Circulation. Arrhythmia and electrophysiology最新文献

{"title":"Decreasing Microtubule Detyrosination Improves Cardiac Mechanics and Sodium Channel Function in Arrhythmogenic Cardiomyopathy.","authors":"Giovanna Nasilli, Xianming Lin, Pamela Swiatlowska, Viviana Meraviglia, Marta Pérez-Hernández, Mingliang Zhang, Jose L Sanchez-Alonso, Milena Bellin, Julia Gorelik, Eli Rothenberg, Simona Casini, Mario Delmar, Carol Ann Remme","doi":"10.1161/CIRCEP.125.014354","DOIUrl":"10.1161/CIRCEP.125.014354","url":null,"abstract":"<p><strong>Background: </strong>Alterations in microtubule dynamics have been shown to affect cardiomyocyte membrane stiffness and modulate ion channels, including the cardiac sodium channel. While conditions, such as heart failure and Duchenne muscular dystrophy, are associated with increased detyrosination of microtubules and reduced sodium current, a potential role for microtubule detyrosination in arrhythmogenic cardiomyopathy has not been explored. We here investigated the impact of microtubule detyrosination on membrane stiffness, cardiac sodium channel distribution, and function in mouse and human models of arrhythmogenic cardiomyopathy.</p><p><strong>Methods: </strong>Isolated ventricular cardiomyocytes from mice with cardiomyocyte-specific, tamoxifen-activated knockout of PKP2 (plakophilin-2), as well as <i>PKP2</i>-c.2013delC, and isogenic control human-induced pluripotent stem cell-derived-cardiomyocytes were incubated for 2 to 4 hours with compounds known to decrease microtubule detyrosination (parthenolide, 10 µmol/L; EpoY, 20 µmol/L) or vehicle (dimethyl sulfoxide). Immunocytochemistry, mechano-scanning ion conductance microscopy, patch-clamp analysis, and stochastic optical reconstruction microscopy were performed.</p><p><strong>Results: </strong>Cardiomyocyte-specific, tamoxifen-activated knockout of PKP2 mouse cardiomyocytes displayed increased microtubule detyrosination and membrane stiffness, which were both attenuated by parthenolide treatment. Parthenolide significantly increased whole-cell sodium current density in cardiomyocyte-specific, tamoxifen-activated knockout of PKP2 mouse cardiomyocytes, with macropatch measurements demonstrating that this increase occurred both at the intercalated disc and lateral membrane. Stochastic optical reconstruction microscopy analysis revealed that parthenolide increased cardiac sodium channel cluster density at the intercalated disc of cardiomyocyte-specific, tamoxifen-activated knockout of PKP2 mouse cardiomyocytes. In contrast, parthenolide had no effect on sodium current density, cardiac sodium channel cluster size, or density in cardiomyocytes from control mice. <i>PKP2</i>-c.2013delC human-induced pluripotent stem cell-derived-cardiomyocytes displayed increased microtubule detyrosination and reduced sodium current density compared with isogenic control human-induced pluripotent stem cell-derived-cardiomyocytes, which were both prevented by parthenolide and EpoY.</p><p><strong>Conclusions: </strong>Increased microtubule detyrosination secondary to loss of PKP2 impacts cardiomyocyte (dys)function beyond the desmosome, contributing to both electrical and mechanical alterations in the setting of arrhythmogenic cardiomyopathy. Our findings identify microtubule detyrosination as a novel therapeutic target in pathophysiological conditions, such as arrhythmogenic cardiomyopathy, aimed at improving both contractile and electrical function.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014354"},"PeriodicalIF":9.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344149","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":"Sudden Death in Young Competitive Athletes Due to Arrhythmogenic Cardiomyopathy: A 4-Decade National Referral Center Experience.","authors":"Monica De Gaspari, Kalliopi Pilichou, Alessandro Zorzi, Maria Bueno Marinas, Marco Cason, Rudy Celeghin, Patrizio Sarto, Ugo Fedeli, Ilaria Rigato, Alberto Cipriani, Martina Perazzolo Marra, Barbara Bauce, Domenico Corrado, Gaetano Thiene, Stefania Rizzo, Cristina Basso","doi":"10.1161/CIRCEP.125.014877","DOIUrl":"10.1161/CIRCEP.125.014877","url":null,"abstract":"<p><strong>Background: </strong>Arrhythmogenic cardiomyopathy (ACM) is a major cause of sudden cardiac death (SCD) in competitive athletes. We aimed to evaluate the prevalence and characteristics of ACM with the increased awareness of the disease at preparticipation screening after the introduction of the 1994 and 2010 diagnostic criteria.</p><p><strong>Methods: </strong>The North-East Italy registry of juvenile SCD (≤40 years old) was searched for competitive athletes dying due to ACM in the time interval from 1985 to 2024. Cases referred from other regions were also included. Clinical and pathology data were analyzed according to guidelines.</p><p><strong>Results: </strong>ACM was the cause of SCD in 29% of athletes. The incidence rate of SCD in athletes was 0.43 (0.27-0.65) versus 0.14 (0.05-0.33) per 100 000/y before and after 2010, respectively. Fifty-one athletes with ACM (50 men, 25±6.4 years) were enrolled. The pattern was right ventricular/biventricular in 74.5% and left ventricular in 25.5% (41% after 2010). Fibrofatty replacement was transmural in 63% of right ventricular/biventricular ACM and exclusively subepicardial-midmural in left ventricular ACM. First-line preparticipation screening revealed abnormalities in 62.7% (83.3% before 1994 and 40.9% after 2010). Twelve-lead ECG abnormalities were present in 50.9% (60.5% in right ventricular/biventricular ACM and 23% in left ventricular ACM), with negative T waves in 39.2% and low QRS voltage in 25.5%. Premature ventricular complexes/nonsustained ventricular tachycardia with left bundle-branch block or multiple morphologies were present on basal or limited exercise ECG in 35.3%. Maximal stress test, Holter, and 2-dimensional echocardiography were positive in 55%, 45.4%, and 5.8% of cases, respectively. In the only case who underwent contrast-enhanced cardiac magnetic resonance, late gadolinium enhancement was detected.</p><p><strong>Conclusions: </strong>ACM-related SCD incidence appeared lower in the post-2010 period. A phenotypic shift toward the left ventricular variant is observed, with ECG changes in a minority of cases and usually normal 2-dimensional echocardiography. If the index of suspicion is high, contrast-enhanced cardiac magnetic resonance is crucial for early identification and SCD prevention.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014877"},"PeriodicalIF":9.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263550","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":"Ablation of Persistent Atrial Fibrillation Using a Dual-Energy Contact Force-sensing Catheter: Topography of Pulsed Field Mediated Symptoms and New Safety Challenges.","authors":"Francesco Notaristefano, Nicolas Johner, Geoffroy Ditac, Allan Plant, Laurens Verhaeghe, John L Fitzgerald, Kinan Kneizeh, Karim Benali, Konstantinos Vlachos, Cinzia Monaco, Marine Arnaud, Benjamin Sacristan, Jan Charton, Léa Benabou, Marianne Tétreault-Langlois, Josselin Duchateau, Frédéric Sacher, Romain Tixier, Mélèze Hocini, Pierre Jaïs, Michel Haïssaguerre, Thomas Pambrun, Nicolas Derval","doi":"10.1161/CIRCEP.126.014920","DOIUrl":"10.1161/CIRCEP.126.014920","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014920"},"PeriodicalIF":9.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249323","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":"Electrophysiological Effects of Right and Left Tragus Nerve Stimulation in Humans.","authors":"Neal Olarte, Heajung Nguyen, Yuliya Krokhaleva, Houman Khakpour, Duc H Do, Justin Hayase, Carlos Macias, Stavros Stavrakis, Marmar Vaseghi","doi":"10.1161/CIRCEP.126.014872","DOIUrl":"10.1161/CIRCEP.126.014872","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014872"},"PeriodicalIF":9.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13477143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263585","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":"Safety Assessment of Pulsed Field Ablation Near the Sinus Node and His Bundle.","authors":"Ryosuke Kato, Masateru Takigawa, Iwanari Kawamura, Megumi Toda, Masaki Honda, Miho Negishi, Ryo Tateishi, Hidehiro Iwakawa, Kazuya Yamao, Kentaro Goto, Takuro Nishimura, Susumu Tao, Shinsuke Miyazaki, Hiroyuki Watanabe, Tetsuo Sasano","doi":"10.1161/CIRCEP.125.014823","DOIUrl":"10.1161/CIRCEP.125.014823","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014823"},"PeriodicalIF":9.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249358","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":"Simplified Tools, Complex Decisions: These Are Rhythm Procedures: Why AF Ablation, Leadless Pacing, and Left Atrial Appendage Occlusion Require Rhythm-Centered Care.","authors":"Tolga Aksu, Kenneth A Ellenbogen, Dhanunjaya Lakkireddy, Mina K Chung","doi":"10.1161/CIRCEP.126.015127","DOIUrl":"10.1161/CIRCEP.126.015127","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e015127"},"PeriodicalIF":9.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263567","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":"First-in-Human Clinical Experience With Focal Pulsed Field and Radiofrequency Dual-Modality Ablation for Treatment Refractory Left Ventricular Summit PVCs.","authors":"Shivaraj Patil, Xiaoke Liu, Konstantinos C Siontis, Narut Prasitlumkum, Samuel J Asirvatham, Yong-Mei Cha, Freddy Del-Carpio Munoz, Abhishek J Deshmukh, Christopher V DeSimone, Fatima M Ezzeddine, Paul A Friedman, Gurukripa N Kowlgi, Malini Madhavan, Siva K Mulpuru, Thomas M Munger, Duy Nguyen, Peter A Noseworthy, Nicholas Y Tan, Alan Sugrue, Suraj Kapa, Ammar M Killu","doi":"10.1161/CIRCEP.126.014942","DOIUrl":"10.1161/CIRCEP.126.014942","url":null,"abstract":"<p><strong>Background: </strong>Radiofrequency (RF) ablation of premature ventricular complexes (PVCs) originating from the left ventricular summit may be unsuccessful, highlighting the need for alternative approaches. We aimed to assess the efficacy and safety of a novel dual-modality focal catheter in treating left ventricular summit PVCs in patients who had failed previous RF ablation.</p><p><strong>Methods: </strong>Patients were prospectively enrolled and underwent a redo ablation procedure using an irrigated, contact-force sensing, dual-modality focal catheter (TactiFlex Duo, Abbott) under compassionate use indication. The ablation strategy, including the choice of energy modality (monopolar pulsed field [PF], RF, or both), was left to the operator's discretion. Safety assessments included serial biomarkers, renal function, and CMR within 36 hours. Efficacy was defined as ≥80% reduction in PVC burden with symptom resolution at 3-month follow-up.</p><p><strong>Results: </strong>Six consecutive patients (4 men; mean age, 53.8±15 years) with symptomatic left ventricular summit PVCs and a prior failed RF ablation (range, 1-2) were prospectively enrolled. All PVCs had an inferior axis, with a left bundle V1 morphology observed in 4 of 6 cases (mean burden, 30.1±5.3%). Acute suppression of PVCs was achieved in all cases. Acute suppression with a single PF application in the great cardiac vein-anterior interventricular vein occurred in 2 patients, while 3 patients required additional RF, PF, or combined RF+PF applications at adjacent sites. One patient with an inaccessible great cardiac vein-anterior interventricular vein was successfully treated in the left ventricular outflow tract with RF+PF application. Transient, reversible left anterior descending vasospasm was observed during PF delivery in 2 of 5 cases that underwent PF application adjacent to a coronary artery, despite pretreatment with intracoronary nitroglycerin without ECG or hemodynamic sequelae. All patients had durable suppression of PVCs at follow-up.</p><p><strong>Conclusions: </strong>In its first human application, dual-modality ablation was feasible and effective for refractory left ventricular summit PVCs. Transient coronary vasospasm occurred, though it was reversible and without acute clinical consequences.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014942"},"PeriodicalIF":9.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764197","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":"Utilization and Outcomes of Permanent Pacemakers After Bicaval Heart Transplantation: A Large Institutional Experience.","authors":"John P Sheppard, Abdul K Khan, Evan P Kransdorf, Michelle M Kittleson, Jon A Kobashigawa, Archana Ramireddy, Ashkan Ehdaie, Xunzhang Wang, Michael M Shehata, Eric D Braunstein","doi":"10.1161/CIRCEP.125.014442","DOIUrl":"10.1161/CIRCEP.125.014442","url":null,"abstract":"<p><strong>Background: </strong>Permanent pacemaker (PPM) implantation after heart transplantation (HT) is common, but contemporary data regarding utilization, outcomes, and emerging pacing technologies are limited.</p><p><strong>Methods: </strong>We studied PPM placement among 1225 bicaval HT recipients (28% women) treated at our institution from 2010 to 2025 and compared PPM recipients with HT patients without PPMs matched on sex, age, and transplant year.</p><p><strong>Results: </strong>Median age at HT was 58 years (interquartile range, 48-65 years). Sixty-six (5%) patients received a PPM, with stable implantation rates over time. Median HT-to-PPM time was 4.3 months (interquartile range, 2 weeks to 4.8 years). The main indications were sinus node dysfunction (41 patients, 62%) or atrioventricular block (19 patients, 29%). Median post-HT survival was similar between PPM and non-PPM recipients (12.8 versus 11.5 years, <i>P</i>=0.14). Older organ donor age independently predicted PPM placement (odds ratio, 1.75; <i>P</i>=0.04). After 3.2 years of median follow-up, 1 transvenous PPM had a major complication requiring device extraction. Thirteen (20%) patients received leadless PPMs, including 3 atrial leadless PPMs and 1 dual-chamber leadless PPM. Leadless PPMs had no short-term complications over 1 year of median follow-up.</p><p><strong>Conclusions: </strong>Post-HT PPM implantation rates were low and unchanged since 2010. Most devices were implanted for sinus node dysfunction, with 44% implanted within 1 month post-HT. PPM placement was not associated with post-HT survival. Advanced organ donor age was associated with risk of PPM placement. Transvenous PPM complication rates were comparable to rates described in general populations. Leadless PPMs accounted for a substantial minority of PPM placements since their introduction in 2018, with no complications to date. Longer follow-up is needed to establish their long-term outcomes and safety in patients with HT.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014442"},"PeriodicalIF":9.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147970969","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":"Scope and Outcome of Early Repolarization Syndrome in Unexplained Cardiac Arrest: Insights From the National HiRO Registry.","authors":"Bhupesh Jassal, Benjamin M Moore, Brianna Davies, Rafik Tadros, Julia Cadrin-Tourigny, Christian Steinberg, Simon Hansom, Jason D Roberts, Paul Angaran, Martin S Green, Jeffrey S Healey, Laura Arbour, Ciorsti MacIntyre, David Lee, Christopher S Simpson, Shubhayan Sanatani, Colette Seifer, Erkan Ilhan, Alexios Hadjis, Jacqueline Joza, Anne Fournier, Zachary W M Laksman, Habib R Khan, Andrew D Krahn","doi":"10.1161/CIRCEP.125.014433","DOIUrl":"10.1161/CIRCEP.125.014433","url":null,"abstract":"<p><strong>Background: </strong>Early repolarization syndrome (ERS) is diagnosed in survivors of unexplained cardiac arrest (UCA) who exhibit a distinct ECG pattern of early repolarization (ER), defined as J-point elevation ≥0.1 mV in ≥2 contiguous inferolateral leads. UCA survivors without ER or another identifiable cause are classified as idiopathic ventricular fibrillation (IVF). This study evaluated long-term outcomes in ERS compared with IVF.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed patients from the CASPER (Cardiac Arrest Survivors with Preserved Ejection Fraction Registry) who survived UCA and had structurally normal hearts with an Implantable Cardioverter Defibrillator. Of 709 patients, 186 with explanatory diagnoses and no ER pattern were excluded. The remaining 523 were categorized as ERS (n=48), IVF (n=463), or UCA with ER plus an additional diagnosis (Dx+ER, n=12). Patients were followed for the primary outcome of appropriate Implantable Cardioverter Defibrillator therapy, and logistic regression identified predictors of arrhythmia recurrence.</p><p><strong>Results: </strong>Corrected QT interval intervals were significantly shorter in ERS than in IVF (412±25 ms versus 431±41 ms; <i>P</i><0.01). Over a median follow-up of 5.6 years, appropriate Implantable Cardioverter Defibrillator interventions occurred in 23% of ERS and 13% of IVF patients (<i>P</i>=0.09), with incidence rates of 3.0 and 1.5 per 100 person-years, respectively. Four deaths occurred (0.8%), with no significant difference between groups (<i>P</i>=0.39). In Dx+ER, appropriate Implantable Cardioverter Defibrillator therapies occurred in 42% of patients (incidence rate, 4.5 per 100 person-years). Arrhythmia-free survival was lower in ERS than in IVF (<i>P</i>=0.03). After adjusting for age, sex, and ethnicity, ER was an independent predictor of arrhythmia recurrence (odds ratio, 2.59 [95% CI, 1.33-4.85]; <i>P</i>=0.004).</p><p><strong>Conclusions: </strong>ERS is associated with shorter corrected QT interval intervals and reduced arrhythmia-free survival compared with IVF, with an incidence rate of 3.0 per 100 person-years. These findings underscore the importance of careful ECG review in patients with apparent UCA, to detect ER and undertake individualized risk assessment in affected individuals.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014433"},"PeriodicalIF":9.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147970988","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":"Safety and Outcomes of Intracardiac Versus Transesophageal Echocardiography for Left Atrial Appendage Closure in the Very Elderly: Propensity Score Matched Real-World Outcomes From a Large US Network.","authors":"Khalid Sawalha, Saeed Abughazaleh, Kyle Gobeil, Marshal Fox, Guy Rozen, E Kevin Heist, Fadi Chalhoub","doi":"10.1161/CIRCEP.126.014864","DOIUrl":"10.1161/CIRCEP.126.014864","url":null,"abstract":"<p><strong>Background: </strong>Intracardiac echocardiography (ICE) is increasingly used to guide left atrial appendage occlusion as an alternative to transesophageal echocardiography (TEE), particularly in elderly patients for whom general anesthesia may pose additional risks. Real-world comparative safety data in older adults remain limited, with prior studies including only small ICE cohorts. We aimed to compare short- and long-term outcomes of ICE- versus TEE-guided left atrial appendage occlusion in adults aged ≥80 years.</p><p><strong>Methods: </strong>We queried the TriNetX US Collaborative Network to identify patients aged ≥80 years with atrial fibrillation who underwent percutaneous left atrial appendage occlusion from 2015 to 2025. Patients were stratified by imaging modality: ICE- versus TEE-guided approach. Propensity score matching (1:1) was performed across demographics and comorbidities, yielding 2913 patients per group. Outcomes were assessed from the index procedure through 7 days, 90 days, and 1 year using Cox proportional hazards models to generate hazard ratios with 95% CIs. Outcomes included mortality, stroke, device thrombosis, pericardial effusion, pericardiocentesis, tamponade, and device leak.</p><p><strong>Results: </strong>Baseline characteristics were well balanced after matching, with a mean age of 83 years and 44% women. At 90 days, ICE and TEE demonstrated no significant differences in mortality (hazard ratio, 1.18 [95% CI, 0.81-1.73]), stroke, device thrombosis, pericardial effusion, pericardiocentesis, tamponade, or device leak. At 1-year follow-up, mortality (hazard ratio, 0.93 [95% CI, 0.76-1.13]), stroke, and device thrombosis remained similar between groups. However, ICE was associated with a higher incidence of device leak compared with TEE (hazard ratio, 1.81 [95% CI, 1.11-2.97]).</p><p><strong>Conclusions: </strong>In this large propensity-matched cohort of very elderly patients undergoing left atrial appendage occlusion, ICE and TEE demonstrated comparable rates of mortality, stroke, and device thrombosis at 90 days and 1 year. ICE was associated with a higher rate of device leak at 1 year, warranting careful procedural technique and follow-up surveillance. Prospective studies are needed to define optimal intraprocedural imaging strategies in this high-risk population.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014864"},"PeriodicalIF":9.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147970916","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}