Characteristics of patients with delayed compared to immediate new onset left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR) are poorly defined. To describe the incidence and features of patients with delayed post TAVR LBBB as well as risk factors for permanent pacemaker implantation (PPI). 1469 consecutive TAVR patients were screened for the occurrence of new onset LBBB. ECG was performed within 1 week before the procedure, immediately post procedure, and daily thereafter until discharge. According to the immediate post TAVR ECG, patients were divided into 2 groups, immediate and delayed new onset LBBB. Both groups were followed for the occurrence of PPI and mortality. Among patients who underwent TAVR, 296 (20.1

INTRODUCTION:Transvenous pacemakers are effective but carry significant short- and long-term complications. Leadless pacemakers were developed to overcome these limitations, however, data in high-risk patients ineligible for transvenous systems remain limited. AIM:To evaluate the real-world outcomes of leadless pacemaker in high risk bradyarrhythmia patients unsuitable for transvenous pacing. METHODS:A retrospective, observational, multi center registry (MLPI) across four Israeli hospitals, included all patients undergoing leadless pacemaker implantation July 2021-December 2022 within a national pilot program. Indications included venous abnormalities, prior device infection, Twiddler's syndrome or high infection risk. Procedural success, complications, electrical performance, and mortality were assessed at 48 h, 30 days, and 12 months. RESULTS:A total of 138 patients were enrolled, with a high comorbidity burden (hypertension 74%, heart failure 44%, chronic kidney disease 36%). High grade atrioventricular block was the main pacing indication (70%), and the leading reason for leadless implantation (54%) was high infection risk. Implantation was successful in 98% of the patients, almost all with Micra. Acute complications occurred in 2.9%, (primarily pericardial effusion); three patients (2.2%) died within 48 h. At 1-year, electrical performance remained stable, with low pacing thresholds (median 0.5 V), preserved sensing, and declining impedance. Two late complications occurred (tamponade, loss of capture). The 1-year cumulative complication rate was 4.7%, and all-cause mortality 12.3%. CONCLUSION:Leadless pacemaker implantation in a very high-risk Israeli cohort achieved high procedural success, stable performance, and low complication rate, supporting its role as a safe and effective alternative to conventional pacing systems.

INTRODUCTION:This is a summary of a few of the recent innovations in cardiology that affect our practice. In the area of cardiac intensive care, recent developments included the use of AI algorithms to improve multi-modality monitoring, thus improving patient safety. The use of robots in Coronary Care Units (CCUs) and the extensive use of mechanical support are also some of the major breakthroughs in intensive care cardiology. The area of cardiac interventions is characterized by procedures performed in octogenarians and nonagenarians, including coronary interventions in heavily calcified coronary arteries, and valvular interventions of various kinds. In the field of arrhythmia, there was a recent entrance of new energies for ablation, especially the pulsed field ablation, based on non-thermal electroporation, that is less destructive to the surrounding tissue and is therefore safer to the patient. Another breakthrough is the wide adoption of conduction system pacing which paces the heart in a physiological mode that decreases the long-term damage of pacing to the function of the heart. Another new trend in pacing is the use of small leadless pacemakers that are implanted directly into the heart by an interventional technique via the femoral vein. Innovations in imaging include the increased use of 3-dimensional echocardiography as well as strain echocardiography that increases sensitivity to specific conditions such as drug effects and cardiomyopathy. The new photon counting CT technology improved the quality of CT imaging considerably. Heart failure treatment has improved significantly over recent years, with special emphasis on the use of mechanical support for bridging and destination treatments. This is just a partial list of the great advances that have happened in the field of cardiology.

Introduction Pulmonary hypertension (PH) is associated with an increased risk of atrial fibrillation (AF), and AF onset in PH may signal advanced disease. While catheter ablation (CA) offers clinical benefits, post-ablation recurrence remains a challenge. We evaluated whether systolic pulmonary artery pressure (sPAP) predicts AF recurrence following pulmonary vein isolation (PVI). Methods Data from the prospective, multicenter Israeli Catheter Ablation Registry (ICAR) included 485 patients undergoing PVI between January 2019 and December 2021, all with echocardiographic sPAP measurements. Patients were stratified into two groups based on sPAP values: high-probability PH (sPAP > 45 mmHg) and low/intermediate probability PH (sPAP ≤ 45 mmHg). AF recurrence within 12 months was assessed, along with subgroup analyses and evaluation of procedural complications. Results Patients with high-probability PH were older (69.05 ± 8.75 vs. 64.34 ± 11.27 years; p < 0.01) and had more comorbidities. Cryoballoon ablation was utilized in 387 patients (79.8%). High-probability PH patients had significantly higher 12-month AF recurrence rates (30.4% vs. 17.2%; p = 0.029), despite similar acute procedural success and overall periprocedural complication rates. A Cox proportional hazards model identified sPAP > 45 mmHg as an independent predictor of recurrence (adjusted HR 2.55; p < 0.01), while spline analysis demonstrated a dose-dependent relationship between rising sPAP values and recurrence. Conclusion This study emphasizes the importance of PH, evaluated through echocardiographic sPAP values, in predicting post-PVI AF recurrence. These findings support incorporating echocardiographic sPAP into pre-procedural risk assessment to guide customized post-ablation monitoring.

Introduction Cardiovascular disease is a leading cause of death worldwide, of which coronary artery disease is the most common form. Sudden cardiac death (SCD) is a serious complication following acute myocardial infarction (MI), accounting for the highest percentage of all deaths in this population. Currently implantable cardioverter-defibrillators (ICDs) provide an acceptable method of primary prevention of SCD. However, the current literature is heterogeneous with regard to studies evaluating the benefits of ICDs for the primary prevention of SCD after MI, particularly relating to the timing of ICD implantation, risk stratification of patients for ICD implant selection and reporting non-rhythmic deaths after ICD implantation.Methods and analysis A meta-analysis will be performed to estimate the pooled effect size of randomised controlled trials (RCTs) examining the relationship between prophylactic transvenous ICD (TV-ICD) implantation and other medical therapies for primary prevention of SCD after MI. A comprehensive literature search and review will be performed using electronic medical databases including Scopus, Ovid MEDLINE, EMBASE (Ovid Platform), Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, ProQuest (Health and Medicine) and CINAHL (EBSCO) from January 1980 to June 2025. The literature search will be limited to peer-reviewed original studies carried out in human subjects and published in English. Type of study design will be limited to RCTs. The systematic review and meta-analysis will be developed according to the Joanna Briggs Institute Manual for Evidence Synthesis (2024 edition) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. Data analysis will be performed according to a structured and predetermined analysis plan. The primary outcome of the study will be all-cause-mortality, for which Hazard Ratios (HRs) will be reported as a measure of effect with 95% CI. Based on data availability, subgroup analysis will be carried out. The effect sizes will be reported based on a random effects model.Expected study outcomes and dissemination This systematic review and meta-analysis will evaluate and provide primary evidence for the effectiveness of prophylactic implantation of TV-ICDs on all-cause mortality in patients who experienced MI, aiming for primary prevention of SCD after MI. The primary prevention of SCD after MI is an important goal to reduce community incidence of out-of-hospital cardiac arrests, improving patient survival rates and their quality of life after MI. Out-of-hospital cardiac arrests currently have a survival rate of less than 10% and could result in long-lasting neurological damage in those who survive.PROSPERO registration CRD42023456995.

INTRODUCTION:ESC Guidelines recommend implantable loop recorder (ILR) use in unexplained syncope patients, given their high diagnostic value compared with external loop recorders (ELR). At times, syncope diagnosis is made shortly after ILR implantation, suggesting ELR may suffice. PURPOSE:Evaluate prevalence and characteristics of patients with early syncope diagnosis, within <1 month of ILR implant, potentially enabling ELR-based diagnosis. METHODS:Retrospective cohort of unexplained syncope post-ILR patients in two tertiary centers (2013-2023). Study endpoint was early ILR-based syncope diagnosis. Clinical characteristics associated with early diagnosis were assessed using univariable and multivariable penalized regression analyses. RESULTS:Study included 106 unexplained syncope post-ILR patients. During a 33-month median follow-up, 49/106 reached an ILR-based diagnosis. Fifteen (30.6%) achieved early diagnosis, including high-degree atrio-ventricular block (AVB) (n = 9), non-arrhythmic syncope (n = 5), and ventricular tachycardia (n = 1). Older age (≥70 y/o), diabetes, and intraventricular conduction delay (IVCD) were significantly associated with early AVB diagnosis in univariable analysis, whereas only age and IVCD remained associated with early AVB on penalized multivariable analysis. Young age (<50 y/o), normal ECG, and normal echocardiography were associated with early non-arrhythmic etiology. CONCLUSIONS:Our study revealed a 30.6% prevalence of early ILR-based diagnoses, raising the hypothesis that selected unexplained syncope patients might be diagnosed using 1-month ELR. Future studies are needed to confirm these results.

Clinical features associated with sustained ventricular arrhythmias (sVA) during acute myocarditis (AM) are poorly defined. Identify simple clinical characteristics of arrhythmogenic AM patients who develop sVA during acute-phase hospitalization. Case-control study of AM patients hospitalized in two tertiary centers from 2000 to 2020. Patients with documented sVA during AM hospitalization (cases) were compared with AM patients without VA (controls). Patients with history of myocardial infarction, heart failure or VA were excluded. Univariate and multivariable analyses were used to evaluate clinical parameters associated with occurrence of sVA during AM hospitalization. Study included 41 cases with sVA and 137 controls without any VA during AM hospitalization period. VAs included monomorphic VT and polymorphic VT/VF in 24/41 (58.5

Background: Complete atrioventricular block (CAVB) following transcatheter aortic valve replacement (TAVR) is primarily attributed to mechanical compression of the penetrating or branching portions of the His bundle, and less commonly, the atrioventricular (AV) node. This study aimed to characterize the electrocardiographic features of stable escape rhythms (ERs) occurring during CAVB after TAVR. Methods: This retrospective study analyzed 12-lead electrocardiograms (ECGs) obtained at three time points: before TAVR (ECG 1), after TAVR but before CAVB (ECG 2), and during CAVB (ECG 3). The ERs on ECG 3 were classified as AV junctional if the rate was 40–60 beats per minute (bpm) and, compared with ECG 2, if the QRS morphology matched in ≥10/12 leads, the QRS duration differed by <10 ms, and the frontal QRS axis differed by <30°. The ERs not meeting these criteria were considered ventricular in origin. Three patients with ERs <40 bpm but matching AV junctional morphology were included in the AV junctional group. ECG 2 was unavailable in 12 patients. Results: Among the 58 patients included, 56.9% had no conduction abnormalities on baseline ECG 1. Following TAVR (ECG 2), left and right bundle branch blocks were observed in 69.6% and 17.4% of the patients, respectively. During CAVB (ECG 3), the ERs were presumed to originate from the AV junction in 23 patients (39.6%), from the ventricles in 28 (48.3%), and had an undetermined origin in 7 (12.1%). Conclusions: Consistent with the anatomical regions commonly affected by the prosthetic aortic valve during TAVR, a substantial proportion of patients exhibited ERs likely originating from the AV junction, suggesting a potential role for conduction system pacing in managing CAVB in this setting of patients.

Objective:Bronchiolitis is a major cause of respiratory illness in infants. Few studies have demonstrated arrhythmias during bronchiolitis, including bradycardia and atrioventricular block, some requiring pacemaker implantation. However, the association between bronchiolitis and cardiac arrhythmias remains unclear. In this work we sought to investigate the incidence and characteristics of arrhythmias during bronchiolitis in infants younger than 1 year of age. Study design:A single-center, prospective cohort study was conducted on infants hospitalized with a clinical diagnosis of bronchiolitis. Demographic and clinical data were collected via questionnaire. All infants underwent overnight Holter monitoring during hospitalization. Results:Among 100 enrolled infants (79% positive for respiratory syncytial virus), 18 (18%) demonstrated arrhythmias: sinus arrest (2-13 seconds) in 8 infants, bradycardia <60 bpm in 7 infants, and frequent atrial premature complexes (3%-18% of beats) in 3 infants. Follow-up Holter recordings in 7 patients (38%) showed resolution of arrhythmias within 1-4 months. No significant demographic or clinical predictors were identified. None of the infants exhibited symptoms (eg, cyanosis, unresponsiveness) associated with arrhythmia severity. Conclusions:Our study shows that bronchiolitis is associated with significant arrhythmias in infants, particularly sinus arrest, bradycardia, and atrial premature complexes. In our cohort, none of the infants with significant arrhythmia required arrhythmia intervention. Clinicians should be aware of this association and consider delaying decisions regarding pacemaker implantation until after the resolution of bronchiolitis even in cases of infants with severe bradycardia. Future investigations should explore the pathophysiology and prognostic implications of this phenomenon.

Limited and inconsistent data exist regarding the impact of kidney function on outcomes following ablation procedures in patients with atrial fibrillation (AF). This study aimed to evaluate the effectiveness and safety of AF ablation in a large national cohort stratified by levels of estimated glomerular filtration rates (eGFR). The Israeli Catheter Ablation Registry (ICAR) is a prospective, multicenter cohort study of patients who underwent pulmonary vein isolation (PVI) for AF treatment between 2019 and 2021. The primary study endpoints were AF recurrence and the need for repeat ablation at 12 months. Secondary endpoints included rehospitalization and procedural complications. Between January 2019 and December 2021, 925 AF patients underwent PVI. Baseline creatinine data were available for 856 patients, forming the study cohort. Among these, 211 patients (24.6%) had preserved eGFR (>90 mL/min/1.73m²), 466 (54.4%) had mildly reduced eGFR (60–89 mL/min/1.73m²), and 179 (21%) had moderate to severely reduced eGFR (<59 mL/min/1.73m²), classified as chronic kidney disease (CKD). Baseline characteristics are summarized in Table 1. Patients with lower eGFR were older, less frequently women, and more likely to have cardiovascular risk factors and a history of cardiovascular disease. Median AF duration was three years across all groups, with persistent AF significantly more common in patients with lower eGFR. Most patients (87%) underwent cryoablation, 5% underwent radiofrequency (RF) ablation, and 7% received both cryo and RF ablation. No significant procedural differences were observed between groups (Table 2). Of the 856 patients, 25 had no 12-month follow-up data, and 19 were lost to follow-up. Among the remaining 812 patients, there were 8 deaths (1 cardiac, 6 non-cardiac, and 1 of unknown cause); two of the deceased provided usable data, and five patients withdrew consent, resulting in outcome data for 801 patients, Table 3. Twelve-month AF recurrence rates did not differ significantly among the groups: 16%, 20%, and 20% in patients with preserved, mild, and moderate-severely reduced eGFR/CKD, respectively (p=0.3). However, the one-year rehospitalization rate was higher in those with moderate to severely reduced eGFR: 13%, 17%, and 25% for preserved, mild, and moderate-severely reduced eGFR/CKD, respectively (p=0.005, Table 4). Pulmonary Vein Isolation is a safe and effective treatment for Atrial Fibrillation in patients with Chronic Kidney Disease and should be considered for all suitable CKD patients, regardless of kidney function.Graph and tables

AIMS:Atrial fibrillation (AF), the most common sustained arrhythmia in adults, is increasing in prevalence globally. Catheter ablation (CA), particularly pulmonary vein isolation (PVI), is a key treatment option. Pulmonary vein isolation can be performed using different energy sources, including cryoballoon ablation (CBA), radiofrequency ablation (RFA), or pulse field ablation. Anaesthesia modalities for these procedures include general anaesthesia (GA), deep sedation (DS), and conscious sedation (CS). However, the optimal anaesthesia modality remains unclear, as previous studies have shown mixed outcomes. This study aims to compare the safety and efficacy of different anaesthesia modalities in PVI. METHODS AND RESULTS:This prospective, multicentre study, based on the Israeli Catheter Ablation Registry, evaluated the impact of different anaesthesia modalities on procedural outcomes and safety in AF ablation. Data from 1002 patients who underwent PVI between January 2019 and December 2021 across 14 centres were analysed. Patients were stratified by anaesthesia modality-CS vs. GA, with the latter encompassing DS. Key outcomes, including AF recurrence, procedural complications, and success rates, were evaluated over a 24-month follow-up period. Additionally, a sensitivity analysis was performed for the subgroup of patients who underwent CBA. Of the 1002 patients, 53% received GA, 6.3% DS, and 40% CS, with CBA used in 84% of cases. Complete PVI was achieved in 91% of patients, with comparable success rates observed between CS and GA groups. No significant differences were found between CS and GA modalities in terms of AF recurrence rates at 12 months (15% vs. 16%) and 24 months (19.5% vs. 21.2%), or in 12-month rehospitalization rates (19.8% vs. 16.5%). Sensitivity analysis of the CBA subgroup yielded similar results, with no significant differences in AF recurrence, complications, or procedural duration between CS and GA modalities. CONCLUSION:Conscious sedation is as safe and effective as general anaesthesia in AF ablation, particularly with cryoablation. The choice of anaesthesia appears to be driven by patient characteristics and institutional factors without affecting long-term outcomes such as AF recurrence or complication rates.

Conduction system pacing (CSP) is being increasingly adopted as a more physiological alternative to right ventricular and biventricular pacing. Since the 2021 European Society of Cardiology pacing guidelines, there has been growing evidence that this therapy is safe and effective. Furthermore, left bundle branch area pacing was not covered in these guidelines due to limited evidence at that time. This Clinical Consensus Statement provides advice on indications for CSP, taking into account the significant evolution in this domain.

Background:An early catheter ablation treatment strategy is effective for rhythm control in patients with atrial fibrillation (AF). In clinical practice, most patients undergo catheter ablation as a second-line treatment, following a trial of antiarrhythmic drugs (AADs). We aimed to investigate the effectiveness and safety of AF catheter ablation performed as a first-line vs a second-line approach, based on data from the nationwide, multicentre Israeli Catheter Ablation Registry. Methods:Following AF catheter ablation, patients were stratified into 2 groups-first-line vs second-line therapy approaches. The second-line group included AF patients who were referred for catheter ablation following treatment with at least one AAD. The primary endpoint was the 1-year freedom from AF recurrence. The secondary endpoints included 1-year hospitalizations, death, cerebrovascular events, and the composite of adverse cardiac events. Results:The 923 participants had a mean age of 66 ± 4.5 years. Catheter ablation was performed as a first-line therapy in 192 patients (20.8%). Median times from AF diagnosis to catheter ablation were 1.5 and 3 years in the first- and second-line groups, respectively. Patients in the first-line group were younger, had a shorter AF duration, and more frequently had a normal left atrial size prior to the procedure. The primary endpoint of AF recurrence at 1 year did not differ significantly between the groups (24.9% vs 30%, P = 0.205). No significant differences in the incidence of secondary outcomes occurred. Conclusions:Mildly delayed AF catheter ablation for patients with AF did not compromise the procedure's efficacy or safety.

Background In contrast to left bundle branch block, right bundle branch block (RBBB) is rare after transcatheter aortic valve replacement (TAVR). Objectives This study sought to define the incidence of post-TAVR new-onset RBBB and the risk factors associated with permanent pacemaker implantation (PPI) need. Methods Data from 7,782 consecutive TAVR procedures performed in 7 Israeli centers were retrospectively analyzed. A baseline electrocardiogram was performed within 2 days before TAVR and daily thereafter. Absolute pacing indication (API) was defined as the occurrence of high-grade atrioventricular block or alternating bundle branch block. Results Overall, 41 patients with new-onset RBBB were identified, translating into an incidence of 5.3 (95% CI: 3.8-7.1) cases per 1,000 TAVR procedures. During 1 year post-TAVR, 19 patients (46.3%) underwent PPI, of whom 15 (36.6%) had API. All API occurred before discharge from the index TAVR hospitalization except in 1 case of late atrioventricular block. A cutoff of post-TAVR PR of 228 ms had a specificity of 95% and a sensitivity of 50% in predicting API, whereas Δ PR of 24 ms had a specificity of 80% and a sensitivity of 83% in predicting API. Patients who did not undergo PPI had a nonsignificantly better overall survival compared with patients with PPI. Conclusions Post-TAVR new-onset RBBB is a rare phenomenon that is associated with high rates of further conduction system deterioration and need for PPI, occurring mostly within 1 week post-TAVR. Post-TAVR PR ≥230 ms and Δ PR ≥24 ms, vs post-TAVR PR <230 ms and unchanged PR, may help stratifying the patients into high and relatively low risk of progressive conduction worsening, respectively.

Cardiac magnetic resonance imaging-based late gadolinium enhancement (LGE-CMR) of left atrial (LA) fibrosis distribution can be valuable for preprocedural planning, patient selection and real-time guidance during atrial fibrillation (AF) ablation. However, the accuracy of LGE-CMR in assessing LA fibrosis is still debated. To evaluate the accuracy of LGE-CMR-based LA fibrosis (CMR-fib) among ablation-naive patients compared to electroanatomical mapping (EAM-fib). Patients with non-permanent AF who underwent CARTO-based mapping with preprocedural LGE-CMR scan were included. 3D substrate atrial maps were generated using the ADAS-3D-LA software and the CARTO 3 system with a fibrosis threshold of 1.2 and 0.5mV, respectively (Figure 1). The two maps were evaluated for fibrosis through anatomically synchronized, quantitative point-by-point comparison, with EAM used as the gold standard. Further analyses were performed based on the anatomical LA wall regions and, when available, CT-based LA wall thickness. The study included 41,543 points acquired from 24 patients (aged 64±11 yrs; 7 females; 15 paroxysmal AF). CMR-fib showed 21% of LGE, while the EAM-fib demonstrated 42% of low-voltage areas. The CMR-fib vs. EAM-fib point-by-point comparison showed an agreement of 89% and interrater reliability of 0.53 (p<0.001). The sensitivity and specificity were 50% and 100%, respectively, while the PPV and NPV were 100% and 74%, respectively. The Area Under the Curve was 75. An increase in the EAM-fib fibrosis threshold (1.5mV) resulted in a decrease in the diagnostic performance. The lowest agreement was observed in the LA roof, while the highest agreement was seen in the inferoseptal and anterior walls. Categorizing acquired points into different ranges of LA wall thickness (among 16 pts) revealed the highest agreement at diameters between 2.5 and 4 mm. In contrast, the agreement was lowest for diameters ≥4 mm and ≤0.5 mm (Figure 2). LGE-CMR tends to underestimate the presence of fibrosis compared to EAM; however, the fibrosis that is detected is generally accurate. CT-based thickness measurements can be used for procedure preplanning to identify LA wall areas with enhanced CMR-based fibrosis accuracy. The low accuracy in mapping points at the outer ends of the scale suggests that the reduced sensitivity may be attributed to the lower spatial resolution of CMR, as well as the fact that EAM maps the subendocardial layer, while CMR-fib provides an averaged transmural mapping. A large-scale study is required to assess the accuracy of CMR-fib, considering various wall thicknesses and establishing the fibrosis threshold, particularly for ablation-naive patients.Figure 1 Figure 2

Background: Limited and inconsistent information exist about how kidney function affects the outcomes of ablation procedures in patients with atrial fibrillation (AF). Therefore, the aim of this study was to investigate the effectiveness and safety of AF ablation in a large national study across groups classified by varying levels of estimated glomerular filtration rates (eGFRs). Methods: The Israeli Catheter Ablation Registry (ICAR) is a prospective, multicenter cohort that includes patients who underwent pulmonary vein isolation (PVI) during the years 2019-2021 for the treatment of AF. Primary study endpoints were the recurrence of AF and the need for repeat ablation at 12 months. Secondary endpoints were rehospitalization and procedural complications after AF ablation. Results: Between January 2019 and December 2021, 1002 AF patients underwent PVI. Baseline creatinine was available in 929 patients, which comprised the study cohort. Of these patients, 226 (24%) had preserved eGFR (>90 mL/min/1.73 m2), 511 (55%) had mildly reduced eGFR (60-89 mL/min/1.73 m2), and 192 (21%) had moderately to severely reduced eGFR (<59 mL/min/1.73 m2). Patients with moderately to severely reduced eGFR were generally older and more likely to be female. There were no clinically meaningful differences in the use of antiarrhythmic medications among the eGFR groups, either before or after PVI. There were no significant differences in 12-month AF recurrence rates among the three study groups: 30%, 32%, and 40% in patients with preserved eGFR, mild, and moderately to severely reduced eGFR, respectively (p = 0.1). The one-year rehospitalization rate was higher in patients with moderately to severely reduced eGFR: 19%, 24%, and 32% in patients with preserved eGFR, mild, and moderately to severely reduced eGFR, respectively (p = 0.01). Periprocedural complications were infrequent across all the eGFR groups. Patients with an eGFR of <30 mL/min/1.73 m2 were underrepresented (<1%), limiting applicability to this group. Conclusions: PVI is a safe and effective procedure that should be considered for CKD patients with AF who are deemed as suitable for the intervention, even in the presence of declined eGFR values. Future studies are still needed to evaluate the safety and effectiveness of the procedure in individuals with severely reduced eGFR or end-stage kidney disease.

Background:Early detection of atrial fibrillation (AF) can prevent AF-related complications. Radiomic analysis of epicardial adipose tissue (EAT) was shown to predict AF recurrence postablation, but only limited data exist regarding left atrial EAT (LA-EAT) radiomic analysis for predicting AF in patients with yet unknown AF. Our aim was to develop prediction model for AF, based on the association of machine learning-based radiomic analysis of LA-EAT and AF. Methods:Retrospective matched case-control study of patients with and without AF, undergoing noncontrast electrocardiographic (ECG)-gated cardiac computed tomography (CT). Segmentation of LA-EAT and extraction of LA-EAT radiomic features were performed using syngo.via Frontier (Siemens Healthineers, Forchheim, Germany). Univariate analysis identified radiomic features associated with AF. Predictive models for AF were developed via logistic regression and machine learning-based random forest analyses. Models were validated on external cohort of patients with 1:1 AF : control ratio and deployed in a real-world setting with an AF : control ratio of 15:85. Results:The study included 280 patients, 120 with documented AF and 160 matched controls. Based on LA-EAT radiomic features, which were significantly associated with AF, logistic regression and random forest models were constructed and tested on separate internal cohort of patients, yielding area under the curve (AUC) of 0.88 and 0.86, respectively, for prediction of AF. External validation verified these results (AUC 0.84 and 0.78, respectively). Both models were further validated in a real-world setting cohort (AUC 0.85 and 0.81, respectively). Conclusions:Models, based on LA-EAT radiomic features extracted from noncontrast ECG-gated cardiac CT, could accurately predict AF, suggesting a potential widespread noninvasive method for predicting the presence of AF. Clinical Registration Number:0281-23-ASF.

Background:Atrial fibrillation (AF) is the most common sustained arrhythmia in adults and is associated with significant morbidity and mortality. Obesity is a known risk factor for AF, but its impact on the success of AF ablation and the risk of recurrence remains inconclusive. Objective:This study evaluated the safety and efficacy of AF ablation across different obesity subgroups. Methods:This prospective, nationwide, multicenter registry study included 878 patients who underwent AF ablation between January 2019 and December 2021. Participants were categorized into nonobese and obesity classes I-III (body mass index [BMI] ≥30 kg/m2) per the World Health Organization classification. Procedural characteristics, clinical outcomes, and adverse events were collected. Primary endpoints were AF recurrence and rehospitalization within 1 year. Results:AF recurrence at 1 year occurred in 23% of patients, with no significant differences among BMI groups. In multivariable analysis, none of the obesity subgroups were independently associated with recurrent AF or need for reablation. Female gender, systolic pulmonary artery pressure, and left atrium size were significant predictors of AF recurrence. Rehospitalization rates were higher in obesity classes I (adjusted hazard ratio 2.2; P = .02) and II (adjusted hazard ratio 3.9; P < .001). Diabetes was also an independent predictor of rehospitalization. Procedural safety was comparable across BMI categories, with no significant differences in major complications. Conclusion:This study suggests that although obesity is associated with a higher rate of rehospitalization, it does not significantly affect the 12-month efficacy or safety of AF ablation. These findings support the continued use of AF ablation in obese patients, regardless of obesity class.