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.

Background: Psoriasis is linked to an increased risk of atrial fibrillation (AF). However, data on the electrophysiological substrate and outcomes of AF ablation in patients with psoriasis are lacking. Methods: We conducted a retrospective, multicenter study involving 48 patients with psoriasis (median age, 66 years [56–72]; 79% male) and paroxysmal (n=25.52%) or persistent AF (n=23.48%) who underwent ablation at 4 high‐volume institutions between 2018 and 2023. Propensity score‐matching identified 96 controls without psoriasis undergoing AF ablation at the same institutions. The primary end point was survival free from atrial tachyarrhythmia recurrence after an 8‐week blanking period. Results: Baseline clinical characteristics were well balanced between groups. However, patients with psoriasis had higher CRP (C‐reactive protein) than controls (0.85 mg/dL [0.45–1.2] versus 0.3 mg/dL [0.3–0.4], P <0.001) and a greater burden of left atrial low‐voltage regions at electroanatomical mapping (20% [11%–20%] versus 5% [5%–10%]; P =0.013). Over a median follow‐up of 20 (13–32) months, atrial tachyarrhythmia recurrence occurred in a higher proportion of patients with psoriasis (40% versus 24%, log‐rank P =0.023). Patients with psoriasis also had a slightly higher risk of acute coronary syndrome (log‐rank P =0.045), with similar risks of death (log‐rank P =0.517) and procedural complications (2% versus 2%, P =1.000), whereas no stroke occurred. Multivariable analysis identified early recurrence within blanking period (adjusted hazard ratio [aHR], 5.9, P <0.001), preablation CRP levels (aHR, 1.2, P =0.016), and psoriasis history (aHR, 2.2, P =0.046) as predictors of atrial tachyarrhythmia recurrence. In the group with psoriasis, the optimal CRP cutoff associated with atrial tachyarrhythmia recurrence was found to be 1 mg/dL. Conclusions: Psoriasis is associated with low‐grade systemic inflammation, more severe electroanatomical markers of atrial cardiomyopathy, and worse postablation outcomes. The association between CRP levels and rhythm outcomes suggests that inflammation may drive recurrences among patients with psoriasis undergoing AF ablation.

Background: Cardiac amyloidosis (CA) has been associated with an increased risk of atrial arrhythmias and development and worsening of heart failure due to infiltration of the amyloid protein in the atrial wall. Few data exist regarding prognosis, symptoms, and quality of life after catheter ablation of atrial fibrillation in this category of patients. Objective: The study evaluates the outcome of hospitalization for heart failure and quality of life in cardiac amyloidosis patients with atrial fibrillation after catheter ablation. Methods: This is a study including 102 consecutive patients from two different centers with an established diagnosis of amyloidosis ATTR that underwent their first AF catheter ablation for persistent AF. They underwent pulmonary vein (PV) isolation + isolation of left atrial posterior wall and superior vena cava. Additionally, extrapulmonary triggers were identified and ablated. Post procedure, patients were followed up routinely with ECG during office visits, 7-day Holter monitor and event recorders during the first year followed by biannual checkups during the remaining part of the follow-up period. Quality of life (QoL) was measured using The Minnesota Living Heart Failure Questionnaire (MLHFQ) before Catheter ablation and after 18 months follow up; QoL was compared with T-test. Results: 102 patients (mean age 72 ± 6) were included in the study. After 18 months follow up, 72 patients (70.6%) remained arrhythmia-free without antiarrhythmic drugs (Group 1), whereas 30 patients (29.4%) experienced recurrence (Group 2). In Group 1, 9 patients were hospitalized for heart failure, in contrast to 18 patients in Group 2, indicating a higher rate of heart failure hospitalizations associated with arrhythmia recurrence (p=0.02). The Quality of life in group 1 was 62 ±12 points before ablation and 63±16 points at 18 months follow up (p=0.17) while in group 2 was 68±16 points before ablation and 86±12 points at 18 months follow up (p<0.001). Conclusion: Catheter ablation for AF in patients with cardiac amyloidosis is associated with reduced hospitalizations for heart failure, along with improvement in QoL.