Ablation Approach Research Articles

Clinical Approach for Thyroid Radiofrequency Ablation

Radiofrequency ablation (RFA) is a non-surgical treatment for symptomatic, benign thyroid nodules. This treatment works by heating and destroying the nodule tissue, which results in reduction of its size and alleviation of the symptoms involved. RFA is indicated for nodules which are confirmed to be benign on two or more cytological or histological examinations, and which result in clinical symptoms requiring medical treatment. It is associated with good short-term outcomes on one-year follow-up; however, 20%-30% of the nodules regrow after more than three years. Therefore, on the basis of long-term follow-up, management of regrowth is key to patient care following RFA. Regrowth is more likely to occur in nodules that are large in size prior to RFA, and in those with high or increased vascularity. Recently, new techniques such as hydrodissection, artery-first ablation, and venous ablation have been introduced to inhibit regrowth. In addition, appropriate criteria for additional RFA should be applied to manage regrowth and prolong its therapeutic effects. RFA is essentially an alternative to surgery; therefore, the ultimate goal of this procedure is to avoid surgery permanently, rather than to achieve temporary effects.

Analgesic and potentiated photothermal therapy with ropivacaine-loaded hydrogels.

Rationale: Tumor ablation can cause severe pain to patients, but there is no satisfactory means of analgesia available. In addition, recurrence of residual tumors due to incomplete ablation threatens patient safety. Photothermal therapy (PTT), a promising approach for tumor ablation, also faces the aforementioned problems. Therefore, developing novel photothermal agents that can efficiently relieve PTT-associated pain and potentiate the PTT efficacy are urgently needed. Methods: The Pluronic F127 hydrogel doped with indocyanine green (ICG) was served as photothermal agent for PTT. Mouse model that inoculation of tumor near the sciatic nerve was constructed to assess the PTT-evoked pain. Subcutaneous and sciatic nerve vicinal tumor-bearing mice were used to test the efficacy of PTT. Results: PTT-evoked pain depends on an increase in tumor temperature and is accompanied by the activation of TRPV1. A simple introduction of local anesthetic (LA) ropivacaine into ICG-loaded hydrogels relieves PTT-induced pain and exerts long-lasting analgesia compared with opioid analgesia. More interestingly, ropivacaine upregulates major histocompatibility complex class I (MHC-I) in tumor cells by impairing autophagy. Therefore, a hydrogel co-doped with ropivacaine, TLR7 agonist imiquimod and ICG was rationally designed. In the hydrogel system, imiquimod primes tumor-specific CD8+ T cells through promoting DCs maturation, and ropivacaine facilitates tumor cells recognition by primed CD8+ T cells through upregulating MHC-I. Consequently, the hydrogel maximumly increases CD8+ T cells infiltration into tumor and potentiates PTT efficacy. Conclusion: This study for the first time provides an LA-dopped photothermal agents for painless PTT and innovatively proposes that a LA can be used as an immunomodulator to potentiate the PTT efficacy.

Catheter Ablation for Ventricular Tachycardia After MI: A Reconstructed Individual Patient Data Meta-analysis of Randomised Controlled Trials.

The prognostic impact of ventricular tachycardia (VT) catheter ablation is an important outstanding research question. We undertook a reconstructed individual patient data meta-analysis of randomised controlled trials comparing ablation to medical therapy in patients developing VT after MI. We systematically identified all trials comparing catheter ablation to medical therapy in patients with VT and prior MI. The prespecified primary endpoint was reconstructed individual patient assessment of all-cause mortality. Prespecified secondary endpoints included trial-level assessment of all-cause mortality, VT recurrence or defibrillator shocks and all-cause hospitalisations. Prespecified subgroup analysis was performed for ablation approaches involving only substrate modification without VT activation mapping. Sensitivity analyses were performed depending on the proportion of patients with prior MI included. Eight trials, recruiting a total of 874 patients, were included. Of these 874 patients, 430 were randomised to catheter ablation and 444 were randomised to medical therapy. Catheter ablation reduced all-cause mortality compared with medical therapy when synthesising individual patient data (HR 0.63; 95% CI [0.41-0.96]; p=0.03), but not in trial-level analysis (RR 0.91; 95% CI [0.67-1.23]; p=0.53; I2=0%). Catheter ablation significantly reduced VT recurrence, defibrillator shocks and hospitalisations compared with medical therapy. Sensitivity analyses were consistent with the primary analyses. In patients with postinfarct VT, catheter ablation reduces mortality.

GOLD AND SILVER NANOPARTICLES AS COMPUTED TOMOGRAPHY (CT) CONTRAST AGENTS PRODUCED BY A PULSED LASER ABLATION TECHNIQUE: STUDY In-vitro AND In-vivo

High-purity metal nanoparticles such as gold and silver nanoparticles become an interesting subject for application in the medical field. Using the laser ablation approach, these nanoparticles were successfully synthesized in this present work. Experimentally, a pulse neodymium yttrium aluminum garnet laser (1064 nm, 30 mJ, 10 Hz) was used to irradiate high-purity metals immersed in an iodine liquid medium. Purple, yellow, and dark purple colloidal nanoparticles of Au, Ag, and Au-Ag were successfully synthesized. The results certified that all nanoparticles have a spherical shape; Au nanoparticles had an average diameter of 26 nm and a standard deviation of 4 nm, while Ag nanoparticles had an average diameter of 24 nm and a standard deviation of 5 nm. The diameter distribution of AuAg nanoparticles is extraordinarily vast, ranging from 18 to 80 nm. Colloids of mixed Au-Ag nanoparticles had the highest Hounsfield Units (HU) value in an in vivo test, with a value of 302. This was supported by the results of an in vitro contrast enhancement evaluation, which determined that a mixture of Au-Ag nanoparticles provided the best contrast enhancement compared to other colloids. These results confirmed that the Au-Ag nanoparticles are very suitable as contrast agents in CT.

High-density Approaches to Ventricular Tachycardia Substrate Ablation

Ventricular tachycardia (VT) ablation is a challenging procedure with significant clinical benefit for patients. The classic VT ablation approach centers on arrhythmia induction and entrainment of tachycardia to identify the critical components of a VT circuit. In the post-coronary reperfusion era, smaller infarct size and subsequently faster VT cycle lengths have led to an increased occurrence of unstable, unmappable VT cases, making the classic approach untenable. While approaches of signal-based substrate modification have shown clinical efficacy in the past, these approaches are sometimes imprecise and require extensive ablation. With the advancement of high-density (HD) mapping technology and recognition of functional tissue properties requisite for VT initiation and propagation, a more finely targeted VT ablation approach may be pursued. Benefits of HD mapping include better tissue and signal characterization, avoidance of ‘perpendicular blinding’ and better identification of VT putative channels. Functional characterization of tissue, such as isochronal late activation mapping or decremental evoked potential mapping, allow for the identification of functional slowing required for VT reentry. Pre-ablative imaging continues to play an increasing role in substrate characterization and pre-operative planning. Using a comprehensive, tailored, substrate-based functional HD VT ablation strategy can allow for safe and effective ablation of even unstable and unmappable VT.

Neuroprotection by Preconditioning in Mice is Dependent on MyD88-Mediated CXCL10 Expression in Endothelial Cells.

The central nervous system (CNS) can be preconditioned to resist damage by peripheral pretreatment with low-dose gram-negative bacterial endotoxin lipopolysaccharide (LPS). Underlying mechanisms associated with transient protection of the cerebral cortex against traumatic brain injury include increased neuronal production of antiapoptotic and neurotrophic molecules, microglial-mediated displacement of inhibitory presynaptic terminals innervating the soma of cortical projection neurons, and synchronized firing of cortical projection neurons. However, the cell types and signaling responsible for these neuronal and microglial changes are unknown. A fundamental question is whether LPS penetrates the CNS or acts on the luminal surface of brain endothelial cells, thereby triggering an indirect parenchymal neuroprotective response. The present study shows that a low-dose intraperitoneal LPS treatment increases brain endothelial cell activation markers CD54, but does not open the blood-brain barrier or alter brain endothelial cell tight junctions as assessed by electron microscopy. NanoString nCounter transcript analyses of CD31-positive brain endothelial cells further revealed significant upregulation of Cxcl10, C3, Ccl2, Il1β, Cxcl2, and Cxcl1, consistent with identification of myeloid differentiation primary response 88 (MyD88) as a regulator of these transcripts by pathway analysis. Conditional genetic endothelial cell gene ablation approaches demonstrated that both MyD88-dependent Toll-like receptor 4 (TLR4) signaling and Cxcl10 expression are essential for LPS-induced neuroprotection and microglial activation. These results suggest that C-X-C motif chemokine ligand 10 (CXCL10) production by endothelial cells in response to circulating TLR ligands may directly or indirectly signal to CXCR3 on neurons and/or microglia. Targeted activation of brain endothelial receptors may thus provide an attractive approach for inducing transient neuroprotection.

Ablation versus anti-arrhythmic therapy for reducing all hospital episodes from recurrent atrial fibrillation: a prospective, randomized, multi-centre, open label trial.

There is rising healthcare utilization related to the increasing incidence and prevalence of atrial fibrillation (AF) worldwide. Simplifying therapy and reducing hospital episodes would be a valuable development. The efficacy of a streamlined AF ablation approach was compared to drug therapy and a conventional catheter ablation technique for symptom control in paroxysmal AF. We recruited 321 patients with symptomatic paroxysmal AF to a prospective randomized, multi-centre, open label trial at 13 UK hospitals. Patients were randomized 1:1:1 to cryo-balloon ablation without electrical mapping with patients discharged same day [Ablation Versus Anti-arrhythmic Therapy for Reducing All Hospital Episodes from Recurrent (AVATAR) protocol]; optimization of drug therapy; or cryo-balloon ablation with confirmation of pulmonary vein isolation and overnight hospitalization. The primary endpoint was time to any hospital episode related to treatment for atrial arrhythmia. Secondary endpoints included complications of treatment and quality-of-life measures. The hazard ratio (HR) for a primary endpoint event occurring when comparing AVATAR protocol arm to drug therapy was 0.156 (95% CI, 0.097-0.250; P < 0.0001 by Cox regression). Twenty-three patients (21%) recorded an endpoint event in the AVATAR arm compared to 76 patients (74%) within the drug therapy arm. Comparing AVATAR and conventional ablation arms resulted in a non-significant HR of 1.173 (95% CI, 0.639-2.154; P = 0.61 by Cox regression) with 23 patients (21%) and 19 patients (18%), respectively, recording primary endpoint events (P = 0.61 by log-rank test). The AVATAR protocol was superior to drug therapy for avoiding hospital episodes related to AF treatment, but conventional cryoablation was not superior to the AVATAR protocol. This could have wide-ranging implications on how demand for AF symptom control is met. Clinical Trials Registration: NCT02459574.

Colorectal Liver Metastases: A Literature Review of Viable Surgical Options with a Special Focus on Microwave Liver Thermal Ablation and Mini-Invasive Approach.

Colorectal cancer (CRC) is the third most common tumor worldwide and it is characterized in 20-30% of cases by liver involvement, which strongly affects the long-term patient outcome. There are many available therapies for liver colorectal metastases (CRLMs); the current standard of care is represented by liver resection, and when feasible, associated with systemic chemotherapy. Microwave thermal ablation (MWA) is a viable option in unresectable patients or to achieve treatment with a parenchymal spearing approach. A literature review was performed for studies published between January 2000 and July 2022 through a database search using PUBMED/Medline and the Cochrane Collaboration Library with the following MeSH search terms and keywords: microwave, ablation, liver metastases, colorectal neoplasm, and colon liver rectal metastases. The recurrence rate and overall patients' survival were evaluated, showing that laparoscopic MWA is safe and effective to treat CRLMs when resection is not feasible, or a major hepatectomy in fragile patients is necessary. Considering the low morbidity of this procedure, it is a viable option to treat patients with recurrent diseases in the era of effective chemotherapy and multimodal treatments.

Predictors of late pulmonary vein reconnection in patients with arrhythmia recurrence after cryoballoon ablation-per vein analysis including cardiac computed tomography-based anatomic factors.

To identify predictors of individual late pulmonary vein (PV) reconnection after second-generation cryoballoon (CB2) ablation. Anatomic indicators of late pulmonary vein reconnection (LPVR) post-CB2 ablation have not yet been studied on an individual PV level, nor weighed against clinical and procedural factors. Clinical, procedural, and PV anatomic data from 125 patients with a repeat procedure for arrhythmia recurrence after index CB2 ablation were analyzed. Preprocedural computed tomography (CT) evaluated 486 PVs for measurement of size; shape (ovality index); carina width; and orientation angle in frontal (superior/inferior) and transversal (anterior/posterior) plane (with horizontal line 0° as reference and upper/lower half circle as positive/negative value, respectively). Durable isolation in all PVs was demonstrated in 50/125 (40%) patients. Late reconnection rates at the different PVs were as follows: 16% left superior (LS), 12% left inferior (LI), 17% right superior (RS), and 31% right inferior (RI) PV. Multivariable analysis performed per vein showed following independent determinants predicting LPVR: ovality index [odds ratio (OR) 1.61, 95% confidence interval (CI) 1.07-2.41, P = 0.022] and carina width (OR 0.75, CI 0.59-0.96, P = 0.024) for LSPV; carina width (OR 0.71, CI 0.53-0.95, P = 0.020) for LIPV; frontal angle (OR 0.91, CI 0.87-0.95, P < 0.001) for RIPV; and transversal angle (OR 1.15, CI 1.03-1.31, P = 0.032) for RSPV. Cardiac CT-based evaluation of anatomic PV characteristics presented higher predictive value compared to clinical and procedural variables for individual LPVR after CB2 ablation. Pre-procedural identification of unfavourable PV anatomy might be important to tailor the ablation approach.

Computer Simulations of Dual-Antenna Microwave Ablation and Comparison to Experimental Measurements

Single-antenna microwave ablation (MWA) is mainly used to treat small tumors less than 3 cm in diameter. To obtain a larger coagulation zone in a single ablation, a dual-antenna ablation approach was proposed. A three-dimensional finite element method (FEM) simulation model of parallel dual-antennas was developed. Ex vivo experiments at 50 W for 8 min were performed to verify the model. Both the temperature changes in tissue and the size of the coagulation zone were recorded. The effects of dual-antenna spacing, heating power, and blood perfusion on the coagulation zone were analyzed. Fifteen experiments were carried out. The errors between the mean measurements and simulated results at the set temperature points were 1.08 °C, 0.95 °C, and 2.1 °C, respectively. For the same conditions, the blood perfusion of 1.0, 1.5, and 3.0 kg/(m3·s) can result in a reduction in the coagulation volume by 18.4%, 25.4%, and 42.5%. As the spacing increased, the coagulation zone of each antenna started to fuse together later and the resulting integral coagulation zone became larger. Dual-antenna MWA is expected to be used for the treatment of tumors larger than 5 cm in diameter.

Rapid fabrication of CuMoO4 nanocomposites via electric field assisted pulsed-laser ablation in liquids for electrochemical hydrogen generation

Transition–metal-doped electrocatalysts are considered as low-cost alternatives of Pt and RuO2 electrocatalysts for large scale electrochemical generations of hydrogen and oxygen, respectively. Although, chemical synthesis, typically adopted to produce these electrocatalysts, is scalable but hazardous by-products and chemical wastes create growing environmental concerns. Here, we developed a single step, single pot, and environmentally friendly physical approach of electric field-assisted pulsed laser ablation in liquid for the synthesis of colloidal solution of pure CuMoO4 (CMO) electrocatalysts. The entire process took few minutes and did not involve or generate any chemical. A pulsed picosecond laser was used to ablate MoS2 target at the solid-liquid interface to generate spatially confined plasma plume. Two parallel electrodes (copper sheets) were mounted around the plasma plume to modulate the plasma parameters, control the reactions at the plasma-liquid interface, and simultaneously inject copper ions from the electrode to the laser-produced plasma (LPP) for the generation of CMO. nanoparticles. Surprisingly, we observed that by varying the applied electric field, we can efficiently control the size, shape, crystallinity, morphology, and composition of as produced CMO nanocomposites and enhance their hydrogen evolution reaction (HER) performance. The characterization results proves that the introduction of applied electric field during the laser ablation process significantly change the morphology of as-prepared nanomaterials, and the shape of these nanomaterials were spherical, spindle and cuboid for MoS2, CuO and CMO respectively. Among all the fabricated electrocatalysts, CMO-60 is the best HER performer in alkaline medium, while MoS2 and CuO nanoparticles were the worse. For CMO-60 sample, only 440 mV overpotential required to reach the current density of 10 mA/cm2 and as well as posess good stability. We found that electrocatalysts produced at a higher electric field have higher contents of copper and oxygen leading to a superior HER activity. The developed approach can be applied for the synthesis of other electrocatalysts for a range of chemical reactions.

PD05 Novel Non-Thermal Ablation Technology For The Treatment Of Atrial Fibrillation

IntroductionPulsed-field ablation (PFA) is a new non-thermal ablative approach for treating paroxysmal and persistent atrial fibrillation (AF). It provides an alternative to the conventional thermal techniques of radiofrequency ablation and cryoablation. PFA is currently performed with the Farapulse PFA system (Boston Scientific, USA), which recently received CE marking in Europe. In this study, we describe the current evidence on the efficacy, safety, and cost-effectiveness of this new technology.MethodsThe Early Awareness and Alert System of the Agencia de Evaluación de Tecnologías Sanitarias-at the Instituto de Salud Carlos III- identified this new ablation approach in June 2021. An early technology assessment was conducted by reviewing relevant literature published to November 2021. The literature was identified by searching PubMed, Embase, the International Clinical Trials Registry Platform, ClinicalTrials.gov, and the Cochrane Library.ResultsSeven relevant publications were identified, including three open-label trials for paroxysmal AF and one for persistent AF. Three studies comparing PFA with conventional thermal ablation techniques were also included. The safety results showed a lower incidence of complications (esophageal injury, pulmonary venous stenosis, pericardial effusion, and aortic injury) after PFA relative to conventional techniques. In terms of efficacy, PFA resulted in lower rates of AF recurrence in the medium and long term, compared with conventional techniques, and there were no differences in the lengths or success rates of the procedures. No cost-effectiveness studies were identified. Seven ongoing trials were identified, but no results have been published.ConclusionsThe current evidence for PFA in the treatment of AF showed good safety and promising efficacy. However, there is a lack of information on its effect on quality of life and the risk of death, disabling stroke, or cardiac arrest. Early evaluation of new and emerging technologies makes it possible to gather the minimum information necessary to support decisions on their inclusion in the healthcare system. In this case, based on current evidence, the widespread use of PFA is not recommended, except under a rigorous research protocol.

Ventricular Tachycardia Ablation in Adult Congenital Heart Disease.

Patients with congenital heart disease (CHD) are at risk for late ventricular tachycardia (VT) and sudden cardiac death. Slow conducting anatomical isthmuses, bordered by unexcitable tissue created by valve annuli, ventricular incisions, and prosthetic material are the dominant substrate for macroreentrant monomorphic VTs in repaired CHD. These well-defined substrates allow for catheter or surgical transection with clear endpoints. This review elaborates on VT substrates in various CHD, and evolving mapping and ablation approaches. Because most research is conducted in patients with repaired tetralogy of Fallot, this malformation will serve as a paradigm.

MWA Performed at 5.8 GHz through ‘Side Firing’ Approach: An Exploratory Study

Recent studies have shown that ablation techniques have the potential to eradicate adrenal adenomas while preserving the functionalities of the adrenal gland and the surrounding anatomical structures. This study explores a new microwave ablation (MWA) approach operating at 5.8 GHz and using anatomical and dielectric characteristics of the target tissue to create directional heating patterns. Numerical simulations are executed in planar and 3D adrenal models, considering two energy doses. The numerical study is refined accounting for the vaporization of the tissue water content. Ex vivo experimental evaluations on porcine adrenal models complete the study. The numerical and experimental results show that spherical ablation zones are able to cover the target for both energy doses considered. Nonetheless, most of the non-targeted tissues can be preserved from excessive heating when low energy level is used. Numerical models accounting for water vaporization are capable to foresee the experimental temperature values. This study shows that the proposed MWA directional approach operating at 5.8 GHz can be considered for creating effective and selective ablation zones.

Thermal ablation induced by low-intensity ultrasound for pulmonary vein isolation

Atrial fibrillation (AF) is currently the most common arrhythmia disease in clinic and its incidence increases with the age, which seriously endangers peoples health. Percutaneous catheter ablation is an important treatment strategy for AF, and pulmonary vein (PV) isolation has been widely accepted as the key approach of AF ablation since AFs are regarded the most important trigger of AF. The ablation scheme based on low-intensity ultrasound has the advantages of low biotoxicity and minimal invasion, while its applicability and parameter settings are still not well known. In this paper, we proposed a finite element model that could be used to simulate the ablation application of ultrasound intervention device for the purpose of PV isolation. The acoustic pressure and temperature fields generated during the process of low-intensity ultrasound pulmonary vein ablation were simulated based on linear acoustic wave equation and Pennes biological heat transfer equation, and then the corresponding thermal damage was quantitatively analyzed by taking into account of the equivalent heat dose equation. The results showed that the incident acoustic energy was mainly concentrated in the blood vessels of PV, and the temperature rise was mainly constrained in the inner part of the vessel walls, which suggested that high temperature rise could be realized nearby the central region of the low-intensity ultrasound transducer to achieve significant thermal damage in the inner part of the vessel walls. Moreover, the current study also discussed the impacts of different parameters on the ultrasound ablation effect, which would provide theoretical support and guidance for the optimization of ultrasound ablation strategy in clinics.

Behandlungsoptionen bei Meno-Metrorrhagie

Heavy and irregular menstrual bleeding (menorrhagia/metrorrhagia; MM) is common and affects between 10 and 30% of women of reproductive age. MM is associated with numerous clinical symptoms and a significant reduction in quality of life. The most important etiological factors of MM include endometrial polyps, myomas, adenomyosis, hyperplasia/malignancy, hereditary or acquired coagulation disorders, ovulatory dysfunction, and iatrogenic causes. The only definitive and therefore most effective treatment of MM is hysterectomy. Alternatives are uterus-conserving ablative approaches, e.g. endometrial resection (RS) and endometrial ablation (EA). In the case of hysterectomy, laparoscopic supracervical hysterectomy (LASH) is the method of first choice, if there are no specific reasons to remove the cervix. Conservative, non-surgical therapies of MM are available, including levonorgestrel-releasing intrauterine devices, oral/parenteral progestogens, oral/parenteral combination contraceptives, tranexamic acid, non-steroidal antirheumatics, selective progesterone receptor modulators, and gonadotropin releasing hormone agonists/antagonists.

Ventricular arrhythmias originating from the basal septum of the ventricle: Clinical and electrophysiological characteristics and a systematic ablation approach.

There is a paucity of data about VAs clustered at the vicinity of the basal septum of the ventricle. We aimed to report and characterize the clinical and electrophysiological features of basal septum VAs and explore the systematic ablation approach. A consecutive series of 51 patients who had their VAs successfully ablated at the basal septum of the ventricle was enrolled in this study. The basal septum was defined as the area 2 cm away from the septal annulus, the upper boundary was the site of the left or right His-Purkinje system, and the lower boundary was the borderline that separated away from the septum. RFCA was performed based on detailed activation mapping or pace mapping. Patients who underwent VA ablation from other areas of the tricuspid annulus (TA) and mitral annulus (MA) during the same period were enrolled as the control group. The patients with basal septum VAs were significantly older (p < 0.01) and had more comorbidities (hypertension and coronary artery disease) (p < 0.01). Meanwhile, the precordial R wave transition was significantly different in right side, left side and intramural foci group (p < 0.001). Acute procedural success was achieved in 44 patients (86.3%) in the study group and in 63 patients (95.5%) in the control group. After a median of 12 (6-36) months of follow-up, compared with VA recurrence in the control group (2 cases), 11 patients with basal septum VAs had recurrences (p = 0.002), while a delayed cure was observed in 3 in intramural foci group. Based on the unique anatomical and electrophysiological characteristics, a systematic approach for VAs originating from the basal septal area is warranted. Moreover, the follow-up data seemed to show a relative high recurrence rate for basal septal VAs during a period of time.

Epicardial ablation of refractory focal atrial tachycardia after a failed endocardial approach

Endocardial ablation is effective for most focal atrial tachycardias (FATs). In rare circumstances, the FAT can originate from the epicardial side of the atrium. In the present study, we retrospectively assessed the percutaneous approach for epicardial ablation of FAT when standard endocardial ablation had failed. Among a consecutive 186 patients undergoing ablation for 198 FATs, epicardial mapping and ablation via a percutaneous subxiphoid approach were attempted in 10 patients because of failed endocardial ablation. In 3 cases, the origin of FAT was at the epicardial side of the junction of the right atrial appendage and superior vena cava. In 3 cases, the origin of FAT was located in the epicardial region of the left atrial insertion of Bachmann bundle. In 2 cases, the FAT originated from the epicardial side of the right atrial free wall. In 1 case, the FAT was successfully ablated from the epicardial side of the right atrial appendage, and in the remaining case, the origin of FAT was located in the epicardial region of the vein of Marshall. All FATs were successfully eliminated by ablation at the epicardial earliest activation site. Epicardial mapping and ablation can be considered as an effective and safe option for FAT resistant to endocardial ablation.

Evaluation and Catheter Ablation of Ventricular Arrhythmias in Cardiac Sarcoidosis.

Ventricular arrhythmias are a common clinical manifestation in patients with cardiac sarcoidosis (CS) and other arrhythmogenic inflammatory cardiomyopathies (AIC). The management of sustained ventricular arrhythmias in these patients presents unique challenges. Current therapies include immunosuppressive, antiarrhythmic agents, and catheter ablation. Significant progress has been made in deciphering the importance of patient selection for ablation, systematic preablation evaluation, and optimal ablation timing, as well as ablation approaches and techniques. In this overview, we discuss the evaluation and management of ventricular arrhythmias in patients with CS, focusing on catheter ablation, which has evolved into an effective approach in reducing the burden of ventricular arrhythmias in these patients in the context of multifaceted treatment along with medical therapies.

Ultra‐Robust Joule‐Heated Superhydrophobic Smart Window: Dually‐Switching Droplets Adhesion and Transparency via In Situ Electric‐Actuated Reconfigurable Shape‐Memory Shutters

AbstractSlippery liquid‐impregnated porous surfaces (SLIPS) based smart windows (SWs) that dynamically fine‐tune the solar energy gain are promising candidates for alleviating the global energy crisis, especially for dim rainy climates. Unfortunately, the inferior durability arising from viscous dissipation over SLIPS‐based SWs remains a great challenge that needs to be addressed. Here, an ultra‐robust all‐solid‐state superhydrophobic SW is reported namely electric‐actuated reconfigurable shape memory shutter (EA‐RSMS) via a hybrid approach of laser ablation and soft transfer. Thanks to electrothermal effect of underlying silver nanowires heater, EA‐RSMS can be dynamically glazing by switching the surface shutters between bent mode (the transmittance of 10.8%) and erect one (the transmittance of 56.6%) within 60 s in situ. Synergistically, EA‐RSMS motivates the reversible transition between sticky state (sliding angle of 24°) and slippery one (sliding angle of 8°) by alternate Joule‐heating/pressing operation. Fundamental physics renders to clarify the effect of shutters topography on the hysteresis and light performance. Last but not the least, by utilizing the optimized EA‐RSMS shelter, indoor thermal‐comfort regulation, visibility encoding together with angle‐variable display are deployed. Current superhydrophobic EA‐RSMS with robust durability, novel tuning modulation, fast electric‐sensitivity, and optical angle‐dependence holds promising potential in self‐cleaning smart windows, energy‐saving buildings, anti‐voyeurism, etc.