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.

Background/Objectives: The Wolff-Parkinson-White (WPW) pattern is characterized by ventricular preexcitation due to an accessory atrioventricular pathway. Population-based data on the prevalence of asymptomatic WPW patterns in children are limited, and automated ECG interpretation may be misleading in the setting of preexcitation. Our aim was to determine the prevalence of the WPW pattern in a large cohort of asymptomatic Romanian school children and to describe electrocardiographic characteristics, ECG-based accessory pathway localization, and automated ECG interpretation errors. Methods: We performed a retrospective cross-sectional analysis of 12-lead ECGs obtained during a school-based screening program in Romania (May-December 2015). After exclusion of duplicates, technical errors, and participants outside the prespecified age range, 24,112 unique children aged 6-18 years were included. The WPW pattern was adjudicated by pediatric electrophysiologists. Prevalence was estimated using the Wilson score method. Sex differences were assessed using Fisher's exact test. Results: The WPW pattern was identified in 18/24,112 children, yielding a prevalence of 0.075% (0.75 per 1000). The WPW pattern was more frequent in boys than girls (12/11,858 (0.10%) vs. 6/12,255 (0.048%), p = 0.18). Most cases demonstrated mild preexcitation, with only a minority showing marked QRS widening. ECG-based algorithms suggested a predominance of left-sided accessory pathways. Automated ECG interpretation frequently produced misleading diagnostic statements, including bundle branch block/intraventricular conduction delay (5/18; 27.8%) and pseudo-infarction/ischemia patterns (1/18; 5.6%), and did not explicitly identify WPW/preexcitation. Conclusions: In a large school-based screening cohort of asymptomatic Romanian children, WPW pattern prevalence was 0.074%, with a trend toward male predominance. Most cases exhibited mild preexcitation. Automated ECG interpretation commonly misclassified preexcitation-related ECG findings, highlighting the importance of expert ECG review in pediatric screening programs.

Vitamin D deficiency is a widespread health issue within the paediatric population. In recent years, vitamin D deficiency has been linked to numerous cardiovascular diseases such as atherosclerosis, arterial hypertension, myocardial infarction, and heart failure. Previous studies have also suggested a possible relationship between low vitamin D levels and electrocardiographic changes in both adult and paediatric populations. In this retrospective study, we investigated whether circulating 25-OH-vitamin D levels are associated with changes in ventricular repolarisation, depolarisation, and atrial conduction on ECG in the paediatric population. A total of 66 patients aged 1 to 17 years were divided into three groups according to serum 25-OH Vitamin D levels: sufficient (>30 ng/ml; n=21), insufficient ( 20-30ng/ml; n=30) and deficient (<20 ng/ml; n=15). QRS duration, QTc interval, Tpe interval, Tpe/QTc ratio, JTp interval, Tpe/JTp ratio, JTc interval, PR interval, P-wave duration, LAP interval and P-wave dispersion were assessed. Associations between vitamin D status and the measured ECG parameters were analyzed using one-way analysis of variance (ANOVA). No statistically significant associations were found between vitamin D level and any of the evaluated ECG parameters (p>0.05). These findings do not support an independent association between vitamin D status and ECG changes related to ventricular repolarisation, depolarisation, or atrial conduction in the paediatric population.

Background: Atrial fibrillation is the most common human heart rhythm disorder, yet its underlying causes remain largely unknown. Trimethylamine N-oxide (TMAO), a by-product derived from the gut microbiota contributed by red meat, has been linked to numerous cardiovascular and metabolic diseases. Aims: This study aimed to evaluate the impact of serum TMAO levels on the occurrence of atrial fibrillation in patients with cardiovascular disease. Results: Utilizing a cross-sectional study design, fasting serum TMAO levels were measured and compared between 153 patients without cardiovascular disease and patients hospitalized for cardiovascular disease, stratified by the presence or absence of atrial fibrillation. While patients with more comorbidities had higher TMAO overall, the TMAO levels were not significantly different between cardiovascular disease patients with and without atrial fibrillation (p = 0.57). Moreover, there was no difference between atrial fibrillation progression phenotypes (p = 0.27). In multivariate analysis, a significant association was found with atherosclerotic cardiovascular disease (p = 0.04) and chronic kidney disease (p < 0.001), but there was no significant association between TMAO and atrial fibrillation (p = 0.9). Conclusions: Serum TMAO levels are not associated with the occurrence of atrial fibrillation and disease progression phenotypes in patients with cardiovascular disease, but are associated with ASCVD and CKD.

TMAO, a gut microbiota derived byproduct, has been associated with various cardiometabolic diseases by promoting oxidative stress and inflammation. The liver is the main organ for TMAO production and chronic exposure to high doses of TMAO could alter its function. In this study, we evaluated the effect of chronic exposure of high TMAO doses on liver oxidative stress, inflammation, and fibrosis. TMAO was administered daily via gastric gavage to laboratory rats for 3 months. Blood was drawn for the quantification of TMAO, and liver tissues were harvested for the assessment of oxidative stress (MDA, GSH, GSSG, GPx, CAT, and 8-oxo-dG) and inflammation by quantification of IL-1α, TNF-α, IL-10, TGF-β, NOS and COX-2 expression. The evaluation of fibrosis was made by Western blot analysis of α-SMA and Collagen-3 protein expression. Histological investigation and immunohistochemical staining of iNOS were performed in order to assess the liver damage. After 3 months of TMAO exposure, TMAO serum levels enhanced in parallel with increases in MDA and GSSG levels in liver tissue and lower values of GSH and GSH/GSSG ratio as well as a decrease in GPx and CAT activities. Inflammation was also highlighted, with enhanced iNOS, COX-2, and IL-10 expression, without structural changes and without induction of liver fibrosis.

Vitamin D deficiency is a significant global public health issue, even in regions with all year sun exposure. Currently, the scientific community has not yet reached a unanimous agreement regarding the optimum levels of vitamin D and the precise threshold values. Additional efforts are required to standardize the evaluation of vitamin D insufficiency and deficiency and to provide uniform treatment guidelines. Epidemiological studies have identified a broad spectrum of estimated prevalences in athletes. Their performance when participating in sports. depend on their muscles, heart and lung function. It seems that athletes have significantly lower levels of vitamin D compared to the general population. However, there is a lack of comprehensive studies and systematic reviews on this subject, making it challenging to reach conclusions due to variations in laboratory techniques and cut-off values. While there is an abundant of research on the supplementation of vitamin D and its benefits, it is challenging to provide general recommendations for athletes due to the limitations of extrapolation. However, there is a rather high occurrence of Vitamin D deficiency among individuals who engage in regular physical activity. Supplementing with Vitamin D helps prevents osteoporosis, bone fractures, enhances muscle strength, avoids lung infections, heart failure, and arrhythmias. It is generally safe when used in appropriate quantities, given its wide therapeutic range. Athletes can decrease the occurrence of training dropouts caused by infection, arrhythmias, muscular weakness and potentially prevent the inability to participate in competitions through correct nutrition and vitamin D supplementation.

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia globally. High-power, short-duration radiofrequency (RF) catheter ablation (CA) for AF has recently emerged, reducing ablation times and enhancing patient tolerability with comparable efficacy and safety. While the benefits of general anesthesia (GA) for standard-power, standard-duration CA are well-established, data comparing GA to mild conscious sedation (MCS) for high-power, short-duration CA are limited. Methods: We included patients undergoing high-power, short-duration CA for AF under GA (group 1) or MCS (group 2). Procedural characteristics, success rates, and mid-term outcomes were compared. Results: In total, 131 patients, 47 in the GA group and 84 in the MCS group, were included. CA was performed for paroxysmal AF in 34 patients in group 1 (72.3%) and 68 patients in group 2 (80.9%). We found lower a mean total procedure time (100 [90–120] vs. 160 [130–180] min, p < 0.0001), lower radiation exposure (932.5 [625–1716] vs. 2445 [1228–4791] μGy, p < 0.0001 and 4.5 [3–7.1] 7.3 [4.2–13.5] min, p = 0.0003) and fewer RF applications (71 [54.8–83.8] vs. 103 [88.5–120.5], p < 0.0001) in the GA group. No major complications occurred. The 6-month AF recurrence rate was comparable between the groups (21.2% vs. 33.3%, p = 0.15). Conclusion: In patients undergoing high-power, short-duration RFCA for AF, the use of GA is associated with better procedural efficiency while simultaneously associated with an early recurrence rate comparable to MCS.

Background: Achieving bidirectional mitral isthmus block is still challenging. Conventional ablation methods involve radiofrequency applications on the endocardial aspect of the lateral mitral isthmus, and often epicardial applications inside the coronary sinus. Aim: To evaluate the impact of the systematic use of ethanol infusion in the vein of Marshall on the achievement of acute mitral isthmus block of additional epicardial component lesion. Methods: We evaluated patients referred to two centres for long-standing persistent atrial fibrillation ablation or recurrent peri-mitral flutter. All patients had pulmonary vein isolation and mitral isthmus line using ethanol infusion in the vein of Marshall for the first procedure and additional radiofrequency ablation lesion if necessary. For redo procedures, additional ablations (atrial lines and complex fractionated atrial electrogram ablations, if needed) were also performed. Results: We included 149 patients, and ethanol infusion in the vein of Marshall was not performed in 27 patients (18%). Among 122 patients, 115 had long-standing persistent atrial fibrillation (94.2%) and seven had peri-mitral flutter (5.8%). The mean duration of continuous atrial fibrillation was 53 months before ablation. Acute bidirectional mitral isthmus block was obtained in 115 (94.2%) of the 122 patients who received ethanol infusion in the vein of Marshall (77% when considering the total population). The mean radiofrequency delivery time to obtain mitral isthmus block was 2.6 minutes for the endocardial mitral isthmus radiofrequency ablation and 2.6 minutes for the epicardial mitral isthmus radiofrequency ablation. Failure to obtain mitral isthmus block was associated with increased mitral isthmus length and left atrial dilation. No major complications related to ethanol infusion in the vein of Marshall were observed. Conclusion: Ethanol infusion in the vein of Marshall, when feasible (82%), was a safe approach to obtaining a high success rate (94%) of acute bidirectional endocardial and epicardial mitral isthmus block. (c) 2023 Elsevier Masson SAS. All rights reserved.

Atrial cardiomyopathy and remodeling play pivotal roles in the development of atrial fibrillation (AF) and heart failure (HF), involving complex changes in atrial structure and function. These changes facilitate the progression of AF and HF by creating a dynamic interplay between mechanical stress and electrical disturbances in the heart. Sodium–glucose cotransporter 2 inhibitors (SGLT2is), initially developed for the management of type 2 diabetes, have demonstrated promising cardiovascular benefits, being currently one of the cornerstone treatments in HF management. Despite recent data from randomized clinical trials indicating that SGLT2is may significantly influence atrial remodeling, their overall effectiveness in this context is still under debate. Given the emerging evidence, this review examines the molecular mechanisms through which SGLT2is exert their effects on atrial remodeling, aiming to clarify their potential benefits and limitations. By exploring these mechanisms, this review aims to provide insights into how SGLT2is can be integrated into strategies for preventing the progression of atrial remodeling and HF, as well as the development of AF.

Background: Bayés syndrome is a recently identified condition that is defined by the presence of an interatrial block on a surface electrocardiogram, in addition to atrial arrhythmias such as atrial fibrillation, tachycardia, or left atrial flutter. This syndrome is linked to an increased risk of stroke, morbidity, and mortality. An interatrial block is a conduction delay between the right atrium and left atrium and can be recognized by a P wave duration >120 ms. It is known that P wave duration can estimate the size of the left atrium measured via echocardiography, which is a marker for stratifying cardiovascular risk. Our study aims to verify whether the duration of the P wave can estimate the volume of the left atrium measured by computed tomography in patients with an interatrial block. Methods: We included 105 patients with a sinus rhythm and a partial or advanced interatrial block (IAB) who underwent contrast-enhanced cardiac computed tomography (CT). The mean age was 62.2 ± 10.1 years, and 38% of the patients were women. Results: The mean P wave duration was 122.6 ± 11.4 ms in the partial IAB group and 150 ± 8.4 ms in the advanced IAB group (p < 0.01). The mean left atrial volume was 115 ± 39 mL in the partial IAB group and 142 ± 34 mL in the advanced IAB group (p = 0.001). P wave duration was longer in patients with an advanced as opposed to partial interatrial block. Left atrial volume and LAVI were higher in patients with an advanced as opposed to partial interatrial block. Conclusions: All the patients (100%) with an advanced IAB had a dilated left atrium. P wave duration can accurately estimate LA volume in patients with an IAB using the formula: LA volume = 0.6 × P wave + 46 mL.

A growing body of evidence suggests that the gut microbiota affects the cardiovascular system directly and indirectly via biologically active molecules. TMAO, a key metabolite produced by gut bacteria is implicated in atherosclerosis and chronic endothelial dysfunction, but with an unclear effect on vascular tone, oxidative stress, and inflammation. Our study aimed to evaluate the acute effects of TMAO on vascular contractility in relation with oxidative stress markers and inflammation. Aortic rings were harvested from laboratory rats and placed in a tissue bath system containing TMAO in concentrations of 300, 100, 10 µM, and control. Vascular tone under the influence of vasoconstrictor phenylephrine and non-endothelial-dependent vasodilator sodium nitroprusside was assessed using force transducers connected to a computer-based acquisition system. Oxidative stress and inflammation were quantified by vascular assessment of the activity of NF-κB, NRF2, SOD1, and iNOS by western-blotting and MDA by spectrofluorimetry. After the incubation of the aortic rings in TMAO solutions for 1 h, there was no difference in vasoconstrictor and non-endothelial vasodilator response between the studied doses. TMAO acutely induced oxidative stress and inflammation, significantly increasing levels of MDA and the expression of NF-κB, NRF2, SOD1, and iNOS, mostly in a dose-dependent manner. Our study showed the lack of a short-term effect of studied TMAO doses on vascular contractility, but demonstrated an acute prooxidative effect and activation of major inflammatory pathways, which can partially explain the detrimental effects of TMAO in cardiovascular disease.