Abstract
The year 2015 was once more filled with exciting and important novel developments in the field of invasive electrophysiology and implantable cardiac devices. These include technical innovation, novel molecular and cellular insights, and presentation of large randomized clinical trials as well as important ‘real-world’ registries. In addition, several new guidelines surfaced in 2015, including those for the treatment of ventricular arrhythmias and prevention of sudden cardiac death. It is virtually impossible to cover all novel developments that would merit discussion in this type of overview; as a result, the authors had to make a selection, focusing on several important developments with direct implications for daily clinical practice. ### Atrial fibrillation Catheter ablation of atrial fibrillation (AF) remained in focus of clinical studies and large-scale trials. The use of force-sensing ablation catheter technologies seems to improve the induction of durable atrial lesions and was shown to significantly reduce AF recurrence rate after catheter ablation in a meta-analysis mainly made of non-randomized trials.1 This technology will become standard for AF catheter ablation in the future. A word of caution: there is growing evidence that more extensive ablation in the atria does not per se improve the rhythm outcome after AF catheter ablation. The Minimax Trial compared two ablation strategies for pulmonary vein isolation (PVI) in 234 patients who underwent catheter ablation of paroxysmal AF: circumferential antral PVI alone (‘minimal’) vs. PVI with intravenous ridge ablation to achieve individual PVI (‘maximal’). After a mean follow-up of 17 ± 8 months, freedom from AF after limited ‘minimal’ ablation was not worse compared with more extensive ‘maximal’ ablation (70 vs. 62%; P = 0.25).2 Previous data indicated that adenosine-guided detection of …
Highlights
Electrophysiology remains a growing part of modern cardiology
While technical innovation is a key determinant in invasive electrophysiology, both for ablation and device therapy, understanding the mechanisms, natural course, and evaluation of arrhythmias is the cornerstone of progress
The analysis suggests that controlling activation of the renin–angiotensin system or interfering with calcium handling, in addition to controlling blood pressure, is associated with a reduced risk of atrial fibrillation (AF)
Summary
Electrophysiology remains a growing part of modern cardiology. While technical innovation is a key determinant in invasive electrophysiology, both for ablation and device therapy, understanding the mechanisms, natural course, and evaluation of arrhythmias is the cornerstone of progress. The year 2014 noticed many new insights, from which the authors had to make a distinct selection. While the 2013 overview mainly focussed on technical innovation, we opted to zoom in more on clinically relevant new developments from 2014 that apply to every clinical cardiologist’s practice. Multiple large-scale studies and trials with potential guideline relevance have been published in various fields related to cardiac arrhythmias. Follows an excerpt of the key findings of these studies and an assessment of their clinical relevance
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