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.

Aims: Pulsed Field ablation (PFA) is a non-thermal ablation modality with functional myocardial sparing. Recent evidence suggests that clinically used PFA systems may produce non-negligible thermal effects, particularly at the tissue-catheter interface, potentially increasing the risk of thrombo-embolic complications. This study sought to characterize the temperature dynamics of two PFA pulse waveforms, delivered using a variable-loop circular catheter, under different irrigation conditions. Methods and results: In total, 132 ablations were performed on 31 bovine myocardial tissue specimens, using Sequence_1 and Sequence_2 at two different irrigation rates—4 and 30 mL/min. Maximum temperatures and their rise from baseline were measured at the tissue surface, and at 3 and 7 mm depths, across different ablation conditions. Sequence_1 at 4 mL/min produced the highest surface temperature (56.4°C [54.9–58.4]) and temperature rise (ΔT: 19.4°C [17.9–21.4]). Sequence_2 at 30 mL/min showed the most favourable thermal profile, with significantly lower surface temperatures (40.8°C [37.9–43.0], ΔT: 3.8°C [0.9–6.0], P < 0.0001). At 3 mm depth, temperature increases were reduced for all settings, but remained highest with Sequence_1 at 4 mL/min (42.5°C, ΔT: 5.5°C). At 7 mm depth, temperatures remained close to baseline. Both waveform and irrigation optimization independently and synergistically reduced tissue heating, with the Sequence_2 at 30 mL/min achieving the lowest thermal load at all depths. Conclusion: This study confirms that PFA can induce relevant thermal effects, especially at the tissue interface. However, waveform optimization and active cooling significantly mitigate these effects. Such strategies to minimize thermal effects should be implemented in clinical practice to enhance procedural safety.

Atrial fibrillation (AF), the most prevalent tachyarrhythmia worldwide, is a complex condition influenced by genetic, structural, and environmental factors. While AF in the elderly is often associated with underlying cardiac disease, early-onset or “lone” AF (LAF) exhibits a stronger genetic predisposition. Studies have identified both monogenic and polygenic contributors to AF risk. Monogenic mutations, inherited in Mendelian patterns, often affect ion channels and regulatory proteins, while polygenic variants modulate susceptibility and interact with environmental factors. Genome-wide association studies (GWAS) and exosome-wide association studies (ExWAS) have expanded our understanding of AF genetics, identifying numerous susceptibility loci, though challenges remain in linking these variants to specific molecular mechanisms. Pathophysiologically, AF results from a balance of triggers, drivers, and substrates. Triggers, such as ectopic foci in the pulmonary veins, initiate AF episodes, while structural and electrical remodeling perpetuates the arrhythmia. Fibrosis, atrial dilation, and tachycardia-induced remodeling promote reentry circuits and irregular conduction, increasing AF vulnerability. The interplay between genetic predisposition and remodeling processes underscores the complexity of AF maintenance, particularly in persistent AF forms. Emerging insights into AF genetics and pathophysiology highlight the need for personalized approaches to its prevention and management. Understanding genetic risk, combined with targeted therapies addressing structural and electrical remodeling, holds promise for improved patient outcomes. Future research into AF’s molecular and genetic mechanisms will be key to advancing precision medicine in this field.

Background: There are limited effective treatment options for persistent atrial fibrillation (AF) patients, with pulmonary veins (PV) isolation alone being considered suboptimal for many patients. Hybrid convergent ablation has been shown to improve clinical outcomes when compared to an endocardial-only radiofrequency (RF) strategy. Pulsed field ablation (PFA) has recently gained growing interest for its efficacy and safety profile in PV and posterior wall (PW) ablation. Objectives: To compare clinical outcomes of hybrid convergent RF ablation versus endocardial PFA for PV and PW isolation in patients with persistent AF. Methods: From July 2022, 86 persistent AF consecutive patients, receiving endocardial PFA of PV and PW (PFA group, N = 44) or receiving hybrid convergent RF ablation (Hybrid group, N = 42) at our institution were enrolled. Recurrence was defined as any atrial tachyarrhythmia following the 3-month blanking period. Results: No differences were found between PFA and Hybrid groups regarding age (PFA 66.0±7.4 years vs Hybrid 63.9±10.6 years; p=0.193) and left atrial volume index (PFA 45.5 [36.7-57.2] ml/m² vs Hybrid 45.0 [39.2-59.7] ml/m²; p=0.920). Differences regarding left ventricular ejection fraction were borderline significant among groups (PFA 55.0 [49.5-62.0]% vs Hybrid 60.5 [52.3-65.0]%; p=0.048), both showing an overall normal LV function. There were no significant differences regarding AF duration (PFA 38.0 months [IQR: 19.2 to 99.0 months] vs Hybrid 70.0 months [IQR: 46.0 to 118.0 months]; p = 0.063). Redo ablation patients’ rate was higher in the hybrid group (PFA n=16, 36.4% vs Hybrid n=28, 66.6%; p<0.001). Procedure duration was Ionger in the hybrid group (179.9±60.1 minutes) compared to PFA endocardial ablation (PFA 106.2±30.7 minute; p<0.01). After a median follow-up of 233.0 [179.0–331.8] days, there was no difference in atrial tachyarrhythmias recurrence rate (PFA n=11, 25.0% vs Hybrid n=10, 23.8%; p=0.897); no difference in the antiarrhythmic drug use rate was found (PFA n=24, 54.5% vs Hybrid n=19, 45.2%; p=0.388). Conclusions: PFA of PV and PW, compared with the hybrid convergent ablation strategy, is an endocardial-only, less invasive, and faster procedure. 6-month rhythm outcomes were similar in both groups.