Background: High-frequency low-tidal-volume (HFLTV) ventilation is a safe and cost-effective strategy that improves catheter stability, first-pass pulmonary vein isolation, and freedom from all-atrial arrhythmias during radiofrequency catheter ablation (RFCA) of paroxysmal and persistent atrial fibrillation (AF). However, the incremental value of adding rapid-atrial pacing (RAP) to HFLTV-ventilation has not yet been determined. Objective: To evaluate the effect of HFLTV-ventilation plus RAP during RFCA of paroxysmal AF on procedural and long-term clinical outcomes compared to HFLTV-ventilation alone. Methods: Patients from the REAL-AF prospective multicenter registry, who underwent RFCA of paroxysmal AF using either HFLTV+RAP (500-600 msec) or HFLTV ventilation alone from April 2020 to February 2023 were included. The primary outcome was freedom from all-atrial arrhythmias at 12-month follow-up. Secondary outcomes included procedural characteristics, long-term clinical outcomes, and procedure-related complications. Results: A total of 545 patients were included in the analysis (HFLTV+RAP=327 vs. HFLTV=218). There were no significant differences in baseline characteristics between the groups. No differences were observed in procedural (HFLTV+RAP 74 [57-98] vs. HFLTV 66 [53-85.75] min, p=0.617) and RF (HFLTV+RAP 15.15 [11.22-21.22] vs. HFLTV 13.99 [11.04-17.13] min, p=0.620) times. Both groups showed a similar freedom from all-atrial arrhythmias at 12-month follow-up (HFLTV+RAP 82.68% vs. HFLTV 86.52%, HR=1.43, 95% CI [0.94-2.16], p=0.093). There were no significant differences in freedom from AF-related symptoms (HFLTV+RAP 91.4% vs. HFLTV 93.1%, p=0.476) or AF-related hospitalizations (HFLTV+RAP 98.5% vs. HFLTV 97.2%, p=0.320). Procedure-related complications were low in both groups (HFLTV+RAP 0.6% vs. HFLTV 0%, p=0.247). Conclusion: In patients undergoing RFCA for paroxysmal AF, adding RAP to HFLTV-ventilation was not associated with improved procedural and long-term clinical outcomes.

Background: Transvenous lead extraction (TLE) is standard of care for the management of patients with cardiac implantable electronic device infection or lead related complications. Currently, objective data on TLE in Latin America is lacking. Objective: To describe the current practice standards in Latin American centers performing TLE. Methods: An online survey was sent through the mailing list of the Latin American Heart Rhythm Association (LAHRS). Online reminders were sent through the mailing list; duplicate answers were discarded. The survey was available for one month, after which no more answers were accepted. Results: A total of 48 answers were received, from 44 different institutions (39.6% from Colombia, 27,1% from Brazil), with most respondents (83%) being electrophysiologists. Twenty-nine institutions (66%) performed less than 10 lead extractions/year, with 7 (15%) institutions not performing lead extraction. Although most institutions in which lead extraction is performed reported using several tools, mechanical rotating sheaths were cited as the main tool (73%), 13.5% reported the use of mechanical extraction sheaths and only 13.5% reporting the use of laser sheaths. Management of infected leads was performed according to current guidelines. Conclusion: This survey is the first attempt to provide information on TLE procedures in Latin America and could provide useful information for future prospective registries. According to our results, the number of centers performing high volume lead extraction in Latin America is smaller than that reported in other continents, with most interventions performed using mechanical tools. Future prospective registries assessing acute and long-term success are needed.