Circulation. Arrhythmia and electrophysiology最新文献

{"title":"PFKFB2 Gates a Relationship Between Cardiac Glycolytic Regulation and Electrophysiological Function.","authors":"Kylene M Harold, Harris E Blankenship, Keaton E Minor, Abigail S Mulligan, Brooke L Loveland, Chi Fung Lee, Michael Kinter, David A Kass, Stavros Stavrakis, Michael J Beckstead, Kenneth M Humphries","doi":"10.1161/CIRCEP.126.014860","DOIUrl":"10.1161/CIRCEP.126.014860","url":null,"abstract":"<p><strong>Background: </strong>The cardiac isoform of phosphofructokinase-2/fructose 2,6-biphosphatase (PFKFB2) is the heart's strongest glycolytic regulator but is degraded in the absence of insulin signaling. This makes PFKFB2 loss critical to understand in metabolic heart disease, of which impaired insulin signaling is a hallmark. Prolongation of the QT interval, risk of arrhythmia, and sudden cardiac death are also augmented in metabolic heart disease, raising a question as to whether crosstalk between glycolytic dysregulation and electrophysiological dysfunction exists.</p><p><strong>Methods: </strong>We therefore assessed the impact of PFKFB2 loss on cardiac electrophysiology using a cardiomyocyte-specific PFKFB2 knockout mouse model (cKO) and litter-matched controls. To do so, we employed electrocardiography in the fed state and following 12 hours of fasting, examining physiology both at baseline and in the presence of an acute stimulant stress. To further investigate the arrhythmia mechanism, we used patch-clamp electrophysiology and IonOptix Ca²⁺ transient measurements in ventricular cardiomyocytes isolated from control and cKO hearts.</p><p><strong>Results: </strong>The hearts of cKO mice exhibited prolonged repolarization, marked by QT and action potential duration prolongations. This occurred with impaired Ca²⁺ reuptake and increased spontaneous Ca²⁺ release events in ventricular cardiomyocytes. The latter were upregulated via O-GlcNAcylation, a post-translational modification enhanced in the fed state in cKO hearts. Ultimately, these changes culminated in ventricular tachyarrhythmia in cKO mice, which was enhanced in the fed relative to the fasted state.</p><p><strong>Conclusions: </strong>These data suggest that in the presence of sufficient glucose availability, cardiac glycolytic dysregulation at the phosphofructokinase nexus is sufficient to promote cardiac electrophysiological instability.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014860"},"PeriodicalIF":9.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual Heart-Based Prediction of Ablation Outcomes in Persistent Atrial Fibrillation Based on Non-Pulmonary Vein Drivers.","authors":"Taehyun Hwang, Oh-Seok Kwon, Jaeyeon Huh, Doyoung Ahn, Kyeung-Se Im, Hae Min Lee, Hanjin Park, Moon-Hyun Kim, Je-Wook Park, Hee Tae Yu, Tae-Hoon Kim, Jae-Sun Uhm, Boyoung Joung, Moon-Hyoung Lee, Daehoon Kim, Hui-Nam Pak","doi":"10.1161/CIRCEP.125.014266","DOIUrl":"10.1161/CIRCEP.125.014266","url":null,"abstract":"<p><strong>Background: </strong>Clinical outcomes of driver-targeted ablation in persistent atrial fibrillation (AF) have been inconsistent, underscoring the need for virtual heart-based approaches to characterize AF driver dynamics and guide ablation strategies. We used virtual heart models from a large persistent AF cohort to define electrophysiological features of extra-pulmonary vein drivers associated with rhythm outcomes after AF ablation.</p><p><strong>Methods: </strong>We analyzed left atrial virtual heart models integrating cardiac computed tomography and electroanatomical maps in 165 patients with persistent AF from the CUVIA-AF2 study (Clinical Usefulness of Virtual Ablation Guided Catheter Ablation of Atrial Fibrillation 2). During a 34-second virtual AF simulation, stable phase singularities (PSs) were identified by PS lasting ≥2 s within a 10-mm diameter. Dominant frequency (DF) was assessed over 3 consecutive 6-second intervals to evaluate temporal stability. The maximal slope of the action potential duration restitution curve was derived via virtual ramp pacing (200-120 ms). All markers were evaluated across 6 extra-pulmonary vein regions. Associations among stable PS, DF, maximal slope of the action potential duration restitution curve, low-voltage area (<0.5 mV), and 1-year rhythm outcomes were analyzed.</p><p><strong>Results: </strong>Stable PS at extra-pulmonary vein regions was observed in 124 (75%) patients; of these, 43 (34.7%) showed stable DF, and 81 (65.3%) had meandering DF. In regional analysis of the virtual heart models, areas containing stable PS with stable DF showed a higher maximal slope of the action potential duration restitution curve (1.41±0.80 versus 1.09±0.60; <i>P</i><0.001) and greater local virtual low-voltage burden (2.96±3.23% versus 2.10±2.75%) than regions with stable PS with meandering DF. Stable PS with stable DF correlated with higher AF recurrence at 1-year follow-up (log-rank <i>P</i>=0.002; adjusted hazard ratio, 5.78 [95% CI, 2.18-15.3]). A predictive model including stable PS and DF showed an apparent area under the curve of 0.765 for recurrence prediction.</p><p><strong>Conclusions: </strong>Stable PS with stable DF identified in virtual heart models was associated with adverse model-derived regional substrate features and higher recurrence rates after ablation. Virtual heart-based identification of these markers may improve prediction of ablation response in persistent AF, warranting prospective validation.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014266"},"PeriodicalIF":9.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial Fibrillation Ablation Effectiveness End Points, Safety End Points, and Trial Design: Academic Research Consortium Initiative Endorsed by the Heart Rhythm Society.","authors":"Paul J Wang, Edward P Gerstenfeld, Jonathan P Piccini, Atul Verma, T Jared Bunch, Carina Blomstrom-Lundqvist, Stylianos Tzeis, Jason G Andrade, A John Camm, Lin Yee Chen, Rod Passman, Matthew R Reynolds, Hugh Calkins, Andrea M Russo, Pierre Jais, Mina Chung, Boris Schmidt, Marco Perez, Elaine Y Wan, Kevin L Thomas, Eileen Mihas, Mellanie True Hills, J Peter Weiss","doi":"10.1161/CIRCEP.126.015082","DOIUrl":"10.1161/CIRCEP.126.015082","url":null,"abstract":"<p><p>The aim of the AFA-ARC (Atrial Fibrillation Ablation Academic Research Consortium) initiative is to reexamine trial design and the safety and effectiveness end points for pivotal clinical trials evaluating catheter ablation for the treatment of symptomatic atrial fibrillation to provide meaningful and interpretable data to support regulatory decision-making. Beginning in July 2024, a group of international experts began meeting regularly both virtually together and separately in working groups (group 1 effectiveness end points; group 2 safety end points; and group 3 trial design and report forms), with one in-person meeting held in April 2025, and revisions of draft proposals from January 2025 to February 2026. The Food and Drug Administration Office of Cardiovascular Devices at the Center for Devices and Radiological Health provided input throughout the revision and proposal process. A patient advocate participated in the in-person meeting and during the revision phase. Heart Rhythm Society leadership was involved throughout the process and in the revision phase. Industry representatives were sent drafts of the proposed manuscripts during the revision phase before submission. The result of this process was the creation of a combined document to reexamine trial design and the safety and effectiveness end points for pivotal clinical trials evaluating catheter ablation of atrial fibrillation. This document represents contributions from each of the 3 Working Groups. The Heart Rhythm Society endorsed this document. This AFA-ARC document proposes revised effectiveness and safety end points, study design, and report forms for studies evaluating AF ablation in patients with symptomatic paroxysmal, persistent, or longstanding persistent AF.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e015082"},"PeriodicalIF":9.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulse Field Ablation: From Bench to Blueprint: Mechanistic Insights and Device Engineering and Early Clinical Translation.","authors":"Jiaqi Mi, Aashish Katapadi, Jalaj Garg, Luigi Di Biase, Oussama Wazni, Moussa Mansour, Elaine Y Wan, Sanghamitra Mohanty, Andrea Natale, Dhanunjaya Lakkireddy","doi":"10.1161/CIRCEP.125.014597","DOIUrl":"10.1161/CIRCEP.125.014597","url":null,"abstract":"<p><p>Pulsed field ablation has rapidly reshaped the landscape of atrial fibrillation ablation by offering a nonthermal, tissue-selective alternative to conventional thermal energy. This review highlights the scientific foundations, preclinical evidence, and engineering advances that established pulsed field ablation as a safer, faster, and more precise technology. We discuss how irreversible electroporation achieves myocardial selectivity, the pivotal studies that confirmed preservation of nearby structures, and the evolution of modern catheter systems designed for efficient and durable lesion creation. As pulsed field ablation platforms continue to mature, they are redefining procedural safety standards and expanding therapeutic possibilities in cardiac electrophysiology.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014597"},"PeriodicalIF":9.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Pulsed Field Timing Sequence and Electrode Cooling on Ablation Safety and Efficacy Surrogates: A Preclinical Study.","authors":"Luigi Di Biase, Jonathan Hsu, Rahul Bhardwaj, David Newton, William Maddox, Jorge E Romero, Tara Gomez, Eric Byun, Qi Chen, Christopher Beeckler, Fengwei Zou, William H Sauer","doi":"10.1161/CIRCEP.126.015042","DOIUrl":"10.1161/CIRCEP.126.015042","url":null,"abstract":"<p><strong>Background: </strong>The variable loop circular catheter has been shown to be a safe, effective pulsed field ablation catheter for atrial fibrillation treatment. After the commercial launch of the initial waveform (Seq1), a new waveform (Seq2_{30 mL/min}) was developed that reduces electrode surface temperature and ablation delivery time (20-3.8 seconds). This study compares the safety and efficacy of Seq1 versus Seq2 across 2 irrigation rates and 2 dosing conditions.</p><p><strong>Methods: </strong>Twenty-four Yorkshire pigs were treated with pulsed field ablation using the variable loop circular catheter. Subjects were randomized into 3 pulse recipe/irrigation arms (Seq1_{4 mL/min}, Seq1_{30 mL/min}, and Seq 2₃₀ _mL/min). Each group was split into a 1× nominal and a 2×-dose group, resulting in 6 total study groups. Animals were monitored for 28±2 days postablation for follow-up remapping procedures before euthanization. Gross necropsy and histopathology were performed on day 28±2.</p><p><strong>Results: </strong>In all groups, 100% acute and chronic pulmonary vein isolation effectiveness was observed, as indicated by transmural, circumferential, pulmonary vein lesions with no evidence of collateral injury. Transmurality in the left atrial appendage, LA roof, and posterior wall was 75% to 100% across all groups and absent at the mitral isthmus. No catheter thrombus/char was observed at Seq2_{30 mL/min} or Seq1_{30 mL/min}. With Seq1_{4 mL/min}, thrombus/char occurred in 25% (1×) and 100% (2×). Hemolysis and myocardial injury marker changes were similar between all groups, with a notable increase in the 2× groups. On echocardiography, Seq2_{30 mL/min} microbubbles were rated as few or none, while Seq1_{4 mL/min} and Seq1_{30 mL/min} were mostly rated moderate or shower.</p><p><strong>Conclusions: </strong>Consistently durable pulmonary vein isolation was observed across all groups, including Seq1_{4 mL/min}, Seq2_{30 mL/min}, and Seq1_{30 mL/min} across both dosing conditions. Seq2_{30 mL/min} was associated with a reduced ablation delivery time (3.8 seconds), zero catheter thrombus formation, and few microbubbles. Higher irrigation flow in Seq1_{30 mL/min} also mitigated catheter thrombus formation but did not reduce microbubble generation.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e015042"},"PeriodicalIF":9.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Silent Cerebral Lesion Burden Differs Across Pulsed Field Ablation Platforms Despite Comparable Incidence.","authors":"Tetsuro Takase, Yukihiko Yoshida, Hirohiko Suzuki, Yasuhiro Ogura, Akira Shinoda, Masahiro Ishikura, Akifumi Mitsushima, Yoshio Furukawa","doi":"10.1161/CIRCEP.126.015214","DOIUrl":"10.1161/CIRCEP.126.015214","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e015214"},"PeriodicalIF":9.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventricular Fibrillation Mapping in a Large-Animal Model Using Dual Mechanical Circulatory Support: Electroanatomic Substrate Preservation Without Ischemic Changes.","authors":"Karol Quelal Analuisa, Jason A Tri, Ikram U Haq, Amalia A Welle, Hanxu Niu, Atta Behfar, Suraj M Yalamuri, Robert C Ward, Fatima M Ezzeddine, Elena G Tolkacheva, Nicholas Y Tan, Freddy Del-Carpio Munoz, Samuel J Asirvatham, Christopher V DeSimone","doi":"10.1161/CIRCEP.126.014954","DOIUrl":"10.1161/CIRCEP.126.014954","url":null,"abstract":"<p><strong>Background: </strong>Ventricular fibrillation (VF) remains a leading cause of sudden cardiac death with an incompletely characterized electrophysiological substrate. Traditional large-animal VF models are limited by hemodynamic collapse and myocardial ischemia. This study establishes a reproducible swine model using dual mechanical circulatory devices to enable high-density electroanatomic mapping under nonischemic conditions.</p><p><strong>Methods: </strong>Five Yorkshire swine (55-65 kg) underwent sustained VF supported by venoarterial extracorporeal membrane oxygenation (2.5-3.0 L/min) and percutaneous left ventricular unloading (Impella CP, P-2-P-4). High-density electroanatomic mapping using CARTO 7 was performed at baseline and after defibrillation. Bipolar voltage was acquired from 7 predefined ventricular regions (21 measurements per animal per time point; n=210 paired observations). Unipolar voltage mapping and continuous surface ECG monitoring were used to assess acute ischemic injury. Systemic perfusion was maintained at systolic arterial pressure ≥80 mm Hg. Linear mixed-effects modeling was used to analyze voltage changes from pre-VF to post-VF.</p><p><strong>Results: </strong>Sustained VF (10±1 minutes) was reproducibly induced and maintained with consistent hemodynamics (systolic arterial pressure, 90±5 mm Hg; extracorporeal membrane oxygenation flow, 2.5±0.5 L/min). All animals were successfully defibrillated. High-density mapping was feasible in all experiments (1000±300 points per chamber). Bipolar voltage showed no change from pre-VF (5.86±2.56 mV) to post-VF (6.53±2.22 mV; mean difference, 0.67 mV [95% CI, -0.31 to 1.65]; <i>P</i>=0.15). Both left (<i>P</i>=0.17) and right ventricles (<i>P</i>=0.08) demonstrated voltage preservation. Regional analysis showed no significant changes (all <i>P</i>>0.05); post-VF voltages remained above viability thresholds (>1.5 mV). Unipolar voltage maps recovered toward baseline, with no ECG injury pattern identified after defibrillation.</p><p><strong>Conclusions: </strong>Dual mechanical circulatory support with venoarterial extracorporeal membrane oxygenation and Impella CP enables reproducible, high-fidelity electroanatomic mapping and preserves myocardial substrate after sustained VF in a large-animal model. This platform overcomes key technical barriers in VF research, providing a nonischemic foundation for future mechanistic and translational studies.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014954"},"PeriodicalIF":9.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incorporating a Shortened Long-Term Effectiveness End Point Into Catheter Ablation Trials: Statistical Properties and Implications.","authors":"Jason G Andrade, Stephen Hynes, Farid Jamshidian, Andrea Natale","doi":"10.1161/CIRCEP.125.014773","DOIUrl":"10.1161/CIRCEP.125.014773","url":null,"abstract":"<p><strong>Background: </strong>Evidence regarding the use of a 6-month effectiveness end point for trials of atrial fibrillation ablation is limited. This study aims to evaluate the relationship between ablation effectiveness end point detection and follow-up duration, with the secondary goal of informing the design of clinical trials of paroxysmal atrial fibrillation ablation.</p><p><strong>Methods: </strong>Patient-level data from 4 prospective studies were aggregated. Long-term effectiveness end points were calculated with (1) a 3-month blanking period and 12-month follow-up (current) and (2) a 2-month blanking period and 6-month follow-up (proposed). Sensitivity, specificity, and agreement were calculated for each study under the current and proposed end points. A linear approximation method was used to extrapolate the 6-month survival estimate to 12 months, and the predicted 12-month survival rates were compared with the actual 12-month survival rates. Using the linear approximation, a new performance goal was derived and compared against the 6-month survival of each study.</p><p><strong>Results: </strong>The comparative analysis between the current and proposed end points demonstrated concordances ranging from 83% to 92% and sensitivities ranging from 57% to 76% across the 4 recent clinical trials. The linear approximation method produced an estimated 12-month survival rate of the 4 pooled studies of 72.5%, compared with the true 12-month survival rate of 71.0% (-1.5% error). When compared against the true 12-month survival rate in each study individually, the estimated 12-month survival rate resulted in errors ranging from -3.6% to 0.3%. A new performance goal of 56.2% is proposed for trials using a 6-month end point.</p><p><strong>Conclusions: </strong>The proposed end point of a 6-month follow-up duration, inclusive of a 2-month blanking period, demonstrated reasonable levels of agreement with the current 12-month effectiveness end point. Enabling historical comparison, a 12-month survival rate can be reliably extrapolated from a 6-month survival rate using linear approximation.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014773"},"PeriodicalIF":9.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transmurality and Autonomic Effects of Pulsed Field Ablation on the Mitral Isthmus.","authors":"Apoor Patel, Armen Kocharian, Helena Lopez-Martinez, Miguel Maturana Gonzalez, Adi Lador, Paul A Schurmann, Nilesh Mathuria, Amish S Dave, Miguel Valderrábano","doi":"10.1161/CIRCEP.126.015125","DOIUrl":"10.1161/CIRCEP.126.015125","url":null,"abstract":"<p><strong>Background: </strong>Radiofrequency ablation of the mitral isthmus (MI) is unreliable. Vein of Marshall (VOM) ethanol infusion can improve MI ablation success and eliminate local MI autonomic innervation. The role of pulsed field ablation (PFA) in MI ablation and its autonomic effect is unclear. We evaluated the transmurality of endocardial PFA at the MI and its autonomic effects, using real-time epicardial VOM electrograms and VOM high-frequency stimulation.</p><p><strong>Methods: </strong>Patients undergoing atrial fibrillation ablation (n=71) were prospectively enrolled. MI ablation (endocardial to VOM) was delivered using FaraPulse (N=31), PulseSelect (N=9), or Affera (N=31) while monitoring VOM epicardial electrograms to assess transmurality, defined as VOM signal elimination after 20 minutes. MI block was assessed using differential pacing from the left atrial appendage and VOM. High-frequency stimulation from the VOM was performed before and after PFA. VOM ethanol infusion was administered when MI ablation was incomplete.</p><p><strong>Results: </strong>Endocardial PFA led to durable epicardial electrogram attenuation in 52.1% (FaraPulse in 38.7%, PulseSelect in 44.4%, and Affera in 67.7%; <i>P</i><0.05). Myocardial capture with VOM pacing persisted in 43.7% (FaraPulse in 45.2%, PulseSelect in 100%, and Affera in 25.8%; <i>P</i><0.05). Pseudoblock (epicardial-only MI conduction and MI delays) was present in 38%. MI block was achieved with PFA alone in 45% (32/71) of patients; VOM ethanol infusion achieved MI block in an additional 38% (27/71) of patients for a cumulative 83% (59/71); and coronary sinus ablation was used in the remaining 17% (12/71). After PFA, VOM high-frequency stimulation elicited intact parasympathetic responses evidenced as atrioventricular block.</p><p><strong>Conclusions: </strong>Across all 3 PFA platforms, endocardial ablation of the MI is not reliably transmural and does not ablate VOM parasympathetic innervation. VOM ethanol infusion can complete transmurality and denervation of the MI.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e015125"},"PeriodicalIF":9.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Efficacy of Catheter Ablation for Reentrant Atrial Tachycardia in Dextro-Transposition of the Great Arteries Patients After Atrial Switch.","authors":"Carlos A Álvarez-Ortega, Teba González-Ferrero, Lucía Canales-Muñoz, Soraya González-Estriégana, Jesús Diz-Díaz, Ana Elvira González-García, José Ruiz-Cantador, Pablo Merás-Colunga, Carlos Merino-Argos, Nuria Gutiérrez Ruiz, Raúl Moreno-Gómez, Rafael Peinado-Peinado","doi":"10.1161/CIRCEP.125.014811","DOIUrl":"https://doi.org/10.1161/CIRCEP.125.014811","url":null,"abstract":"<p><strong>Background: </strong>Reentrant atrial tachycardias (ATs) are frequent after atrial switch for dextro-transposition of the great arteries and are associated with adverse prognosis. Catheter ablation is first-line therapy, yet long-term outcomes and predictors of recurrence remain poorly defined. Our aim was to characterize induced AT circuits, describe acute and long-term catheter ablation outcomes, and identify recurrence predictors in dextro-transposition of the great arteries.</p><p><strong>Methods: </strong>Single-center ambispective cohort of consecutive adults with dextro-transposition of the great arteries undergoing a first AT ablation (2003-2025). Arrhythmias were mechanically induced with decremental pacing or extra stimuli. Acute success was defined as elimination of all clinical and reproducibly inducible tachycardias (cycle length >200 ms), with bidirectional cavotricuspid isthmus block when applicable. Recurrence was defined as any documented AT >30 seconds.</p><p><strong>Results: </strong>Thirty-three patients underwent 46 procedures. During the index procedure, 66 ATs were induced; 51 (83%) were characterized: 32 (63%) were cavotricuspid isthmus-dependent and 11 (22%) incisional. Cavotricuspid isthmus block was achieved in 84%; acute noninducibility in 73%. Median follow-up was 7.0 years (interquartile range, 2.5-10.4). Overall, 15 patients (45.5%) recurred; 1-year freedom was 75%. Recurrence was strongly associated with failed or uncertain acute efficacy, severely impaired systemic right ventricular fractional shortening ≤22%, prolonged PR interval (220 ms), and greater number of inducible ATs (all <i>P</i><0.05). In multivariable modelling, these 4 variables yielded an optimism-corrected C-index of 0.85. Eleven (33%) underwent redo ablation; 8 achieved acute noninducibility, and only 3 recurred thereafter.</p><p><strong>Conclusions: </strong>In dextro-transposition of the great arteries postatrial switch, cavotricuspid isthmus-dependent flutter is most common, but scar-related circuits are frequent. Catheter ablation is safe and acutely effective, but long-term recurrence remains substantial. Failed acute efficacy, severely impaired systemic right ventricle contractility, prolonged PR interval, and multiple inducible ATs identify patients at highest risk and may guide follow-up and referral for early repeat ablation.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":"19 9","pages":"e014811"},"PeriodicalIF":9.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}