Year in Review in Cardiac Electrophysiology

In the past year, our field has seen publication of a number of studies that have potential immediate and far-reaching impact on our practice.Whether considering novel forms of achieving cardiac resynchronization via His bundle pacing (HBP), randomized clinical trials validating the utility of wearable technologies or atrial fibrillation (AF) ablation, or emerging techniques for management of ventricular fibrillation, publications from several investigators, teams, and multicenter collaborations have served to further our understanding of existing disease and consider new opportunities.In putting together this list of key articles from the past year, in addition to picking the top 25 articles from Circulation: Arrhythmia and Electrophysiology, we have also focused on major studies across the published literature.Although in this review we have sought to prioritize the highest impact research, we feel it is also important to highlight several evolving areas of study that may affect the rapidity, scope, and approach to research within our field.Augmented and virtual reality integration into the electrophysiology laboratory, artificial intelligence, and rapidly miniaturizing wearable technologies have the potential to exponentially alter our field, whether in the way we practice or the way we come to new understanding of disease and its management.Given the paucity of high-impact electrophysiology-related research published in these areas to date, but the equal importance for our readership to be aware of what may be on the horizon, we have included a brief discussion of these evolving techniques and associated publications in the Data Supplement. BASIC CARDIAC ELECTROPHYSIOLOGYThere were many advances in areas of basic cardiac electrophysiology ranging from application of genetic tools to better understanding electrophysiological disease to identifying potentially targetable molecular and protein mechanisms of arrhythmogenesis to characterizing the noncardiac milieu that drives evolution of substrate in a variety of different myocardial processes.Here, we focus on 2 publications that may have future consequences in clinical practice.Understanding the ionic basis of rhythm disease in the failing heart is essential if pharmacotherapeutics are to be effective.To this end, Hegyi et al 1 presented an elegant study that delves into the ionic mechanisms mediating the arrhythmic substrate in ischemic cardiomyopathy.Using a porcine postmyocardial infarct heart failure model, the authors studied the behavior of 8 ionic currents during the action potential of ventricular myocytes from the infarct border zone and a remote site.The summation of inward and outward currents occurred differently depending on location, with border-zone myocytes exhibiting action potential shortening and remote-zone myocytes displaying action potential prolongation.It follows that differential electrical remodeling increases proarrhythmia susceptibility by

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