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Introduction and Objectives: We report the results of the 2023 Spanish catheter ablation registry., Methods: Procedural data were collected and incorporated into the REDCap platform by all participating centers through a specific form., Results: There were 104 participating centers in 2023 compared with 103 in 2022. In 2023, the total number of ablation procedures was 26 207, indicating a stabilization of the increase observed in 2022 following the pandemic. The increase was mainly due to procedures for atrial fibrillation (AF), with a total of 9942 ablations, representing 38% of all substrates. Notably, pulse-field ablation represented 10.3% of all AF ablation procedures, leading single-shot ablation strategies to outnumber point-by-point AF ablation for the first time in the history of the registry. Cavotricuspid isthmus ablation remained the second most targeted substrate (19% of all substrates, n=5067). The overall acute success rate remained high (97%), with a downward trend in the complication rate (1.6% vs 1.8% in 2022) and mortality rate (0.03%; n=7). Compared with 2022, there was a significant increase in procedures performed using electro-anatomical mapping and zero-fluoroscopy techniques for cavotricuspid isthmus ablation (52% vs 26%), AV node re-entrant tachycardia (48% vs 34%), and accessory pathways (62% vs 22%). We registered 466 ablations in pediatric patients., Conclusions: The data indicate a stabilization in the post-pandemic increase in ablation procedures, with an absolute and relative increase in AF as the predominant substrate. Success rates remained stable with a modest reduction in complication and mortality rates., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

A young woman with systemic lupus erythematosus (SLE) and antiphospholipid antibodies was referred to our Cardiology Department. She had a large vegetation on the mitral valve, along with significant mitral regurgitation, pulmonary hypertension and slight signs of heart failure on physical examination and chest X-ray. A previously undetected iatrogenic arteriovenous fistula was surgically corrected, with subsequent normalization of pulmonary arterial pressure. Surprisingly, the mitral valve recovered a normal appearance in 21 days. We interpret the hemodynamic disturbances as a consequence of the high-output situation created by the fistula, and the regression of the vegetation as the lysis of a thrombus versus a silent embolism.