When we recapture the Micra system, we capture the body by pulling the tether attached to the delivery catheter and retrieve it, but sometimes it is difficult, and the Micra is dislodged and fixed in the tricuspid valve annulus. Using a single snare catheter from the superior vena cava and pushing the tines changes the orientation of the device and enables recapture.

The number needed to treat for the net benefit (NNTnet) was calculated from the benefit of stroke prevention and risk of major bleeding of warfarin and non-vitamin K antagonist oral anticoagulants (NOACs) and no oral anticoagulant (OAC). Warfarin had a negative NNTnet compared to no OAC. Only warfarin with TTR 65% has positive NNTnet. NOACs had positive NNTnet compared to no OAC and when compared to warfarin.

ECGi-specific studies for assessment of arrhythmic risk in ischemic heart disease. Studies specifically using ECGi have identified several metrics that may be associated with ventricular arrhythmia risk in patients with ischemic cardiomyopathy. ARI, activation-recovery interval; AT, activation time; ICM, ischemic cardiomyopathy; LV, left ventricle; MI, myocardial infarction; VT, ventricular tachycardia.

Transseptal catheter ablation resolved ventricular arrhythmias originating from the left ventricular outflow tract following transcatheter aortic valve implantation with a self-expanding Evolut valve. This report highlights the transseptal approach as a safe and effective alternative, overcoming the structural complexities of self-expanding valves while reducing procedural risks and preserving valve integrity.

Elderly patients undergoing ICD implantation have multiple comorbidities and competing causes of mortality. Device use is overall infrequent but occurs well before observed mortality.

The case highlights the possibility of nonischemic cardiomyopathy in patients with coronary artery disease and the complex nature of the isthmus with multiple entry and exit points. A combination of multiple strategies, that is, unipolar mapping, isochronal late activation mapping during sinus rhythm, and positioning of a multielectrode catheter at the putative isthmus during VT induction in the case of hemodynamically unstable VT, was used to achieve a successful outcome.

Lesion creation was influenced by blood pool local impedance (BP-LI) in the Stablepoint catheter. Time-fixed and power-fixed protocols showed different linear regressions between LI drop and lesion sizes across three BP-LIs (100, 140, and 180 ohms). Adjusted LI by BP-LI corrected lesion formation prediction among three BP-LIs.

LBBAP resulted in better clinical and echocardiographic response compared with BVP in patients with pacing-induced cardiomyopathy. The superior efficacy of LBBAP in reverse remodeling was dependent on its improved electrical synchrony.

This is the first report describing a shock lead whose functionality can be assessed using TSI measurement, even in cases where shock impedances derived from LVSM exceed 200 Ω. However, the lead exhibited high shock impedance after the DFT test, highlighting the need to monitor it closely.

In the era of cryoablation and pulsed-field ablation, where large sheaths are commonly used, preventing air embolism is crucial. The lid from SL sheath packaging can be repurposed as a water-seal device for catheter insertion, thereby eliminating the need for additional equipment.

Device implantation with a generator pocket raises cosmetic concerns regarding external appearance. We present a case of successful left bundle branch area pacing and left axillary pacemaker generator implantation via a two-incision approach in a young female patient, resulting in favorable cardiac function and cosmetic satisfaction.

This is the case of a 29-year-old female with sudden palpitations due to tachycardia. The atrial activation focusing point (AFP) was presumed to be the atrial entrance site within the reentry circuit of slow/fast atrioventricular nodal reentrant tachycardia by postpacing interval mapping. AFP is a novel ablation site because it is more distal to the His-bundle recording site and more atrial site compared to the conventional SP ablation site.

Female patients hospitalized with complete heart block face higher risks of adverse outcomes, including increased mortality and cardiac events, yet are less likely to receive timely pacemaker implantation compared to male patients. Recognizing female CHB patients as a high-risk group necessitates tailored management and interventions to improve their clinical outcomes.

Adenosine-sensitive atrial tachycardia (AT) is typically associated with a slow conduction zone (SCZ) near the atrioventricular node or tricuspid annulus. We report an unusual case of adenosine-sensitive AT with a SCZ located between the left atrial appendage and the left atrial anterior septum, which was successfully ablated 9.2 mm from the left atrial earliest activation site. This case highlights the importance of advanced mapping and entrainment techniques in the identification and management of rare left-sided SCZ variants of adenosine-sensitive AT.

Pulsed-field ablation (PFA) is safer and more efficient than radiofrequency catheter ablation. Furthermore, PFA is promising in terms of efficacy, especially considering that operators continue to gain experience and further improvements in PFA devices are expected in the future.

HBP and LBBAP were associated with a similar incidence of device-detected new-onset AHRE during a medium-term follow-up period in patients with atrioventricular block and no history of atrial fibrillation.

This study highlights the feasibility and safety of left bundle branch area pacing (LBBAP) in patients with a history of open-heart surgery (OHS). Despite increased technical difficulty, LBBAP achieved comparable success rates in OHS and non-OHS groups, with stable pacing parameters observed over 1 year.

The complex signal identification function of CARTO version 8 enables quantitative evaluation of local potential fractionation. We present a case where this advanced technology successfully identified non-pulmonary vein foci associated with fractionated potentials during sinus rhythm.

To prevent cardiac tamponade caused by catheter tip slippage during the retraction of the protective sleeve in Aveir VR implantation, it is crucial to carefully evaluate not only the bulge of the protective sleeve but also the shape of the system's shaft using fluoroscopic imaging.

The circular-shaped PulseSelect™ PFA catheter has demonstrated comparable efficacy to traditional thermal catheter ablation in achieving pulmonary vein isolation (PVI), while preventing thermally mediated complications. However, this catheter does not have any objective parameters to confirm real-time tissue-catheter contact. We report a case in which PVI was achieved through PFA using optimal biplane fluoroscopic angulations which were more useful for accurately assessing and adjusting the position and rotation of the circular catheter electrodes than the conventional fluoroscopic angulations.

SVC isolation is sometimes difficult because of avoidance of phrenic nerve and sinus node injury. Omnipolar mapping technology (OT) could enhance the efficacy of SVC isolation, requiring fewer RF applications and reducing procedure duration.

This study shows that persAF patients exhibit larger LA and LAA dimensions compared to PAF patients, with no significant differences in LAA morphology. These findings suggest that preprocedural analysis of anatomical dimensions, rather than LAA shape, could play a more important role in guiding personalized ablation strategies, particularly for complex AF cases.

This study reports the efficacy and safety of intrinsic antitachycardia pacing (iATP) for ventricular tachycardia (VT) not terminated by the first ATP sequence, compared to conventional ATP. In the analysis of Sequence 2 and beyond, the iATP group demonstrated a higher VT termination rate and a lower acceleration rate.

Our results identified disparities in gastrointestinal bleed mortality among decedents with atrial fibrillation, emphasizing the importance of public health measures to mitigate healthcare inequities.

Successful catheter ablation (CA) can improve exercise tolerance and quality of life (QOL) in patients with atrial fibrillation (AF); however, its differential effects on muscle strength between paroxysmal AF (PAF) and nonparoxysmal AF (Non-PAF) remain unclear. Successful CA improved QOL and exercise tolerance in both PAF and Non-PAF patients, with additional improvements in leg strength observed in Non-PAF patients.

Anticoagulation with direct thrombin inhibitors was a reasonable periprocedural anticoagulation regimen to reduce periprocedural complications in atrial fibrillation ablation.

CKD-related CA mortality rates have remained stable with temporary rise in the early 2010s. Disparities in CKD-related CA mortality were observed among gender, racial/ethnic, socioeconomic status, and geographic subpopulations

Critical analysis of electrograms of any therapy delivery event is paramount to identify the etiology, specificity, and sensitivity of the programmed algorithms to differentiate supraventricular versus ventricular tachycardia, its effectiveness, and potential interventions to prevent recurrence. Besides the aspects mentioned above, this case delves into the potential limitations of existing algorithms and the adverse effects of anti-tachycardia pacing.

With routine available clinical variables, we have developed a calculator for the individualized survival probability in contemporary CRT-D recipients with good discrimination and excellent calibration performance.

A video demonstration presents the retrieval of a dislodged leadless pacemaker using the double-snare technique. Sharing troubleshooting strategies in such cases is clinically important for managing rare pacemaker complications.

We report a case of long RP′ tachycardia diagnosed as fast–slow atrioventricular nodal reentrant tachycardia (AVNRT) with a bystander nodoventricular pathway (NVP). Differential responses to right ventricular extrastimuli from the base and apex highlighted the anatomical proximity of the NVP attachment, contributing to the diagnosis.

In this sub-analysis of the ETNA-AF registry on Asian patients, the low clinical event rates in two-year follow-up reassure the effectiveness and safety of edoxaban in routine care for AF patients in Taiwan, South Korea, Hong Kong, and Thailand.

This meta-analysis of 16 studies examined the timing of leadless pacemaker implantation during CIED extraction for infections. While simultaneous implantation shows a low risk of reinfection, it is associated with higher all-cause mortality, and careful consideration of the timing of implantation is recommended.

Current guidelines recommend cardioverter-defibrillator (ICD) programming, including faster detection rates, longer detection durations, and strict discrimination for supraventricular tachycardia (SVT) to prevent unnecessary ICD treatment. This delayed-style ICD programming could lead to a rise in the possibility of VF undersensing. To avoid this risk, an innovative algorithm known as VF Therapy Assurance (VFTA; Abbott, Sylmar, CA) has been developed. VFTA uses far-field R-wave signals during VT or VF episodes to provide ICD therapy in cases of near-field R-wave signal undersensing.

For both appropriate and inappropriate therapy, the risk of a subsequent ICD therapy is significantly elevated following the 1st therapy. An approach combining treatment strategies may be more effective than using single strategies alone to prevent subsequent therapy in patients presenting following a 1st ICD therapy.

A structured preprocedural imaging protocol integrated into the invasive mapping system may improve both safety and long-term efficacy, with NICM patients exhibiting outcomes comparable to those with ICM.

This study demonstrated the feasibility and safety of using high-density mapping catheters during atrial fibrillation ablation in the Asia Pacific region, highlighting efficient mapping strategies with low adverse events across 200 patients.

The clinical significance of premature ventricular contractions (PVCs) and nonsustained ventricular tachycardia (NSVT) without structural heart disease remains unclear. The presence of NSVT was associated with heart failure hospitalization.

The Up to AF trial evaluates Apple Watch-guided personalized anticoagulation therapy for atrial fibrillation (AF), adjusting DOAC use based on real-time AF detection. In this single-arm study, 50 post-ablation patients are monitored, aiming to reduce DOAC days while assessing mortality, stroke, and bleeding events. Results are expected in 2025.

Radiofrequency lesions were created using double applications (DA) with a 6 mm inter-lesion distance (ILD) and inter-lesion times (ILT) of 60, 10, 5, and 0 s. Shorter ILT groups (10, 5, 0 s) showed significantly deeper intermediate lesion depth than the 60 s group, suggesting involvement of the conductive thermal effect.

A 17-year-old patient presented with frequent palpitations, where the tachycardia was not sustained and could not be induced, making it impossible to pinpoint the earliest activation site using the activation map. However, by utilizing a dual-chamber electrogram-based pace mapping technique, we successfully identified the origin and achieved effective treatment.

Prolonged QTc was associated with increased risk of HCM-related mortality, including sudden death or lethal arrhythmias, and could serve as a simple, practical marker for identifying high-risk patients. Our findings suggest that QTc prolongation is also valuable in Japanese populations, supporting its use in guiding personalized treatment strategies.

Our meta-analysis found that patients undergoing AF ablation with malnutrition (GNRI <98) had a significantly higher risk of AF recurrence after the procedure (Pooled RR = 2.74, 95% CI 1.36–5.51, I² = 67%, p = .005).

This study describes the demographic, clinical, therapeutic, and 12-month outcome differences between male and female patients in the Kerala-AF registry. AF—Atrial Fibrillation. *Missing anticoagulation is defined as the absence of anticoagulation therapy despite an elevated CHA₂DS₂-VASc score.

With the cases of mechanical valves, especially double mitral and aortic valves, ablation at the left ventricle is very challenging. This case report used equipments that are readily available in the Electrophysiology laboratory, which can make the access feasible.

Patients with paroxysmal atrial fibrillation had significantly increased odds ratio for poor sleep quality, as evaluated with the Pittsburgh Sleep Quality Index. In contrast, those with persistent or permanent atrial fibrillation did not have significant odds ratio for poor sleep quality.

Hyperpolypharmacy was significantly associated with clinical outcome in patients who underwent cardiac resynchronization therapy. Noncardiovascular (CV) polypharmacy, but not CV polypharmacy, may be related to the adverse effects of hyperpolypharmacy.

The First-pass isolation (FPI) group had a significantly greater impedance drop compared to the non-FPI group, with cut-off values of 13.5 ohms for the LPV and 14.5 ohms for the RPV.

Carbon dioxide injection through coronary vein puncture can greatly reduce complications from epicardial access. We reported a case of ventricular tachycardia that was successfully ablated by this procedure under ECMO support.

Left atrial posterior wall (LAPW) residual potentials via epicardial connections during LAPW isolation are often low-frequency continuous potentials. Accurate annotation of these residual potentials by three-dimensional electroanatomical mapping systems is challenging and can be misleading. Herein, we present a case of successful LAPW isolation using peak frequency analysis.

Atrial myocarditis characterized by granulomatous inflammation typical of sarcoidosis or tuberculosis, can be a cause of atrial fibrillation in young patients who don't exhibit classical risk factors. It can present with extracardiac features such as lymphadenopathy and stroke. This emphasizes the importance of recognizing and managing the underlying inflammatory condition.