Cardiology and Beyond: Bishnu's Personal Blog: Innovations and Trials Shaping Arrhythmia Care in 2024

Pulsed-field ablation (PFA) gained significant traction in 2024 following the FDA approval of multiple PFA systems, starting with Medtronic’s PulseSelect system in late 2023.
Additional approvals included Farapulse (Boston Scientific) in January, as well as Varipulse (Johnson & Johnson MedTech) and Medtronic’s Affera mapping and ablation system with the Sphere-9 catheter, capable of delivering both pulsed-field and radiofrequency energy.
While electrophysiologists are enthusiastic about the shorter, safer procedures enabled by PFA, concerns remain about long-term durability and rare complications like coronary spasm and hemolysis, which can lead to acute renal failure.

The SHAM-PVI trial, presented at the European Society of Cardiology Congress and published in JAMA, addressed concerns about the feasibility of a sham-controlled trial for catheter ablation in AF.
The trial showed that pulmonary vein isolation (PVI) using cryoablation significantly reduced AF burden, improved arrhythmia-related symptoms, and enhanced patients' quality of life compared to sham procedures.

The OPTION trial, presented at the American Heart Association Scientific Sessions and published in the New England Journal of Medicine, explored adding left atrial appendage occlusion (LAAO) with the Watchman FLX device to catheter ablation for AF.
The trial demonstrated that LAAO reduced bleeding and offered non-inferior efficacy compared with direct oral anticoagulants, though some experts questioned the trial’s endpoints. Learn More

The EPIC-CAD trial, presented at ESC 2024 and published in NEJM, found that in high-risk AF patients with stable coronary artery disease, treatment with edoxaban (Savaysa) alone significantly reduced net adverse clinical events at 1 year compared to edoxaban plus antiplatelet therapy.
The reduced risk was primarily due to a lower incidence of bleeding, highlighting a safer approach for managing this patient population. Learn More

The updated European AF guidelines introduced a new pathway called AF-CARE, emphasizing comorbidity and risk factor management (C), avoidance of stroke and thromboembolism (A), rate and rhythm control (R), and evaluation and dynamic assessment (E).
These guidelines reflect an increasingly comprehensive approach to AF management, integrating both clinical and patient-centered strategies. Learn More

Physiologic or conduction-system pacing, particularly left bundle branch area pacing, has emerged as a prevalent and impactful development in clinical care. HOT CRT Trial

The application of artificial intelligence (AI) in arrhythmia diagnosis continued to gain momentum, driven by ongoing research and promising advancements in the field.

A study published in JACC: EP highlighted the benefits of smoking cessation, showing a significant reduction in the risk of developing AF among individuals who quit smoking. Learn More

The field anticipates expanded data on implantable and wearable devices, as well as broader use of left atrial appendage occlusion devices.
Additional research is expected on the role of catheter ablation for ventricular tachycardia and the use of pulsed-field ablation for substrates beyond atrial fibrillation, including ventricular arrhythmias.

Cardiology and Beyond: Bishnu's Personal Blog