ABSTRACT Aims Intra‐atrial reentrant tachycardia (IART) frequently occurs following cardiac surgery due to scar‐related conduction abnormalities. While advances in mapping technologies have improved the acute success rate of catheter ablation, arrhythmia recurrence remains a significant clinical concern. This study aimed to evaluate whether a preventive linear ablation strategy guided by voltage mapping improves the long‐term success rate of catheter ablation in patients with IART post‐cardiac surgery. Methods and Results A total of 46 consecutive patients following cardiac surgery who underwent atrial tachycardia ablation between 2022 and 2024 were enrolled in the study group. After activation mapping‐guided ablation for ongoing IART, preventive linear ablation was performed based on voltage mapping. Fifty consecutive sex‐ and age‐matched patients with cardiac surgery undergoing activation mapping‐guided ablation alone served as the historical control group between 2018 and 2021. At a mean follow‐up of 21 ± 4.9 months, the rate of freedom from atrial arrhythmias was significantly higher in the study group compared to the control group (82.6% vs. 64.0%; p = 0.019). Despite the improved outcomes, the study group had significantly longer total procedure times (192 ± 37 vs. 126 ± 25 min; p < 0.001) and radiofrequency ablation durations (29 ± 5 vs. 20 ± 6 min; p < 0.001). However, there were no significant differences in complication rates between the two groups. Conclusions Preventive linear ablation strategy was associated with improved arrhythmia‐free survival in patients with IART post cardiac surgery, but these exploratory findings require confirmation in future prospective studies.
ABSTRACT Background PulseSelect pulmonary vein isolation (PVI) lacks a dedicated contact indicator. Methods We retrospectively compared 63 patients undergoing PVI before and after EnSite Contact Index (CI) implementation. Because electrical isolation does not confirm lesion transmurality, post‐procedural unipolar electrograms (u‐EGMs) were assessed as acute surrogate markers. Results CI guidance was associated with more applications, shorter fluoroscopy, and in an exploratory analysis of analyzable patients, fewer residual high‐voltage u‐EGMs (1/20 vs. 8/24; p = 0.027). No complications occurred. Conclusions CI‐guided PVI was feasible; these procedural and acute electrophysiological associations require prospective validation.
Silent infective endocarditis after CAR-T therapy caused septic embolic occlusion of a septal coronary branch, producing localized myocardial infarction involving the His bundle region and transient complete atrioventricular block. This case highlights a rare, pathologically confirmed mechanism of conduction disturbance.
ABSTRACT Background Acute effects of pulsed field ablation (PFA) on passive atrial mechanical properties have not hitherto been assessed by reconstruction of pressure–volume relationship using invasive intracavitary pressure measurements. Methods In a cohort of 38 first‐time atrial fibrillation ablation patients, submitted to pulmonary vein isolation, we studied the effects of PFA and cryoballoon ablation on the left atrial elastic constant and passive elastic chamber stiffness constant, expressing baseline left atrial conditions and quantifying passive left atrial stiffness, respectively. Left atrial pressure was invasively measured immediately pre‐ and post‐procedurally, while volume values were obtained echocardiographically. Results No differences were noted in passive elastic chamber stiffness constant values, pre‐ and post‐procedurally in either group. No differences were noted between CBA and PFA groups. There were no observable associations between Δ α and Δ b and either AF duration or preprocedural left atrial volume. Conclusions Based on the above, CBA and PFA demonstrated comparable effects on left atrial mechanical properties in the acute post‐ablation setting.
ABSTRACT Background Pulmonary vein isolation (PVI) alone is frequently insufficient for persistent atrial fibrillation (AF). Although pulsed‐field ablation (PFA) ensures durable linear lesions, extensive transmural ablation risks iatrogenic atrial tachycardia. A tailored strategy combining PFA with titrated radiofrequency (RF) energy for mild substrate homogenization remains poorly defined. Case Summary A 77‐year‐old male with post‐stroke refractory long‐standing AF underwent a re‐do ablation. Biatrial substrate evaluation was performed using the ExTRa mapping system, enabled by the Affera system (Prism‐2) to visualize the nonmagnetic 20‐pole spiral catheter. Areas with a mean non‐passively activated ratio (%NP) ≥ 35% and low voltage (< 0.3 mV) were targeted. Following PFA‐led posterior wall isolation, mild homogenization was performed using the Sphere‐9 catheter with highly titrated RF energy (60%, 60°C, and 1‐s duration). Although AF did not terminate directly, the AF cycle length significantly prolonged, and sinus rhythm was restored via cardioversion. Post‐procedural mapping confirmed complete isolation without extensive dense scar formation at homogenization sites. The patient maintained sinus rhythm during follow‐up. Conclusion The hybrid PFA/RF system integrated with AI‐driven phase mapping enables a safe, non‐destructive, tailor‐made substrate modification strategy for refractory persistent AF.
