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.

01/09/2026

In this live case, Jérôme Lacotte and Vladimir Manenti demonstrate the importance of detailed mapping during a complex ablation procedure.

Using Medtronic Affera technology, the team analyses tachycardia activation patterns, with a decapolar catheter showing eccentric coronary sinus activation and a tachycardia cycle length above 200 milliseconds.

The right atrium appears to be a bystander, with early activation originating from the septal region while the CTI remains silent.

This case highlights how careful interpretation of activation sequences and electrogram data helps define the true arrhythmia mechanism and guide targeted ablation strategy.

31/08/2026

In this live case, Devi Nair discusses the role of real-time assessment and clinical judgement during redo AF ablation with PFA.

Following AF termination during ablation, the team considers the challenges of interpreting acute responses to PFA and whether termination reflects true circuit modification or localised effects.

Devi highlights the importance of looking beyond lesion tags alone, using ICE to assess tissue characteristics and applying additional overlapping lesions in areas of thicker tissue, such as the left superior pulmonary vein roof and posterior region.

This case demonstrates how imaging, substrate assessment and operator experience continue to shape decision-making in complex redo AF procedures.

28/08/2026

In this live case, A***n Sultan demonstrates catheter positioning strategies during balloon-in-basket PFA, highlighting the role of sheath manipulation in achieving effective contact.

During ablation, real-time visualisation helps assess catheter stability and confirm positioning. A***n explains how he primarily uses the sheath to steer the system, allowing the catheter to maintain its position while optimising contact.

This practical approach highlights how understanding catheter mechanics and controlled manoeuvring can support efficient, reproducible PFA workflows.

27/08/2026

In this live case, Christian Sohns demonstrates how precise catheter positioning and rotation can help optimise PFA lesion delivery during AF ablation.

Following successful signal elimination after initial applications, the team uses the steerable sheath to continue the ablation sequence and address remaining areas of interest.

The discussion highlights how catheter rotation can help compensate for potential gaps between electrodes, enabling more complete energy delivery across the target area.

This case demonstrates the importance of understanding electrode configuration, catheter manoeuvrability and workflow optimisation when performing PFA.

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.

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