Kristian Eskesen

Introduction: Pulmonary vein isolation (PVI) is the cornerstone in atrial fibrillation (AF) ablation but achieving durable PVI remains a challenge. The radiofrequency balloon (RFB) is a “single‐shot” ablation catheter for PVI that offers selective energy titration from 10 surface electrodes and 3D mapping system integration. The durability of RFB PVI has not been investigated.Methods: The objective of this study was to evaluate the durability of RFB PVI by protocol‐mandated remaps in patients with paroxysmal or persistent AF referred for AF ablation at a high‐volume center. RFB procedures were performed under conscious sedation, PVI assessed by high‐density mapping, bidirectional block confirmed after a waiting period of ≥ 20 min, and dormant conduction assessed by adenosine injections. After 4–6 months patients underwent a remap study for assessment of PVI durability by high‐density mapping and assessment of bidirectional block.Results: Forty‐five patients were enrolled, 43 completed the RFB PVI, and 35/43 (81%) completed the remap study: 26% female, 43% persistent AF, median age 65 (interquartile range: 61–69) years, median CHA₂DS₂‐VASc score 1 (0–2), and median left atrial volume 31 (25–42) mL/m². Acute PVI was achieved in 99% of pulmonary veins (PVs) but focal radiofrequency touch‐up lesions were required in 31% of patients. After 5.4 (4.9–6.1) months, 71% of PVs were durably isolated, and 29% of patients had all PVs durably isolated; 86% of patients were free from documented atrial tachyarrhythmias.Conclusion: The durability of RFB PVI achieved under conscious sedation was relatively low. However, medium‐term freedom from clinical recurrent arrhythmia was favorable.Trial Registration: URL: https://www.clinicaltrials.gov. Unique Identifier: NCT06296888.

Currently there is no reliable medical treatment for aortic regurgitation (AR). Thirty-nine Sprague–Dawley rats underwent creation of AR or sham operation. Treated rats were assigned to early or late institution of sildenafil therapy (100 mg/kg/day) for a total of 10 weeks. Treatment–effects were measured by serial echocardiography, invasive hemodynamic measurements, and tissue analysis. Rats assigned to early treatment developed less remodeling than untreated rats. Thus, left ventricular (LV) dilation was blunted by sildenafil with end–systolic diameter being significantly smaller (6.6 ± 0.4 vs. 7.7 ± 0.4 mm, respectively, p < 0.05). Also, LV wall thickness was significantly decreased in treated rats compared to controls (2.23 ± 0.08 vs. 2.16 ± 0.05 mm, p < 0.01). Fractional shortening was improved by treatment (p < 0.05). Myocardial fibrosis was borderline decreased by treatment (p = 0.09). Akt was increased in treated compared to controls (p < 0.05). Sildenafil slightly inhibits LV remodeling and improves fractional shortening in rats with AR when treatment is initiated early.

Beta-blockade is contraindicated in severe aortic regurgitation (AR) due to the fear of prolonging diastole and thus aggravate regurgitation. However, this has never been scientifically proven and positive effects of targeting the sympathetic system in AR has been demonstrated in several studies. Thirty-nine Sprague–Dawley rats with AR were randomized to ten weeks of medical treatment with carvedilol or no treatment. Treatment was initiated either early or late after AR induction. The effect of carvedilol was assessed by serial echocardiography and invasive hemodynamic measurements. AR resulted in eccentric hypertrophy and left ventricular (LV) dysfunction. LV remodeling and function as measured by echocardiography was unaffected by treatment. LV dimensions were similar between treated and untreated groups and measures of LV performance (including strain and strain rate) were also unaltered. This result was confirmed by invasive measurements showing maximal and minimal pressure–time development, LV volumes, and LV pressures, to be unaltered by treatment. On the contrary, despite relative bradycardia carvedilol did not reflect any negative impact on the heart. Carvedilol did not improve left ventricular remodeling or function in rats with surgically induced AR. Despite relative bradycardia, we did not find carvedilol to negatively impact the heart, either when treatment was initiated early or late in the course of disease.