Ante Anic

@Dr_Santangeli Shall we add diltiazem to the already long list of the PFA procedure specific drugs? Is intraprocedural nitro shifting/delaying spasm in some patients rather than preventing it? I doubt we will have a 30 000 patient RCT on this topic

The new atrio-esophageal fistula

Speaking soon at a live webinar on the future of #AFablation with #PFA technology.
Join experts sharing real-world insights, clinical workflows, and mapping strategies. Register here: bostonsci.co/Ij6AsnaH7Sb #Epeeps #Cardiology

@atulverma_md Fantastic group to talk about PFA!

Nearly a full house in the main event hall for our session on the basics of PFA: what every clinician should know #HRS2025 Great colleagues!

Did you know that the EHRA Ablation Innovation Summit 2025 is happening just a day before #EHRA2025? 🔥 📍 29 March 2025 | 08:30 – 17:30 CET | Messe Wien, Austria 🔬 Dive into the latest AF ablation innovations, with a special focus on PFA, and explore cutting-edge advancements in VT ablation. Don't miss this exclusive opportunity—register now! ⏳👇 🔗 Register here esc365.escardio.org/event/1881 @escardio @jongichun @tomdepotter @DanielScherr3 @SergeBoveda @Mel_Gunawardene @VivekReddyMD @ManningerMartin @HenrikeHillmann @drjohnm @ivroca @NTrayanova @AndreaSarkozy

@DrJasonAndrade Great points Jason. It is time to depart from binary approach to AF ablation outcomes (recurrence Y/N) and focus what we really bring with interventional AF treatment

Remarkably these trials show a very consistent result, catheter ablation was associated with a 85% reduction in the rate of progression to more advanced forms of AF (eg persistent AF). Meaning we now have an intervention that is disease modifying. heartrhythmjournal.com/article/S1547-…

Atrial Fibrillation is a chronic and progressive disease, with progression being associated with worse clinical outcomes. @KarimBenali42 @CHRS_SCR @CardioUBC @VGHFdn @UBCDoM heartrhythmjournal.com/article/S1547-…

@JICE_EP @vish_luther @DhirajGuptaBHRS As we adopt more powerful PFA platforms, deep sedation or GA will be a must. We have been through journey and realized that that the more powerful the PFA platform is, the deeper the sedation has to be (and higher the dose of atropine to antagonize the vagal reflexes :-))

New #OpenAccess Article in @JICE_EP Feasibility of Pulsed Field Ablation for Atrial Fibrillation under Mild Conscious Sedation 🧐📖 doi.org/10.1007/s10840… by Peter Calvert, Mark T. Mills, Ben Murray, Jonathan Kendall, Justin Ratnasingham, @vish_luther & @DhirajGuptaBHRS #EPeeps

@clementy_ep Dear Nicholas, a big thanks for these “reflections”. Sometimes they tell more than thousand papers! And above all, add a bit of a good feeling to what is mostly very serious business!

VT activation mapping 🥰

@AndreasMetzner7 @AndreasRillig @jongichun @BorisSchmidt5 @laura_rottner @AGEP_DGK Very important contrubution Andreas! Kudos for the teams. Operators using focal PFA in deep sedation will have to develop ways for tackling coughing and PN stimulation induced movements. Only short acting paralytics were used in your report, an important detail.

🫵Just published: General anaesthesia or deep sedation for monopolar PFA with #Affera and #Sphere9. Another Hamburg/Frankfurt collaboration!💪🙏 Europace.2024 Nov 1;26(11):euae270.doi:10.1093/europace/euae270. @AndreasRillig @jongichun @BorisSchmidt5 @laura_rottner @AGEP_DGK

@kvernooy @Dominik_Linz @atulverma_md @DrJasonAndrade @purerfellner @DrRoderickTung That’s one in a thousand variant. One could opt for the focal ablation to allow max capability to adapt for the angle, however Faradrive sheath/Farawave catheter are well designed to perform ablation for the posterior/inferior targets and why not going with the initial plan.

Interesting anatomy of the pulmonary veins today. scheduled for AF ablation with Farapulse, but was this the best choice based on this anatomy. Do you guide your procedure based on LA anatomy? @Dominik_Linz @atulverma_md @DrJasonAndrade @purerfellner @DrRoderickTung

@omwazni @tavrkapadia @LarsSvenssonMD @CleClinicHVTI @CleClinicNews Impressive. It all starts with culture of communication, this is what I have learned during my stay at CCF! Congratulations!

30 big ones. Thank you @tavrkapadia and @LarsSvenssonMD for your vision and leadership @CleClinicHVTI @CleClinicNews

@Dr_Santangeli @arwayounis2 @CleClinicHVTI @omwazni We definitely need to start raising awareness that for any PFA technology story about efficacy and clinical effectiveness starts with lesion volume/depth

Comparative Efficacy and Safety of PFA Versus RFA of Idiopathic LV Arrhythmias - PFA outperformed RFA in challenging locations like Papillary, LV summit via distal CS and direct epicardium. jacc.org/doi/10.1016/j.… Congrats to star fellow @arwayounis2 @CleClinicHVTI @omwazni

@TraykovVassil @ehj_ed @escardio Had a very good laugh at first. Unfortunately these alternatives are so many times used in real world practice instead of spending time with a patient and face him what medical science knows on natural course of his current state and what EBM says about intervening in his state

The seven alternatives to evidence-based medicine… A very inspiring talk on tips and tricks for getting accepted at medical journals by @ehj_ed Prof. Crea at the National Congress of Cardiology Society of Kosovo 🙏🙏🙏 @escardio #CardioTwitter

@mattaustein Monopolar PFA is contact dependent. I would be scared to use ablation technology that delivers deep lesion without tissue contact. How the hell would we control that? So contact brings not only lesion depth yet control over the lesion creation.

And there goes another claim for PFA superiority over RFA…

@Chadi_97EP @arwayounis2 @omwazni @CirculationEP @aymanhusseinmd @Dr_Santangeli @CleClinicHVTI Important contribution. We need contact feedback for PFA platforms and we need to know the tissue depth we are reaching with given settings! Congratulations!

📌How does Contact Force affect PFA outcomes? Check out our latest preclinical work lead by the star fellow @arwayounis2 and the excellent mentorship @omwazni just published in @CirculationEP. @aymanhusseinmd @Dr_Santangeli @CleClinicHVTI #Epeeps ahajournals.org/doi/abs/10.116…

@Dominik_Linz @FaisalMMerchant On top of durability Dominik, let us not underestimate the constrictive scar RFA is leaving behind that can contribute to reduced LA reservoir/conduit function and by itself increase the chance for AF recurrence

Agree… 💯 But it seems, that posterior wall isolation is better achievable by PFA than by RFA (at least when we look at the procedural outcomes)… This creates a good basis for future RCTs in a specific set of patients (e.g. with low voltage areas at the posterior wall…). Then we might be able to answer your question: does the posterior wall matter?!

#PFASummit @EHRA2024 Posterior wall isolation: 👉🏻~100% first pass isolation with #PFA It is so funny… our fellows see this incredible high procedural acute success rate and efficacy with PFA and they cannot believe us, that posterior wall isolation has been so difficult with radiofrequency… (see CAPLA, see ahajournals.org/doi/10.1161/CI… @peterkistler3 @PrashSanders @Mel_Gunawardene @jongichun @DrJasonAndrade @Phiso_de @atulverma_md

@Dominik_Linz @Mel_Gunawardene It’s all about understanding well the substrates and choosing the right tool. No commercially available PFA platform can match lesion depth we can get with RFA. However, PFA delivered through CENTAURI PFA generator can provide 8-9 mm depth which is enough for ATs

Congratulations @Mel_Gunawardene and team... A nice manuscript now published in #EUROPACE 👏 The bipolar #PFA-multispline catheter is fast, but less efficient vs point-by-point RFA for the treatment of LA tachycardia post #PVI... Maybe point-by-point monopolar focal PFA with increased versatility and better contact control will make a better job in this specific setting?! Our experience on point-by-point biphasic monopolar focal PFA in patients undergoing (predominantly re-do) catheter ablation for persistent AF: 👉First pass isolation of the post wall in 38 consecutive patients. 📖 academic.oup.com/europace/advan… @EuropaceEiC 👉And here the Hamburg experience on anterior line ablation using the same focal PFA catheter 📖 heartrhythmjournal.com/article/S1547-… @hrs_journal @Farnir_Florent @kvernooy @JLuermans @AndreasMetzner7 @jongichun @BorisSchmidt5 @Verma @PrashSanders @peterkistler3 @EladAnter @LuigiDiBiaseMD @AnteAnic4

@omwazni A way forward for the NavX! It was unbelievable years ago that one company would work on their system being integrated with another company’s ablation platform. Probably this speaks a lot about that ablation platform but also on decision makers in the Abbott! #PFA , #FARAPULSE

First PFA visualization using Ensite X new software.

heartrhythmjournal.com/article/S1547-… Check out the paper on using focal PFA to treat accessory pathways. KBC Split EP team is using this as a preferred way of AP ablation. Vicinity to a conduction system remains main limitation. There are tips and tricks to learn…

@CirculationEP Check out this paper that addresses the same question: is it truly blocked, are our lesions transmural? ahajournals.org/doi/10.1161/ci…

Differential pacing from VOM reflects epicardial mitral isthmus conduction. This maneuver uncovers epicardial connection after radiofrequency ablation that differential CS pacing cannot detect #AHAJournals #Epeeps doi.org/10.1161/CIRCEP…

@EuropaceEiC @GiulioConte9 @Dominik_Linz @marcovitoloMD @AndyZhangMD @FraSantoroMD @LuigiDiBiaseMD @AndreasMetzner7 @BorisSchmidt5 @Phiso_de @Mel_Gunawardene Though primary efficacy endpoint is composite and therefore numbers can be lower than in an idealistic setting, still there is a sense we can do better with this platform. Pentaspline PFA platform is a great PVI tool, but like any hardware has its own tips and tricks!

📢#Europace #EPeeps #CardioTwitter #PVI using a pentaspline #PFA catheter was effective & safe 👉 in 179 PAF patients 👉 prospective, non-randomized, multicenter shorturl.at/lpxU6 @GiulioConte9 @Dominik_Linz @marcovitoloMD @AndyZhangMD @FraSantoroMD @LuigiDiBiaseMD