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Background: Pulsed-field ablation (PFA) using a pentaspline-catheter for the treatment of atrial fibrillation (AF) is performed in a standardized fashion. Whether a reduced number of applications results in similar clinical outcomes has not been fully investigated., Objectives: To assess a simplified PFA-dosing protocol for pulmonary vein isolation (PVI) compared to a standard protocol., Method: consecutive Patients undergoing their first PVI using PFA were enrolled. In the simple PFA-group, patients received 4 applications/PV (2x basket and 2x flower configuration) whereas 8 applications/PV (4x basket and 4x flower configuration) were used in the standard PFA-group., Results: We included 245 patients (32% female, median age 66 years): 96 patients were in the simple PFA-group (39%) and 149 in the standard PFA-group (61%). Median procedure duration, left atrial dwell time and fluoroscopy time were significantly shorter in the simple-PFA group compared to the standard PFA-group with 40 [25-55] min vs. 53 [41-67] min (p<0.001); 22 [13-37] min vs. 37 [27-50] min (p<0.001); 9 [7-12] min vs. 11 [9-14] min (p<0.001), respectively. First pass isolation was similar for the simple PFA and the standard PFA-group (95% vs. 95%, p>0.999). Overall, 4 procedural complications were observed, all in the standard PFA-group (p=0.303). During a median follow-up of 373 days, freedom from atrial arrhythmias was 79% in the simple PFA-group and 77% in the standard PFA-group (p=0.767), respectively. Findings were confirmed when only comparing patients who received PVI with/without EAM., Conclusion: In conclusion, the novel simplified PFA-protocol was associated with increased procedural efficiency while maintaining non-inferior efficacy and safety compared to the standard PFA-protocol., (Copyright © 2024. Published by Elsevier Inc.)

Background: Infranodal conduction disorders are common after transcatheter aortic valve replacement (TAVR). Risk factors are incompletely understood., Objective: The purpose of this study was to assess the impact of valve implantation depth and calcium burden of the device landing zone on infranodal conduction intraprocedure pre- and post-TAVR., Methods: In all patients undergoing TAVR between June 2020 and June 2021, the His-ventricle (HV) interval was measured pre- and post-valve deployment. The difference between the 2 measurements defined delta HV, whereas infranodal conduction delay was defined as HV interval >55 ms. Valve implantation depth was measured as the distance between the aortic annular plane and the ventricular prosthesis end. Calcium burden was quantified as the volume of calcium in 6 regions of interest: the non-, right, and left coronary cusps (NCC, RCC, and LCC, respectively) and the corresponding regions of the left ventricular outflow tract (LVOT) underlying each cusp (LVOT NCC , LVOT RCC , LVOT LCC , respectively)., Results: Of 101 patients (mean age 81 ± 5.7 years; 47% women), 37 demonstrated infranodal conduction delay intraprocedure post-TAVR. Overall, mean implantation depth was 5 ± 3.1 mm, median calcium volume was 2080 mm 3 [interquartile range 632-2400]. Delta HV showed no correlation with implantation depth or calcium burden (r = -0.08 and r = 0.12, respectively). However, LVOT NCC calcification was a significant predictor for infranodal conduction delay post-valve deployment in a multivariable logistic regression model (odds ratio 1.62 per 100-mm 3 increase (95% confidence interval 1.06-2.69; P = .04)., Conclusion: Assessment of LVOT NCC calcification may identify patients at risk for infranodal conduction delay after TAVR, whereas implantation depth did not predict infranodal conduction delay., (© 2023 Heart Rhythm Society. Published by Elsevier Inc.)