Pulsed field ablation (PFA), a new catheter-based, non-thermal ablation technique, enhances the safety and efficacy of catheter ablation of atrial fibrillation (AF) compared to conventional thermal methods. While widely adopted in Europe and the United States, its application in Brazil is recent and remains undocumented. This study reports the initial multicenter Brazilian experience with the pulse field ablation to treat patients with AF, emphasizing its rapid adoption and short learning curve. A retrospective analysis of 394 consecutive procedures, performed by 60 operators across multiple Brazilian centers, was conducted. Data encompassed patient demographics, procedural metrics, imaging modalities, and ablation outcomes. A sub-analysis compared high-volume operators (n=139 procedures) with others (n=255). All statistical tests were two-tailed, with a p-value threshold of <0.05 for statistical significance. Paroxysmal AF was predominant (62%), with pulmonary vein isolation (PVI) only as the primary lesion set in 54%. General anesthesia was near-universal (98%), and no major complications occurred. High-volume centers had significantly shorter procedure and ablation times (82 ± 27 vs. 131 ± 76 minutes; p<0.001 and 33 ± 14 vs. 50 ± 33 minutes; p<0.001, respectively), alongside fewer additional lesions after remapping (7% vs. 30%; p<0.001), suggesting a rapid learning curve. Pulsed field ablation demonstrates high acute efficacy, safety, and ease of adoption in Brazil, with a notably short learning curve, as evidenced by the efficiency of high-volume operators. Long-term outcome studies are warranted.

Evidence regarding the efficacy of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in amyloidosis-related heart failure (HF) remains limited. To evaluate the impact of SGLT2i in patients with amyloid transthyretin (ATTR) or amyloid light-chain (AL) amyloidosis and HF. By using global electronic medical record data, we identified patients aged ≥ 18 years with ATTR or AL amyloidosis and HF. After matching, outcomes were compared between patients treated with SGLT2i and matched controls, including 2,036 patients with ATTR amyloidosis and 692 patients with AL amyloidosis. Endpoints included 12-month all-cause mortality, hospitalization, and kidney outcomes. Statistical significance was defined as a two-sided p < 0.05. A total of 96 (9.43%) deaths occurred among patients with ATTR amyloidosis in the SGLT2i group, compared to 196 (19.2%) in the control group (hazard ratio [HR], 0.52; 95% CI, 0.41-0.66). Hospitalization occurred in 387 (38.0%) patients receiving SGLT2i and in 505 (49.6%) controls (HR, 0.74; 95% CI, 0.65-0.84). Kidney outcomes were observed in 204 (20.0%) patients in the SGLT2i group and 298 (28.5%) in the control group (HR, 0.72; 95% CI, 0.60-0.86). Among patients with AL amyloidosis, 39 (11.2%) deaths occurred in the SGLT2i group and 80 (23.1%) in the control group (HR, 0.51; 95% CI, 0.34-0.74). Hospitalization occurred in 161 (46.5%) patients treated with SGLT2i and in 204 (58.96%) controls (HR, 0.71; 95% CI, 0.58-0.88). Kidney outcomes occurred in 86 (24.8%) patients in the SGLT2i group and 137 (39.6%) in the control group (HR, 0.60; 95% CI, 0.46-0.78). In patients with HF due to ATTR or AL amyloidosis, the use of SGLT2i was associated with lower all-cause mortality, hospitalization, and kidney outcomes.

Accurate characterization of coronary bifurcation geometry is essential for planning and optimizing percutaneous coronary interventions. Although several geometric models have been proposed to predict coronary bifurcation dimensions, their performance in diseased vessels remains insufficiently explored. To assess the accuracy and precision of three geometric prediction models (Murray, Finet, and Huo-Kassab) in estimating left main coronary artery (LMCA) bifurcation diameters, using quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS) as reference standards. This retrospective, single-center study included 13 patients undergoing IVUS evaluation of the LMCA, left anterior descending artery, and left circumflex artery. Bifurcation diameters predicted by each geometric model were compared with measurements obtained by QCA and IVUS. Accuracy, precision, and model ratios were calculated for each comparison. Agreement between predicted and measured values was further assessed using Bland-Altman analysis. When compared with QCA, the Murray and Huo-Kassab models demonstrated higher accuracy (0.06 mm and -0.03 mm, respectively) and similar precision (0.95 mm for both) than the Finet model (accuracy -0.35 mm, precision 0.96 mm). In comparisons with IVUS, the Murray model showed the best performance, with an accuracy of -0.49 mm and a precision of 0.84 mm. Bland-Altman analysis indicated superior agreement for the Murray model, particularly when IVUS was used as the reference standard. In this population of patients with moderately diseased LMCA bifurcations, the Murray and Huo-Kassab models provided more accurate geometric predictions than the Finet model. Overall, the Murray model demonstrated the best performance, especially in IVUS-based assessments.

Congenital heart diseases (CHD) require an in-depth anatomopathological understanding. 3D printing is a promising educational tool for creating physical prototypes from imaging data, but costs are a major issue. This study aimed to describe a feasible low-cost workflow for the development of 3D-printed (3DP) CHD models and create a shareable educational set. Data from cardiac tomography images were used, following the steps of image acquisition, segmentation, digital design, slicing, 3D printing, and post-printing. Valvar structures were created from echocardiographic data using the cartographic heightmap technique and inserted into prototypes. 3DP models were evaluated by an expert team, enhanced, and applied to medical residents during an educational session. Free software, a desktop 3D printer, and low-cost materials were used. Twelve 3DP models were developed, including ventricular septal defect with patent ductus arteriosus, atrial septal defect, Tetralogy of Fallot, transposition of the great arteries, atrioventricular septal defect, coarctation of the Aorta, hypoplastic left heart syndrome, tricuspid atresia, pulmonary atresia, total anomalous pulmonary venous connection, Truncus arteriosus, and interrupted aortic arch. All residents (100%) agreed that prototypes were "faithful to the anatomy", "visually appealing", "motivated the study", and "allowed better spatial conceptualization". They related 3DP CHD models "are an important pedagogical resource" and can potentially benefit the education of "undergraduate students" (100%), "interdisciplinary team" (100%), "cardiologists, surgeons and residents" (100%), and "families" (93%). Development of 3DP CHD models using a low-cost workflow is feasible. Models developed are freely available for download and printing, intending to promote education to all interested in CHD.

Background Congenital heart diseases (CHD) require an in-depth anatomopathological understanding. 3D printing is a promising educational tool for creating physical prototypes from imaging data, but costs are a major issue. Objective This study aimed to describe a feasible low-cost workflow for the development of 3D-printed (3DP) CHD models and create a shareable educational set. Methods Data from cardiac tomography images were used, following the steps of image acquisition, segmentation, digital design, slicing, 3D printing, and post-printing. Valvar structures were created from echocardiographic data using the cartographic heightmap technique and inserted into prototypes. 3DP models were evaluated by an expert team, enhanced, and applied to medical residents during an educational session. Free software, a desktop 3D printer, and low-cost materials were used. Results Twelve 3DP models were developed, including ventricular septal defect with patent ductus arteriosus, atrial septal defect, Tetralogy of Fallot, transposition of the great arteries, atrioventricular septal defect, coarctation of the Aorta, hypoplastic left heart syndrome, tricuspid atresia, pulmonary atresia, total anomalous pulmonary venous connection, Truncus arteriosus, and interrupted aortic arch. All residents (100%) agreed that prototypes were “faithful to the anatomy”, “visually appealing”, “motivated the study”, and “allowed better spatial conceptualization”. They related 3DP CHD models “are an important pedagogical resource” and can potentially benefit the education of “undergraduate students” (100%), “interdisciplinary team” (100%), “cardiologists, surgeons and residents” (100%), and “families” (93%). Conclusion Development of 3DP CHD models using a low-cost workflow is feasible. Models developed are freely available for download and printing, intending to promote education to all interested in CHD.