Choi SS, et al. Korean Circ J. 2025 Apr;55:e74. https://doi.org/10.4070/kcj.2024.0411

Background and Objectives: Pulsed field ablation (PFA) and cryoballoon ablation (CRYO) are established approaches for pulmonary vein isolation in atrial fibrillation (AF). Given emerging concerns regarding hemolysis following PFA, this pilot study aims to directly compare outcomes between these modalities. This study aims to evaluate differences in laboratory parameters potentially compatible with hemolysis and procedural safety between PFA and CRYO among AF patients. Materials and Methods: In this retrospective single-center analysis, 33 symptomatic AF patients underwent either PFA (n = 17) or CRYO (n = 16). Hemoglobin, hematocrit, platelet count, total bilirubin and renal function were measured at all three pre-specified time points: baseline, immediately after ablation and on day 1. Group × time interactions were tested with linear mixed-effects models, and changes are reported with 95% confidence intervals (CIs). Acute kidney injury (AKI) was defined by KDIGO serum creatinine criteria and assessed individually; sensitivity analyses were restricted to pulmonary-vein-isolation (PVI)-only procedures. Additionally, procedural metrics and complication frequencies were analyzed between groups. Results: The baseline demographics and clinical characteristics did not differ significantly between both groups. Both ablation techniques led to substantial reductions in hemoglobin following the procedure, with no between-group difference (day-1 change −1.84 vs. −1.57 g/dL; difference −0.27, 95% CI −1.01 to +0.47; group × time p = 0.192). Notably, total bilirubin increased to a greater extent with PFA (day-1 change +0.48 vs. +0.15 mg/dL; difference +0.33, 95% CI +0.06 to +0.59; group × time p = 0.003), with the largest separation immediately after ablation (1.43 ± 0.36 vs. 0.99 ± 0.35 mg/dL, p = 0.001). No patient in either group met KDIGO criteria for AKI of any stage; the largest post-procedural rise in creatinine was +0.10 mg/dL in both groups. Conclusions: Both PFA and CRYO caused acute declines in hemoglobin, and total bilirubin rose more after PFA, with no accompanying change in renal function. Further studies involving larger cohorts and direct hemolysis biomarkers are necessary to corroborate these findings.

Background: Cardiac dextroposition involves a rightward shift of a normally configured heart, setting it apart from mirror-image dextrocardia. This anatomical variant can alter typical thoracic relationships, rendering conventional fluoroscopic reference points unreliable and increasing the complexity of electrophysiological procedures. Case summary: A 57-year-old man was admitted following an out-of-hospital ventricular fibrillation arrest attributed to pre-excited atrial fibrillation. Chest radiography identified rightward displacement of the heart’s silhouette. Further diagnostic imaging confirmed cardiac dextroposition without abnormalities in atrioventricular or great-vessel orientation, thus distinguishing it from mirror-image dextrocardia. Electrophysiological study revealed that mapping the anteroseptal accessory pathway was complicated by altered fluoroscopic landmarks. Successful radiofrequency ablation was achieved with the aid of three-dimensional electroanatomical mapping and intracardiac echocardiography, resulting in the elimination of pre-excitation without causing atrioventricular nodal injury. Discussion: The integration of advanced imaging modalities facilitated accurate localization and ablation, despite the abnormal cardiac position. This case demonstrates that even in the setting of significant anatomical displacement, safe and effective ablation of anteroseptal pathways can be accomplished through the application of multimodal mapping techniques.

(1) Background: Moderate-intensity statin therapy, when compared to high-intensity statin therapy in Asian populations, has shown no significant difference in cardiovascular prognosis in small studies. The aim of this study was to compare the prognosis of patients based on statin intensity following rotational atherectomy (RA) during high-complexity percutaneous coronary intervention (PCI). (2) Methods: The ROCK registry, a multicenter retrospective study, included patients who had undergone rotational atherectomy (RA) during percutaneous coronary intervention (PCI) at nine tertiary medical centers in South Korea between January 2010 and October 2019. The patients were divided into high-intensity statin (H-statin) and moderate/low-intensity statin (M/L-statin) therapy groups. The primary endpoint includes outcomes (cardiac death, target vessel myocardial infarction (MI), and target vessel revascularization (TVR)) within an 18-month follow-up period. (3) Results: In this registry, a total of 540 patients with 583 lesions were included. We excluded 39 lesions from the analysis due to the absence of statin usage. The H-statin group had 394 lesions and the M/L-statin group had 150 lesions. There were no significant differences in baseline characteristics, procedural adverse events without heart failure history, triglycerides, or medications between the two groups. The procedural success rate showed a significant difference between the two groups. Multivariate analysis did not show a significant association between M/L-statin therapy and an increased risk of the primary endpoint. In propensity score matching analysis, no significant difference was observed in the primary endpoint either. (4) Conclusions: In high-complex RA PCI, moderate/low-intensity statin therapy is not inferior to high-intensity statin therapy in Korea.

Kim K, et al. Int J Arrhythm. 2025 Aug;26:e5. https://doi.org/10.18501/ija.2025.26.e5

(1) Background: Atrial fibrillation (AF) is the most common arrhythmia and poses a clinical dilemma in the very elderly due to increased thromboembolic and bleeding risks. This study aimed to evaluate clinical outcomes—including thromboembolic events, major bleeding, and all-cause mortality—by age group in elderly East Asian patients with non-valvular AF receiving oral anticoagulants. (2) Methods: This retrospective single-center study included 502 patients aged ≥70 years treated with direct oral anticoagulants (DOACs: dabigatran, rivaroxaban, edoxaban, or apixaban) or warfarin between 2016 and 2024. Patients were stratified into two age groups: 70–79 and ≥80 years. The primary outcomes were ischemic stroke, systemic thromboembolism, and major bleeding. (3) Results: Although patients aged ≥80 years showed a numerically higher incidence of bleeding in both the DOAC and warfarin groups, these differences were not statistically significant after multivariable adjustment (DOAC group: HR 0.832; 95% CI, 0.456–1.518; p = 0.549; warfarin group: HR 3.617; 95% CI, 0.600–21.804; p = 0.161). Ischemic and thromboembolic event rates were also comparable between age groups. (4) Conclusions: Despite a numerically higher bleeding risk in the very elderly, DOACs remained safe and effective when appropriately managed. These findings support individualized anticoagulation decisions based on clinical factors rather than age alone in elderly East Asian patients with AF.