It is an understatement to say that rhythmology was once again in the spotlight in 2024, and the choice of articles to present was Cornelian. The first article analyzes the major changes in the latest recommendations for atrial fibrillation (AF; not updated for almost 4 years), which were both presented at the European Society of Cardiology congress and published simultaneously at the end of this summer. Also in the field of atrial arrhythmia, which affects the largest number of people (up to 37% of the general population, depending on age), the concept of atrial heart disease is being revolutionized. While the parameters associated with the development of AF, such as risk factors, are well known, we know less about the importance of left atrial dilatation, which is a consequence of AF and reflects a certain remodeling, as a determining factor in the history of this arrhythmia. The second article deals with the notion of cardiopathy, its prognosis, and the techniques that allow it to be better identified and probably lead to better indications for ablation. The last article presented focuses on a no less important arrhythmia, ventricular tachycardia (VT). Infarct scarring can lead to the formation of a substrate that causes VT. Implanting a defibrillator allows rapid pacing or shock delivery to resuscitate patients in cardiac arrest. Patients are sometimes stabilized with pharmacological treatments, including antiarrhythmic drugs. However, these may prove ineffective or, like amiodarone, have significant adverse effects. A very interesting study, VANISH2, published in the New England Journal of Medicine in 2024, attempted to analyze the efficacy of ablation of the arrhythmogenic substrate at the origin of VT as a first-line treatment. The results of this randomized study of 416 patients are very promising and could change the therapeutic approach for this high-risk patient population.
Keywords
Arrhythmia, atrial fibrillation, ventricular tachycardia, antiarrhythmic drugs, CHA2DS2-VA, atrial cardiopathy, ablation