'Why we do What we do in Cardiology'

Electrophysiology: Important EP Updates from 2023

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Heart Rhythm 2023: Innovations in Ablation, Devices, and Conduction System Pacing.

Catheter Ablation and LAAO Advance:

  • CASTLE-HTx: Ablation for AF proved beneficial in patients with advanced heart failure, potentially paving the way for wider adoption.
  • Pulsed-field ablation (PFA): PULSED AF and ADVENT trials showed promise for novel PFA technologies like PulseSelect (Medtronic) and Farapulse (Boston Scientific).
  • Left atrial appendage occlusion (LAAO): WATCH-TAVR confirmed LAAO safety and efficacy alongside TAVI in severe aortic stenosis and AF.
  • Updated AF guidelines: Both US and European guidelines incorporated advancements in ablation, LAAO, and medications.

    • Medical Therapies: Mixed Bag:

    • NOAH-AFNET 6: Edoxaban (Savaysa) increased risks in patients with subclinical AF detected by implanted devices.
    • ARTESiA: Apixaban (Eliquis) reduced stroke but increased major bleeding in subclinical AF patients.
    • Meta-analysis: DOACs reduce ischemic stroke but significantly increase major bleeding in subclinical AF.
    • AZALEA-TIMI 71: Abelacimab (Anthos Therapeutics) showed promise for reducing bleeding compared to rivaroxaban in AF patients.
    • ReVeRA-201: Etripamil nasal spray effectively reduced ventricular rate in AF with rapid ventricular rate.
    • FRAIL-AF: Switching frail elderly AF patients from warfarin to DOACs increased bleeding risks.

      • Pacing and ICDs: Conduction System Pacing Takes Center Stage:

      • Large observational study: LBBAP outperformed biventricular pacing in CRT patients.
      • HOT-CRT pilot study: His-bundle pacing improved LV function more than biventricular pacing in CRT candidates.
      • EHRA consensus statement: Standardized implantation technique for conduction system pacing.
      • DANPACE II: Reducing atrial pacing in sinus node dysfunction patients did not lower AF risk but increased presyncope/syncope.
      • US FDA approves first EVICD: Aurora EV-ICD by Medtronic avoids transvenous lead complications.


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        'Why we do What we do in Cardiology'By Bishnu Subedi

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