Aims: A novel three-dimensional mapping platform combined with a lattice-tip catheter that can toggle between monopolar pulsed field ablation (PFA) and radiofrequency energy delivery was recently launched. So far, the system was predominantly applied in general anaesthesia (GA), not in deep sedation. Methods and results: Patients with symptomatic paroxysmal or persistent atrial fibrillation (AF) were enrolled, and pulmonary vein isolation (PVI) and ablation of additional linear lesion sets were performed either in GA or in deep sedation. Pulsed field ablation was applied exclusively to perform ipsilateral PVI. A total of 63 patients (35% female, 75% persistent AF, mean age 64 ± 9 years) were included in the analysis with 23 patients treated in GA and 40 patients in deep sedation. Acute efficacy was comparable in both groups with a PVI rate of 100%. Additional 74 lesion sets were performed in the total cohort. Mean procedure and lab occupancy time in the GA and deep sedation group was 96 ± 24 min vs. 100 ± 23 min (P = 0.52) and 165 ± 40 min vs. 131 ± 35 min (P = 0.0008). Mean dose area product was 489 (216;1093) vs. 452 (272;882) cGycm2 in the GA and the deep sedation group (P = 0.82). There was one conversion from deep sedation to GA. There were no map shifts observed in any group. Pericardial tamponade occurred in one patient of the deep sedation group. Conclusion: The use of a novel ablation platform in conjunction with a lattice-tip catheter in deep sedation is feasible, effective, and associated with significantly shorter lab occupancy time when compared with GA.

Aims: Optimal outcomes for patients with cardiac arrhythmias can be achieved through multimodal therapy including lifestyle support, medication, and interventions. Planning of these therapy concepts requires a detailed understanding of phenotypes, responses to therapies, and outcomes. Objective: The prospective Long-term Outcome and Predictors for Recurrence after Medical and Interventional Treatment of Arrhythmias at the University Heart Center Hamburg (TRUST) combines deep phenotypic, procedural, and follow-up information in a contemporary cohort of patients with cardiac arrhythmias. Methods and results: TRUST is an investigator-initiated, prospective, cohort study enrolling consecutive patients at the UHZ Hamburg. Comprehensive baseline work-up, imaging, and biobanking at baseline is combined with follow-up using a combination of in-person visits, online questionnaires, and remote rhythm-monitoring. Enrolment started in March 2021 and is ongoing. This paper describes the design and the clinical characteristics of the first 1500 enrolled patients with verified baseline datasets (562 women (37%), median age 64 (IQR 55, 74) years). Overall, 1077/1500 patients (71%) were seen for atrial fibrillation, 161/1500 (11%) for ventricular tachycardia and premature ventricular complexes, 239/1500 (16%) for supraventricular tachycardia, and 23/1500 (2%) patients for other reasons. Ablations, rhythm surgery, or invasive procedures were performed in 1363/1500 (91%) within 1 month after inclusion. Conclusion: This snapshot of the first 1500 patients enrolled in TRUST illustrates current characteristics and comorbidity burden in patients undergoing arrhythmia treatment. This rich data set will provide information on treatment patterns, detailed phenotypes, and follow-up, offering insights into the natural progression and treatment responses of arrhythmias in routine care.

Background: Malignant cardiac tumours are rare entities that cause severe morbidity and mortality. Possible treatment options vary between surgical removement, (immuno-) chemotherapy, and palliative care, whilst diagnostic workup comprises of imaging and histopathology analysis. Excimer laser sheaths are a new possibility to extract significant tissue samples to offer adequate treatment.Case summary: A 67-year-old Caucasian female presented with progressive shortness of breath, new onset of fevers, weight loss, and recurrent night sweats. She showed signs of upper venous stasis.Cardiac imaging revealed an obstructive, hypoperfused right atrial mass superior to the tricuspid valve and a sessile structure at the mitral valve. Guideline-directed therapy for endocarditis was started subsequently.A conventional intracardiac biopsy of the tumour was unsuccessful, but an off-label approach using an excimer laser sheath as bioptome leads to the diagnosis of a diffuse large B-cell lymphoma. Immuno-chemotherapy was commenced, leading to reduction in tumour size and rapid improvement in the quality of life.Discussion: Intracardiac biopsies are an important piece of the puzzle in the diagnostic workup of cardiac neoplasms. This case report is the first description of the utilization of a laser lead extraction tool as a bioptome for intracardiac tumours. Two imaging modalities (echocardiogram, fluoroscopy), as well as the precise technique of the excimer laser, ensured safety for the patient. Clinical studies are paramount to further evaluate the laser sheath as a possible new instrument in the toolbox of an interventional cardiologist.

Background: The incidence of cardiac implantable electronic device (CIED)-related complications, as well as the prevalence of obesity, is rising worldwide. Transvenous laser lead extraction (LLE) has grown into a crucial therapeutic option for patients with CIED-related complications but the impact of obesity on LLE is not well understood. Methods and Results: All patients (n = 2524) from the GermAn Laser Lead Extraction RegistrY (GALLERY) were stratified into five groups according to their body mass index (BMI, <18.5; 18.5–24.9; 25–29.9; 30–34.9; ≥35 kg/m²). Patients with a BMI ≥ 35.0 kg/m² had the highest prevalence of arterial hypertension (84.2%, p < 0.001), chronic kidney disease (36.8%, p = 0.020) and diabetes mellitus (51.1%, p < 0.001). The rates for procedural minor (p = 0.684) and major complications (p = 0.498), as well as procedural success (p = 0.437), procedure-related (p = 0.533) and all-cause mortality (p = 0.333) were not different between groups. In obese patients (BMI ≥ 30 kg/m²), lead age ≥10 years was identified as a predictor of procedural failure (OR: 2.99; 95% CI: 1.06–8.45; p = 0.038). Lead age ≥10 years (OR: 3.25; 95% CI: 1,31–8.10; p = 0.011) and abandoned leads (OR: 3.08; 95% CI: 1.03–9.22; p = 0.044) were predictors of procedural complications, while patient age ≥75 years seemed protective (OR: 0.27; 95% CI: 0.08–0.93; p = 0.039). Systemic infection was the only predictor for all-cause mortality (OR: 17.68; 95% CI: 4.03–77.49; p < 0.001). Conclusions: LLE in obese patients is as safe and effective as in other weight classes, if performed in experienced high-volume centers. Systemic infection remains the main cause of in-hospital mortality in obese patients.