Francis Marchlinski

Pulmonary hypertension (PH) is a progressive condition characterized by pulmonary vascular remodeling and elevated pulmonary arterial pressure. Atrial arrhythmias are common in PH and may contribute to right ventricular failure and death

The current atrial fibrillation (AF) management guidelines wisely indicate that oral anticoagulant (OAC) therapy ‘should be considered’(Class IIa) in patients with CHA2DS2-VASc score of 1 in men and 2 in women. 1 These patients typically are appropriately binned into the category of intermediate risk for stroke and were inadequately represented in the large pivotal OAC in AF randomized trials despite representing> 15%–20% of patients with AF. 2, 3 Supporting the benefit for making this consideration with a strong suggestion of clinical value in using OAC for many of these intermediate-risk AF patients is the report by Anjum and colleagues in this issue of the European Heart Journal. 4 Using a population-based registry that included an> 1.1 million nationwide Norwegian patient cohort with one non-sex CHA2DS2-VASc risk factor, of whom 34 460 patients were diagnosed with AF, the investigators found in the AF …

BackgroundIn arrhythmogenic right ventricular cardiomyopathy (ARVC), risk of atrial arrhythmias (AAs) persists after ventricular tachycardia (VT) ablation.ObjectiveThe purpose of this study was to determine the type, prevalence, outcome, and risk correlates of AA in ARVC in patients undergoing VT ablation.MethodsProspectively collected procedural and clinical data on ARVC patients undergoing VT ablation were analyzed. Risk score for typical atrial flutter was determined from univariate logistic regression analysis.ResultsOf 119 consecutive patients with ARVC and VT ablation, 40 (34%) had AA: atrial fibrillation (AF) in 31, typical isthmus-dependent atrial flutter (AFL) in 27, and atrial tachycardia/atypical flutter (AT) in 10. Seventeen patients (43%) with AA experienced inappropriate defibrillator therapy, with 15 patients experiencing shocks. Ablation was performed for typical AFL in 21 (53%), AT in 5 (13%), and …

Mastectomy with lymphadenectomy is a common surgical approach for patients with breast cancer. The risk of breast surgical site infection after mastectomy could be more than 10% 1. Cardiovascular implantable electronic devices (CIED) implantation in these patients presents unique challenges due to the postoperative lymph node disturbance. However, there is currently no study assessing infection and vascular complication risks in these patients post-CIED implantation. Our study aims to evaluate these risks in patients with prior mastectomy compared to those without.Using the National Readmission Database, we identified females≥ 18 years old who underwent CIED implantation from January to June (2017 to 2020). Patients were divided into two groups based on the presence of prior bilateral mastectomy. While the germane question is whether ipsilateral mastectomy increases the risk of CIED, this was not …

BackgroundCardiac stereotactic body radiotherapy (SBRT) has emerged as a promising noninvasive treatment for refractory ventricular tachycardia (VT).ObjectiveThe purpose of this study was to describe the safety and effectiveness of SBRT for VT in refractory to extensive ablation.MethodsAfter maximal medical and ablation therapy, patients were enrolled in a prospective registry. Available electrophysiological and imaging data were integrated to generate a plan target volume. All SBRTs were planned with a single 25 Gy fraction using respiratory motion mitigation strategies. Clinical outcomes at 6 weeks, 6 months, and 12 months were analyzed and compared with the 6 months prior to treatment. VT burden (implantable cardioverter-defibrillator [ICD] shocks and antitachycardia pacing sequences) as well as clinical and safety outcomes were the main outcomes.ResultsFifteen patients were enrolled and …

BackgroundTargeting non-pulmonary vein triggers (NPVTs) after pulmonary vein isolation may reduce atrial fibrillation (AF) recurrence. Isoproterenol infusion and cardioversion of spontaneous or induced AF can provoke NPVTs but typically require vasopressor support and increased procedure time.ObjectiveTo identify risk factors for the presence of NPVTs and create a risk score to identify higher-risk subgroups.MethodsUsing AF ablation registry at the Hospital of the University of Pennsylvania, we included consecutive patients who underwent AF ablation between January 2021 and December 2022. We excluded patients who did not receive NPVT provocation testing after failing to demonstrate spontaneous NPVTs. NPVTs were defined as non-pulmonary vein ectopic beats triggering AF or focal atrial tachycardia. We used risk factors associated with NPVTs with p-value<0.1 in multivariable logistic regression …

Cardioneuroablation (CNA) of ganglionated plexus has been performed for vasovagal syncope and as a supplementary therapy for atrial fibrillation (AF). CNA is limited in part by the lack of a standard procedural endpoint. 1 High-frequency stimulation has been used to identify ganglionated plexus, and elimination of a response after ablation has been used as an endpoint, but this approach only evaluates local, rather than global, vagal innervation. Elimination of a response to vagal stimulation is a potential endpoint that demonstrates parasympathetic denervation. To date, this has been performed with extracardiac vagal stimulation (ECVS) via a catheter in the internal jugular veins documenting vagal response. 2 This method is limited by technical challenges and the lack of a device cleared for this use in the United States.Transcutaneous electrical stimulation of the tragus has been studied for AF based on …

BackgroundVentricular tachycardia (VT) recurrence rates remain high following ablation among patients with nonischemic cardiomyopathy (NICM).ObjectivesThis study sought to define the prevalence of lipomatous metaplasia (LM) in patients with NICM and VT and its association with postablation VT recurrence.MethodsFrom patients who had ablation of left ventricular VT, we retrospectively identified 113 consecutive NICM patients with preprocedural contrast-enhanced cardiac computed tomography (CECT), from which LM was segmented. Nested within this cohort were 62 patients that prospectively underwent CECT and cardiac magnetic resonance from which myocardial border zone and dense late gadolinium enhancement (LGE) were segmented. A control arm of 30 NICM patients without VT with CECT was identified.ResultsLM was identified among 57% of control patients without VT vs 83% of patients …