The efficacy of extensive linear ablation strategies, in addition to pulmonary vein (PV) isolation, remains controversial in persistent atrial fibrillation (AF) ablation. Gaps in previously ablated lesions can induce arrhythmias and potentially decrease the effectiveness of extensive ablation. This study evaluated the incidence of conduction gaps, gap-related reentry, and subsequent recurrence following redo AF ablation in the EARNEST-PVI trial (Efficacy of Pulmonary Vein Isolation Alone in Patients With Persistent Atrial Fibrillation; REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03514693).

The pulsatile nature of blood flow and the hydrostatic effect of pulmonary capillary wedge pressure are 2 fundamental, yet often overlooked features of right ventricular-pulmonary arterial interactions in advanced heart failure and cardiogenic shock. These 2 features (above all others) define both the mechanical forces experienced by the pulmonary arteries, and in turn, the vascular afterload imposed by the pulmonary circulation on the right ventricular. For over half a century, it has been assumed that the pulsatile components of the pulmonary circulation exist in predictable and constant proportion to resistive afterload. In other words, that the vascular afterload can be estimated from mean pulmonary arterial pressure and pulmonary vascular resistance alone. While this tenet holds true for most forms of pulmonary hypertension, pulmonary hypertension resulting from the passive transmission of elevated left atrial pressure is a notable exception. In these cases, arterial compliance decreases proportionally more than any increase in pulmonary vascular resistance and is highly dependent upon recruitment and distensibility of the pulmonary circulation. As questions regarding the optimal method to predict right ventricular failure resurface, along with a modern armamentarium of techniques to assess pulsatile pressure-flow relations, it serves as a timely reminder that, in those with normal or near-normal pulmonary arterial pressures, the pulsatile component of pulmonary vascular afterload may account for anywhere between one-quarter and half of the total power of the right ventricular. In this State-of-the-Art Review, we address the role of pulmonary circulation in those with advanced heart failure and cardiogenic shock. Unlike previous discussions on this topic, we set aside considerations of established precapillary disease, focusing specifically on the process by which an acute or chronic elevation of pulmonary capillary wedge pressure results in pulmonary hypertension from left-sided heart failure. In doing so, we create a framework to assess pulmonary vascular afterload in an era of advanced therapeutics and device technologies to treat advanced heart failure and cardiogenic shock.

Persistent thoracic false lumen flow and subsequent aortic expansion are common complications following thoracic endovascular aortic repair for type B aortic dissection, as well as aortic arch replacement with the elephant trunk technique for type A aortic dissection. Although thoracic false lumen-perfused branches are known to contribute to thoracic false lumen backflow, robust imaging evidence is still lacking. This review illustrates how these branches perpetuate thoracic false lumen flow through detailed imaging analysis, emphasizing the critical need for advancing rapid, accurate, and minimally invasive imaging techniques and novel therapeutic devices to address this persistent clinical challenge.

Although survival for out-of-hospital cardiac arrest (OHCA) is lower at emergency medical service (EMS) agencies serving Black/Hispanic communities, it is unknown whether this is due to practice differences.

The accuracy of contemporary administrative claims codes to discriminate between different phenotypes of peripheral artery disease is not well defined. We aimed to validate a predefined set of International Classification of Diseases, Tenth Revision, codes used to distinguish between claudication and chronic limb-threatening ischemia (CLTI) and to optimize their diagnostic accuracy using a supervised machine-learning approach.