to definitive therapy rather than as established survival-modifying treatments. Furthermore, this review describes the primary anatomical foundations of the cervicothoracic sympathetic nervous system and the various techniques for SGB, along with their most relevant clinical indications. The risks and complications associated with these interventions are also addressed. Finally, clinical implications and potential future research directions in this field are discussed, with the aim of providing guidance for the comprehensive management of critically ill patients with refractory ES. Full article

Background: Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF); however, its impact on long-term left atrial (LA) structural and mechanical remodeling may differ between ablation techniques. Objectives: The aim of this study is to assess changes in LA structure and function after PVI using cryoballoon ablation (CBA) and radiofrequency catheter ablation (RFCA). Methods: Forty-two patients undergoing PVI were prospectively analyzed (CBA, n = 28; RFCA, n = 14). Transthoracic echocardiography with speckle-tracking analysis was performed before PVI and at 12-month follow-up. LA size, volumetric indices (LAVI), strain components, and functional parameters were assessed. Results: Patients undergoing CBA demonstrated greater increases in selected LA structural parameters during follow-up compared with RFCA. Repeated-measures ANOVA revealed a significant group-by-time interaction for LA diameter (p = 0.0017), while similar trends were observed for LAA (p = 0.0645) and LAS-R (p = 0.0547). No significant interaction effects were observed for LAVI-derived parameters or other indices of LA mechanical function. Conclusions: In this preliminary exploratory study, CBA showed a tendency toward greater structural LA remodeling compared with RFCA during a 12-month follow-up. However, these findings should be interpreted with caution given the limited sample size and population heterogeneity. Larger prospective studies are warranted to validate these observations. Full article

Background/Objectives: Scar-related ventricular tachycardia (VT) remains a major contributor to morbidity and mortality in patients with structural heart disease (SHD), despite advances in catheter ablation (CA). Existing risk scores are limited by their focus on procedural outcomes, restricted variable sets, and insufficient integration of arrhythmic burden. This study aimed to bridge this gap in evidence and develop and internally validate two novel, clinically applicable prediction models—the VISTA-R and VISTA-M scores—for estimating the risk of 24-month arrhythmic recurrence and mortality following VT ablation. Methods: We analyzed a retrospective, single-center cohort of consecutive patients undergoing radiofrequency catheter ablation (RFCA) for scar-related VT in the setting of SHD and included a comprehensive set of clinical, arrhythmic, device-related, and procedural variables. Candidate predictors were identified through univariate logistic regression and subsequently incorporated into an exhaustive combinatorial modeling framework, generating over 1000 candidate models per endpoint. Final model selection was based on discrimination, calibration, and clinical interpretability. Internal validation was performed using leave-one-out cross-validation. Results: The VISTA-M model, incorporating left ventricular ejection fraction (LVEF), NYHA class IV at admission, number of clinical VT morphologies, and appropriate implantable-cardioverter defibrillator (ICD) shocks, demonstrated strong discriminative performance (AUC 0.866 in-sample, 0.826 cross-validated) and a pseudo R² of approximately 30%. The VISTA-R model, including history of electrical storm (ES), ICD shocks, and VT morphologies, showed moderate discrimination (AUC 0.70 in-sample, 0.63 cross-validated) with a pseudo R² of approximately 12%. Both models enabled meaningful risk stratification with progressively increasing event rates across the predefined risk classes. Conclusions: In conclusion, the VISTA scores provide parsimonious and clinically applicable tools for a comprehensive risk stratification after VT RFCA. Mortality is primarily driven by myocardial dysfunction and heart failure severity, whereas recurrence reflects arrhythmic burden and electrical instability. External validation is warranted to confirm these findings. Full article

Hypertension is a leading risk factor for cardiovascular morbidity and mortality. Despite the availability of effective medications and lifestyle interventions, blood pressure control rates remain poor globally, and the prevalence of hypertension continues to rise. In 2023, the US Food and Drug Administration approved renal denervation—a catheter-based procedure that ablates the renal sympathetic nerves—as an adjunctive treatment for patients with uncontrolled or resistant hypertension, defined as blood pressure above goal despite the use of at least three antihypertensive medications, including a diuretic at maximally tolerated doses. Both radiofrequency and ultrasound-based devices are approved for this procedure. However, individual patient responses vary, and further research is needed to clarify long-term efficacy, safety, and optimal patient selection. The number of trained proceduralists and access to facilities is increasing, but multidisciplinary teams and shared decision-making are recommended to ensure appropriate referrals and patient education. In this review, we discuss the pathophysiology of hypertension and approaches to treatment, review the history of renal denervation and the data on which FDA approval was based, detail the safety profile of commercially available devices, and provide a practical, team-based approach to appropriate patient selection. Full article

Background and Objectives: Idiopathic ventricular arrhythmias commonly occur in patients without structural heart disease and most often present as premature ventricular contractions (PVCs). Although generally considered benign, a high PVC burden may cause symptoms, reduce quality of life, and lead to reversible PVC-induced cardiomyopathy. This study aimed to evaluate long-term outcomes after radiofrequency catheter ablation of idiopathic outflow tract PVCs. Materials and Methods: This single-center retrospective study included 101 patients with idiopathic PVCs who underwent radiofrequency catheter ablation. PVC burden and clinical outcomes were assessed at baseline and during follow-up at 3 months, 12 months, and 5 years. Procedural success, predictors of success, and changes in antiarrhythmic drug therapy were analyzed. Results: During follow-up, a marked reduction in PVC burden was observed compared with baseline values. The median PVC burden decreased from 21.89% at baseline to 0.79% at 3 months, 0.23% at 12 months, and 0.09% at the 5-year follow-up after ablation. Acute procedural success was achieved in 88.1% of patients. Long-term success at 5 years was observed in 80.2% of patients. The use of antiarrhythmic drugs decreased during follow-up. Left ventricular ejection fraction remained stable, with no significant difference between baseline and 5-year values. Monomorphic PVC morphology and procedural success at 12 months were identified as independent predictors of long-term success. Conclusions: Radiofrequency catheter ablation provides effective and sustained reduction in PVC burden in patients with idiopathic outflow tract PVCs, with high acute success rates, durable long-term outcomes, and reduced reliance on antiarrhythmic drug therapy. Full article

Background: Atrial fibrillation (AF) remains the most common cardiac arrhythmia, with pulmonary vein isolation (PVI) established as the cornerstone of interventional treatment. However, in patients with persistent AF (PersAF), the success rates of PVI alone tend to be limited. A promising additional target is the left atrial appendage (LAA). In recent years, cryoballoon (CB) technology has become a tool for achieving durable PVI. Its application for LAAI has been investigated as a potentially advantageous alternative to radiofrequency ablation, and a positive effect on long-term outcome has been reported. However, the available data is limited. This study sought to investigate the clinical impact of CB-based LAAI in addition to PVI. Methods: This is a prospective, interventional, single-centre study. Consecutive patients with symptomatic PersAF were prospectively enrolled. In total 23 patients with PersAF underwent PVI plus LAAI using the CB system. Percutaneous LAA closure was performed within 2–3 months in all patients by implanting an endocardial LAA-closure device. Prior to LAA closure, LAAI durability was systematically assessed by invasive remapping studies. Results: A total of 100% of PVs were successfully isolated using the CB only (n = 91/91). Concerning LAAIs, a total of 21/23 (91%) remained isolated at the end of the procedure. After the ablation procedure including LAAI, all patients were scheduled for TEE assessment and LAA closure. TEE was performed after a mean of 54 ± 19 days. In 6/23 (26%) patients, LAA thrombus formation was detected after LAAI. A total of 23/23 patients (100%) received LAAC after a mean of 72 ± 45 days. Durability of LAAI was assessed utilizing a spiral mapping catheter in 23/23 patients (100%). In a total of 17/23 (74%) patients, durable LAA isolation was detected. Durable PVI of all PVs was detected in 16/23 (70%) patients. During a mean follow-up of 13 ± 3.4 months, stable sinus rhythm was maintained in 15 (65%) patients. The LAA showed reconnection in 3/23 (13%) patients, with arrhythmia recurrence. During follow-up, one stroke (318 days after LAAC) and one device thrombus (56 days after LAAC) occurred. Conclusions: While CB-based LAAI may offer benefits in managing persistent AF, it presents a significant risk of thrombus formation in the LAA, even with appropriate OAC. Early closure of the LAA following LAAI appears promising in mitigating these risks, but further evidence is needed to establish clear best practices. Full article

Catheter ablation has become a cornerstone therapy for atrial fibrillation, with pulmonary vein isolation as its mechanistic foundation. Radiofrequency ablation and cryoablation, the two established thermal technologies, have demonstrated robust efficacy across multiple randomized trials but remain limited by collateral tissue injury inherent to heat- or cold-mediated lesion formation. Pulsed field ablation has recently emerged as a novel non-thermal energy source based on irreversible electroporation, offering myocardial-selective injury with relative sparing of adjacent structures. This review synthesizes evidence across three complementary domains: fundamental studies; preclinical evidence; and clinical data supporting radiofrequency ablation, cryoablation, and pulsed field ablation for atrial fibrillation. We summarize mechanistic differences in lesion formation, key animal studies that established safety and efficacy profiles, and pivotal randomized clinical trials, including recent head-to-head comparisons and meta-analyses of randomized controlled trials. By synthesizing these levels of evidence, the review aims to place recent clinical results into a mechanistic and translational context. Available evidence demonstrates that pulsed field ablation achieves rhythm-control efficacy comparable to radiofrequency and cryoablation while offering procedural efficiency and a potentially improved safety profile. However, long-term durability data and broader experience remain limited. Understanding the strengths and limitations of each ablation modality is essential for informed clinical decision-making as non-thermal ablation technologies enter routine practice. Full article

Background/Objectives: Radiofrequency (RF) wire energy can be used for tissue ablation across many conditions. Adjusting RF generator parameters allows RF energy to puncture tissue with minimal adjacent damage. When RF energy is applied to tissue, however, microbubbles are produced, obstructing intravascular ultrasound (IVUS). Mitigation of RF-generated microbubbles has been studied for ablation but not for puncture. Methods: This paper describes an in vitro bench study using ex vivo bovine live tissue. A model was created with bovine liver tissue and an IVUS catheter submerged in a saline bath. Tissue was punctured with an RF guidewire to recreate microbubbles. Following the puncture, various methods were applied: altering the mechanical index of the IVUS, applying a VF10-5 Linear probe (Siemens), and applying a L12-3 Linear probe (Philips). Regions of interest (ROIs) were selected to track pixel brightness as a proxy for microbubbles. Results: The control increased ROI brightness by 1.5%. Altering the mechanical index of IVUS reduced ROI brightness by 1.2%. VF10-5 probe application increased ROI brightness by 1.2%. L12-3 probe application reduced ROI brightness by 33.0% (p = 0.046, n = 3, one-sample t-test). Brightness reduction was most pronounced at the site of initial RF wire puncture, where microbubbles accumulated. Tip visualization improved, allowing for more precise wire trajectory adjustments. Conclusions: External US with an L12-3 probe was able to dissipate microbubbles effectively to improve IVUS guidance following RF wire puncture in an in vitro exploratory bench model. Full article

Background: To investigate the predictive value of catheter ablation parameters during pulmonary vein isolation (PVI) on long-term recurrence in patients with paroxysmal atrial fibrillation (pAF). Methods: A retrospective analysis was conducted on 386 pAF patients who underwent initial catheter-based radiofrequency ablation (RFA) for PVI. After excluding ineligible cases and those lost to follow-up, 150 patients were included (mean follow-up: 28.86 ± 3.03 months). Patients were divided into recurrence and AF-free groups. Ablation parameters including catheter contact force (CF), ablation index (AI), and GAPs were collected via the CARTO VISITAG Module, and Cox regression was used to identify recurrence predictors. Results: The 2-year AF recurrence rate was 13.33% (20/150). No significant differences in baseline clinical characteristics, AI compliance rate, VISITAG GAP incidence, ablation points and time, or complication rates were observed between groups (p > 0.05). However, CF compliance rate was significantly lower in the AF recurrence group compared to AF-free group (79.17% vs. 90.10%, p < 0.001), and it was an independent predictor of late AF recurrence (HR = 0.950, 95%CI: 0.919–0.981; p = 0.002). Conclusion: CF compliance rate is independently associated with late AF recurrence after PVI. Maintaining stable CF during ablation may promote durable lesions and potentially reduce recurrence risk. Full article