Pulsed field ablation (PFA) has emerged as a novel, non-thermal energy source to selectively ablate cardiac tissue. We describe a multicentre experience on pulmonary vein isolation (PVI) via the pentaspline Farapulse™ PFA system vs. thermal-based technologies in a propensity score-matched population of paroxysmal atrial fibrillation (PAF) patients. Propensity score matching was adopted to compare PVI-only ablation outcomes via the Farawave™ system (Group PFA), cryoballoon (Group CRYO), or focal radiofrequency (Group RF) (PFA:CRYO:RF ratio = 1:2:2). Among 1572 (mean age: 62.4 ± 11.3 years; 42.5% females) PAF patients undergoing first time PVI with either PFA (n = 174), CRYO (n = 655), or RF (n = 743), propensity score matching yielded 174 PFA, 348 CRYO, and 348 RF patients. First-pass isolation was achieved in 98.8% of pulmonary veins (PVs) with PFA, 81.5% with CRYO, and 73.1% with RF (P < 0.001). Procedural and dwell times were significantly shorter with PFA, whereas the availability of a 3D mapping system led to a significant reduction in X-ray exposure with RF. Overall complication rates were 3.4% (n = 6) with PFA, 8.6% (n = 30) with CRYO, and 5.5% (n = 19) with RF (P = 0.052). The 1-year Kaplan–Meier estimated freedom from any atrial tachyarrhythmia was 79.3% with PFA, 74.7% with CRYO, and 72.4% with RF (log-rank P-value: 0.24). Among 145 repeat ablation procedures, PV reconnection rate was 19.1% after PFA, 27.5% after CRYO, and 34.8% after RF (P = 0.01). Pulsed field ablation contributed to significantly shorter procedural times. Follow-up data showed a similar arrhythmia freedom, although a higher rate of PV reconnection was documented in post-CRYO and post-RF redo procedures.

BACKGROUND: The safety and efficacy of pulsed field ablation for pulmonary vein and posterior wall isolation in atrial fibrillation ablation are well established; however, evidence regarding its use in extra-pulmonary vein areas remains limited. The aim of this study was to assess the feasibility and durability of pulsed field ablation for coronary sinus (CS) and left atrial appendage (LAA) isolation and mitral isthmus (MI) ablation. METHODS: We analyzed data from consecutive patients who underwent repeat atrial fibrillation ablation with pulsed field ablation between February and October 2024. MI ablation, CS isolation, and LAA isolation were attempted in all patients using the Farapulse (Boston Scientific) ablation system. Acute isolation was assessed after a 20-minute waiting period and an adenosine challenge, while chronic durability was evaluated during a repeat procedure for LAA closure at 3 months. RESULTS: A total of 236 patients (145, 61.4% male) were included in our analysis. Acute CS isolation was achieved in 147 (62.2%) patients for the CS and in all patients for the LAA. Acute MI block was obtained in all patients. After a 20-minute waiting time, the adenosine challenge revealed dormant conduction in 52 (26.4%) cases for the CS, in 4 (1.7%) for the LAA, and MI block regression in 35 (14.8%). All patients underwent remapping at the time of left atrial appendage occlusion, which showed CS and LAA isolation in only 3 (1.3%) and 10 (4.6%) patients, respectively, and MI block in 13 (5.5%) cases. CONCLUSIONS: Pulsed field ablation is a feasible and acutely effective method for CS and LAA isolation and MI block; however, lesion durability remains a significant limitation.

Pulsed-field ablation (PFA) is a novel, myocardial-selective, non-thermal ablation modality used to target cardiac arrhythmias. Although prompt electrogram (EGM) signal disappearance is observed immediately after PFA application in the pulmonary veins, whether this finding results in adequate transmural lesions is unknown. The aim of this study is to check whether application repetition and catheter–tissue contact impact lesion formation during PFA. A circular loop PFA catheter was used to deliver repeated energy applications with various levels of contact force. A benchtop vegetal potato model and a beating heart ventricular myocardial model were utilized to evaluate the impact of application repetition, contact force, and catheter repositioning on contiguity and lesion depth. Lesion development occurred over 18 h in the vegetal model and over 6 h in the porcine model. Lesion formation was found to be dependent on application repetition and contact. In porcine ventricles, single and multiple stacked applications led to a lesion depth of 3.5 ± 0.7 and 4.4 ± 1.3 mm, respectively (P = 0.002). Furthermore, the greater the catheter–tissue contact, the more contiguous and deeper the lesions in the vegetal model (1.0 ± 0.9 mm with no contact vs. 5.4 ± 1.4 mm with 30 g of force; P = 0.0001). Pulsed-field ablation delivered via a circular catheter showed that both repetition and catheter contact led independently to deeper lesion formation. These findings indicate that endpoints for effective PFA are related more to PFA biophysics than to mere EGM attenuation.

Pediatric cardiomyopathies (CMs) and electrical diseases constitute a heterogeneous spectrum of disorders distinguished by structural and electrical abnormalities in the heart muscle, attributed to a genetic variant. They rank among the main causes of morbidity and mortality in the pediatric population, with an annual incidence of 1.1–1.5 per 100,000 in children under the age of 18. The most common conditions are dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM). Despite great enthusiasm for research in this field, studies in this population are still limited, and the management and treatment often follow adult recommendations, which have significantly more data on treatment benefits. Although adult and pediatric cardiac diseases share similar morphological and clinical manifestations, their outcomes significantly differ. This review summarizes the latest evidence on genetics, clinical characteristics, management, and updated outcomes of primary pediatric CMs and electrical diseases, including DCM, HCM, arrhythmogenic right ventricular cardiomyopathy (ARVC), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), long QT syndrome (LQTS), and short QT syndrome (SQTS).

Background: Artificial intelligence (AI) is poised to significantly impact the future of cardiology and electrophysiology, offering new tools to interpret complex datasets, improve diagnosis, optimize clinical workflows, and personalize therapy. ChatGPT-4o, a leading AI-based language model, exemplifies the transformative potential of AI in clinical research, medical education, and patient care. Aim and Methods: In this paper, we present an exploratory dialogue with ChatGPT to assess the role of AI in shaping the future of cardiology, with a particular focus on arrhythmia management and cardiac electrophysiology. Topics discussed include AI applications in ECG interpretation, arrhythmia detection, procedural guidance during ablation, and risk stratification for sudden cardiac death. We also examine the risks associated with AI use, including overreliance, interpretability challenges, data bias, and generalizability. Conclusions: The integration of AI into cardiovascular care offers the potential to enhance diagnostic accuracy, tailor interventions, and support decision-making. However, the adoption of AI must be carefully balanced with clinical expertise and ethical considerations. By fostering collaboration between clinicians and AI developers, it is possible to guide the development of reliable, transparent, and effective tools that will shape the future of personalized cardiology and electrophysiology.