1. Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, et al. 2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022;43:3997–4126. https://doi.org/10.1093/ eurheartj/ehac262 This document presents an update of the 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death.
2. Marrouche NF, Wazni O, McGann C, Greene T, Dean JM, Dagher L, et al. Effect of MRI-guided fibrosis ablation vs conventional catheter ablation on atrial arrhythmia recurrence in patients with persistent atrial fibrillation: the DECAAF II randomized clinical trial. JAMA 2022;327:2296–2305. https://doi.org/10.1001/jama.2022.8831 Among patients with persistent atrial fibrillation (AF), MRI-guided fibrosis ablation plus pulmonary veins isolation (PVI), compared with PVI catheter ablation only, resulted in no significant difference in atrial arrhythmia recurrence. Findings do not support the use of MRI-guided fibrosis ablation for the treatment of persistent AF.
3. Cerrone M, Marrón-Liñares GM, van Opbergen CJM, Costa S, Bourfiss M, Pérez-Hernández M, et al. Role of plakophilin-2 expression on exercise-related progression of arrhythmogenic right ventricular cardiomyopathy: a translational study. Eur Heart J 2022;43:1251–1264. https://doi.org/10.1093/eurheartj/ehab772 We speculate that exercise challenges a cardiomyocyte “desmosomal reserve” which, if impaired genetically (e.g., PKP2 loss), accelerates progression of cardiomyopathy.
4. Protonotarios A, Bariani R, Cappelletto C, Pavlou M, García-García A, Cipriani A, et al. Importance of genotype for risk stratification in arrhythmogenic right ventricular cardio– myopathy using the 2019 ARVC risk calculator. Eur Heart J 2022;43:3053–3067. https://doi.org/10.1093/eurheartj/ehac235 The 2019 Arrhythmogenic right ventricular cardiomyopathy (ARVC) risk model performs reasonably well in gene-positive ARVC (particularly for plakophilin-2) but is more limited in gene-elusive patients. Genotype should be included in future risk models for ARVC.
5. Tung R, Xue Y, Chen M, Jiang C, Shatz DY, Besser SA, et al. First-Line catheter ablation of monomorphic ventricular tachycardia in cardiomyopathy concurrent with defibrillator implantation: the PAUSE-SCD randomized trial. Circulation 2022;145:1839–1849. https://doi.org/10.1161/CIRCULATIONAHA. 122.060039 Among patients with cardiomyopathy of varied causes, early catheter ablation performed at the time of ICD implantation significantly reduced the composite primary outcome of ventricular tachycardia recurrence, cardiovascular hospitalization, or death. These findings were driven by a reduction in ICD therapies.
6. Della Bella P, Baratto F, Vergara P, Bertocchi P, Santamaria M, Notarstefano P, et al. Does timing of ventricular tachycardia ablation affect prognosis in patients with an implantable cardioverter defibrillator? Results from the multicenter randomized PARTITA trial. Circulation 2022;145:1829–1838. https://doi. org/10.1161/CIRCULATIONAHA. 122.059598 Ventricular tachycardia ablation after first appropriate shock was associated with a reduced risk of the combined death or worsening heart failure hospitalization end point, lower mortality, and fewer ICD shocks. These findings provide support for considering ventricular tachycardia ablation after the first ICD shock.
7. Arenal Á, Ávila P, Jiménez-Candil J, Tercedor L, Calvo D, Arribas F, et al. Substrate ablation vs antiarrhythmic drug therapy for symptomatic ventricular tachycardia. J Am Coll Cardiol 2022;79:1441–1453. https://doi.org/10.1016/j.jacc.2022.01.050 In ICD patients with ischemic cardiomyopathy and symptomatic ventricular tachycardia, catheter ablation reduced the composite endpoint of cardiovascular death, appropriate ICD shock, hospitalization due to heart failure, or severe treatment-related complications compared to anti-arrhythmic drugs.
8. Piccini JP, Caso V, Connolly SJ, Fox KAA, Oldgren J, Jones WS, et al. Safety of the oral factor Xia inhibitor asundexian compared with apixaban in patients with atrial fibrillation (PACIFIC-AF): a multicentre, randomised, double-blind, doubledummy, dose- finding phase 2 study. Lancet 2022;399:1383–1390. https://doi.org/10.1016/ S0140- 6736(22)00456-1 The FXIa inhibitor asundexian at doses of 20 mg and 50 mg once daily resulted in lower rates of bleeding compared with standard dosing of apixaban, with near-complete in-vivo FXIa inhibition, in patients with atrial fibrillation.
9. Connolly SJ, Karthikeyan G, Ntsekhe M, Haileamlak A, El Sayed A, El Ghamrawy A, et al. Rivaroxaban in rheumatic heart disease associated atrial fibrillation. N Engl J Med 2022; 387:978–988. https://doi.org/10.1056/ NEJMoa2209051 Among patients with rheumatic heart disease–associated atrial fibrillation, vitamin K antagonist therapy led to a lower rate of a composite of cardiovascular events or death than rivaroxaban therapy, without a higher rate of bleeding.
10. Park J, Shim J, Lee JM, Park JK, Heo J, Chang Y, et al. Risks and benefits of early rhythm control in patients with acute strokes and atrial fibrillation: a multicenter, prospective, randomized study (the RAFAS trial). J Am Heart Assoc. 2022 Feb;11(3): e023391. doi: 10.1161/JAHA.121.023391. Epub 2022 Jan 19. The early rhythm control strategy of an acute ischemic stroke (IS) decreased the sustained atrial fibrillation and recurrent IS within 12 months without an increase in the composite adverse outcomes.
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