Rhythm Interventions Online

Rhythm Interventions Online Where innovation meets expertise in EP and cardiac rhythm management.

Rhythm Interventions Online is where innovation meets expertise in the global world of electrophysiology and cardiac rhythm management. At the heart of Rhythm Intervention Online lies a singular objective: to empower you, the healthcare practitioner, in achieving optimal clinical outcomes in electrophysiology and cardiac rhythm management. Join us for an unforgettable journey where knowledge meets innovation and together, let's shape the future of cardiovascular care.

26/08/2026

Durable pulmonary vein isolation remains one of the key challenges in AF ablation.

In this live case, Jérôme Lacotte and Vladimir Manenti discuss the ongoing challenge of achieving consistent, durable lesions across every patient, highlighting why recurrence and reconnection remain important considerations in clinical practice.

As ablation technologies continue to evolve, improving lesion durability remains central to advancing outcomes for patients undergoing AF treatment.

25/08/2026

This live case demonstrates conduction system pacing (CSP) lead positioning and septal targeting, led by Amr Abdin.

Lead deployment is performed with controlled rotations, followed by use of a locking helix tool to secure fixation. Anatomical landmarks, including the TAVI valve, are used to guide positioning and estimate depth relative to the septum.

Fluoroscopic views in RAO and LAO projections are used to confirm alignment and ensure perpendicular orientation to the septal wall. Mapping is then performed to confirm signal capture and optimal lead placement.

24/08/2026

This live case demonstrates a streamlined approach to concomitant pulsed field ablation (PFA) and left atrial appendage occlusion (LAAO), led by Julian Chun, as part of RIO’s collaborative, case-led learning format.

Pulmonary vein isolation is performed using an OLIVE configuration, with careful catheter positioning guided by real-time electrograms. Residual signals within the vein are identified and eliminated through targeted applications, followed by rotational adjustments to optimise lesion coverage.

Pulmonary vein angiography supports accurate sizing and individualisation of the ablation configuration, ensuring effective contact and consistent lesion delivery.

22/08/2026

In this case, Andre d’Avila discusses a substrate-based approach to VT ablation, questioning the need for VT induction when the critical substrate can be identified during sinus rhythm mapping.

By comparing VT activation with sinus rhythm substrate mapping and CS spacing, the team identified a shared channel responsible for multiple VTs. This allowed targeted ablation of the critical area without extensive VT induction.

The final lesion set treated only a small proportion of the low-voltage substrate, demonstrating how precise substrate modification can achieve effective VT control while limiting unnecessary ablation.

21/08/2026

In this live case, Zain Khalpey demonstrates a robotic approach to epicardial access during complex AF ablation.

Faced with significant adhesions following previous ablation procedures, the team uses robotic assistance to carefully dissect the epicardial space and create access for catheter delivery.

Using robotic instruments, including hot shears and irrigation, Zain highlights how controlled tissue manipulation can help navigate challenging anatomy while maintaining precision and safety.

This case demonstrates the potential of robotic surgery to support complex epicardial ablation strategies where adhesions and prior procedures create additional challenges.

20/08/2026

In this live case, Devi Nair demonstrates a precision workflow for PVI using the PulseSelect™ catheter, combining wire positioning, ICE guidance and mapping to optimise lesion delivery.

The team uses the mapping system to visualise wire position and guide catheter placement within the left superior pulmonary vein. Real-time ICE assessment helps confirm contact, while catheter torque and rotation are used to achieve targeted ostial applications.

Devi highlights the value of integrated mapping during PFA, particularly when acute electrogram changes make signal assessment challenging. By confirming lesion overlap and maintaining catheter control, the workflow supports confidence in pulmonary vein isolation.

This case demonstrates how imaging, mapping and procedural technique work together to optimise PFA delivery.

19/08/2026

In this live case, Melanie Gunawardene demonstrates a precision-based approach to PVI using a circular PFA system.

Following occlusion angiography, the team identifies a small gap at the anterior carina and adjusts balloon positioning to target the remaining area. Offline electrograms confirm signal elimination following the initial PFA application, while additional applications are used to reinforce lesion durability.

By rotating the balloon to align with the projected electrical field, Melanie demonstrates how positioning adjustments can help address gaps and optimise coverage. The workflow includes four fully inflated balloon applications followed by two additional pear-shaped applications.

This case highlights the importance of real-time assessment, anatomical understanding and procedural adaptability in achieving durable PVI with PFA.

18/08/2026

In this live case, A***n Sultan demonstrates how real-time contact assessment guides balloon-in-basket PFA delivery.

The workflow highlights how electrode feedback helps distinguish effective tissue contact from inadequate positioning. When electrodes are not engaging the tissue, limited bar movement indicates that energy delivery may not be optimal.

By adjusting catheter orientation towards the anterior wall, increased electrode contact can be achieved, allowing more confident lesion delivery.

This case highlights the importance of interpreting real-time catheter feedback to optimise PFA applications and support procedural precision.

14/08/2026

In this live case, Roderick Tung demonstrates targeted epicardial VT ablation within the RVOT, focusing on real-time assessment of substrate and lesion delivery.

The team performs a focused ablation strategy, using electrogram changes and ECG observations to guide energy delivery. Live ST-segment changes in V2 and evolving electrogram signals help assess the impact of ablation in the targeted region.

The discussion also highlights the challenges of epicardial mapping, including interpretation of far-field signals and the potential influence of epicardial fat on signal characteristics.

A practical insight into the decision-making required during complex epicardial VT ablation procedures.

13/08/2026

In this live case, Salem Younsi and Jérôme Lacotte discuss practical considerations for achieving effective PFA applications during PVI.

With no current technology able to directly predict contact quality and lesion formation, procedural experience and catheter handling remain important factors in optimising delivery.

The team highlights how catheter behaviour, including controlled pressure and tilt during ostial applications, can help operators assess contact and guide effective energy delivery.

A practical discussion on the importance of operator technique and procedural judgement in contemporary PFA workflows.

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