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Despite the global COVID-19 pandemic, during the past 2 years, there have been numerous advances in our understanding of arrhythmia mechanisms and diagnosis and in new therapies. We increased our understanding of risk factors and mechanisms of atrial arrhythmias, the prediction of atrial arrhythmias, response to treatment, and outcomes using machine learning and artificial intelligence. There have been new technologies and techniques for atrial fibrillation ablation, including pulsed field ablation. There have been new randomized trials in atrial fibrillation ablation, giving insight about rhythm control, and long-term outcomes. There have been advances in our understanding of treatment of inherited disorders such as catecholaminergic polymorphic ventricular tachycardia. We have gained new insights into the recurrence of ventricular arrhythmias in the setting of various conditions such as myocarditis and inherited cardiomyopathic disorders. Novel computational approaches may help predict occurrence of ventricular arrhythmias and localize arrhythmias to guide ablation. There are further advances in our understanding of noninvasive radiotherapy. We have increased our understanding of the role of His bundle pacing and left bundle branch area pacing to maintain synchronous ventricular activation. There have also been significant advances in the defibrillators, cardiac resynchronization therapy, remote monitoring, and infection prevention. There have been advances in our understanding of the pathways and mechanisms involved in atrial and ventricular arrhythmogenesis.

Background Patients with cardiovascular manifestations of sarcoidosis are at an increased risk for ventricular arrhythmias (VA) and sudden cardiac death. Catheter ablation (CA) for ventricular tachycardia (VT) can be a useful treatment strategy, however, few studies have compared CA to medical therapy in this patient population. Objective To assess in-hospital outcomes and unplanned readmissions following CA for VT compared to medical therapy in patients with sarcoidosis. Methods Using ICD-9 and ICD-10 diagnostic and procedural codes, data was obtained from the Nationwide Readmissions Database between January 2010 and December 2019 to identify patients with a diagnosis of sarcoidosis admitted for VT either undergoing CA or medical therapy. Primary endpoints were 30-day unplanned hospital readmissions as well as a composite endpoint of inpatient mortality, cardiogenic shock, and cardiac arrest. Complications at index hospitalization and causes of readmission were also identified. Results Among a total of 1,581 patients, 1,349 patients with sarcoidosis and a diagnosis of VT were managed medically compared to 232 that underwent CA. Readmission rates at 30 days were 10.8% and 8.0%, respectively (p=0.266). In univariate analysis, the composite endpoint of mortality, cardiac arrest and cardiogenic shock trended in favor of ablation (7.4% vs 11.7%, p=0.067). In the subgroup of patients undergoing elective CA for VT, there was an improvement in the univariate composite of mortality, cardiac arrest, and cardiogenic shock (3.2% vs. 11.7%, p=0.039). After multivariable adjustment, patients undergoing elective CA were less likely to be readmitted within 30-days (OR 0.23 [95% CI 0.05,0.90] p=0.042). The most common cause of readmission were VA in both groups, however, those undergoing elective CA were less likely to be readmitted for VA compared to non-elective ablation. Complications in the CA group included cardiac tamponade (4.7%), vascular complications (2.6%), and hematomas (3.0%). Conclusion In a national database of patients admitted with sarcoidosis and VT, when compared to medical therapy, CA results in a similar 30-day readmission rate with a trend towards reduction in the univariate composite endpoint of inpatient mortality, cardiogenic shock, and cardiac arrest. Patients undergoing elective VT ablation have a superior univariate outcome in the primary composite endpoint and were less likely to be readmitted within 30-days in adjusted analysis compared to medical therapy. Procedure related complications were low in the ablation group. The findings of short-term safety compared to medical therapy in addition to early intervention adds further support to an elective CA approach.

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