Justin T Tretter, Robert H Anderson, Kenneth A Ellenbogen, ShlomoA Ben-Haim
{"title":"3D Anatomy of the Atrioventricular Conduction Axis Reconstructed Relative to Gross Anatomical Landmarks Using Hierarchical Phase-contrast Tomography.","authors":"Justin T Tretter, Robert H Anderson, Kenneth A Ellenbogen, ShlomoA Ben-Haim","doi":"10.15420/aer.2025.18","DOIUrl":"10.15420/aer.2025.18","url":null,"abstract":"<p><p>Anatomical investigations aiming to delineate the 3D anatomy of the conduction system have been limited. Hierarchical phase-contrast tomography now provides the ability for 3D imaging at the micron-level spatial resolution. In this report, we present 3D reconstructions of the atrioventricular conduction axis within a structurally normal autopsied heart.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"14 ","pages":"e11"},"PeriodicalIF":2.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12159855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Fascicular and Papillary Muscle Arrhythmias in the Structurally Normal Heart.","authors":"Travis D Richardson, Roy M John","doi":"10.15420/aer.2024.54","DOIUrl":"10.15420/aer.2024.54","url":null,"abstract":"<p><p>Arrhythmias originating from the specialised cardiac conduction system and papillary muscles can occur in both structurally normal and diseased hearts. Conduction system associated arrhythmias include bundle branch re-entry, fascicular re-entry, non-re-entrant fascicular ventricular tachycardia and idiopathic ventricular fibrillation. Each type of arrhythmia requires a unique diagnostic and therapeutic approach. The papillary muscles may also be a source of ventricular arrhythmias. Ablation of papillary muscle associated arrhythmias may be difficult due to the complexities of mapping, structural abnormalities and potentially the deep location of arrhythmia foci. Tools, such as intracardiac echocardiography, can be valuable.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"14 ","pages":"e10"},"PeriodicalIF":2.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12127961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kyaw Z Win, Matthew J Armstrong, Richard P Steeds, Manish Kalla
{"title":"The Management of Obesity Before Catheter Ablation of AF: The Missing Piece?","authors":"Kyaw Z Win, Matthew J Armstrong, Richard P Steeds, Manish Kalla","doi":"10.15420/aer.2024.45","DOIUrl":"10.15420/aer.2024.45","url":null,"abstract":"<p><p>Obesity independently increases AF risk and negatively affects the outcomes of catheter ablation. This review examines the relationship between obesity and AF, focusing on structural and electrical remodelling. Multiple studies demonstrate worse ablation outcomes in patients with obesity. Pre-ablation weight loss improves outcomes and maintaining weight loss post-ablation is equally important. Risk factor modification programmes show promise, however they require a large investment in resources. Less intensive strategies focusing on diet and exercise have shown mixed results. Glucagon-like peptide-1 receptor agonists have been identified as potential adjunct therapies. They have multiple effects, including preferential reduction of epicardial adipose tissue and an anti-inflammatory action. Further research is needed to establish their efficacy in improving ablation outcomes. This review highlights the importance of weight management in AF treatment and suggests potential monitoring strategies using cardiac imaging. Future studies may shift the paradigm for the management of AF patients with obesity who are undergoing ablation.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"14 ","pages":"e09"},"PeriodicalIF":2.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12127968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
George Katritsis, George Stavropoulos, Nikolaos Fragakis
{"title":"Electroanatomic Mapping of the Atrioventricular Node and Right Inferior Nodal Extension: Insights from a Case Series.","authors":"George Katritsis, George Stavropoulos, Nikolaos Fragakis","doi":"10.15420/aer.2024.34","DOIUrl":"https://doi.org/10.15420/aer.2024.34","url":null,"abstract":"<p><p>Three patients, two women and one man, aged 50.0 ± 9.8 years, who underwent catheter ablation for typical atrioventricular nodal re-entrant tachycardia, were studied during sinus rhythm. An electroanatomic system suitable for high-resolution mapping and recording of both bipolar and unipolar electrograms was used. Recording of potentials from the area of the right inferior extension was feasible in all patients with bipolar signals. Using unipolar signals, the electrical activity of the atrioventricular node was recorded in all patients. This preliminary report supports the existing evidence that the activity of the atrioventricular node and its right inferior extension can be successfully mapped in the electrophysiology lab.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"14 ","pages":"e08"},"PeriodicalIF":2.6,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kristian Wollner, Christian Tønseth, Eivind Solheim, Jian Chen
{"title":"Ten-year Follow-up Study of Patients with Persistent Atrial Fibrillation Treated by Combined Pulmonary Vein Isolation and Complex Fractionated Electrogram Ablation.","authors":"Kristian Wollner, Christian Tønseth, Eivind Solheim, Jian Chen","doi":"10.15420/aer.2024.43","DOIUrl":"10.15420/aer.2024.43","url":null,"abstract":"<p><strong>Aim: </strong>This study retrospectively investigated the clinical outcomes of patients with persistent AF treated with a combined approach of pulmonary vein isolation (PVI) and complex fractionated atrial electrogram (CFAE) ablation over a follow-up period of 10 years.</p><p><strong>Methods: </strong>A total of 73 patients with persistent and long-standing persistent AF who underwent combined pulmonary vein isolation and CFAE ablation in the first procedure were included. A complete CFAE mapping of the left atrium and coronary sinus was performed with a 3D mapping system. All CFAEs defined as electrograms with continuous activity or mean cycle length detected by the system of <80 ms were excluded. Patients were controlled regularly during the first year followed by annual control. Any documented atrial tachyarrhythmia (ATA) was regarded as a recurrence.</p><p><strong>Results: </strong>After index ablation, 18 (24.7%) were free of ATAs during 10-year follow-up. The proportion of atrial flutter (AFL) was 39.7%, with six typical AFL. A mean of 2.2 ± 1.2 ablation procedures were performed in each patient. After multiple procedures, 33 (45.2%) patients were free of ATA during the follow-up. The proportion of AFL was 23.2% with no typical AFL. Older age, female sex and a longer AF history were associated with ATA recurrence.</p><p><strong>Conclusion: </strong>A high recurrence rate of ATA was observed after index procedure of pulmonary vein isolation plus CFAE ablation in patients with persistent AF. No significant difference in freedom of ATA was found between persistent and long-standing persistent AF groups beyond 1 year. The incidence of postablation AFL was particularly high, even after multiple ablations.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"14 ","pages":"e07"},"PeriodicalIF":2.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Letizia Rosa Romano, Alberto Polimeni, Ciro Indolfi, Antonio Curcio
{"title":"Management of Cardiac Rhythm Disorders in Cardio-oncology.","authors":"Letizia Rosa Romano, Alberto Polimeni, Ciro Indolfi, Antonio Curcio","doi":"10.15420/aer.2024.20","DOIUrl":"10.15420/aer.2024.20","url":null,"abstract":"<p><p>Arrhythmias and cancer are two pathological conditions that often coexist due to a patient's pre-existing comorbidities, or toxicity linked to anti-neoplastic drugs, and both are often characterised by poor prognosis. Cardio-oncology is a new interdisciplinary field that focuses on the cardiovascular health of cancer patients, especially those undergoing cancer treatment. Furthermore, cardiotoxicity can cause arrhythmias through primary and secondary mechanisms. Chemotherapy drugs have been shown to directly affect molecular pathways associated with arrhythmia development, as well as indirectly through mechanisms involving ischaemia or inflammatory injury to the heart. Understanding how to prevent and to treat these electrophysiological issues in cancer is an important challenge for cardio-oncologists. This review explores the intersection between cardio-oncology and electrophysiology, the various cardiac cell types implicated in the development of arrhythmias during cancer, the interplay between arrhythmias and cancer pathogenesis, and the need for the implantation of electronic devices along with their associated risks.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"14 ","pages":"e05"},"PeriodicalIF":2.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marek Jastrzębski, Weijian Huang, Pablo Moriña Vazquez, Pugazhendhi Vijayaraman
{"title":"His Bundle Pacing in the Era of Left Bundle Branch Pacing.","authors":"Marek Jastrzębski, Weijian Huang, Pablo Moriña Vazquez, Pugazhendhi Vijayaraman","doi":"10.15420/aer.2024.31","DOIUrl":"10.15420/aer.2024.31","url":null,"abstract":"<p><p>Soon after the rapid growth of the popularity of His bundle pacing (HBP), the use of this conduction system pacing modality was overshadowed by left bundle branch area pacing (LBBAP). This focused review on HBP addresses whether there are any advantages of HBP over LBBAP and what the current uses of HBP may be. We conclude that HBP must be considered as an alternative physiological pacing method with several potential applications, undoubtedly at least as a rescue option for failed CRT/LBBAP. For wider application of HBP, prospective studies are needed to document a reduction in the incidence of late threshold rise with modern implantation techniques. Nevertheless, HBP should be available in every modern pacing laboratory. This requires an active HBP program to maintain and develop the ability of operators to deliver HBP when it is most needed.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"14 ","pages":"e06"},"PeriodicalIF":2.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Conduction System Pacing for CRT: A Physiological Alternative.","authors":"Bengt Herweg, Mishal Mumtaz, Pugazhendhi Vijayaraman","doi":"10.15420/aer.2024.10","DOIUrl":"10.15420/aer.2024.10","url":null,"abstract":"<p><p>There are many factors contributing to the failure of conventional CRT with biventricular pacing, including coronary anatomy and an inability to stimulate diseased tissue. In this paper, we review evolving conduction system pacing (CSP), a physiological alternative to conventional CRT. CSP allows correction of bundle branch block and provides new opportunities to address multiple limitations of conventional CRT. Further studies are required to determine how the techniques are best applied in specific clinical situations.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"14 ","pages":"e04"},"PeriodicalIF":2.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Benjamin Clay, Balamrit S Sokhal, Sarah Zeriouh, Neil T Srinivasan, Parag R Gajendragadkar, Claire A Martin
{"title":"Temperature-controlled Ablation Versus Conventional Ablation for Pulmonary Vein Isolation in the Treatment of AF: A Systematic Review and Meta-Analysis.","authors":"Benjamin Clay, Balamrit S Sokhal, Sarah Zeriouh, Neil T Srinivasan, Parag R Gajendragadkar, Claire A Martin","doi":"10.15420/aer.2024.41","DOIUrl":"10.15420/aer.2024.41","url":null,"abstract":"<p><strong>Background: </strong>This study compared the efficacy and safety of temperature-controlled and conventional contact-force-sensing radiofrequency ablation catheters for pulmonary vein isolation (PVI) in AF.</p><p><strong>Methods: </strong>Seven studies (1,138 patients) were included. Randomised controlled trials and observational (single-arm and two-arm) studies that reported freedom from AF ≥3 months after PVI with temperature-controlled radiofrequency ablation catheters (Biosense Webster QDOT MICRO operating in QMODE or Medtronic DiamondTemp) were included.</p><p><strong>Results: </strong>Freedom from AF at a mean (± SD) follow-up of 9.0 ± 3.6 months did not differ significantly between temperature-controlled and conventional ablation (OR 1.22; 95% CI [-0.79, 1.64]; p=0.24). Total procedure duration (-13.5 minutes; 95% CI [-17.1, -10.0 minutes]; p<0.001) and total ablation duration (-8.9 min; 95% CI [-10.3, -7.5 min]; p<0.01) were significantly shorter for temperature-controlled ablation. There were no significant differences between temperature-controlled and conventional ablation in either the aggregated rates of procedural complications (OR 0.69; 95% CI [-0.15, 1.54]; p=0.11) or in the rate of any individual complication.</p><p><strong>Conclusion: </strong>Temperature-controlled ablation was found to be at least non-inferior to conventional ablation in all measures of efficacy and safety. Further randomised controlled trials are warranted to evaluate long-term rates of freedom from AF and patient comfort.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"14 ","pages":"e03"},"PeriodicalIF":2.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nikhil Ahluwalia, Ahmed Hussain, Rui Providencia, Richard J Schilling
{"title":"Predictors of Improvement in Left Ventricular Systolic Dysfunction in Patients with Atrial Fibrillation Undergoing Catheter Ablation: Systematic Review.","authors":"Nikhil Ahluwalia, Ahmed Hussain, Rui Providencia, Richard J Schilling","doi":"10.15420/aer.2024.24","DOIUrl":"10.15420/aer.2024.24","url":null,"abstract":"<p><strong>Background: </strong>Left ventricular systolic dysfunction (LVSD) can improve after catheter ablation (CA) in many patients with AF. However, prospective prediction of response can be challenging. The aim of this study was, therefore, to perform a systematic literature review of features associated with improvement in left ventricular ejection fraction (LVEF) in patients with AF and LVSD undergoing first CA.</p><p><strong>Method: </strong>Systematic search of Ovid MEDLINE, Embase and Cochrane Library databases up to 24 January 2024, for studies involving adult patients with LVSD receiving treatment for AF. The focus was on research articles and clinical trials reporting features associated with changes in LVEF following CA. The review followed PRISMA guidelines.</p><p><strong>Results: </strong>A total of 789 unique articles were reviewed and 20 were included in the systematic review. Sixty-nine per cent (range, 54-79%) of included patients met the criteria for responder status, which were based on LVEF improvement (usually an increase in LVEF >10% or to >50% at follow-up). Baseline surrogates of myocardial fibrosis on MRI (R<sup>2</sup>=-0.67), electroanatomical mapping (R<sup>2</sup>=-0.93) and biochemical surrogates have shown the strongest association with LVEF change. Left atrium and LV chamber size, diastolic dysfunction ECGbased parameters and a known heart failure aetiology have shown prognostic value independently and in combination.</p><p><strong>Discussion: </strong>Imaging, clinical and ECG-based surrogates of LV fibrosis may be pre-CA markers of LVEF improvement in patients with AF and LVSD. However, the confounding effect of procedural outcomes should be considered. A composite risk stratification tool would have clinical utility in risk stratification and patient selection; however, prospective studies are needed.</p>","PeriodicalId":8412,"journal":{"name":"Arrhythmia & Electrophysiology Review","volume":"14 ","pages":"e02"},"PeriodicalIF":2.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}