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This position paper, jointly authored by the Polish Society of Cardiothoracic Surgeons and the Heart Rhythm Association of the Polish Society of Cardiology, defines the role of hybrid approaches in the treatment of cardiac arrhythmias, particularly atrial fibrillation. We present a rationale for integrating epicardial and endocardial ablation strategies, summarize current evidence, and advocate for multidisciplinary planning, including arrhythmia treatment during cardiac surgery for other indications and atrial fibrillation treatment as a stand-alone procedure. The paper highlights the importance of minimally invasive approaches, the need for heart team-based planning, structured curricula, and postoperative referral pathways for comprehensive management of atrial fibrillation and non-atrial fibrillation arrhythmias.

Immune checkpoint inhibitors (ICIs) are an important advancement in the field of cancer treatment, significantly improving the survival of patients with a series of advanced malignancies, like melanoma, non-small cell lung cancer (NSCLC), hepatocellular carcinoma (HCC), renal cell carcinoma (RCC), and Hodgkin lymphoma. ICIs act upon T lymphocytes and antigen-presenting cells, targeting programmed cell death protein 1 (PD1), programmed cell death protein ligand 1 (PD-L1), and cytotoxic T-lymphocyte antigen 4 (CTLA-4), breaking the immune tolerance of the T cells against malignant cells and enhancing the body’s own immune response. A variety of cardiac-adverse effects are associated with ICI-based treatment, including pericarditis, arrhythmias, cardiomyopathy, and acute coronary syndrome, with myocarditis being the most studied due to its often-unexpected onset and severity. Overall, Myocarditis is rare but presents an immune-related adverse event (irAE) that has a high fatality rate. Considering the rising number of oncological patients treated with ICIs and the severity of their potential adverse effects, a good understanding and continuous investigation of cardiac irAEs is of the utmost importance. This systematic review aimed to revise recent publications (between 2016–2022) on ICI-induced cardiac toxicities and highlight the therapeutical approach and evolution in the selected cases.

2 Kinetic friction depends on the plunger stopper design and its 'fit' within the barrel, the material properties of both the barrel and the plunger stopper (rubber type, surface roughness, etc.), and environmental factors such as temperature or humidity. 2 Static friction depends additionally on the duration of stationary contact (the longer the time, the higher the friction coefficient) and the geometrical and elastic properties of both objects. 2 The static friction is always higher than the kinetic friction ( figure 1 ) and hence, the pressure needed to keep the plunger moving will always be lower than the pressure required to initiate this movement.

Atrial fibrillation (AF) is the most prevalent arrhythmia and is often found during times of other cardiac pathologies that require surgical management including coronary revascularization and valve surgery. Surgical ablation of AF, most frequently performed through the Cox-Maze IV procedure, is highly effective in restoring sinus rhythm. Despite robust society guideline recommendations for concomitant surgical ablation (CSA) for AF, the practice has yet to be widely adopted. In this review, we discuss the current indications for CSA, its efficacy in maintaining freedom from atrial tachyarrhythmias, stroke, and adverse long-term outcomes, the safety profile of SA when performed alongside cardiac surgical cases, and challenges with its implementation across the most common concomitant cardiac operations. In conclusion, we present a reminder to multidisciplinary heart teams to consider CSA when indicated for their patients.

Background: Artificial intelligence (AI) is poised to significantly impact the future of cardiology and electrophysiology, offering new tools to interpret complex datasets, improve diagnosis, optimize clinical workflows, and personalize therapy. ChatGPT-4o, a leading AI-based language model, exemplifies the transformative potential of AI in clinical research, medical education, and patient care. Aim and Methods: In this paper, we present an exploratory dialogue with ChatGPT to assess the role of AI in shaping the future of cardiology, with a particular focus on arrhythmia management and cardiac electrophysiology. Topics discussed include AI applications in ECG interpretation, arrhythmia detection, procedural guidance during ablation, and risk stratification for sudden cardiac death. We also examine the risks associated with AI use, including overreliance, interpretability challenges, data bias, and generalizability. Conclusions: The integration of AI into cardiovascular care offers the potential to enhance diagnostic accuracy, tailor interventions, and support decision-making. However, the adoption of AI must be carefully balanced with clinical expertise and ethical considerations. By fostering collaboration between clinicians and AI developers, it is possible to guide the development of reliable, transparent, and effective tools that will shape the future of personalized cardiology and electrophysiology.

BackgroundSingle-session cardiac stereotactic radiation therapy (SBRT) has demonstrated promising results for patients with refractory ventricular tachycardia (VT). However, the full safety profile of this novel treatment remains unknown and very limited data from prospective clinical multicenter trials are available.MethodsThe prospective multicenter multiplatform RAVENTA (radiosurgery for ventricular tachycardia) study assesses high-precision image-guided cardiac SBRT with 25 Gy delivered to the VT substrate determined by high-definition endocardial and/or epicardial electrophysiological mapping in patients with refractory VT ineligible for catheter ablation and an implanted cardioverter defibrillator (ICD). Primary endpoint is the feasibility of full-dose application and procedural safety (defined as an incidence of serious [grade ≥ 3] treatment-related complications ≤ 5% within 30 days after therapy). Secondary endpoints comprise VT burden, ICD interventions, treatment-related toxicity, and quality of life. We present the results of a protocol-defined interim analysis.ResultsBetween 10/2019 and 12/2021, a total of five patients were included at three university medical centers. In all cases, the treatment was carried out without complications. There were no serious potentially treatment-related adverse events and no deterioration of left ventricular ejection fraction upon echocardiography. Three patients had a decrease in VT episodes during follow-up. One patient underwent subsequent catheter ablation for a new VT with different morphology. One patient with local VT recurrence died 6 weeks after treatment in cardiogenic shock.ConclusionThe interim analysis of the RAVENTA trial demonstrates early initial feasibility of this new treatment without serious complications within 30 days after treatment in five patients. Recruitment will continue as planned and the study has been expanded to further university medical centers.Trial registration numberNCT03867747 (clinicaltrials.gov). Registered March 8, 2019. Study start: October 1, 2019.

Background: The hospital-at-home (HAH) model is a viable alternative for conventional in-hospital stays worldwide. Serum electrolyte abnormalities are common in acute patients, especially in those with many comorbidities. Pathologic changes in cardiac electrophysiology pose a potential risk during HAH stays. Periodical electrocardiogram (ECG) tracing is therefore advised, but few studies have evaluated the accuracy and efficiency of compact, self-activated ECG devices in HAH settings. This study aimed to evaluate the reliability of such a device in comparison with a standard 12-lead ECG. Methods: We prospectively recruited consecutive patients admitted to the Sheba Beyond Virtual Hospital, in the HAH department, during a 3-month duration. Each patient underwent a 12-lead ECG recording using the legacy device and a consecutive recording by a compact six-lead device. Baseline patient characteristics during hospitalization were collected. The level of agreement between devices was measured by Cohen’s kappa coefficient for inter-rater reliability (Ϗ). Results: Fifty patients were included in the study (median age 80 years, IQR 14). In total, 26 (52%) had electrolyte disturbances. Abnormal D-dimer values were observed in 33 (66%) patients, and 12 (24%) patients had elevated troponin values. We found a level of 94.5% raw agreement between devices with regards to nine of the options included in the automatic read-out of the legacy device. The calculated Ϗ was 0.72, classified as a substantial consensus. The rate of raw consensus regarding the ECG intervals’ measurement (PR, RR, and QT) was 78.5%, and the calculated Ϗ was 0.42, corresponding to a moderate level of agreement. Conclusion: This is the first report to our knowledge regarding the feasibility of using a compact, six-lead ECG device in the setting of an HAH to be safe and bearing satisfying agreement level with a legacy, 12-lead ECG device, enabling quick, accessible arrythmia detection in this setting. Our findings bear a promise to the future development of telemedicine-based hospital-at-home methodology.