Circulation. Arrhythmia and electrophysiology最新文献

{"title":"RACGAP1 as a Circulating Biomarker of Atrial Fibrillation in Heart Failure: A Dual-Cohort Proteomic Study.","authors":"Amen Bekele Zelleke, Joe David Azzo, Jonathan D Moreno, Douglas L Mann, Thomas P Cappola, Julio A Chirinos, Ali Javaheri","doi":"10.1161/CIRCEP.125.014024","DOIUrl":"https://doi.org/10.1161/CIRCEP.125.014024","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014024"},"PeriodicalIF":9.8,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669966","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":"Win Ratio Analysis of an Extensive Ablation Strategy in Patients With Persistent Atrial Fibrillation: Insights From the EARNEST-PVI Randomized Trial.","authors":"Yuki Matsuoka, Akihiro Sunaga, Daisuke Sakamoto, Hideaki Hasegawa, Daisaku Nakatani, Katsuki Okada, Hirota Kida, Tetsuhisa Kitamura, Nobuaki Tanaka, Masaharu Masuda, Tetsuya Watanabe, Hitoshi Minamiguchi, Yasuyuki Egami, Takafumi Oka, Miwa Miyoshi, Masato Okada, Yasuhiro Matsuda, Masato Kawasaki, Koichi Inoue, Shungo Hikoso, Tomoharu Dohi, Yohei Sotomi, Yasushi Sakata","doi":"10.1161/CIRCEP.125.014463","DOIUrl":"10.1161/CIRCEP.125.014463","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014463"},"PeriodicalIF":9.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580640","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":"Delivery System Support Prevents Endocardial Entanglement and Delamination During Left Bundle Branch Area Pacing.","authors":"Yuichiro Miyazaki, Hiroshi Nakajima, Mark Rimmer, Peter Hanna, Justin H Hayase, Duc H Do, Kalyanam Shivkumar, Shumpei Mori","doi":"10.1161/CIRCEP.125.014355","DOIUrl":"10.1161/CIRCEP.125.014355","url":null,"abstract":"<p><strong>Background: </strong>The mechanisms behind endocardial entanglement and resultant delamination during left bundle branch area pacing, as well as potential solutions, have not been fully demonstrated in the human heart.</p><p><strong>Methods: </strong>Active fixation of a lumenless screw-in lead into the right ventricular septum was attempted with or without delivery system support using donor human hearts rejected for transplant. Delivery sheath support was ensured through firm catheter support maintained by a fixed clip. Endocardial entanglement, endocardial delamination after unscrewing, and lead penetration were evaluated using both macroscopic and microscopic analyses.</p><p><strong>Results: </strong>Each of 10 lead deployments with or without support was attempted using 4 donor human hearts. There was a higher incidence of endocardial entanglement and resultant helix-only penetration in the nonsupport group than the support group (70% versus 0%). Unscrewing after the endocardial entanglement consistently revealed extensively delaminated endocardium entwined around the helix. The median endocardial delamination area was larger in the entanglement group than in the nonentanglement group (25.0 mm² versus 0.9 mm², <i>P</i><0.001). In the regions with endocardial entanglement, histological analysis confirmed extensive endocardial delamination with minimal myocardial injury. On the other hand, localized endocardial delamination and deep intramural penetration were observed in the regions without entanglement. Screw-in procedures reattempted into the regions with extensive endocardial delamination following entanglement achieved deep penetration even without delivery system support.</p><p><strong>Conclusions: </strong>Endocardial entanglement and delamination were confirmed in donor human hearts. Adequate delivery system support, particularly its coaxiality and counterforce effect, is likely to prevent endocardial entanglement and facilitate effective penetration of a lumenless screw-in lead into the human ventricular septum.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014355"},"PeriodicalIF":9.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638097","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":"Post-Catheter Ablation Long-Term Antithrombotic Strategies in Atrial Fibrillation: A Network Meta-Analysis of Randomized Controlled Trials.","authors":"Juan F Rodriguez-Riascos, Dravid Navale, Aakash Somappa, Ricardo J Estrada-Mendizabal, Luis R Scott, Win-Kuang Shen, Komandoor Srivathsan","doi":"10.1161/CIRCEP.125.014692","DOIUrl":"10.1161/CIRCEP.125.014692","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation for atrial fibrillation is a widely used rhythm-control strategy, yet its role in reducing thromboembolic risk and enabling oral anticoagulation (OAC) discontinuation remains uncertain. This meta-analysis aims to comprehensively synthesize and evaluate randomized controlled trial evidence supporting long-term antithrombotic strategies in patients with atrial fibrillation undergoing catheter ablation.</p><p><strong>Methods: </strong>A systematic literature search was performed in MEDLINE/PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials evaluating antithrombotic strategies after catheter ablation for atrial fibrillation. The primary outcome was ischemic stroke. A frequentist network meta-analysis comparing reported treatment arms, along with a pooled incidence meta-analysis for outcomes of interest, was conducted.</p><p><strong>Results: </strong>Four randomized controlled trials, including 3924 patients, met the inclusion criteria. Three trials compared long-term OAC continuation versus OAC discontinuation, and 1 compared OAC continuation with left atrial appendage occlusion after catheter ablation. No significant differences in stroke incidence were observed when comparing OAC or left atrial appendage occlusion with no antithrombotic therapy (incidence rate ratio, 0.90 [95% CI, 0.02-33.85]; <i>P</i>=0.95; incidence rate ratio, 0.79 [95% CI, 0.00-241.01]; <i>P</i>=0.94, respectively). Among patients who discontinued antithrombotic therapy without undergoing left atrial appendage occlusion (n=1161), with 2864 cumulative person-years of follow-up, the pooled incidence of stroke was 0.23 events per 100 person-years (95% CI, 0.02-2.43; I²=0%).</p><p><strong>Conclusions: </strong>This analysis reinforces that, across randomized data, the incidence of thromboembolic events in patients who discontinued OAC after successful ablation remained low. However, the evaluation of net clinical benefit is limited by the low number of events across all treatment arms, underscoring the need for larger studies with prolonged follow-up to further validate the safety of this strategy, particularly in higher-risk populations.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014692"},"PeriodicalIF":9.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13098661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608130","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":"Anticoagulation De-escalation After Atrial Fibrillation Ablation: Evidence From the OCEAN and ALONE-AF Randomized Trials.","authors":"Song Peng Ang, Julia H Indik","doi":"10.1161/CIRCEP.125.014679","DOIUrl":"10.1161/CIRCEP.125.014679","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014679"},"PeriodicalIF":9.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580696","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":"Differential Impact of Low Voltage Area Radiofrequency Ablation on Recurrence of Atrial Fibrillation Versus Atrial Tachycardia in Patients With Persistent Atrial Fibrillation.","authors":"Daisuke Sakamoto, Akihiro Sunaga, Yuki Matsuoka, Hideaki Hasegawa, Hirota Kida, Tomoharu Dohi, Daisaku Nakatani, Katsuki Okada, Tetsuhisa Kitamura, Masaharu Masuda, Nobuaki Tanaka, Tetsuya Watanabe, Hitoshi Minamiguchi, Yasuyuki Egami, Takafumi Oka, Tomoko Minamisaka, Takashi Kanda, Masato Okada, Masato Kawasaki, Yasuhiro Matsuda, Koji Tanaka, Nobuhiko Makino, Shungo Hikoso, Koichi Inoue, Yohei Sotomi, Yasushi Sakata","doi":"10.1161/CIRCEP.125.014408","DOIUrl":"10.1161/CIRCEP.125.014408","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014408"},"PeriodicalIF":9.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13098648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590298","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":"Female Sex-Related Stroke Risk in Atrial Fibrillation: A Thing From the Past?","authors":"Konsta Teppo, K E Juhani Airaksinen, Jari Haukka, Ville L Langén, Olli Halminen, Jukka Putaala, Miika Linna, Pirjo Mustonen, Juha Hartikainen, Gregory Y H Lip, Mika Lehto","doi":"10.1161/CIRCEP.125.014728","DOIUrl":"10.1161/CIRCEP.125.014728","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014728"},"PeriodicalIF":9.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13098662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147662257","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":"Hemolysis Profile of a Novel Balloon-Filled Basket Pulsed Field Ablation Catheter.","authors":"Jed Overmann, Mayara Marques, Chris Lafean, Catherine Pipenhagen, Boyce L Moon, Jeffrey M Fish, Atul Verma","doi":"10.1161/CIRCEP.125.014233","DOIUrl":"10.1161/CIRCEP.125.014233","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014233"},"PeriodicalIF":9.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13098647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510009","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":"Optimal Ablation Strategies for Persistent Atrial Fibrillation With Heart Failure: Three-Year Follow-Up of a Prospective Multicenter Randomized Trial.","authors":"Kaige Li, Xinhua Wang, Mu Qin, Ping Ye, Bing Han, Weifeng Jiang, Yu Zhang, Qidong Zheng, Anjing Ji, Menghe Zhang, Yanzhe Wang, Shaohui Wu, Kai Xu, Changhao Xu, Xu Liu, Xumin Hou","doi":"10.1161/CIRCEP.125.014394","DOIUrl":"10.1161/CIRCEP.125.014394","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation has been shown to improve prognosis in patients with heart failure (HF) and atrial fibrillation (AF); however, the optimal ablation strategy remains undefined.</p><p><strong>Methods: </strong>In this multicenter, randomized controlled trial, 300 patients with persistent AF and HF, including both HF with reduced ejection fraction (ejection fraction ≤40%) and HF with preserved ejection fraction (ejection fraction >40%, including mid-range ejection fraction [ejection fraction 41% to 50%]), were enrolled and randomized equally to the anatomic-guided ablation, electrogram-guided ablation, and extensive electrogram-anatomic-guided ablation groups, with 100 patients in each group. The coprimary end points were: (1) the composite of cardiovascular death or HF-related hospitalization/urgent visit within 36 months; and (2) maintenance of sinus rhythm at 36 months. Secondary end points included AF burden <1%, New York Heart Association class improvement (≥1 grade), 6-minute walk test change, NT-proBNP (N-terminal pro-B-type natriuretic peptide) reduction, and procedure-related complications. Subgroup analyses were performed for HF with reduced ejection fraction and HF with preserved ejection fraction.</p><p><strong>Results: </strong>At 36 months, the extensive electro-anatomic-guided ablation group demonstrated the lowest incidence of the composite end point (17.0%) compared with the electrogram-guided ablation (29.0%) and anatomic-guided ablation (36.0%; overall <i>P</i>=0.010) groups, and the highest rate of sinus rhythm maintenance (62.0%) compared with the electrogram-guided ablation (53.0%) and anatomic-guided ablation (44.0%; <i>P</i>=0.039) groups. Consistent improvements were observed for AF burden <1%, New York Heart Association class, 6-minute walk test, and NT-proBNP. Major complications were low and similar across all groups. These trends were consistent in both the HF with reduced ejection fraction and HF with preserved ejection fraction subgroups.</p><p><strong>Conclusions: </strong>Electrogram-anatomic ablation provides superior long-term rhythm control, reduces cardiovascular events, and improves symptoms in patients with persistent AF and HF, regardless of ejection fraction.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT07153718.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014394"},"PeriodicalIF":9.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580625","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":"Clinical Impact of Rare Variants in Racial and Ethnic Minorities With Atrial Fibrillation.","authors":"Michael C Hill, Brandon Chalazan, Shashank Sandu, Joshua H Arnold, Peter Boxley, Anish S Shah, Siddharth Bhayani, Hajwa Kim, Victor Qiao, Ashwini Deshpande, Mahmud Arif Pavel, David S Tofovic, Dawood Darbar","doi":"10.1161/CIRCEP.125.014641","DOIUrl":"10.1161/CIRCEP.125.014641","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014641"},"PeriodicalIF":9.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13052138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580658","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}