6. Pharmacological and non-pharmacological therapies clinical EP (rationale, material and equipment, techniques and procedures, side-effects and complications, results, indications and contraindications, ESC Guidelines)

Physical and autonomous system manoeuvres

• Bradfield   JS,   Ajijola   OA,   Vaseghi   M,   Shivkumar   K.   Mechanisms   and management of refractory ventricular arrhythmias in the age of autonomic modulation. Heart Rhythm Aug 2018;15:1252-1260.
  This review presents different case-based examples of currently available neuromodulatory interventions for the treatment of ventricular arrhythmias. The translational data and the clinical literature supporting the use of neuromodulation as a therapeutic option is reviewed.
• Shivkumar K, Ajijola OA, Anand I, et al. Clinical neurocardiology defining the value of neuroscience-based  cardiovascular  therapeutics.  J  Physiol Jul  15 2016;594:3911-3954.
  This review describes the role of the autonomic nervous system in regulation of cardiac function and pathophysiology of many cardiovascular diseases. It focuses on human cardiac neuroanatomy, neurophysiology and pathophysiology in specific disease conditions. Autonomic testing, risk stratification, and neuromodulatory strategies to mitigate the progression of cardiovascular diseases is discussed.
• Krul  SPJ,  Berger  WR,  Veldkamp  MW,  Driessen  AHG,  Wilde  AAM,  Deneke  T,de Bakker JMT, Coronel R, de Groot JR. Treatment of Atrial and Ventricular Arrhythmias Through  Autonomic  Modulation.  JACC  Clin  Electrophysiol Dec 2015;1:496-508.
  This review focuses on the contribution of autonomic nervous system modulation in the treatment of atrial and ventricular arrhythmias, the imaging techniques to identify the cardiac ANS system, and the procedures modulating intrinsic and extrinsic autonomic systems. 
• Appelboam A, Reuben A, Mann C, Gagg J, Ewings P, Barton A, Lobban T, Dayer M, Vickery J, Benger J; REVERT trial collaborators: Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial Lancet. 2015 Oct 31;386(10005):1747-53
  This randomised, single-blinded study of 428 patients with paroxysmal supraventricular tachycardia showed the superiority of modified Valsalva manoeuvre with leg elevation and supine positioning at the end of the strain in terminating SVT within one minute. No serious adverse events were recorded.
• Ceylan E, Ozpolat C, Onur O, Akoglu H, Denizbasi A: Initial and Sustained Response Effects of 3 Vagal Maneuvers in Supraventricular Tachycardia: A Randomized, Clinical Trial J Emerg Med. 2019 Sep;57(3):299-305
  This prospective, randomized study assessed the success rate of standard Valsalva maneuver (sVM), modified Valsalva (mVM) maneuver, and carotid sinus massage (CSM), in terms of PSVT termination and sustaining sinus rhythm at 5th minute in 98 patients. Modified Valsalva maneuver was superior in terminating PSVT and maintaining sinus rhythm without side effects.
• van Dijk N, Quartieri F, Blanc JJ, Garcia-Civera R, Brignole M, Moya A, Wieling W; PC-Trial Investigators: Effectiveness of physical counterpressure maneuvers in preventing vasovagal syncope: the Physical Counterpressure Manoeuvres Trial (PC-Trial). J Am Coll Cardiol. 2006 Oct 17;48(8):1652-7
  This multicenter, prospective and randomized clinical trial including 223 patients with recurrent vasovagal syncope and recognizable prodromal symptoms assessed the effectiveness of physical counterpressure maneuvers (PCM) in daily life. This maneuver was effective and risk-free compared to standard conventional therapy alone.
• de  Vos  CB,  Nieuwlaat  R,  Crijns  HJ,  Camm  AJ,  LeHeuzey  JY,  Kirchhof  CJ, Capucci  A,  Breithardt  G,  Vardas  PE,  Pisters  R,  Tieleman  RG.  Autonomic trigger   patterns   and   anti-arrhythmic   treatment   of   paroxysmal   atrial fibrillation: data from the Euro Heart Survey. Eur Heart J Mar 2008;29:632-639.
  This study was the first study that analysed the autonomic trigger patterns in paroxysmal AF in a large population. It collected data in 1517 patients with paroxysmal AF from an European Survey, showing that 6 % of patients had vagal trigger patterns, 15% adrenergic pattern, and 12 % mixed pattern. Non-guideline recommended drug treatment may result in aggravation of vagal AF. 
• Stavrakis  S,  Nakagawa  H,  Po  SS,  Scherlag  BJ,  Lazzara R,  Jackman  WM.  The role  of  the  autonomic  ganglia  in  atrial  fibrillation.  JACC  Clin  ElectrophysiolMar-Apr 2015;1:1-13.
  This review discusses the role of the autonomic ganglia in the initiation and maintenance of AF and reviews potential therapeutic implications, such as ablation of the autonomic ganglia with standard pulmonary vein (PV) isolation procedure for patients with paroxysmal AF.
• Chen  PS,  Chen  LS,  Fishbein  MC,  Lin  SF,  Nattel  S.  Role  of  the  autonomic nervous system in atrial fibrillation: pathophysiology and therapy. Circ Res Apr 25 2014;114:1500-1515.
  This review focuses on the relationship between the autonomic nervous system and pathophysiology of AF and the role of autonomic nerve function modulation in improved management of AF.
• Campbell M, Buitrago SR: BET 2: Ice water immersion, other vagal manoeuvres or adenosine for SVT in children Emerg Med J. 2017 Jan;34(1):58-60 
  Short review about the use of vagal maneuvers in children with PSVT. After analysis of retrospective poor-quality cohort studies or case series, the authors conclude that brief (5 sec) immersion of face in ice water is a safe, quick and effective maneuver in the pediatric population. Adenosine is effective but more invasive, while Valsalva mauever and carotid massage appeared less effective. 
• Un H, Dogan M, Uz O, Isilak Z, Uzun M: Novel vagal maneuver technique for termination of supraventricular tachycardias Am J Emerg Med. 2016 Jan;34(1):11
  This case series of 5 patients describes the effect of a new vagal maneuver to terminate paroxysmal supraventricular tachycardia when the carotis sinus massage and Valsalva maneuver fail. This maneuver consists of quickly changing from seated to supine body position.
• Romme JJ, Reitsma JB, Go-Schön IK, Harms MP, Ruiter JH, Luitse JS, Lenders JW, Wieling W, van Dijk N Prospective evaluation of non-pharmacological treatment in vasovagal syncope. Europace. 2010 Apr;12(4):567-73
  This prospective study analysed the role of non-pharmacological treatments, such as adequate fluid and salt intake, regular exercise and application of physical counterpressure manoeuvres, in 100 patients with recurrent episodes of vasovagal syncope. The results showed that these treatments were able to reduce the episodes of syncope and improve quality of life, but nearly half of the patients still experienced episodes of syncope.
• Brignole M, Croci F, Menozzi C, Solano A, Donateo P, Oddone D, Puggioni E, Lolli G: Isometric arm counter-pressure maneuvers to abort impending vasovagal syncope.  J Am Coll Cardiol. 2002 Dec 4;40(11):2053-9
  This is an important randomized study that showed in 19 patients the usefulness of isometric arm contraction to abort impending vasovagal syncope by increasing systemic blood pressure. During 9 months of follow-up, the treatment was actually performed in 95/97 episodes of impending syncope (98%) and was successful in 94/95 (99%).
• Hou  Y,  Scherlag  BJ,  Lin  J,  Zhang  Y,  Lu  Z,  Truong  K,  Patterson  E,  Lazzara  R, Jackman   WM,   Po   SS.   Ganglionated   plexi   modulate   extrinsic   cardiac autonomic  nerve  input:  effects  on  sinus  rate,  atrioventricular conduction, refractoriness,  and  inducibility  of  atrial  fibrillation.  J  Am  Coll  Cardiol Jul  3 2007;50:61-68.
  This animal study in 28 dogs describes the interactions between the extrinsic and intrinsic cardiac autonomic nervous systems in modulating electrophysiological properties of the heart and initiation of atrial fibrillation. Ablation of a single or multiple ganglionated plexi showed different response in terms of sinus rate, ventricular rate during atrial fibrillation, shortening of effective refractory period and AF inducibility.
• Driessen AHG, Berger WR, Krul SPJ, van den Berg NWE, Neefs J, Piersma FR, Chan  Pin  Yin  D,  de  Jong  J,  van  Boven  WP,  de  Groot  JR.  Ganglion  Plexus Ablation in Advanced Atrial Fibrillation: The AFACT Study. J Am Coll Cardiol Sep 13 2016;68:1155-1165.
  This important prospective randomized trial showed the effect of ganglion plexus (GP) ablation in patients undergoing thoracoscopic AF ablation with pulmonary vein isolation and left atrial lines. Additional GP ablation during thoracoscopic surgery for advanced AF did not affect freedom of AF recurrence after a follow-up of 2 years, neither in paroxysmal nor in persistent AF patient populations.
• Vaseghi  M,  Barwad  P,  Malavassi  Corrales  FJ,  Tandri  H,  Mathuria  N,  Shah  R, Sorg JM, Gima J, Mandal K, Saenz Morales LC, Lokhandwala Y, Shivkumar K. Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmias. J Am Coll CardiolJun 27 2017;69:3070-3080.
  This prospective multicentre study analysed the role of cardiac sympathetic denervation in 121 patients with refractory ventricular arrhythmias and structural heart disease. It demonstrated that denervation reduced sustained VT burden and ICD shock after 1.1 year of follow-up. Advanced heart failure, VT cycle length, and a left-sided-only procedure were independent predictors of recurrence and mortality in this population. 

Resuscitation and life support 

• Santangeli P, Rame JE, Birati EY, Marchlinski FE. Management of Ventricular Arrhythmias in Patients With Advanced Heart Failure. J Am Coll Cardiol Apr 11 2017;69:1842-1860.
  This well-done review discusses the role of antiarrhythmic drugs, catheter ablation and hemodynamic support devices during catheter ablation of ventricular arrhythmias. Indications of heart transplantation or durable mechanical circulatory support in patient with advanced heart failure and ventricular arrhythmias is reviewed.
• Palaniswamy C, Miller MA, Reddy VY, Dukkipati SR. Hemodynamic Support for    Ventricular    Tachycardia    Ablation.    Card    Electrophysiol    ClinMar 2017;9:141-152.
  This review analysed the role of hemodynamic support devices (intra-aortic balloon pump, Impella, TandemHeart, extracorporeal membrane oxygenation) during catheter ablation of unstable ventricular tachycardia. Discussion of device characteristics, patients’ selection criteria, and hemodynamic monitoring is included.
• Kudenchuk PJ, Brown SP, Daya M, Rea T, Nichol G Morrison LJ, Leroux B, Vaillancourt C, Wittwer L, Callaway CW, Christenson J, Egan D, Ornato JP, Weisfeldt ML, Stiell IG, Idris AH, Aufderheide TP, Dunford JV, Colella MR, Vilke GM, Brienza AM, Desvigne-Nickens P, Gray PC, Gray R, Seals N, Straight R, Dorian P; Resuscitation Outcomes Consortium Investigators. Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest N Engl J Med. 2016 May 5;374(18):1711-22
  In this randomized double-blind trial 3026 patients with out-of-hospital cardiac arrest due to initial shock-refractory ventricular fibrillation or pulseless ventricular tachycardia were randomly assigned to amiodarone, lidocaine or placebo. Use of amiodarone or lidocaine during the resuscitation didn’t improve the survival rate or neurological outcomes compared with placebo.
• Kudenchuk PJ, Leroux BG, Daya M, Rea T, Vaillancourt C, Morrison LJ, Callaway CW, Christenson J, Ornato JP, Dunford JV, Wittwer L, Weisfeldt ML, Aufderheide TP, Vilke GM, Idris AH, Stiell IG, Colella MR, Kayea T, Egan D, Desvigne-Nickens P, Gray P, Gray R, Straight R, Dorian P; Resuscitation Outcomes Consortium Investigators: Antiarrhythmic Drugs for Nonshockable-Turned-Shockable Out-of-Hospital Cardiac Arrest: The ALPS Study (Amiodarone, Lidocaine, or Placebo) Circulation. 2017 Nov 28;136(22):2119-2131   
  In this randomized double-blind trial patients with nonshockable-turned-shockable out-of-hospital cardiac arrest were enrolled. The use of amiodarone or lidocaine in this setting showed consistently higher survival rate, although the trends were not statistically significant. 
• Siao FY, Chiu CC, Chiu CW, Chen YC, Chen YL, Hsieh YK, Lee CH, Wu CT, Chou CC, Yen HH. Managing cardiac arrest with refractory ventricular fibrillation in the emergency department: Conventional cardiopulmonary resuscitation versus   extracorporeal   cardiopulmonary   resuscitation.   ResuscitationJul 2015;92:70-76.
  In this retrospective study 60 patients with ventricular fibrillation refractory to resuscitation for more than 10 min were enrolled. The study showed that patients treated with extracorporeal cardiopulmonary resuscitation (E-CPR) had significantly improved neurological outcomes, higher rates of sustained return of spontaneous circulation and longer duration of CPR than those receiving conventional CPR. The survival rate at discharge and at 1-year follow-up was not statistically different.
• Santangeli P, Muser D, Zado ES, et al. Acute hemodynamic decompensation during  catheter  ablation  of  scar-related  ventricular  tachycardia:  incidence, predictors,  and  impact  on  mortality.  Circ  ArrhythmElectrophysiolFeb 2015;8:68-75.
  In this observational prospective study of 193 consecutive patients undergoing scar-related ventricular tachycardia ablation, acute hemodynamic decompensation during the procedure occured in 11% of patients and was associated with increased risk of mortality over 21 months follow-up. Main predictors of acute hemodynamic decompensation were advanced age, ischemic cardiomyopathy, NYHA class III/IV, lower ejection fraction, presence of diabetes mellitus and chronic obstructive pulmonary disease, presentation with VT storm, and use of general anesthesia.
• Chen CY, Tsai J, Hsu TY, Lai WY, Chen WK, Muo CH, Kao CH. ECMO Used in a Refractory  Ventricular  Tachycardia  and  Ventricular  Fibrillation Patient:  A National Case-Control Study. Medicine (Baltimore)Mar 2016;95:e3204.
  In this retrospective case control study using data from the national insurance system and including 960 patients with refractory cardiac arrhythmia during resuscitation, ECMO support in high propensity score patients showed improvement in overall survival rate. However, ECMO support for >1 day could be potentially harmful.
• Abuissa  H,  Roshan  J,  Lim  B,  Asirvatham  SJ.  Use  of  the  Impella  microaxial blood    pump    for    ablation    of    hemodynamically    unstable    ventricular tachycardia. J Cardiovasc ElectrophysiolApr 2010;21:458-461.
  This small case series reported the successful use of the Impella™ microcirculatory axial blood flow pump in 3 patients with hemodynamically unstable ventricular tachycardia that allowed successful completion of ventricular tachycardia ablation, without evidence of iatrogenic complications. 
• Thomas  NJ,  Harvey  AT.  Bridge  to  recovery  with  the Abiomed  BVS-5000 device   in   a   patient   with   intractable   ventricular   tachycardia.   J   Thorac Cardiovasc SurgApr 1999;117:831-832.
  This case report described LVAD insertion as “bridging to recovery” in the postcardiotomy setting in a patient with recurrent ventricular tachycardia and resultant circulatory collapse without evidence of overt left ventricular pump failure or acute correctable ischemia.
• Bhandary    SP,    Joseph    N,    Hofmann    JP,    Saranteas    T,    Papadimos    TJ. Extracorporeal   life   support   for   refractory   ventricular   tachycardia.   Ann Transl MedFeb 2017;5:73.
  In this review the role of extracorporeal life support in the setting of refractory ventricular tachycardia is discussed. 
• Soar  J,  Donnino  MW,  Maconochie  I,  et  al.  2018  International  Consensus  on Cardiopulmonary    Resuscitation    and    Emergency    Cardiovascular    Care Science  With  Treatment  Recommendations  Summary.  Circulation Dec  4 2018;138:e714-e730.
• Panchal AR, Berg KM, Kudenchuk PJ, Del Rios M, Hirsch KG, Link MS, Kurz MC, Chan PS, Cabañas JG, Morley PT, Hazinski MF, Donnino MW: 2018 American Heart Association Focused Update on Advanced Cardiovascular Life Support Use of Antiarrhythmic Drugs During and Immediately After Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2018 Dec 4;138(23):e740-e749
• Hazinski  MF,  Nolan  JP,  Aickin  R,  et  al.  Part  1:  Executive  Summary:  2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. CirculationOct 20 2015;132:S2-39.
• Travers AH, Perkins GD, Berg RA, et al. Part 3: Adult Basic Life Support and Automated   External   Defibrillation:   2015   International   Consensus   on Cardiopulmonary    Resuscitation    and    Emergency    Cardiovascular    Care Science With Treatment Recommendations. CirculationOct 20 2015;132:S51-83.

Drugs with antiarrhythmic effects

• Hohnloser SH, Crijns HJ, van Eickels M, Gaudin C, Page RL, Torp-Pedersen C, et al. Effect of dronedarone on cardiovascular events in atrial fibrillation. N Engl J Med. 2009;360(7):668-78.
  # A multicenter randomized trial comparing dronedarone to placebo among patients with paroxysmal or persistent atrial fibrillation. The primary endpoint was cardiovascular hospitalizations or death from any cause. A total of 4629 patients were recruited.  Dronedarone showed a significant reduction in the primary composite endpoint. Cardiovascular death and arrhythmic death were both reduced. There was no difference in all-cause mortality.

• Connolly SJ, Camm AJ, Halperin JL, Joyner C, Alings M, Amerena J, et al. Dronedarone in high-risk permanent atrial fibrillation. N Engl J Med. 2011;365(24):2268-76.
  # Patients aged ≥65 with ≥6 months history of permanent atrial fibrillation and risk factors for major vascular events were randomized to receive dronedarone or placebo. The combined primary endpoint was stroke, myocardial infarction, systemic embolism, or death from cardiovascular causes.  The study recruited 3,236 patients and was terminated at a median follow-up of 3.5 months due to a two-fold increase in the composite primary endpoint of stroke, systemic embolism, myocardial infarction or CV death (HR-2.29, C.I-134-3.94, p=0.002) and the secondary composite endpoint of unplanned CV hospitalization or death (HR-1.95, C.I= 1.45-2.64, p<0.001). All-cause death, CV death, arrhythmic death, stroke, MI, CV hospitalisation and hospitalization for heart failure were all significantly higher in the dronedarone-treated patients. The study concluded that dronedarone should not be used in patients with permanent atrial fibrillation and, current or past symptoms of HF or left ventricular systolic dysfunction (EF <35%).

• Singh BN, Singh SN, Reda DJ, Tang XC, Lopez B, Harris CL, et al. Amiodarone versus sotalol for atrial fibrillation. N Engl J Med. 2005;352(18):1861-72.
  # A double-blind, placebo-controlled trial. A total of 665 patients with persistent atrial fibrillation were randomized to receive amiodarone (267 patients), Sotalol (261 patients), or placebo (137 patients). The primary endpoint was the time to recurrence of atrial fibrillation. The median times to recurrence of atrial fibrillation were 487 days in the amiodarone group, 74 days in the Sotalol group, and 6 days in the placebo group according to intention to treat and 809, 209, and 13 days, according to the received treatment analysis, respectively. Amiodarone was superior to Sotalol (P<0.001) and to placebo (P<0.001), and Sotalol was superior to placebo (P<0.001). In patients with ischemic heart disease, the median time to a recurrence of atrial fibrillation was 569 days with amiodarone therapy and 428 days with Sotalol therapy (P=0.53). Restoration and maintenance of sinus rhythm significantly improved the quality of life and exercise capacity. There were no significant differences in major adverse events among the three groups.

• Torp-Pedersen C, Moller M, Bloch-Thomsen PE, Kober L, Sandoe E, Egstrup K, et al. Dofetilide in patients with congestive heart failure and left ventricular dysfunction. Danish Investigations of Arrhythmia and Mortality on Dofetilide Study Group. N Engl J Med. 1999;341(12):857-65.
  # A prospective randomised double-blind placebo-controlled study evaluating the safety and efficacy of dofetilide in patients with symptomatic heart failure and severe LV dysfunction.  The primary endpoint was all-cause death. A total of 1,518 patients were recruited and followed for a mean of 18 months.  Dofetilide did not reduce mortality but significantly reduced the risk of hospitalisation due to worsening heart failure.  Notably, there were 25 cases of torsade de pointes in the dofetilide group (3.3 %) as compared with none in the placebo group.

• Belhassen B, Glick A, Viskin S. Efficacy of quinidine in high-risk patients with Brugada syndrome. Circulation. 2004;110(13):1731-7.
  # The utility of quinidine in the prevention of ventricular arrhythmia among Brugada syndrome (BrS) patients was tested in 15 patients with symptomatic BrS (post-cardiac arrest or unexplained syncope) and asymptomatic patients. All patients underwent an EPS with VF induction pre and post-quinidine administration. VF was induced in all subjects before quinidine loading but was re-induced in only 3 after loading.  19 patients received long-term (56 ±67 months) treatment with quinidine and none had an arrhythmic event. The authors concluded that quinidine was effective in preventing VF during EPS and suppressing spontaneous arrhythmia in BrS. It was proposed that quinidine may be a safe alternative to ICDs. A landmark study describing the use of quinidine in the prevention of SCD among BrS patients.

• Kannankeril PJ, Moore JP, Cerrone M, Priori SG, Kertesz NJ, Ro PS, et al. Efficacy of Flecainide in the Treatment of Catecholaminergic Polymorphic Ventricular Tachycardia: A Randomized Clinical Trial. JAMA Cardiol. 2017;2(7):759-66.
  # A multi-centre crossover trial comparing maximally tolerated beta blockers with and without flecainide for reduction of exercise-induced ventricular ectopy.  Fourteen patients were randomised and 13 completed the study.  Patients with a clinical diagnosis of CPVT and an ICD underwent a baseline exercise test while receiving maximally tolerated β-blocker therapy that was continued throughout the trial. Patients were then randomized to flecainide or placebo for 3 months, followed by exercise testing. After a 1-week washout period, patients crossed over to the other arm (flecainide or placebo) for an additional 3 months, followed by exercise testing. The combination of flecainide plus beta-blocker significantly reduced ventricular ectopy compared to beta-blockers alone.

• Mazzanti A, Maragna R, Faragli A, Monteforte N, Bloise R, Memmi M, et al. Gene-Specific Therapy With Mexiletine Reduces Arrhythmic Events in Patients With Long QT Syndrome Type 3. J Am Coll Cardiol. 2016;67(9):1053-8.
  # Long QT 3 syndrome is the result of a gain of function mutation in SCN5A, coding for the sodium channel Nav1.5 and resulting in a prolonged ventricular repolarization period.  Mexiletine has been shown to abbreviate the duration of ventricular repolarisation in an animal model of LQT3 (8) and a small group LQT3 patient. This study described the clinical experience of 34 patients with LQTS treated with mexiletine and compared the annual rate of arrhythmic events before and after beginning this therapy.  Mexiletine significantly shortened the QTc and reduced the number of arrhythmic events.

• Lafuente‐Lafuente C, Valembois L, Bergmann JF, Belmin J. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database of Systematic Reviews. 2015(3).
  # A comprehensive review by the Cochrane Group that covers all antiarrhythmic drugs used in AF. Drug effects on mortality and efficacy in maintaining sinus rhythm are presented.

• Claro JC, Candia R, Rada G, Baraona F, Larrondo F, Letelier LM. Amiodarone versus other pharmacological interventions for the prevention of sudden cardiac death. The Cochrane database of systematic reviews. 2015(12):CD008093.
  # A comprehensive systematic review and meta-analysis evaluating the efficacy of amiodarone in primary and secondary prevention of sudden cardiac death. A total of 24 studies comparing amiodarone to placebo or no intervention were included. When used for primary prevention amiodarone appeared to reduce SCD, cardiac death and all-cause mortality compared to placebo or no intervention. It was found superior to other antiarrhythmic drugs used for the same goal. When used for secondary prevention it appeared to increase the risk of SCD and all‐cause mortality. The review provides a valuable summary of the available data regarding the management of patients at risk of sudden cardiac death.

• Echt DS, Liebson PR, Mitchell LB, Peters RW, Obias-Manno D, Barker AH, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial. N Engl J Med. 1991;324(12):781-8.
  # A randomized control study designed to evaluate the benefit of administrating flecainide or Encainide to post-myocardial infarction patients in an attempt to reduce sudden cardiac death. Both drugs were compared to placebo. A total of 1,498 where recruited and followed for a median of 10 months.  The use of the antiarrhythmic drugs was discontinued due to excess mortality.  There was an increase in both arrhythmic and non-arrhythmic cardiac causes (mainly recurrent MI with shock and congestive heart failure).

• Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893-962.
• January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr, Ellinor PT, Ezekowitz MD, Field ME, Furie KL, Heidenreich PA, Murray KT, Shea JB, Tracy CM, Yancy CW. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019 Jul 9;74(1):104-132. 
• Priori SG, Blomstrom-Lundqvist C. 2015 European Society of Cardiology Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death summarized by co-chairs. Eur Heart J. 2015;36(41):2757-9.
• Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society J Am Coll Cardiol. 2018 Oct 2;72(14):e91-e220 

Antithrombotic drugs therapy in atrial fibrillation Antithrombotic drugs therapy in atrial fibrillation 

• Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Dabigatran versus warfarin in patients with atrial fibrillation. New England Journal of Medicine. 2009;361(12):1139-51.
  # A multicenter prospective randomized controlled study comparing 110 mg and 150mg of dabigatran to warfarin in nonvalvular atrial fibrillation.  Dabigatran 150 mg was found superior to warfarin in the reduction of stroke or systemic embolism as well as a reduction in total risk for stroke, hemorrhagic stroke and vascular death.  It was the only drug dose (among all DOACs) that showed a reduction in the risk of ischemic stroke.  It was however associated with an increase in gastrointestinal bleeding. There was no difference in the risk of major bleeding comparing warfarin to Dabigatran 110mg. Dabigatran was found to be non-inferior to warfarin in the reduction of stroke or systemic embolism and was associated with a lower risk of major bleeding.

• Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, et al. Edoxaban versus warfarin in patients with atrial fibrillation. New England Journal of Medicine. 2013;369(22):2093-104.
  # A multicenter prospective randomized controlled study comparing 30 mg and 60 mg of Edoxaban to warfarin in nonvalvular atrial fibrillation.  A total of 21,105 very included.  In the warfarin group, time in the therapeutic INR range was 68.4%.  Both dosages of Edoxaban were non-inferior to warfarin in the prevention of stroke or systemic embolism.  Both showed a decrease in hemorrhagic stroke, major bleeding and all-cause mortality compared to warfarin.  

• Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, et al. Apixaban versus warfarin in patients with atrial fibrillation. New England Journal of Medicine. 2011;365(11):981-92.
  # A randomized double-blind, multicenter controlled study comparing apixaban to warfarin in patients with non-valvular atrial fibrillation. A total of 18,201 were recruited. Notably, only 428 were treated with the reduced dose (2.5 mg BID).  Apixaban was superior to warfarin in the reduction of stroke or systemic embolism.  Apixaban also resulted in a low risk of hemorrhagic stroke, major bleeding, intracranial bleeding and all-cause mortality.

• Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New England Journal of Medicine. 2011;365(10):883-91.
  # A total of 14,264 patients with nonvalvular atrial fibrillation were randomly assigned to warfarin or rivaroxaban in a double-blinded multicentre study.  Rivaroxaban was non-inferior to warfarin in the reduction of stroke or systemic embolism.  Rivaroxaban treatment was associated with a lower risk of hemorrhagic stroke or intracranial hemorrhage, but a higher risk of GI bleeding.

• Hart RG, Pearce LA, Aguilar MI. Meta-analysis: Antithrombotic Therapy to Prevent Stroke in Patients Who Have Nonvalvular Atrial Fibrillation. Annals of Internal Medicine. 2007;146(12):857-67.
  # The meta-analysis includes 29 trials including a total of 28,044 patients comparing warfarin to placebo and/or, antiplatelet agents. Compared with the control group, adjusted-dose warfarin and antiplatelet agents reduced stroke by 64% (95% CI, 49% to 74%) and 22% (CI, 6% to 35%), respectively. Adjusted-dose warfarin was substantially more efficacious than antiplatelet therapy (relative risk reduction, 39% [CI, 22% to 52%]). The absolute increase in major extracranial haemorrhage was small (≤0.3% per year).

• Pollack CV, Jr., Reilly PA, van Ryn J, Eikelboom JW, Glund S, Bernstein RA, et al. Idarucizumab for Dabigatran Reversal - Full Cohort Analysis. N Engl J Med. 2017;377(5):431-41.
  # A multicenter prospective open study evaluating the IV administration of Idarucizumab for reversal of the anticoagulant effect of dabigatran in patients with uncontrolled bleeding or facing an urgent surgical procedure. A total of 503 patients were included  (301 with uncontrolled bleeding and 202 anticipating urgent surgery). Administration of 5 g of IV Idarucizumab resulted in a complete reversal of the anticoagulation effect as measured by thrombin and ecarin clotting time. In addition, peri-procedure hemostasis was considered to be normal in 93.4% of patients undergoing surgery. Among patients presenting with bleeding, the median time to bleeding cessation was 2.5 hours.  At 90 days, thrombotic events occurred in 6.3% of the patients treated due to acute bleeding and in 7.4% of patients who underwent urgent surgery. The mortality rate was 18.8% and 18.9%. There were no serious adverse safety events. Praxbind is approved by EMA and available for use in several countries.  

• Connolly SJ, Crowther M, Eikelboom JW, Gibson CM, Curnutte JT, Lawrence JH, et al. Full Study Report of Andexanet Alfa for Bleeding Associated with Factor Xa Inhibitors. N Engl J Med. 2019;380(14):1326-35.
  # A multicentre prospective level single group study evaluating the efficacy of Andexanet in reversing the effect of anti-factor Xa inhibitors among patients presenting with acute major bleeding.  A total of 350  patients were recruited, most (64%) presenting with intracranial bleeding or gastrointestinal bleeding (26%). Most patients (82%) achieved excellent or good hemostasis within 12 hours of Andexanet administration. Death occurred in 49 patients (14%) and a thrombotic event in 34 (10%) patients within 30 days.

• Providencia R, Marijon E, Boveda S, Barra S, Narayanan K, Le Heuzey JY, et al. Meta-analysis of the influence of chronic kidney disease on the risk of thromboembolism among patients with nonvalvular atrial fibrillation. Am J Cardiol. 2014;114(4):646-53.
  # The meta-analysis included 19 Studies and found that chronic kidney disease (CKD) was associated with an increased risk of thromboembolism particularly in the case of end-stage CKD). Warfarin decreased the incidence of thromboembolic events in patients with non-end-stage CKD.

• Fox KA, Piccini JP, Wojdyla D, Becker RC, Halperin JL, Nessel CC, et al. Prevention of stroke and systemic embolism with rivaroxaban compared with warfarin in patients with non-valvular atrial fibrillation and moderate renal impairment. Eur Heart J. 2011;32(19):2387-94.
  # A subgroup analysis of the ROCKET-AF study focusing on patients with CKD.  Compared with patients with CrCl >50 mL/min (mean age 73 years), the 2950 (20.7%) patients with CrCl 30-49 mL/min were older (79 years) and had higher event rates irrespective of study treatment. Rivaroxaban treatment resulted in similar rates of both thromboembolic events and major bleeding as warfarin in patients with CKD.

• Hijazi Z, Hohnloser SH, Oldgren J, Andersson U, Connolly SJ, Eikelboom JW, et al. Efficacy and safety of dabigatran compared with warfarin in relation to baseline renal function in patients with atrial fibrillation: a RE-LY (Randomized Evaluation of Long-term Anticoagulation Therapy) trial analysis. Circulation. 2014;129(9):961-70.
  # A subgroup analysis of the RE–LY study. Similarly to other studies, rates of stroke or systemic embolism, major bleeding, and all-cause mortality increased as renal function decreased. The rates of stroke or systemic embolism were lower with dabigatran 150 mg and similar with 110 mg twice daily compared with warfarin, without significant heterogeneity in subgroups defined by renal function.  However, the benefit of reduced bleeding with the dabigatran 110 mg dose over warfarin in patients without CKD was absent in patients with CrCl <50mL/min.

• Hohnloser SH, Hijazi Z, Thomas L, Alexander JH, Amerena J, Hanna M, et al. Efficacy of apixaban when compared with warfarin in relation to renal function in patients with atrial fibrillation: insights from the ARISTOTLE trial. Eur Heart J. 2012;33(22):2821-30.# A subgroup analysis of the ARISTOTLE trial. The rate of cardiovascular events and bleeding was higher at impaired renal function (</=80 mL/min). Apixaban was more effective than warfarin in preventing stroke or systemic embolism and reducing mortality irrespective of renal function. These results were consistent, regardless of methods for GFR estimation. Apixaban was associated with lower major bleeding risk compared to warfarin across the spectrum of renal function categories. In particular, the comparative safety of apixaban over warfarin became more apparent with advancing CKD severity, while maintaining the same comparative efficacy on stroke prevention.
• Steffel J, Verhamme P, Potpara TS, Albaladejo P, Antz M, Desteghe L, et al. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J. 2018;39(16):1330-93

Transient electrical stimulation

Transcutaneous

• Cummins RO, Graves JR, Larsen MP, Hallstrom AP, Hearne TR, Ciliberti J, et al. Out-of-hospital transcutaneous pacing by emergency medical technicians in patients with asystolic cardiac arrest. The New England journal of medicine. 1993;328(19):1377-82.
  # A prospective study evaluating the value of transcutaneous pacing for primary or post-defibrillation asystole.  Half of the districts covered by an Emergency Medical Service were supplied with transcutaneous pacemakers and the emergency medical technicians were instructed to use them for primary or post-defibrillation asystole while the other districts continued the usual care. Pacing was done as early as possible, before endotracheal intubation or intravenous medication. There was no difference in the rate of survival to hospital admission or discharge.

• Bektas F, Soyuncu S. The efficacy of transcutaneous cardiac pacing in ED. Am J Emerg Med. 2016;34(11):2090-3.
  # A single-central, observational clinical study describing the outcome of adult patients presenting with acute unstable bradycardia to the tertiary care university ED treated with transcutaneous cardiac pacing (TCP). TCP resulted in a significant improvement in systolic and diastolic blood pressure as well as an increase in heart rate. 

• Zoll PM, Zoll RH, Falk RH, Clinton JE, Eitel DR, Antman EM. External noninvasive temporary cardiac pacing: clinical trials. Circulation. 1985;71(5):937-44.
  # A manuscript describing the initial experience with the Zoll transcutaneous pacing system

• Sherbino J, Verbeek PR, MacDonald RD, Sawadsky BV, McDonald AC, Morrison LJ. Prehospital transcutaneous cardiac pacing for symptomatic bradycardia or bradyasystolic cardiac arrest: a systematic review. Resuscitation. 2006;70(2):193-200.A systematic review that analysed the efficacy of prehospital transcutaneous cardiac pacing (TCP) in the management of symptomatic bradycardia and bradyasystolic cardiac arrest. It showed no evidence to support the use of TCP in bradyasystolic cardiac arrest, and inadequate evidence to determine the efficacy of prehospital TCP in the treatment of symptomatic bradycardia

Transesophageal 

• Brockmeier K, Ulmer HE, Hessling G. Termination of atrial reentrant tachycardias by using transesophageal atrial pacing. J Electrocardiol. 2002;35 Suppl:159-63.
  # A case series describing the experience with using the oesophagal electrodes for establishing the diagnosis of arrhythmia and for overdrive pacing to terminate atrial reentrant tachycardia in Pediatric patients. 39 consecutive patients including 7 newborns were included.  The overdrive pacing consisted of pacing starting at a cycle length 20 ms shorter than the arrhythmia cycle length. Cardioversion was achieved in 81% of cases. The authors recommended using transesophageal atrial pacing as a primary approach for acute cardioversion of atrial re-entrant tachycardia in neonates, infants and children.

Intracardiac percutaneous

• Zei PC, Eckart RE, Epstein LM. Modified temporary cardiac pacing using transvenous active fixation leads and external re-sterilized pulse generators. Journal of the American College of Cardiology. 2006;47(7):1487-9.
  # One of the first descriptions of temporary pacing using an active fixation lead and an external pulse generator. The manuscript describes the initial experience in 62 patients, the indications, technique of implantation and outcomes are reported. A common indication for use was symptomatic AV block in the context of bacteraemia or early post-surgery. There were no deaths due to arrhythmia or related to the implant. Two-thirds of the patients were eventually (median 7.5 days) implanted with a permanent pacing system. This approach is widely used and offers an important option when reliable pacing is needed for more than a few days but permanent pacing is not adequate.

Cardioversion and defibrillation

• Pluymaekers N, Dudink E, Luermans J, Meeder JG, Lenderink T, Widdershoven J, et al. Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation. The New England journal of medicine. 2019;380(16):1499-508.
  # A multicenter, randomized, open-label, noninferiority trial, comparing early cardioversion to wait-and-see approach in patients with recent onset (<36h) symptomatic atrial fibrillation.  The wait-and-see approach involved initial treatment with rate-control medication only, and delayed cardioversion if the atrial fibrillation did not resolve within 48 hours. At 4 weeks of follow-up, the rate of sinus rhythm was equal between both groups.  Spontaneous cardioversion occurred within 48 hours in 69% of patients. The authors concluded that for patients presenting to the emergency department with recent onset symptomatic but hemodynamically stable atrial fibrillation a wait-and-see approach is non-inferior to early cardioversion.

• Airaksinen KE, Gronberg T, Nuotio I, Nikkinen M, Ylitalo A, Biancari F, et al. Thromboembolic complications after cardioversion of acute atrial fibrillation: the FinCV (Finnish CardioVersion) study. J Am Coll Cardiol. 2013;62(13):1187-92.
  # A retrospective analysis of 7,660 cardioversions was performed in 3,143 consecutive patients with atrial fibrillation lasting <48 h. Embolic complications were evaluated during the 30 days after 5,116 successful cardioversions in 2,481 patients with neither oral anticoagulation nor peri-procedural heparin therapy. The authors found 0.7% (0.5-1%) of definite thromboembolic events within 30 days (median 2 days, mean 4.6 days) after cardioversion. Age, female sex, heart failure and diabetes were all independent predictors of embolic events following cardioversion. The work shows that the risk for stroke following cardioversion is significant in high-risk patients even with AF duration of <48h.

• Camm AJ, Capucci A, Hohnloser SH, Torp-Pedersen C, Van Gelder IC, Mangal B, et al. A randomized active-controlled study comparing the efficacy and safety of vernakalant to amiodarone in recent-onset atrial fibrillation. J Am Coll Cardiol. 2011;57(3):313-21.
  # A randomized double-blind study designed to compare the efficacy and safety of intravenous vernakalant and amiodarone for acute conversion of recent-onset atrial fibrillation. A total of 254 adult patients with AF (3 to 48 h duration) eligible for cardioversion were enrolled in the study. Patients received either a 10-min infusion of vernakalant (3 mg/kg) followed by a 15-minute observation period and a second 10-min infusion (2 mg/kg) if still in AF, plus a sham amiodarone infusion or a 60-min infusion of amiodarone (5 mg/ kg) followed by a maintenance infusion (50 mg) over an additional 60 min, plus a sham vernakalant infusion. Vernakalant infusion resulted in a higher rate of cardioversion at 90 minutes as compared to amiodarone (51.7 vs 5.2%).  Torsades de pointes VT, ventricular fibrillation, or polymorphic or sustained ventricular tachycardia were not observed.

• Gallagher MM, Guo XH, Poloniecki JD, Guan Yap Y, Ward D, Camm AJ. Initial energy setting, outcome and efficiency in direct current cardioversion of atrial fibrillation and flutter. J Am Coll Cardiol. 2001;38(5):1498-504.
  # A retrospective analysis of shocks in 1,838 attempts at cardioversion for atrial fibrillation and 678 attempts at cardioversion for atrial flutter. A total of 5,152 shocks were delivered to patients for AF and 1,238 shocks were delivered to patients for atrial flutter. The probability of success on the first shock in AF of >30 days duration was 5.5% at 200 J, 35% at 200 J and 56% at 360 J. In atrial flutter, an initial 100 J shock worked in 68%. The authors concluded that an initial energy setting of 360 J can achieve cardioversion of AF more efficiently than gradually dialling up the power.

• Manning WJ, Leeman DE, Gotch PJ, Come PC. Pulsed Doppler evaluation of atrial mechanical function after electrical cardioversion of atrial fibrillation. J Am Coll Cardiol. 1989;13(3):617-23.
  # An important study describing the acute effect of electrical cardioversion on the mechanical function of the atrium in patients with atrial fibrillation. A total of 21 patients were followed for 3 months after the cardioversion and compared to 12 healthy controls. Peak A velocities were significantly reduced immodestly post cardioversions and gradually normalized over 3 months of follow-up among patients who maintained sinus rhythm. Peak A velocities and % atrial contribution to left ventricular filling among patients maintaining sinus rhythm returned to values comparable to controls only after 3 weeks. This is the basis for our current practice.

• Khan IA. Single oral loading dose of propafenone for pharmacological cardioversion of recent-onset atrial fibrillation. J Am Coll Cardiol. 2001;37(2):542-7.
  # A systematic review of the efficacy and safety of the single dose oral loading regimen of propafenone for pharmacological cardioversion of recent-onset atrial fibrillation. Using the typical dose of 600 mg the rates of cardioversion ranged form  56% to 83%, depending on the duration of AFib and follow-up after drug administration. The conversion time ranged from 110 ± 59 to 287 ± 352 min, depending on the duration of observation after drug administration. The single-dose oral loading regimen of propafenone was significantly more efficacious than placebo in the first 8 h after administration but not at 24 h. Compared with the intravenous regimen, the oral regimen resulted in fewer conversions in the first 2 h, but both regimens were equally efficacious afterwards. The adverse effects reported were transient arrhythmia, reversible QRS-complex widening, transient hypotension and mild noncardiac side effects. The transient arrhythmias were chiefly at the time of conversion and included the appearance of atrial flutter, bradycardia, pauses and junctional rhythm. No life-threatening proarrhythmic adverse effects were reported

• Khan IA. Oral loading single dose flecainide for pharmacological cardioversion of recent-onset atrial fibrillation. Int J Cardiol. 2003;87(2-3):121-8.
  #A systematic review of the efficacy and safety of the single oral loading dose of flecainide for cardioversion of recent-onset atrial fibrillation. The success rate, using a typical dose of 300 mg, ranged from 57 to 68% at 2–4 h and 75 to 91% at 8 h after drug administration. The conversion time ranged from 110±82 to 190±147 min, depending on the duration of observation after drug administration. The single oral loading regimen of flecainide was significantly more efficacious than the placebo and was as efficacious as the single oral loading regimen of propafenone. Both the single oral loading and the intravenous loading regimens of flecainide were equally efficacious but the intravenous regimen resulted in an earlier conversion. Adverse effects reported were mild non-cardiac side effects, reversible QRS complex widening, transient arrhythmias and left ventricular decompensation. The transient arrhythmias were chiefly at the time of conversion and included the appearance of atrial flutter and sinus pauses. No life-threatening ventricular arrhythmia or death was reported.

• Garg A, Khunger M, Seicean S, Chung MK, Tchou PJ. Incidence of Thromboembolic Complications Within 30 Days of Electrical Cardioversion Performed Within 48 Hours of Atrial Fibrillation Onset. JACC: Clinical Electrophysiology. 2016;2(4):487-94.
  # A total of 484 undergoing cardioversion within 48 h of AF onset without therapeutic anticoagulation were prospectively collected and retrospectively reviewed.  These were compared to patients undergoing cardioversion with therapeutic anticoagulation.

• Gall NP, Murgatroyd FD. Electrical cardioversion for AF-the state of the art. Pacing and clinical electrophysiology: PACE. 2007;30(4):554-67.
  # A well-written review covering the history, and physics of cardioversion and defibrillations, ways to improve efficacy. The questions of monophasic vs biphasic shocks, and antiarrhythmic drug effect on DFT and cardioversion success are summarized nicely.  Cardioversion without therapeutic anticoagulation was associated with a 5 fold increase in the risk of thromboembolic events.  The risk was predicted by the  CHA2DS2-VASc scores.  No events occurred in patients with CHA2DS2-VASc score<2 even without anticoagulation.

• Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893-962.

Invasive EP guided therapiesInvasive EP guided therapies

• Vijayaraman P, Chung MK, Dandamudi G, et al. His Bundle Pacing. Journal of the American College of Cardiology Volume 72, Issue 8, August 2018; DOI: 10.1016/j.jacc.2018.06.017
  # This review paper summarizes practical approaches to His bundle pacing, tips and tricks of implantation. The authors provide acute and chronic effects on cardiac conduction, and contractility. The results of clinical applications in patients with preserved and decreased ejection fraction. Clinical challenges and troubleshooting are also provided.

• Abi-Samra F, Gutterman D. Cardiac contractility modulation: a novel approach for the treatment of heart failure. Heart Fail Rev. 2016; 21(6): 645–660. doi: 10.1007/s10741-016-9571-6
  # This review highlights the preclinical and clinical research published on the utility of cardiac contraction modulation in patients with heart failure. The implantation procedure, mechanism of action, and main clinical results are described. The cost-benefit analysis is also covered in the paper.

• Tschöpe C, Kherad B, Klein O, et al. Cardiac contractility modulation: mechanisms of action in heart failure with reduced ejection fraction and beyond. Eur J Heart Fail. 2019 Jan;21(1):14-22. doi: 10.1002/ejhf.1349.
  # This review highlights the preclinical and clinical literature related to cardiac contractility modulation in heart failure with reduced ejection fraction and heart failure with mid-range ejection fraction and outlines the potential of cardiac contractility modulation for heart failure with preserved ejection fraction, concluding that the therapy may fill an important unmet need in the therapeutic approach in patients with heart failure with narrow QRS across the range of ejection fraction.

Percutaneous catheter ablation

Sinusal tachycardias  

• Olshansky B, Sullivan RM. Inappropriate sinus tachycardia. J Am Coll Cardiol. 2013 Feb 26;61(8):793-801. doi: 10.1016/j.jacc.2012.07.074.
  # In this review paper definition, clinical presentation, and epidemiology of inappropriate sinus tachycardia (IST) are described. Mechanisms and causes of IST are presented. Treatment modalities (catheter and surgical ablation) are described, and emerging approaches are provided. The authors emphasize the existent limitations in current treatment modalities and describe a “general” approach to patient management.

• Gianni C, Di Biase L, Mohanty S, Gökoğlan Y, Güneş MF, Horton R, Hranitzky PM, Burkhardt JD, Natale A. Catheter ablation of inappropriate sinus tachycardia. J Interv Card Electrophysiol. 2016 Jun;46(1):63-9. doi: 10.1007/s10840-015-0040-2.
  # In this review the authors discuss the role and limitations of catheter ablation in the management of patients with inappropriate sinus tachycardia and focusing on their approach to patient selection and catheter ablation approach.

• Sanders WE, Sorrentino RA, Greenfield RA, Shenasa H, Hamer ME, Wharton JM. Catheter ablation of sinoatrial node reentrant tachycardia. Journal of the American College of Cardiology, Volume 23, Issue 4, March 1994; DOI: 10.1016/0735-1097(94)90639-4
  # This study evaluates 1) the safety and efficacy of catheter ablation to eliminate sustained sinoatrial node reentrant tachycardia; 2) the incident of sinoatrial node reentrant tachycardia in a group of patients undergoing electrophysiologic study for paroxysmal supraventricular tachycardia; and 3) the association of sinoatrial node reentrant tachycardia with other tachyarrhythmias. The authors found that of 343 consecutive patients referred for electrophysiologic evaluation of paroxysmal supraventricular tachycardia, 11 (3.2%) were found to have inducible sustained sinoatrial node reentrant tachycardia. Nine of the 11 patients had other associated arrhythmias. In 10 patients radiofrequency ablation of reentrant sinus tachycardia was attempted and was successful in all. The authors conclude that sinoatrial node reentrant tachycardia may be effectively and safely treated with radiofrequency current ablation at the site of earliest atrial activation.

• Sheldon RS, Grubb BP, Olshansky B, Shen W-K, Calkins H, Brignole M, Raj SR, Krahn AD, Morillo CA, Stewart JM, Sutton R, Sandroni P, Friday KJ, Hachul DT, Cohen MI, Lau DH, Mayuga KA, Moak JP, Sandhu RK, Kanjwal K. 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope. Heart Rhythm. 2015;12:e41-e63.

AV nodal ablation and ablation of tachycardia is related to the His-Purkinje system

• Chapter 24. Fascicular ventricular tachycardia; in Clinical Arrhythmology and Electrophysiology: A Companion to Braunwald's Heart Disease 3rd Edition by Ziad Issa MD MMM (Author), John M. Miller MD (Author), 2018
  # In this textbook chapter the authors describe characteristics and electrophysiological evaluation of fascicular ventricular tachycardias. Diagnostic and differential diagnostic manoeuvres are presented, and activation, entrainment, pace, and electroanatomic mapping are described. Approaches and different techniques of catheter ablation are described in detail.

• Anderson RD, Kumar S, Kalman JM, Sanders P, Sacher F, Hocini M, Jais P, Haïsaguerre M, Lee G. Catheter Ablation of Ventricular Fibrillation. Heart Lung Circ. 2019 Jan;28(1):110-122. doi: 10.1016/j.hlc.2018.09.005.
  # This is a review paper describing the mechanisms of initiation and perpetuation of ventricular fibrillation. The common mechanism of initiation is an ectopic activity in Purkinje system. Mapping and ablation of Purkinje fibres is well described and discussed in the paper. Nogami A. Purkinje-related arrhythmias part I: monomorphic ventricular tachycardias. Pacing Clin Electrophysiol 2011;May;34(5):625-650.# In this review, the physiopathology, electrophysiological aspects and approach to ablation of the different types of monomorphic VTs related to the Purkinje system are reviewed in detail.

• Nogami A. Purkinje-related arrhythmias part II: polymorphic ventricular tachycardia and ventricular fibrillation. Pacing Clin Electrophysiol. 2011 Aug;34(8):1034-49.
  # In this second part of the review, the physiopathological aspects and approach to ablation of PVC-induced polymorphic VT and ventricular fibrillation are discussed. 

• Patel D, Daoud EG. Atrioventricular Junction Ablation for Atrial Fibrillation. Heart Fail Clin. 2016 Apr;12(2):245-55. doi: 10.1016/j.hfc.2015.08.020.
  # In this review paper the authors discuss several aspects of atrioventricular (AV) junction ablation: benefits in patients with symptomatic atrial fibrillation and patients with atrial fibrillation with high ventricular rate and indications to cardiac resynchronization therapy. The anatomy of the AV junction is described and catheter ablation technique is provided. The authors also describe adverse events related to AV junction ablation. Hemodynamic consequences following AV junction ablation are discussed and long-term outcomes are reviewed. The authors briefly review the results of the main clinical trials on AV junction ablation.

• Atrioventricular junction ablation (pp 526-530) in Chapter 15. Atrial fibrillation; in Clinical Arrhythmology and Electrophysiology: A Companion to Braunwald's Heart Disease 3rd Edition by Ziad Issa MD MMM (Author), John M. Miller MD (Author), 2018
  # In this chapter of the textbook, devoted to atrioventricular node junction ablation, the authors describe the rationale, target of ablation, ablation technique, endpoints of ablation, and long-term outcome after ablation. The chapter is well-illustrated and provides a detailed understanding of the procedure.

• Chatterjee NA, Upadhyay GA, Ellenbogen KA, McAlister FA, Choudhry NK, Singh JP. Atrioventricular Nodal Ablation in Atrial Fibrillation A Meta-Analysis and Systematic Review. Circulation: Arrhythmia and Electrophysiology. 2012;5:68–76. doi.org/10.1161/CIRCEP.111.967810
  # This is a meta-analysis and systematic review of studies on atrioventricular node ablation in patients with atrial fibrillation. A total of 5 randomized or prospective trials were included for efficacy review (314 patients), 11 studies for effectiveness review (810 patients), and 47 studies for safety review (5632 patients). All-cause mortality was similar between AV nodal ablation and medical therapy. The authors have shown that in the management of refractory atrial fibrillation, AV nodal ablation is associated with improvement in symptoms and quality of life, with a low incidence of procedure morbidity. In patients with reduced systolic function, AV node ablation demonstrates small but significantly improved echocardiographic outcomes relative to medical therapy alone.

Atrial and thoracic vein ectopy and tachycardias

•  Chapter 11. Focal atrial tachycardia; in Clinical Arrhythmology and Electrophysiology: A Companion to Braunwald's Heart Disease 3rd Edition by Ziad Issa MD MMM (Author), John M. Miller MD (Author), 2018
  # In this textbook chapter the main clinical, ECG and electrophysiological characteristics of atrial ectopy (ectopy and tachycardias) are provided. Current approaches to induction, mapping and catheter ablation are discussed

• Teh AW, Kistler PM, Kalman JM. Using the 12-lead ECG to localize the origin of ventricular and atrial tachycardias: part 1. Focal atrial tachycardia. J Cardiovasc Electrophysiol. 2009 Jun;20(6):706-9.
  #This review discusses the use of P-wave morphology on surface ECG to localize the site of origin of focal atrial tachycardia.

• Kistler PM, Roberts-Thomson KC, Haqqani HM, Fynn SP, Singarayar S, Vohra JK, Morton JB, Sparks PB, Kalman JM. P-wave morphology in focal atrial tachycardia: development of an algorithm to predict the anatomic site of origin. J Am Coll Cardiol. 2006 Sep 5;48(5):1010-7.
  # In this paper the authors provide ECG characteristics of the most common atrial ectopic sites, based on their findings, the author provides an algorithm for origination site localization that can be used in routine practice. This algorithm helps to plan an invasive electrophysiology study and catheter ablation.

• Beukema RJ, Smit JJ, Adiyaman A, Van Casteren L, Delnoy PP, Ramdat Misier AR, Elvan A. Ablation of focal atrial tachycardia from the non-coronary aortic cusp: case series and review of the literature. Europace. 2015 Jun;17(6):953-61.
  #In this paper, the characteristics of mapping and ablation therapy of NCC focal atrial tachycardias are described. 

• Yang JD, Sun Q, Guo XG, Zhou GB, Liu X, Luo B, Wei HQ, Liang JJ, Zhang S, Ma J. Focal atrial tachycardias from the parahisian region: Strategies for mapping and catheter ablation. Heart Rhythm. 2017 Sep;14(9):1344-1350.
  #In this paper, the different approaches to ablation for parahisian atrial tachycardia are discussed. 

• Morris GM, Segan L, Wong G, Wynn G, Watts T, Heck P, Walters TE, Nisbet A, Sparks P, Morton JB, Kistler PM, Kalman JM. Atrial Tachycardia Arising From the Crista Terminalis, Detailed Electrophysiological Features and Long-Term Ablation Outcomes. JACC Clin Electrophysiol. 2019 Apr;5(4):448-458.
  #This large series characterized the clinical and electrophysiological features and immediate and long-term ablation outcomes for AT originating from the crista terminalis. 

• Higa S, Tai CT, Chen SA. Catheter ablation of atrial fibrillation originating from extrapulmonary vein areas: Taipei approach. Heart Rhythm, Vol 3, No 11, November 2006;  doi:10.1016/j.hrthm.2006.09.006
  # This is a hands-on paper describing approaches to induction and ablation of atrial ectopy outside pulmonary veins. The approaches can be easily implemented by other specialists.

• Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. Haissaguerre M,  Jais P, Shaw DC, Takahashi A, Hocini M, Quiniou G, Garrigue S, Le Mouroux A, Le Métayer P, Clémenty J.  N Engl J Med. 1998;339:659 – 666.
  # A study of 45 pts with frequent episodes of atrial fibrillation refractory to drug therapy. Spontaneous initiation of atrial fibrillation was mapped with the use of multielectrode catheters. A single point of atrial ectopic beats was identified in 29 pts, two points of origin in 9 pts and three or four points of origin in 7 pts for a total of 69 foci. Three foci were in the right atrium, 1 in the posterior left atrium, and 65 (94%) in the pulmonary veins (31 in the left superior, 17 in the right superior, 11 in the left inferior and 6 in the right inferior). These foci respond to treatment with radiofrequency ablation

• Demosthenes G. Katritsis Giuseppe Boriani Francisco G. Cosio Gerhard Hindricks Pierre Jaïs Mark E. Josephson Roberto Keegan Young-Hoon Kim Bradley P. Knight Karl-Heinz Kuck Deirdre A. Lane Gregory Y. H. Lip Helena Malmborg Hakan Oral Carlo Pappone Sakis Themistoclakis Kathryn A. Wood Carina Blomström-Lundqvist. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). EP Europace, Volume 19, Issue 3, March 2017, Pages 465–511, https://doi.org/10.1093/europace/euw301.

Atrial flutter

• Chapter 12. Typical atrial flutter; in Clinical Arrhythmology and Electrophysiology: A Companion to Braunwald's Heart Disease 3rd Edition by Ziad Issa MD MMM (Author), John M. Miller MD (Author), 2018
  # In this textbook chapter the main clinical, ECG and electrophysiological characteristics of typical atrial flutter are provided. The anatomy of relevant structures in the right atrium is described. Approaches to activation, entrainment, pace mapping and catheter ablation are discussed. The endpoints of ablation and techniques for confirmation of bidirectional cavotricuspid isthmus block are well discussed. Acute and long-term outcomes of ablation are provided

• Chapter 13. Macroreentrant atrial tachycardia. In Clinical Arrhythmology and Electrophysiology: A Companion to Braunwald's Heart Disease 3rd Edition by Ziad Issa MD MMM (Author), John M. Miller MD (Author), 2018
  # In this textbook chapter the main clinical, ECG and electrophysiological characteristics of atypical atrial flutter are provided. The anatomy of relevant structures in the right and left atria is described. Approaches to activation, entrainment, pace mapping and catheter ablation are discussed. The endpoints of ablation and techniques for confirmation of bidirectional block across linear lesions are well discussed. Acute and long-term outcomes of ablation are provided.

• Chapter 14. Atrial tachyarrhythmias in adults with congenital heart disease; in Clinical Arrhythmology and Electrophysiology: A Companion to Braunwald's Heart Disease 3rd Edition by Ziad Issa MD MMM (Author), John M. Miller MD (Author), 2018
  # In this textbook chapter the main clinical and electrophysiological characteristics of atrial macrorreentrant tachycardias in patients with congenital heart defects are provided. The anatomy of relevant structures in the right and left atria is described. Approaches to activation, entrainment, pace mapping and catheter ablation are discussed. The endpoints of ablation and techniques for confirmation of bidirectional block across linear lesions are well discussed. The major challenges are highlighted. Acute and long-term outcomes of ablation are provided.

• Steven M. Markowits, George Thomas, Christopher F Liu, Jim W Cheung, James E Ip, Bruce B Lerman. Atrial Tachycardias and Atypical Atrial Flutters: Mechanisms and Approaches to Ablation. Arrhythm Electrophysiol Rev. 2019 Mar; 8(2):131-137. doi: 10.15420/aer.2019.17.2.
  # Steven et al discussed about classification and features that distinguish these tachycardias. We find details about macroreentrant atrial tachycardias such as electrocardiographic features, principles of mapping and ablation techniques of right and left atrial macroreentry and outcomes after catheter ablation. The mechanisms may be distinguished by high-density mapping and responses to pharmacological agents such us adenosine. High-density mapping of re-entry may demonstrate an isthmus of slow conduction, which is a suitable target for ablation. Areas of slow conduction occur mainly in patients with prior catheter ablation, cardiac surgery or atrial myopathy and these sites are characterised by electrograms of extremely low voltage, fractionation and long duration.  

• Francisco G. Cosio. Atrial Flutter, Typical and Atypical: A Review. Arrhythm Electrophysiol Rev. 2017 Jun; 6(2): 55-62. doi: 10.15420/aer.2017.5.2.
  # A review of the literature, in total 145 papers. We find the definition and detailed classification of the atrial flutter, ECG patterns, pathogenesis, clinical presentation, and management.  He also discussed catheter ablation and the long-term strategy of typical and atypical flutter.   

• Pérez FJ, Schubert CM, Parvez B, Pathak V, Ellenbogen KA, Wood MA. Longterm outcomes after catheter ablation of cavotricuspid isthmus dependent atrial flutter: a meta-analysis. Circ Arrhythm Electrophysiol. 2009 Aug;2(4):393401. Epub 2009 Jun 23.
  # This is a meta-analysis of articles reporting clinical outcomes after catheter ablation of atrial flutter published between January 1988 and July 2008. The analysis included 158 studies comprising 10719 pts. The overall acute success rate was 91.1%, 92.7% for 8 to 10mm tip/or irrigated radiofrequency catheters, and 87.9% for 4-6mm tip catheters. Atrial flutter recurrence rates were significantly reduced by the use of 8 to 10 mm tip or irrigated radiofrequency catheters and by the use of a bidirectional cavotricuspid isthmus block as a procedural endpoint.   

• Pathik B, Choudry S, Whang W, D'Avila A, Koruth J, Sofi A, Miller MA, Dukkipati S, Reddy VY. Mitral isthmus ablation: A hierarchical approach guided by electroanatomic correlation. Heart Rhythm. 2019 Apr;16(4):632-637. doi: 10.1016/j.hrthm.2018.10.005.
  # In this review paper the authors describe the major challenges of mitral isthmus ablation and achievement of bidirectional block across the ablation line. The techniques for facilitation of mitral isthmus ablation as well as alternative ablation approaches are described. The review is concise and informative, and the approaches described can be easily implemented.

• Lei S, Jia F, He Q, Gao L, Luo S, Lei H, Zhu DWX. Spontaneous scar-based reentrant atrial flutter: Electrophysiologic characteristics and ablation outcome in a retrospective analysis. Pacing Clin Electrophysiol. 2018 May 23. doi: 10.1111/pace.13383.
  # This is a description of a patient cohort with macroreentrant atrial tachycardias related to spontaneous scarification in the atrial. The authors describe mapping techniques and approaches for ablationMountantonakis S, Gerstenfeld EP. Atrial Tachycardias Occurring After Atrial Fibrillation Ablation: Strategies for Mapping and Ablation. J Atr Fibrillation. 2010 Oct. 22;3(3):290. In this review, the authors summarize the incidence, mechanism, diagnosis and treatment of ATs occurring after AF ablation.

• Scavée C, Jaïs P, Hsu LF, Sanders P, Hocini M, Weerasooriya R, Macle L, Raybaud F, Clementy J, Haïssaguerre M. Prospective randomised comparison of irrigated-tip and large-tip catheter ablation of cavotricuspid isthmus-dependent atrial flutter. Eur Heart J. 2004 Jun;25(11):963-9.
  # Radiofrequency ablation of cavotricuspid isthmus-dependent flutter can be performed using different types of ablation catheters. It has been proposed that irrigated and large-tip catheters are capable of creating larger lesions, resulting in greater efficacy. This prospective, randomised clinical study compared the efficacy of irrigated and large-tip catheters of different designs. Among commonly used ablation catheters, the externally irrigated catheter had a higher efficacy for rapid achievement of CTI block

• Sugimura H, Watanabe I, Okumura Y, Ohkubo K, Ashino S, Nakai T, Kasamaki Y, Saito S. Differential pacing for distinguishing slow conduction from complete conduction block of the tricuspid-inferior vena cava isthmus after radiofrequency ablation for atrial flutter--role of transverse conduction through the crista terminalis. J Interv Card Electrophysiol 2005 Jul; 13(2): 125-34.
  # The aim of this study was to assess transverse conduction through the crista terminalis as a limitation when evaluating isthmus block and the usefulness of differential pacing for distinguishing slow conduction and complete conduction block across the ablation line. Transverse conduction across the crista terminalis influences the sequence of activation along the tricuspid annulus after isthmus ablation. Differential pacing can distinguish slow conduction from complete conduction block across the ablation line in the isthmus.

• Bauernfeind T, Kardos A, Foldesi C, Mihalcz A, Abraham P, Szili-Torok T. Assessment of the maximum voltage-guided technique for cavotricuspid isthmus ablation during ongoing atrial flutter. J Interv Card Electrophysiol. 2007 Sep;19(3):195-9. Epub 2007 Sep 21.
  # The major finding of this study is that the maximal voltage-guided technique is a feasible method even during ongoing atrial flutter. The authors showed that the maximum voltage-guided technique is an effective technique for isthmus ablation with a considerable decrease in procedure and fluoroscopy times

• Kalman JM, Olgin JE, Saxon LA, Fisher WG, Lee RJ, Lesh MD. Activation and entrainment mapping define the tricuspid annulus as the anterior barrier in typical atrial flutter. Circulation 1996 Aug 1; 94 (3): 398-406.
  # Thirteen patients with typical atrial flutter were studied. A 20-pole halo catheter was situated around the tricuspid annulus. A mapping catheter was used for activation and entrainment mapping from seven sequential sites around the tricuspid annulus and from three additional sites including the tip of the right atrial appendage, at the fossa ovalis, and in the distal coronary sinus. Sites were considered to be within the circuit when the postpacing interval minus the flutter cycle length and the stimulus time minus the activation time was < or = 10 ms; sites were considered to be outside the circuit when these intervals were > 10 ms. All seven annular sites were within the circuit; activation occurred sequentially around the annulus and accounted for 100% of the flutter cycle length. The fossa ovalis, the distal coronary sinus, and the right atrial appendage were outside the circuit.

• Kalman JM, VanHare GF, Olgin JE, Saxon LA, Stark SI, Lesh MD. Ablation of 'incisional' reentrant atrial tachycardia complicating surgery for congenital heart disease. Use of entrainment to define a critical isthmus of conduction. Circulation 1996 Feb 1; 93(3): 502-12.
  # Intra-atrial reentrant tachycardia occurs frequently after surgery for congenital heart disease and is difficult to treat. They tested the hypotheses that intra-atrial reentrant tachycardia in patients who had undergone prior reparative surgery for congenital heart disease could be successfully ablated by targeting a protected isthmus of conduction bounded by natural and surgically created barriers and that entrainment techniques could be used to identify these zones.

Atrial fibrillation 

• Chapter 15. Atrial fibrillation; in Clinical Arrhythmology and Electrophysiology: A Companion to Braunwald's Heart Disease 3rd Edition by Ziad Issa MD MMM (Author), John M. Miller MD (Author), 2018
  # In this textbook chapter the main clinical, ECG and electrophysiological characteristics of atrial fibrillation (AF) are provided. Anatomy and histology of common structures harvesting AF triggers are described. Approaches to pulmonary vein isolation and additional substrate modification are described. The authors also provide a review of current visualisation methods and novel methods of energy sources devoted to pulmonary vein isolation. The acute and long-term results of AF ablation are well presented and discussed.

• Paulus Kirchhof, Hugh Calkins. Catheter ablation in patients with persistent atrial fibrillation. European Heart Journal, Volume 38, Issue 1, 1 January 2017, Pages 20–26, https://doi.org/10.1093/eurheartj/ehw260.
  # In this paper the authors review the available information to guide catheter ablation in persistent atrial fibrillation. We find details on the definition of persistent AF, prevention of recurrent AF in patients scheduled for ablation, pulmonary vein isolation and other targets for persistent AF ablation. They are proposing a stepwise approach to catheter ablation emphasizing the need to isolate the pulmonary veins before applying further ablation techniques and also integration of medical and lifestyle interventions. 

• Chen Chen, Xinbin Zhou, Min Zhu, Shenjie Chen, Jie Chen, Hongwen Cai, Jin Dai, Xiaoming Xu, Wei Mao Catheter ablation versus medical therapy for patients with persistent atrial fibrillation: a systematic review and meta-analysis of evidence from randomized controlled trials. Journal of Interventional Cardiac Electrophysiology, June 2018, Volume 52, Issue 1, pp 9–18.
  # A systematic review and meta-analysis on catheter ablation versus medical therapy. Eight studies including 809 patients were included. Compared with medical rhythm control, catheter ablation was superior in achieving freedom from atrial arrhythmia.  Catheter ablation was superior in reducing the probability of cardioversion and hospitalization. Compared with the medical rate control in heart failure, ablation significantly improved the ejection fraction and reduced Minnesota Living with Heart Failure Questionnaire Score. They conclude that catheter ablation appeared to be superior to medical therapy in persistent AF and might be considered a first-line therapy for some persistent AF pts, especially for those with heart failure.  

• Riccardo Proietti, Ahmed AlTurki , Luigi Di Biase,  Paolo China , Giovanni Forleo , Andrea Corrado MD,Elena Marras , Andrea Natale,  Sakis Themistoclakis. Anticoagulation after catheter ablation of atrial fibrillation: An unnecessary evil? A systematic review and meta‐analysis. J Cardiovasc Electrophysiol. 2019 Apr;30(4):468-478. doi: 10.1111/jce.13822. Epub 2019 Jan 7
  # Systematic literature review of all the studies published up to July 31st, 2018 that reported cerebrovascular events. 16 studies, 10 prospective and 6 retrospectives with 25.177 patients; 13.166 without continued oral anticoagulation (off-OAC) and 12.011 with continued oral anticoagulation (on-OAC). No significant difference in the incidence of cerebrovascular events emerged between on-OAC and off-OAC patients after atrial fibrillation ablation. Similar results were found after stratification by CHADS2 and CHA2DS2-VASc scores. Off-OAC patients suffered significantly less bleeding. In this metanalysis, the risk-benefit ratio favoured suspension of continued oral anticoagulation after successful AF ablation  

• Macle L, Khairy P, Weerasooriya R, Novak P, Verma A, Willems S, Arentz T, Deisenhofer I, Veenhuyzen G, Scavée C, Jaïs P, Puererfellner H, Levesque S, Andrade JG, Rivard L, Guerra PG, Dubuc M, Thibault B, Talajic M, Roy D, Nattel S.  Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: an international, multicentre, randomised superiority trial. Lancet 2015; 386:672.
  # Randomised trial at 18 hospitals in Australia, Europe and North America. They enrolled patients who had at least three symptomatic AF episodes in the last 6 months, and for whom treatment with an antiarrhythmic drug failed. After pulmonary vein isolation, intravenous adenosine was administered. If dormant conduction was present, patients were randomly assigned to adenosine-guided ablation to abolish dormant conduction or to no further ablation. Patients were followed up for 1 year. Adenosine unmasked dormant pulmonary vein conduction in 53%. 69.4% of patients with additional adenosine-guided ablation were free from symptomatic atrial tachyarrhythmia compared with 42.3% of patients with no further ablation. They conclude that adenosine testing to identify and target dormant pulmonary vein conduction during ablation is a highly effective strategy to improve arrhythmia-free survival in paroxysmal AF and should be incorporated into clinical practice.   

• Katritsis DG, Pokushalov E, Romanov A, Giazitzoglou E, Siontis GC, Po SS, Camm AJ, Ioannidis JP. Autonomic denervation added to pulmonary vein isolation for paroxysmal atrial fibrillation: a randomized clinical trial. J Am Coll Cardiol 2013; 62:2318.
  # A study conducted on 242 patients with symptomatic paroxysmal AF randomized to circumferential pulmonary vein isolation (PVI)-78 pts; anatomic ablation of the main left atrial ganglionated plexi (GP)-82pts; or circumferential PVI followed by anatomic ablation of the main left atrial GP-82 pts. The primary endpoint was freedom from AF or other sustained atrial tachycardia (AT), during a 2 years follow-up. Freedom from AF/AT was achieved in 56%, 48% and 74% of the PVI, GP and PVI+GP groups. They concluded that additional GP ablation to PVI confers a significantly higher success rate compared with either PVI or GP alone in paroxysmal AF.     

• Verma A, Jiang CY, Betts TR, et al. Approaches to catheter ablation for persistent atrial fibrillation. STAR AF II Investigators. N Engl J Med. 2015 May 7;372(19):1812-22. doi: 10.1056/NEJMoa1408288.
  # This is a clinical trial paper comparing different approaches to persistent atrial fibrillation ablation. The authors report that the performance of neither linear ablation nor ablation of complex fractionated electrograms provided an incremental benefit when added to pulmonary-vein isolation to decrease the rate of recurrent atrial fibrillation. This study has changed the previously common approach to additional substrate ablation in every patient with non-paroxysmal atrial fibrillation.

• Packer DL, Mark DB, Robb RA, et al.  Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. JAMA. 2019 Mar 15. doi: 10.1001/jama.2019.0693.
  # In this randomized clinical trial involving 2204 patients with atrial fibrillation, catheter ablation, compared with medical therapy, did not significantly reduce the primary composite end point of death, disabling stroke, serious bleeding, or cardiac arrest.

• Marrouche NF, Brachmann J, Andresen D, et al. Catheter Ablation for Atrial Fibrillation with Heart Failure. N Engl J Med. 2018 Feb 1;378(5):417-427. doi: 10.1056/NEJMoa1707855.
  # The authors present the data from a large trial of ablation for atrial fibrillation in patients with heart failure. Patients who were assigned to ablation were less likely to meet the primary composite endpoint of death from any cause or heart-failure–related admission or the secondary endpoints (death from any cause and death from cardiovascular disease). 

• Nademanee K, Schwab MC, Kosar EM, Karwecki M, Moran MD, Visessok N, Michael AD, Ngarmukos T. Clinical outcomes of catheter substrate ablation for high-risk patients with atrial fibrillation. J Am Coll Cardiol 2008; 51:843.
  # A study on 674 pts with AF substrate ablation guided by complex fractioned atrial electrogram (CFAE). 635 pts were available for follow-up, and 129 had an ejection fraction of less than 40%. After a mean follow-up of 836±605 days, 517 (81.4%) were in sinus rhythm (SR).  Warfarin therapy was discontinued in 434 (84%) pts in SR post-ablation whose annual stroke rate was only 0.4% compared with 2% in those with warfarin treatment. CFAE-target ablation of AF is effective in maintaining SR in selected high-risk pts. Sinus after ablation is a marker of relatively low mortality and stroke risk.    

• Narayan SM, Krummen DE, Shivkumar K, Clopton P, Rappel WJ, Miller JM. Treatment of atrial fibrillation by the ablation of localized sources: CONFIRM (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation) trial. https://www.ncbi.nlm.nih.gov/pubmed/22818076J Am Coll Cardiol. 2012 Aug 14;60(7):628-36. 
• Baykaner T, Rogers AJ, Meckler GL, Zaman J, Navara R, Rodrigo M, Alhusseini M, Kowalewski CAB, Viswanathan MN, Narayan SM, Clopton P, Wang PJ, Heidenreich PA. Clinical Implications of Ablation of Drivers for Atrial Fibrillation: A Systematic Review and Meta-Analysis. https://www.ncbi.nlm.nih.gov/pubmed/29743170Circ Arrhythm Electrophysiol. 2018 May;11(5): e006119.
  # This systematic literature review and meta-analysis aims to determine outcomes from ablation of AF drivers in addition to PVI or as a stand-alone procedure for atrial fibrillation ablation.

• Seitz J, Bars C, Théodore G, Beurtheret S, Lellouche N, Bremondy M, Ferracci A, Faure J, Penaranda G, Yamazaki M, Avula UM, Curel L, Siame S, Berenfeld O, Pisapia A, Kalifa J. AF ablation guided by spatiotemporal electrogram dispersion without pulmonary vein isolation: A Wholly Patient-Tailored Approach. https://www.ncbi.nlm.nih.gov/pubmed/28104073J Am Coll Cardiol. 2017 Jan 24;69(3):303-321.
  # In this prospective study, ablation at areas exhibiting electrogram dispersion was associated with an arrhythmia-free survival of 85% at 18 months follow-up. 

• Kottkamp H, Schreiber D, Moser F, Rieger A. Therapeutic Approaches to Atrial Fibrillation Ablation Targeting Atrial Fibrosis. https://www.ncbi.nlm.nih.gov/pubmed/29759532JACC Clin Electrophysiol. 2017 Jul;3(7):643-653.
  # In this review, different ablation techniques for atrial fibrillation targeting atrial fibrosis defined by electroanatomical voltage mapping are discussed. 

• Su W, Aryana A, Passman R, Singh G, Hokanson R, Kowalski M, Andrade J, Wang P. Cryoballoon Best Practices II: Practical guide to procedural monitoring and dosing during atrial fibrillation ablation from the perspective of experienced users. https://www.ncbi.nlm.nih.gov/pubmed/29759532Heart Rhythm. 2018 Sep;15(9):1348-1355.
  # This summary includes a comprehensive literature review along with practical usage guidance from physicians using the cryoballoon to facilitate safe, efficient, and effective outcomes for patients with atrial fibrillation.

• Andrade JG, Champagne J, Dubuc M, Deyell MW, Verma A, Macle L, Leong-Sit P, Novak P, Badra-Verdu M, Sapp J, Mangat I, Khoo C, Steinberg C, Bennett MT, Tang ASL, Khairy P; CIRCA-DOSE Study Investigators. Cryoballoon or Radiofrequency Ablation for Atrial Fibrillation Assessed by Continuous Monitoring: A Randomized Clinical Trial. https://www.ncbi.nlm.nih.gov/pubmed/31630538Circulation. 2019 Nov 26;140(22):1779-1788.
  # In this multicenter, randomized, single-blinded trial, contact-force guided radiofrequency AF ablation and 2 different regimens of cryoballoon ablation resulted in no difference in 1-year efficacy

• Essebag V, Azizi Z, Alipour P, Khaykin Y, Leong-Sit P, Sarrazin JF, Sturmer M, Morillo C, Terricabras M, Amit G, Roux JF, Patterson S, Verma A. Comparison of the efficacy of phased multipolar versus traditional radiofrequency ablation: A prospective, multicenter study (CAPCOST). https://www.ncbi.nlm.nih.gov/pubmed/31157407Pacing Clin Electrophysiol. 2019 Jul;42(7):942-950.
  # This study suggests that PVAC may achieve less freedom from AF than point-by-point RF

• Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d'Avila A, de Groot NMSN, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace. 2018 Jan 1;20(1):e1-e160. doi: 10.1093/europace/eux274.

Junctional and AV node ectopy and tachycardiasJunctional and AV node ectopy and tachycardias

• Di Biase L, Gianni C, Bagliani G, Padeletti L. Arrhythmias Involving the Atrioventricular Junction. Card Electrophysiol Clin. 2017 Sep;9(3):435-452.
  # In this review the AV node is described in relation to all tachycardia that need its participation. Initial anatomical features are nicely described and illustrated. Secondly, different entities such as AVNRT, orthodromic tachycardia and non-reentrant junctional tachycardia are described. 

• Katritsis DG, Camm J. Atrioventricular Nodal Reentrant Tachycardia. Circulation 2010; 122:831–840
  # Practical and nice review about AV nodal reentrant tachycardia, from the ECG to the electrophysiological study. A detailed description is made among different types of AVNRT but also with other entities.  It highlights electrophysiological diagnostic manoeuvres needed for differential diagnosis among accessory pathways, atypical AVNRT, atrial tachycardia and bystanders. It includes the differential diagnosis of junctional non-reentrant tachycardia.
• Katritsis DG, Josephson ME.  Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia. Arrhythm electrophysiol Rev 2016 Aug; 5(2): 130–135.# Interesting review of AVNRT that describes precisely typical and atypical AVNRT. In contrast to the other review, in this one the authors highlight the concepts of upper and lower common pathways and revise anatomical concepts of the circuit. 
• Janse MJ, Anderson RH, McGuire MA, Ho SY. AV nodal "reentry: Part I: "AV nodal" reentry revisited. J Cardiovasc Electrophysiol 1993 Oct;4(5):561-72.
  # Deep review of the classical and early publications and experimental data. It includes a deep and detailed description of the anatomy of the AV node and its anatomical relations. Dual AV nodal physiology is also described in depth.
• Isabel Deisenhofer I; Bernhard Zrenner, Yue-hui Yin; Heinz-Friedrich Pitschner; Malte Kuniss; Georg Großmann; Sascha Stiller; Armin Luik; Christian Veltmann; Julia Frank; Julia Linner; Heidi L. Estner, Andreas Pflaumer; Jinjin Wu,; Christian von Bary; Tilko Reents Stylianos Tzeis, Stephanie Fichtner,Susanne Kathan Martin R. Karch, Clemens Jilek, Sonia Ammar Christof Kolb, Zeng-Chang Liu, Bernhard Haller, Claus Schmitt, Gabriele Hessling, Circulation. 2010;122:2239-2245. Cryoablation Versus Radiofrequency Energy for the Ablation of Atrioventricular Nodal Reentrant Tachycardia (the CYRANO Study)
  # Cryoablation has emerged as an alternative to radiofrequency catheter ablation for the treatment of AVNRT. The purpose of this prospective randomized study was to test whether cryoablation is as effective as RFCA during both short-term and long-term follow-up. 
• Hamdan MH, Badhwar N, Scheinman MM. Role of invasive electrophysiologic testing in the evaluation and management of adult patients with focal junctional tachycardia.  J Am Coll Cardiol 2008; 52: pp. 1711-1717
  # Junctional tachycardia is a fast tachycardia due to automaticity or triggered activity. Patients used to be young with reciprocating episodes guiding to systolic dysfunction. Ablation can be very useful but with a high rate of complications. This paper reviews the treatment approach for these patients. 
• Jackman W, Beckman K, McClelland J, Wang X, Friday K, Roman C, Moulton K, Twidale N, Hazlitt HA, Prior M, Oren J, Overholt E, Lazzara R. Treatment of supraventricular tachycardia due to atrioventricular nodal reentry by radiofrequency catheter ablation of slow-pathway conduction. N Engl J Med. 1992 30;327(5):313-8.
  # The treatment for AV nodal reentry tachycardia is based on catheter ablation. The anatomy of the AV node is complex and variable among individuals. In addition to anatomical relations, Jackman described some specific electrogram characteristics that may help to select ablation targets.  
• Haïssaguerre M, Shah DC, Jaïs P. Slow potentials and catheter ablation for AVNRT. Heart 1997;78(1):1-2.
  # The treatment for AV nodal reentry tachycardia is based on catheter ablation. The anatomy of the AV node is complex and variable among individuals. In addition to anatomical relations, Jackman described some specific electrogram characteristics that may help to select ablation targets.  
• Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist C, Calkins H, Corrado D, Deftereos SG, Diller GP, Gomez-Doblas JJ, Gorenek B, Grace A, Ho SY, Kaski JC, Kuck KH, Lambiase PD, Sacher F, Sarquella-Brugada G, Suwalski P, Zaza A; ESC Scientific Document Group . 2019 ESC Guidelines for the management of patients with supraventricular tachycardia - The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). https://www.ncbi.nlm.nih.gov/pubmed/31504425Eur Heart J. 2019 Aug 31. pii: ehz467. doi: 10.1093/eurheartj/ehz467.
• PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease. Philip Saul, J. et al. Heart Rhythm 2016, Volume 13, Issue 6, e251 - e289
• Guidelines for the management of junctional ectopic tachycardia following cardiac surgery in children. Erickson, S.J. Current Paediatrics, Volume 16, Issue 4, 275 - 278

Accessory pathway-mediated tachycardias 

• Paroxysmal Supraventricular Tachycardias and Preexcitation Syndromes. Almendral J, Castellanos E, Ortiz M. Rev Esp Cardiol. 2012;65(5):456–469
  # Very elegant review of supraventricular tachycardia. The section related to Accessory pathways nicely describes types of accessory pathways, and types of tachycardia related to them and shows multiple examples. Clinical and epidemiological aspects are also reviewed. 

• Ablation of Atrioventricular Accessory Pathways: Current Technique–State of the Art. Chen S., Tai C. Pacing and Clinical Electrophysiology 2001; 24: 1795-1809
  # Chen et all describe in this paper mapping techniques for accessory pathways. Initially, he revised the electrocardiographic features for the localisation, both overt and hidden. Afterwards, Chen describes different types of pathways attending to the localisation. He finally describes basic diagnostic manoeuvres to confirm the diagnosis. 

• Callans DJ., Schwartzman D., Gottlieb CD., Marchlinski FE.  Insights into the Electrophysiology of Accessory Pathway-Mediated Arrhythmias Provided by the Catheter Ablation Experience: "Learning While Burning, Part III” Journal of Cardiovascular Electrophysiology 1996; 7 (9): 877-904.
  # This review describes the electrocardiographic patterns and electrophysiological characteristics of accessory pathways. In addition, differential diagnosis during an electrophysiological study and the approach to an asymptomatic patient are discussed. 

• Katritsis D, Wellens H, Josephson ME. Mahaim Accessory Pathways. Arrhythmia & Electrophysiology Review 2017;6(1):29–32
  # The term Mahaim conduction is conventionally used to describe decrementally conducting accessory pathways. Although such pathways are rare, their unique properties make their diagnosis and treatment cumbersome. In this article, published evidence is reviewed, and the electrocardiographic and electrophysiological characteristics as well as the anatomy and origin of these fibres are described. 

• Soares Correa F, Lokhandwala Y, Sánchez-Quintana D, Mori S, Anderson RH, Wellens HJJ, Back Sternick E. Unusual variants of pre-excitation: From anatomy to ablation: Part III-Clinical presentation, electrophysiologic characteristics, when and how to ablate nodoventricular, nodofascicular, fasciculoventricular pathways, along with considerations of permanent junctional reciprocating tachycardia. J Cardiovasc Electrophysiol. 2019 Oct 23. doi: 10.1111/jce.14247. [Epub ahead of print]
  # In this review, the different steps required to come to the correct diagnosis and management in patients with nodofascicular, nodoventricular and fasciculo-ventricular pathways are discussed. 

• Veenhuyzen GD, Quinn FR, Wilton SB, Clegg R, Mitchell LB.  Diagnostic Pacing Maneuvers for Supraventricular Tachycardia: Part 1. Pacing and Clinical Electrophysiology 2011, 34: 767-782
  # Diagnosis of supraventricular tachycardia must be very well organized and protocolarized. Several diagnostic manoeuvres to achieve a differential diagnosis have been made. This paper reviews all the diagnostic manoeuvres performed in an EP lab and organises them in a systematic way.

• Veenhuyzen GD, Quinn FR, Wilton SB, Clegg R, Mitchell LB.  Diagnostic Pacing Maneuvers for Supraventricular Tachycardias: Part 2. Pacing and Clinical Electrophysiology 2012, 35: 757-769
  # Diagnosis of supraventricular tachycardia must be very well organized and protocolarized. Several diagnostic manoeuvres to achieve a differential diagnosis have been made. This paper reviews all the diagnostic manoeuvres performed in an EP lab and organises them in a systematic way.

• Wolff L, Parkinson J, White PD. Bundle-branch block with short PR interval in healthy young people prone to paroxysmal tachycardia. Am Heart J 1930; 5: 685-704
  # Paul Dudley White (1886 – 1973) observed the occurrence of bundle-branch block ECG curves in healthy young adults and children with apparently normal hearts who frequently suffered attacks of paroxysmal tachycardia and atrial fibrillation. Together with John Parkinson described and published the first series of cases of ventricular preexcitation. 

• Wolferth CC, Wood FC. The mechanism of production of short PR interval and prolonged QRS complexes in patients with presumably undamaged hearts; hypothesis of an accessory pathway of auriculo-ventricular conduction. Am Heart J 1933:8:297-311
  # In 1932, Scherf and Holzmann established two theories: a bypass of the atrioventricular node with A-V conduction through a muscular anomalous bundle similar to the one described by Kent or the activation of an abnormal ventricular focus by the contraction of the atrium. Later on, he published the mechanism of production of short P-R interval and prolonged QRS complexes in patients with presumably undamaged hearts; the hypothesis of an accessory pathway of auriculo-ventricular conduction

• Durrer D, Schoo L, Schuilenburg RM, Wellens HJ. The role of premature beats in the initiation and the termination of supraventricular tachycardia in the Wolff-Parkinson-White syndrome. Circulation. 1967 Nov;36(5):644-62
  # Durrer demonstrated with his experiments that the earliest epicardial excitation was located near the right lateral part of the anterior A-V sulcus. The earliest epicardial unipolar electrogram had an ‘rS’ configuration indicating the site of insertion of the accessory pathway.

• Risk stratification for arrhythmic events in patients with asymptomatic pre-excitation: A systematic review for the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Al-Khatib SM, Arshad A, Balk EM, Das SR, Hsu JC, Joglar JA, Page RL. Heart Rhythm. 2016 Apr;13(4):e222-37. doi: 10.1016/j.hrthm.2015.09.017. Epub 2015 Sep 25.

Ventricular ectopy and tachycardias 

• Tanawuttiwat T, Nazarian S, Calkins H. The role of catheter ablation in the management of ventricular tachycardia. Eur Heart Journal 2016; 37, 594-609.
  # Ventricular arrhythmias represent a clinical spectrum ranging from premature ventricular complexes to monomorphic or polymorphic tachycardia. In patients with or without structural heart disease, catheter ablation has become a first-line treatment due to its effectiveness. This review article focuses on techniques and outcomes of catheter ablation in different scenarios and summarises the history of this procedure. 

• Stevenson W, Soejima. Catheter ablation for ventricular arrhythmia. Circulation. 2007;115:2750-2760
  # This article is a classical review of catheter ablation in ventricular arrhythmia. It shows a clear definition and classification of different types of ventricular arrhythmia and gives us a practical description of the main findings and goals in each substrate (structural disease, idiopathic VT). 

• Santangeli P, Muser D, Maeda S, Filtz A, Zado ES, Frankel DS, Dixit S, Epstein AE, Marchlinski FE. Heart Rhythm 2016 Mar 4: S1547-5271.  Comparative effectiveness of antiarrhythmic drugs and catheter ablation for the prevention of recurrent ventricular tachycardia in patients with implantable cardioverter-defibrillators: A systematic review and meta-analysis of randomized controlled trials.
  #In patients with ventricular tachycardia and structural heart disease, the defibrillator (ICD) is the election treatment. ICD therapies are known to be harmful, so other interventions are needed to reduce arrhythmic events. This meta-analysis of randomized control trials compares the effectiveness and safety of combining antiarrhythmic drugs or catheter ablation to reduce arrhythmic burden and/or ICD intervention. The result of this meta-analysis showed a reduction in ICD therapies in both groups.  

• Tung R. Challenges and pitfalls of entrainment of mapping ventricular tachycardia. Circ Arrhythm Electrophysiol. 2017 Apr;10(4): 1-10
  # Entrainment mapping is one of the most important tools for most arrhythmia ablations. This paper summarises the challenges and mistakes associated with this manoeuvre.

• Boyle NG, Shivkumar K. Epicardial interventions in electrophysiology. Circulation. 2012 Oct 2;126(14):1752–69.
  # Endocardial ablation alone may not be sufficient in some patients with ischemic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic cardiomyopathy or other diseases. An epicardial approach is sometimes needed. This article reviews the technical approach, clinical indications and results of epicardial ablation the different clinical scenarios. 

• Patel D, Hasselblad V, Jackson KP, Pokorney SD, Daubert JP, Al-Khatib SM. Catheter ablation for ventricular tachycardia (VT) in patients with ischemic heart disease: a systematic review and a meta-analysis of randomized controlled trials. J IntervCardElectrophysiol. 2016Mar;45(2):111-7
  # This is a meta-analysis of randomized controlled trials (RCTs) comparing catheter ablation with non-ablative strategies for the treatment of ventricular tachycardia (VT) in patients with ischemic heart disease and an ICD. 

• Zeppenfeld K. Ventricular tachycardia ablation in non-ischemic cardiomyopathy. JACC Clin Electrophysiol. 2018 Sep;4(9):1123-1140.
  #This review summarizes available data on VT ablation in patients with dilated cardiomyopathy and, more specifically, reviews procedural and outcome data in specific etiologies and substrate locations.

• Heeger CH, Hayashi K, Kuck KH, Ouyang F. Catheter Ablation of Idiopathic Ventricular Arrhythmias Arising From the Cardiac Outflow Tracts. Recent Insights and Techniques for the Successful Treatment of Common and Challenging Cases.Circ J. 2016 Apr5;80(5):1073-86
  # Outflow tract premature beats and tachycardia is a relatively common entity. Catheter ablation has become a first-line treatment in many cases. This paper illustrates insights and technical issues of VA arising from the cardiac Outflow and adjacent regions.  

• Yamada T. Idiopathic ventricular arrhythmias. Relevance to the anatomy, diagnosis and treatment. J Cardiol. 2016 Dec;68(6):463-471. doi: 10.1016/j.jjcc.2016.06.001.
  # This paper reviews the electrocardiographic features and anatomical correlates of different idiopathic ventricular arrhythmias. 

• Kodali S, Santangeli P, Garcia FC. Mapping and Ablation of Arrhythmias from Uncommon Sites (Aortic Cusp, Pulmonary Artery, and Left Ventricular Summit). https://www.ncbi.nlm.nih.gov/pubmed/31706473Card Electrophysiol Clin. 2019 Dec;11(4):665-674.
  # A systematic approach to ablation of idiopathic ventricular arrhythmias arising from anatomically challenging locations (aortic cusps, pulmonary artery and LV Summit) is discussed

• Santangeli P, Frankel D, Marchlinski FE. End Points for Ablation of Scar-Related Ventricular Tachycardia. Circ Arrhythm Electrophysiol. 2014;7:949-960.
  # Ventricular tachycardia recurrences after VT ablation are frequent. This paper reviews the different endpoints that are currently used for VT ablation: from response to programmed electrical stimulation to different ways of substrate modification. Sramko M, Hoogendoorn JC, Glashan CA, Zeppenfeld K. Advancement in cardiac imaging for treatment of ventricular arrhythmias in structural heart disease. Europace. 2019 Mar 1;21(3):383-403. # In this paper, the current evidence of the value provided by cardiac imaging to facilitate VT ablation and ultimately improve outcomes is reviewed.

• Zeppenfeld K, Schalij MJ, Bartelings MM, Tedrow UB, Koplan BA, Soejima K, Stevenson WG. Catheter ablation of ventricular tachycardia after repair of congenital heart disease: electroanatomic identification of the critical right ventricular isthmus. Circulation. 2007 Nov 13;116(20):2241-52.
  # In this seminal paper, the electrophysiological basis and approach to ablation of ventricular tachycardia in patients with repaired congenital heart disease is described. 

• Kuck kh, Schaumann A, Eckardt L, Villens S, Ventura R, Delacrétaz E, Pitschner HF, Kautzner J, Schumacher B, Hansens PS, VTACH study group. Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): a multicentre randomised controlled trial. Lancet 2010 Jan 2;375(9708):31-40.
  # Prospective, randomized trial evaluating the effectiveness of VT ablation in patients with VT. It showed a delay in VT recurrence as compared to no ablation. 

• Kuck KH,Tilz RR,Deneke T,Hoffmann BA,Ventura R,Hansen PS,Zarse M,Hohnloser SH,Kautzner J,Willems S;SMS Investigators.Impact of Substrate Modification by Catheter Ablation on Implantable Cardioverter-Defibrillator Interventions in Patients With UnstableVentricularArrhythmiasand Coronary Artery Disease: Results From the Multicenter Randomized Controlled SMS (Substrate Modification Study). Circ Arrhythm Electrophysiol. 2017 Mar;10(3). pii: e004422. doi: 10.1161/CIRCEP.116.004422.
  # Prospective, randomized trial evaluating the effectiveness of VT ablation in patients with VT. It showed a reduction in the total number of ICD interventions.

• John L. Sapp, M.D., George A. Wells, Ph.D., Ratika Parkash, M.D., William G. Stevenson, M.D.,Louis Blier, M.D., Jean-Francois Sarrazin, M.D., Bernard Thibault, M.D., Lena Rivard, M.D.,Lorne Gula, M.D., Peter Leong-Sit, M.D., Vidal Essebag, M.D., Ph.D., Pablo B. Nery, M.D., Stanley K. Tung, M.D., Jean-Marc Raymond, M.D., Laurence D. Sterns, M.D., George D. Veenhuyzen, M.D., Jeff S. Healey, M.D., Damian Redfearn, M.D., Jean-Francois Roux, M.D., and Anthony S.L. Tang, M.D. Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs. N Engl J Med 2016;375:111-21.
  # In patients with ischemic cardiomyopathy and an ICD who had ventricular tachycardia despite antiarrhythmic drug therapy, there was a significantly lower rate of the composite primary outcome of death, ventricular tachycardia storm, or appropriate ICD shock among patients undergoing catheter ablation than among those receiving an escalation in antiarrhythmic drug therapy.

• Silvia G Priori, Carina Blomström-Lundqvist, Andrea Mazzanti, Nico Blom, Martin Borggrefe, John Camm, Perry Mark Elliott, Donna Fitzsimons, Robert Hatala, Gerhard Hindricks, Paulus Kirchhof, Keld Kjeldsen, Karl-Heinz Kuck, Antonio Hernandez-Madrid, Nikolaos Nikolaou, Tone M Norekvål, Christian Spaulding, Dirk J Van Veldhuisen, ESC Scientific Document Group; 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), European Heart Journal, Volume 36, Issue 41, 1 November 2015, Pages 2793–2867,2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Sáenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K; ESC Scientific Document Group . Europace. 2019 May 10. pii: euz132. doi: 10.1093/europace/euz132.

Ventricular fibrillation 

• Vern Hsen Tan, Jonathan Yap, Li-Fern Hsu, Reginald Liew; Catheter ablation of ventricular fibrillation triggers and electrical storm - EP Europace, Volume 14, Issue 12, 1 December 2012, Pages 1687–1695
  # It reviews the literature on outcomes in patients who have undergone CA for VF in a variety of different settings, including those with structural heart disease and structurally normal hearts (e.g. patients with inherited arrhythmogenic diseases and idiopathic VF) and discusses the future directions in this field.

• Cheniti G1, Vlachos K, Meo M, Puyo S, Thompson N, Denis A, Duchateau J, Takigawa M, Martin C, Frontera A, Kitamura T, Lam A, Bourier F, Klotz N, Derval N, Sacher F, Jais P, Dubois R, Hocini M, Haissaguerre M.Mapping and Ablation of Idiopathic Ventricular Fibrillation. Front Cardiovasc Med. 2018 Sep 18;5:123.
  # In the majority of cases, VF is triggered by PVCs that originate from the Purkinje network. Recent studies demonstrate subclinical structural alterations as the origin of PVCs. These localized myocardial alterations are identified by high-density electrogram mapping.

• Gianni C, Burkhardt JD, Trivedi C, Mohanty S, Natale A. The role of the Purkinje network in premature ventricular complex-triggered ventricular fibrillation. J Interv Card Electrophysiol. 2018 Aug;52(3):375-383.
  # The Purkinje network (PN) has been shown to play a central role in the pathophysiology of ventricular fibrillation (VF). Abnormal automaticity and triggered activity are commonly seen in the PN, and the resulting premature ventricular complexes (PVCs) are frequently recognized as triggers of this life-threatening arrhythmia.

• Leenhardt A, Glaser E, Burguera M, Nümberg M, Maison-Blanch P, Coumel P. Short-coupled variant of torsade de pointes. A new electrocardiographic entity in the spectrum of idiopathic ventricular tachyarrhythmias. Circulation.1994 Jan;89(1):206-15.
  # First description of short-coupled PVCs as a trigger for ventricular fibrillation. 

• Silvia G Priori, Carina Blomström-Lundqvist, Andrea Mazzanti, Nico Blom, Martin Borggrefe, John Camm, Perry Mark Elliott, Donna Fitzsimons, Robert Hatala, Gerhard Hindricks, Paulus Kirchhof, Keld Kjeldsen, Karl-Heinz Kuck, Antonio Hernandez-Madrid, Nikolaos Nikolaou, Tone M Norekvål, Christian Spaulding, Dirk J Van Veldhuisen, ESC Scientific Document Group; 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), European Heart Journal, Volume 36, Issue 41, 1 November 2015, Pages 2793–2867,

Autonomic system 

• Shen M,  Zipes D. Role of the Autonomic Nervous System in modulating Cardiac Arrhythmias. Circ Res. 2014;114:1004-1021
  # Broad description of the mechanisms by which autonomic activation is arrhythmogenic or antiarrhythmic in different scenarios and different arrhythmias

• Vaseghi M, Shivkumar K. The Role of the Autonomic Nervous System in Sudden Cardiac Death. Prog Cardiovasc Dis. 2008 ; 50(6): 404–419.
  # Description of the anatomy of the autonomic system and its role in the modulation of cardiac arrhythmias 

• Vaseghi M, Barwad P, Malavassi Corrale F, Tandr Hi, Mathuria N, Shah R, Sorg J, Gima J, Mandal K, Sàenz Morales L, Lokhandwala Y, Shivkumar K.  Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmias. Am Coll Cardiol. 2017 June 27; 69(25): 3070–3080
  # Sympathetic denervation can decrease sustained VT and ICD shock recurrence in patients with refractory VT

• Hocini M., Pison L., Proclemer A. Diagnosis and management of patients with inherited arrhythmia syndromes in Europe: results of the European Heart Rhythm Association Survey. Europace. 2014;16:600–603 21. 
• Priori S.G., Wilde A.A., Horie M. HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Heart Rhythm. 2013;10:1932–1963.

Implantable HR devices (pacemakers) Implantable HR devices (pacemakers) 

• Mulpuru SK, Madhavan M, McLeod CJ, Cha Y-M, Friedman PA. Cardiac Pacemakers: Function, Troubleshooting, and Management: Part 1 of a 2-Part Series. J Am Coll Cardiol. 2017;69:189–210.
  # Recent state-of-the-art review of the pacemaker indications, implant-related complications, basic function/programming, common pacemaker-related issues, and remote monitoring, with an overview of the magnetic resonance imaging and perioperative management among patients with cardiac pacemakers. 

• Rajappan K. Permanent pacemaker implantation technique: part I. Heart. 2009;95:259–264.
  # The first of the two parts paper that covers almost all theoretical knowledge needed for permanent pacemaker implantation. Supplemental video footage is available online also.

• Rajappan K. Permanent pacemaker implantation technique: part II. Heart. 2009;95:334–342.
  # The second part. Further aspects of the implant process including lead placement techniques are considered as well as some aspects of post-procedural management/care. 

• Irnich W. The terms "chronaxie" and "rheobase" are 100 years old. Pacing Clin Electrophysiol. 2010;33(4):491–496.
  # Understanding the concept of the strength-duration curve of a pacing electrode is critical. This article is an extraordinary analysis (with a historical perspective) of the two basic terms in (cardiac) electrostimulation and two basic points in the strength-duration curve –chronaxie and rheobase. 

• Lloyd MS, El Chami MF, Langberg JJ. Pacing features that mimic malfunction: a review of current programmable and automated device functions that cause confusion in the clinical setting. J Cardiovasc Electrophysiol 2009;20:453-60.
  # Implementation of the modern pacemaker/defibrillator algorithms and features represent important advances in device safety and performance, but many of them can also mimic device malfunction. This article discusses these features in terms of the confusion they may cause and highlights important clinical clues that aid in their recognition. 

• Monteil B, Ploux S, Eschalier R, Ritter P, Haissaguerre M, Koneru JN, Ellenbogen KA, Bordachar P. Pacemaker‐mediated tachycardia: manufacturer specifics and spectrum of cases. Pacing Clin Electrophysiol 2015;38:1489–1498.
  # This is the review of the main elements of the physiopathology of pacemaker-mediated tachycardia that describes its specific characteristics regarding different manufacturers’ pacemaker algorithms. 

• Alasti M, Machado C, Rangasamy K, Bittinger L, Healy S, Kotschet E, Adam D, Alison J. Pacemaker-mediated arrhythmias. J Arrhythm 2018;34(5):485-492.
  # This is a short review of pacemaker-mediated arrhythmias. It summarizes the different types of pacemaker‐mediated arrhythmias, their predisposing factors, and mechanisms of prevention or termination.

• Lau E.W. Upper body venous access for transvenous lead placement–review of existent techniques. Pacing Clin Electrophysiol. 2007;30:901–909.
  # This paper reviews the different techniques available for obtaining upper-body venous access for transvenous lead placement. 

• Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD.2018. ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. Circulation 2019;140(8):e382-e482.

Implantable HR devices (ICDs)

• Biffi M. ICD programming. Indian Heart J. 2014; 66 Suppl 1:S88-S100.
  # This review summarizes the principles that may assist clinicians in defining ICD settings that may be suitable to the vast majority of patients as a generic framework to reduce inappropriate therapy delivery while maintaining the efficacy to detect and terminate VT and VF, and that can be used to provide individualised programming for any specific patient. 

• Israel CW, Burmistrava T.Optimal tachycardia programming in ICDs: Recommendations in the post-MADIT-RIT era. Herzschrittmacherther Elektrophysiol. 2016;27(3):163-70.
  # This paper reviews knowledge on optimal ICD programming to decrease the burden of inappropriate shock therapy. Device parameters programming suggestions in single- or dual-chamber ICDs by different manufacturers and in different groups of patients are presented.

• Brüggemann T, Dahlke D, Chebbo A, Neumann I.Tachycardia detection in modern implantable cardioverter-defibrillators. Herzschrittmacherther Elektrophysiol. 2016;27(3):171-85.
  # This paper reviews BIOTRONIK implantable cardioverter-defibrillator tachycardia detection algorithms.

• Zanker N, Schuster D, Gilkerson J, Stein K. Tachycardia detection in ICDs by Boston Scientific: Algorithms, pearls, and pitfalls.Herzschrittmacherther Elektrophysiol. 2016;27(3):186-92.
  # This article summarizes how Boston Scientific ICDs sense, detect, discriminate rhythms, and classify episodes. Device programming considerations regarding the landmark MADIT-RIT trial are listed also.

• Kolb C, Ocklenburg R. Tachycardia detection in implantable cardioverter-defibrillators by Sorin/LivaNova: Algorithms, pearls and pitfalls. Herzschrittmacherther Elektrophysiol. 2016;27(3):213-25.
  # This article summarizes how Sorin/LivaNova ICDs sense, detect, discriminate rhythms, and classify episodes. Although in German, the paper is essential because similar review papers are not published.

• Brown ML, Swerdlow CD. Sensing and detection in Medtronic implantable cardioverter defibrillators. Herzschrittmacherther Elektrophysiol. 2016;27(3):193-212.
  # This article summarizes how Medtronic ICDs sense, detect, discriminate rhythms, and classify episodes.

• Zdarek J, Israel CW. Detection and discrimination of tachycardia in ICDs manufactured by St. Jude Medical. Herzschrittmacherther Elektrophysiol. 2016;27(3):226-39.
  # This article summarizes how St. Jude Medical (Abbott) ICDs sense, detect, discriminate rhythms, and classify episodes.

• Al-Khatib SM, Friedman P, Ellenbogen KA. Defibrillators: Selecting the Right Device for the Right Patient. Circulation. 2016;134(18):1390-1404.
  # This review provides up-to-date data on the different types of defibrillators (transvenous ICDs with or without CRT, subcutaneous ICDs, and wearable cardioverter-defibrillators) with special emphasis on which type of device to choose for certain patients. Landmark ICD and CRT-ICD trials are listed with their inclusion criteria, sample size, primary endpoint and, main findings.

• Qian Z, Zhang Z, Guo J, Wang Y, Hou X, Feng G, Zou J. Association of Implantable Cardioverter Defibrillator Therapy with All-Cause Mortality-A Systematic Review and Meta-Analysis.Pacing Clin Electrophysiol. 2016;39(1):81-8.
  # The recent systematic review and meta-analysis of the association of implantable cardioverter defibrillator therapy (shocks) with all-cause mortality. 

• Wilkoff BL, Fauchier L, Stiles MK, Morillo CA, Al-Khatib SM, Almendral J, Aguinaga L, Berger RD, Cuesta A, Daubert JP, Dubner S, Ellenbogen KA, Estes NA 3rd, Fenelon G, Garcia FC, Gasparini M, Haines DE, Healey JS, Hurtwitz JL, Keegan R, Kolb C, Kuck KH, Marinskis G, Martinelli M, McGuire M, Molina LG, Okumura K, Proclemer A, Russo AM, Singh JP, Swerdlow CD, Teo WS, Uribe W, Viskin S, Wang CC, Zhang S.2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. .J Arrhythm. 2016;32(1):1-28.# Expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing.
• Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL.2017 AHA/ACC/HRS guideline for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.Heart Rhythm. 2018;15(10):e190-e252.
  # Guideline for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

• Køber L, Thune JJ, Nielsen JC, Haarbo J, Videbæk L, Korup E, Jensen G, Hildebrandt P, Steffensen FH, Bruun NE, Eiskjær H, BrandesA, Thøgersen AM, Gustafsson F, Egstrup K, Videbæk R, Hassager C, Svendsen JH, Høfsten DE, Torp-Pedersen C, Pehrson S. for the DANISH Investigators.Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure.N Engl J Med. 2016;375(13):1221-30.
  # This was the landmark trial that, at first sight, raised the concerns and opened the discussion (that still lasts) about the usefulness of ICD implantation in patients who had heart failure that was not caused by ischemic heart disease. 

Implantable HR devices (CRTs) 

• Leyva F, Nisam S, Auricchio A. 20 years of cardiac resynchronization therapy. J Am Coll Cardiol. 2014;64(10):1047-58.
  # This review takes a historical perspective on CRT’s evolution (the pre-CRT era, early CRT studies, the core trials). Common CRT topics and dilemmas are discussed (CRT in mild heart failure, CRT and right ventricular pacing, CRT in atrial fibrillation, CRT and a narrow QRS complex, non-responders, the role of imaging, targeting the LV pacing site, delivery of CRT in the real world, health economics). 

• Madhavan M, Mulpuru SK, McLeod CJ, Cha YM, Friedman PA. Advances and Future Directions in Cardiac Pacemakers: Part 2 of a 2-Part Series. J Am Coll Cardiol. 2017;69(2):211-235.
  # This is the second part of the recent state-of-the-art review where some general aspect of CRT is discussed. Figures with the radiographic lead position of the coronary venous lead and paced QRS morphology (electroanatomic correlation) are very useful as well as discussion on the appropriate patient selection, lead implantation, and device programming. Alternative techniques such as multisite pacing, His bundle pacing, and endocardial left ventricular pacing are also presented briefly.

• Poole JE, Singh JP, Birgersdotter-Green U. QRS Duration or QRS Morphology: What Really Matters in Cardiac Resynchronization Therapy? J Am Coll Cardiol. 2016;67(9):1104-17.
  # Despite the obvious success of CRT, a significant proportion of patients may not respond sufficiently or in a predictable way to this pacing therapy or may not respond at all. This paper summarizes the clinical trial data regarding QRS morphology and QRS duration as ECG predictors of CRT response.

• Cleland JG, Abraham WT, Linde C, Gold MR, Young JB, Claude Daubert J, Sherfesee L, Wells GA, Tang AS. An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure. Eur Heart J. 2013;34(46):3547-56.
  # Meta-analysis of five landmark CRT trials (MIRACLE, MIRACLE-ICD CARE-HF, REVERSE, RAFT) using individual patient data to identify pre-implantation variables that predict the response to CRT.

• Barold SS, Herweg B.Usefulness of the 12-lead electrocardiogram in the follow-up of patients with cardiac resynchronization devices. Part I.Cardiol J. 2011;18(5):476-86.
  # The first of the two-part paper on interpreting and using 12-lead ECG in CRT patients. Detailed analysis of the CRT-paced 12-lead ECG in the paper confirmed that it is an indispensable tool in the assessment of patients with CRT devices. 

• Barold SS, Herweg B. Usefulness of the 12-lead electrocardiogram in the follow-up of patients with cardiac resynchronization devices. Part II. Cardiol J. 2011;18(6):610-24.
  # The second of the two-part paper on interpreting and using 12-lead ECG in CRT patients. Detailed analysis of the CRT-paced 12-lead ECG in the paper confirmed that it is an indispensable tool in the assessment of patients with CRT devices

• Marijon E, Leclercq C, Narayanan K, Boveda S, Klug D, Lacaze-Gadonneix J, Defaye P, Jacob S, Piot O, Deharo JC, Perier MC, Mulak G, Hermida JS, Milliez P, Gras D,Cesari O, Hidden-Lucet F, Anselme F, Chevalier P, Maury P, Sadoul N, Bordachar P, Cazeau S, Chauvin M, Empana JP, Jouven X, Daubert JC, Le Heuzey JY.CeRtiTuDe Investigators. Causes-of-death analysis of patients with cardiac resynchronization therapy: an analysis of the CeRtiTuDe cohort study.Eur Heart J. 2015;36(41):2767-76. Seminal paper
  # The choice of resynchronization therapy between with (CRT-D) and without (CRT-P) defibrillator remains a contentious issue. Cause-of-death analysis among CRT-P, compared with CRT-D, patients could help evaluate the extent to which CRT-P patients would have additionally benefited from a defibrillator in a daily clinical practice. 

• Steffel J, Robertson M, Singh JP, et al. The effect of QRS duration on cardiac resynchronization therapy in patients with a narrow QRS complex: a subgroup analysis of the EchoCRT trial. Eur Heart J. 2015;36:1983–9.
  #This is a subgroup analysis of the EchoCRT trial -a randomized trial evaluating the effect of cardiac resynchronization therapy (CRT) in patients with a QRS duration of <130 ms and echocardiographic evidence of left ventricular desynchrony. 

• Steffel J, RuschitzkaF. Superresponse to Cardiac Resynchronization Therapy. Circulation. 2014;130:87-90.
  # This paper deeply analyzes and defines the super response to CRT. Includes the figure that represents possible clinical courses after CRT implantation.

• Daubert JC, Saxon L, Adamson PB, Auricchio A, Berger RD, Beshai JF, Breithard O, Brignole M, Cleland J, Delurgio DB, Dickstein K, Exner DV, Gold M, Grimm RA, Hayes DL, Israel C, Leclercq C, Linde C, Lindenfeld J, Merkely B, Mont L, Murgatroyd F, Prinzen F, Saba SF, Shinbane JS, Singh J, Tang AS, Vardas PE, Wilkoff BL, Zamorano JL. European Heart Rhythm Association; European Society of Cardiology; Heart Rhythm Society; Heart Failure Society of America; American Society of Echocardiography; American Heart Association; European Association of Echocardiography; Heart Failure Association. 2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management. Heart Rhythm. 2012;9(9):1524-76.# Expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management.

Implantable HR devices (other: lead extraction)

• Love CJ. Lead Management and Lead Extraction. Card Electrophysiol Clin. 2018;10(1):127-136.
  # This article provides an overview of lead extraction (now called lead management). Topics like indications for lead extraction, facility requirements, evaluation of the present cardiac implantable electronic device system, evaluation of the patient, preparation of the operating room and patient, lead extraction procedure and complications are well discussed.

• CroninEM, Wilkoff BL. Coronary Sinus Lead Extraction. Heart Fail Clin. 2017;13(1):105-115.
  # This article reviews the approach, techniques, and outcomes of coronary sinus lead extraction. 

• Azarrafiy R, Carrillo RG.Surgical and Hybrid Lead Extraction. Card Electrophysiol Clin. 2018;10(4):659-665.
  # This article reviews surgical and hybrid lead extraction (management). The hybrid approach was defined as open heart surgery and transvenous lead extraction (TLE) in a single, combined procedure.

• Hussein AA, Wilkoff BL. Lead Extraction Considerations for the Referring Cardiologist. Cardiol Rev. 2017;25(1):17-21.
  # This article provides an overview of lead extraction (management). It discusses lead binding and fibrosis, lead management planning, infrastructure for lead extractions and preprocedural planning, indications for lead extraction, non-infectious indications for extraction, and lead extraction tools.

• Wilkoff BL, Love CJ, Byrd CL, Bongiorni MG, Carrillo RG, Crossley GH 3rd, Epstein LM, Friedman RA, Kennergren CE, Mitkowski P, Schaerf RH, Wazni OM; Heart Rhythm Society; American Heart Association. Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications, and patient management: this document was endorsed by the American Heart Association (AHA).Heart Rhythm. 2009;6(7):1085-104.
  # Expert consensus on facilities, training, indications, and patient management

• Kusumoto FM, Schoenfeld MH, Wilkoff BL, Berul CI, Birgersdotter-Green UM, Carrillo R, Cha YM, Clancy J, Deharo JC, Ellenbogen KA, Exner D, Hussein AA, Kennergren C, Krahn A, Lee R, Love CJ, Madden RA, Mazzetti HA, Moore JC, Parsonnet J, Patton KK, Rozner MA, Selzman KA, Shoda M, Srivathsan K, Strathmore NF, Swerdlow CD, Tompkins C, Wazni O.2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm. 2017;14(12):e503-e551.
  # Expert consensus statement on cardiovascular implantable electronic device lead management and extraction.

• Bongiorni MG, Burri H, Deharo JC, Starck C, Kennergren C, Saghy L, Rao A, Tascini C, Lever N, Kutarski A, Fernandez Lozano I, Strathmore N, Costa R, Epstein L, Love C, Blomstrom-Lundqvist C; ESC Scientific Document Group.2018 EHRA expert consensus statement on lead extraction: recommendations on definitions, endpoints, research trial design, and data collection requirements for clinical scientific studies and registries: endorsed by APHRS/HRS/LAHRS. Europace. 2018;20(7):1217.
  # Expert consensus statement on lead extraction: recommendations on definitions, endpoints, research trial design, and data collection requirements for clinical scientific studies and registries

General knowledge of cardiac and antiarrhythmic surgery

• Maesen B, Van-Loo I, Pison L, La-Meir M. Surgical ablation of atrial fibrillation: is electrical isolation of the pulmonary veins a must? J Atr Fibrillation. 2016;9(1):1426.
  # This is the review article about surgical ablation of atrial fibrillation from the aspect of the necessity of the electrical isolation of the pulmonary veins since the pulmonary veins are the most common location for triggers of AF. Electrical reconnection of the pulmonary veins is associated with arrhythmia recurrence. 

• Abo-Salem E, Lockwood D, Boersma L, Deneke T, Pison L, Paone RF, Nugent KM.Surgical Treatment of Atrial Fibrillation. J Cardiovasc Electrophysiol. 2015;26(9):1027-1037.
  # Ablation lines have largely replaced the historical and challenging cut-and-sew techniques. Surgical ablation of atrial fibrillation (AF) is commonly performed in cases with other indications for cardiac surgery and less commonly as a stand-alone therapy. 

• Deal BJ, Mavroudis C.Arrhythmia surgery for adults with congenital heart disease. Card Electrophysiol Clin. 2017;9(2):329-340.
  # Patients with repaired or unrepaired congenital heart anomalies are at increased risk for arrhythmia development throughout their lives, often paralleling the need for reoperations for hemodynamic residua. This article reviews and summarises the operative techniques for arrhythmia surgery that are based on the arrhythmia mechanisms.

• Sartipy U, Albåge A, Strååt E, Insulander P, Lindblom D. Surgery for ventricular tachycardia in patients undergoing left ventricular reconstruction by the Dor procedure. Ann Thorac Surg. 2006 Jan;81(1):65-71.
  # This is a single centre experience on the surgical ablation of the ventricular tachycardia (VT) in patients undergoing left ventricular reconstruction by the Dor procedure.

Other

• Della Rocca DG, Gianni C, Di Biase L, Natale A, Al-Ahmad A. Leadless Pacemakers: State of the Art and Future Perspectives. Card Electrophysiol Clin. 2018;10(1):17-29.
  # The state-of-the-art review paper on leadless pacing includes brief historical considerations, a description of technological features of currently available single-component leadless pacemakers, analysis of the safety and efficacy of single-and multi-component leadless pacemakers as well as future perspectives discussion.

• Chang JD, Manning WJ, Ebrille E, Zimetbaum PJ.Tricuspid Valve Dysfunction Following Pacemaker or Cardioverter-Defibrillator Implantation. J Am Coll Cardiol.2017;69(18):2331-2341.
  # The potential for cardiac implantable electronic devices to interfere with tricuspid valve (TV) function has gained increasing recognition as having hemodynamic and clinical consequences associated with incremental morbidity and death.

• Aquilina O. A brief history of cardiac pacing. Images Paediatr Cardiol. 2006;8(2):17–81.
  # Interesting and well-structured review paper on the history of cardiac pacing therapy with the broader framework of electro-diagnosis and electro-therapy.

• Martins RP, Galand V, Leclercq C, Daubert JC. Cardiac electronic implantable devices after tricuspid valve surgery. Heart Rhythm. 2018;15(7):1081-1088.
  # This contemporary review describes the different options currently available for patients requiring pacemakers or defibrillation leads implantation after tricuspid valve surgery. 

• Miller JD, Nazarian S, Halperin HR. Implantable Electronic Cardiac Devices and Compatibility With Magnetic Resonance Imaging. J Am Coll Cardiol. 2016;68(14):1590-8.
  # This review discusses the safety concerns of magnetic resonance in patients with devices, the clinical evidence of safety, and the appropriate protocols for determining feasibility and safety in this setting.

• Parikh V, Sauer A, Friedman PA, Sheldon SH. Management of cardiac implantable electronic devices in the presence of left ventricular assist devices. Heart Rhythm. 2018;15(7):1089-1096.
  # This paper reviews the current literature, presents management recommendations, and discusses potential future investigations for cardiac implantable electronic devices in patients with left ventricular assist devices.

• Wagner BR, Frishman WH. Devices for Autonomic Regulation Therapy in Heart Failure With Reduced Ejection Fraction. Cardiol Rev. 2018;26(1):43-49.
  # This is the review of current clinical trials of device-based autonomic regulation therapy in the management of heart failure with a reduced ejection fraction.

• Bendary A, Bendary M, Salem M. Autonomic regulation device therapy in heart failure with reduced ejection fraction: a systematic review and meta-analysis of randomized controlled trials. Heart Fail Rev. 2018 Oct 13. doi: 10.1007/s10741-018-9745-5. [Epub ahead of print]
  # This systematic review aimed to determine the effect of autonomic regulation therapy by devices on functional status and quality of life in patients with heart failure with reduced ejection fraction. 

• Vijayaraman P, Chung MK, Dandamudi G, Upadhyay GA, Krishnan K, Crossley G, Bova Campbell K, Lee BK, Refaat MM, Saksena S, Fisher JD, Lakkireddy D, on befalf of ACC’s Electrophysiology Council.His Bundle Pacing.J Am Coll Cardiol. 2018;72(8):927-947.
• # His bundle pacing holds promise as an attractive mode to achieve physiological pacing. Widespread adaptation of this technique is dependent on enhancements in technology, as well as further validation of efficacy in large randomized clinical trials.

• Baddour LM, Epstein AE, Erickson CC, Knight BP, Levison ME, Lockhart PB, Masoudi FA, Okum EJ, Wilson WR, Beerman LB, Bolger AF, Estes NA 3rd, Gewitz M, Newburger JW, Schron EB, Taubert KA; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee; Council on Cardiovascular Disease in Young; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Nursing; Council on Clinical Cardiology; Interdisciplinary Council on Quality of Care; American Heart Association. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association.Circulation. 2010;121(3):458-77.
  # Update on cardiovascular implantable electronic device infections and their management.

• Gorenek B, Bax J, Boriani G, Chen SA, Dagres N, Glotzer TV, Healey JS, Israel CW, Kudaiberdieva G, Levin LÅ, Lip GYH1, Martin D, Okumura K, Svendsen JH, Tse HF, Botto GL Co-Chair; ESC Scientific Document Group. Device-detected subclinical atrial tachyarrhythmias: definition, implications and management -a European Heart Rhythm Association (EHRA) consensus document, endorsed by Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE).Europace. 2017;19(9):1556-1578.
  # Consensus on device-detected subclinical atrial tachyarrhythmias: definitions, implications and management.

• Indik JH, Gimbel JR, Abe H, Alkmim-Teixeira R, Birgersdotter-Green U, Clarke GD, Dickfeld TL, Froelich JW, Grant J, Hayes DL, Heidbuchel H, Idriss SF, Kanal E, Lampert R, Machado CE, Mandrola JM, Nazarian S, Patton KK, Rozner MA, Russo RJ, Shen WK, Shinbane JS, Teo WS, Uribe W, Verma A, Wilkoff BL, Woodard PK. 2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices. Heart Rhythm. 2017 Jul;14(7):e97-e153.
  # Expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices.

• Sandoe JA, Barlow G, Chambers JB, Gammage M, Guleri A, Howard P, Olson E, Perry JD, Prendergast BD, Spry MJ, Steeds RP, Tayebjee MH, Watkin R; British Society for Antimicrobial Chemotherapy; British Heart Rhythm Society; British Cardiovascular Society; British Heart Valve Society; British Society for Echocardiography. Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint Working Party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE).J Antimicrob Chemother. 2015;70(2):325-59.
  # Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection.

• Vijayaraman P, Dandamudi G, Zanon F, Sharma PS, Tung R, Huang W, Koneru J, Tada H, Ellenbogen KA, Lustgarten DL.Permanent His bundle pacing: Recommendations from a Multicenter His Bundle Pacing Collaborative Working Group for standardization of definitions, implant measurements, and follow-up. Heart Rhythm. 2018;15(3):460-468.
  # Recommendations from a Multicenter His Bundle Pacing Collaborative Working Group