Europace最新文献

{"title":"Identifying extra pulmonary vein targets for persistent atrial fibrillation ablation: bridging advanced and conventional mapping techniques.","authors":"Alexander J Sharp, Michael T Pope, Andre Briosa E Gala, Richard Varini, Abhirup Banerjee, Timothy R Betts","doi":"10.1093/europace/euaf048","DOIUrl":"10.1093/europace/euaf048","url":null,"abstract":"<p><strong>Aims: </strong>Advanced technologies such as charge density mapping (CDM) show promise in guiding adjuvant ablation in patients with persistent atrial fibrillation (AF); however, their limited availability restricts widespread adoption. We sought to determine whether regions of the left atrium containing CDM-identified pivoting and rotational propagation patterns during AF could also be reliably identified using more conventional contact mapping techniques.</p><p><strong>Methods and results: </strong>Twenty-two patients undergoing de novo ablation of persistent AF underwent both CDM and electroanatomic voltage mapping during AF and sinus rhythm with multiple pacing protocols. Through the use of a left atrium statistical shape model, the location of distinctive propagation patterns identified by CDM was compared with low-voltage areas (LVAs) and regions of slow conduction velocity (CV). Neither LVA nor CV mapping during paced rhythms reliably identified regions containing CDM propagation patterns. Conduction velocity mapping during AF did correlate with these regions (ρ = -0.63, P < 0.0001 for pivoting patterns; ρ = -0.54, P < 0.0001 for rotational patterns). These propagation patterns consistently occurred in two specific anatomical regions across patients: the anteroseptal and inferoposterior walls of the left atrium.</p><p><strong>Conclusion: </strong>Mapping techniques during paced rhythms do not reliably correspond with regions of CDM-identified propagation patterns in persistent AF. However, these propagation patterns are consistently observed in two specific anatomical regions, suggesting a predisposition to abnormal electrophysiological properties. While further research is needed, these regions may serve as promising targets for empirical ablation, potentially reducing the reliance on complex mapping techniques.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603854","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":"Sensing and detection performance of the novel, small-diameter OmniaSecure defibrillation lead: in-depth analysis from the LEADR trial.","authors":"Prashanthan Sanders, Pamela K Mason, Bert Hansky, Paolo De Filippo, Maully J Shah, Darius P Sholevar, John S Zakaib, Francois Philippon, Bernice Tsang, Rajeev K Pathak, Travis D Richardson, Meir Friedman, Robert D Schaller, Ignasi Anguera, Attila Mihalcz, Babak Bozorgnia, Amy E Thompson, Katherin Arias, Baerbel Maus, Chad Bounds, George H Crossley","doi":"10.1093/europace/euaf062","DOIUrl":"10.1093/europace/euaf062","url":null,"abstract":"<p><strong>Aims: </strong>The Lead EvaluAtion for Defibrillation and Reliability (LEADR) trial evaluated the small-diameter (4.7 Fr), integrated bipolar OmniaSecure defibrillation lead. As previously reported, the trial exceeded primary safety and efficacy objective thresholds, demonstrating favourable performance and zero fractures through ∼12 months follow-up, with patients in ongoing follow-up. Longer-term follow-up of the LEADR trial with emphasis on the sensing and detection capabilities of the OmniaSecure lead is reported here.</p><p><strong>Methods and results: </strong>Patients with indications for de novo implantable cardioverter-defibrillators/cardiac resynchronisation therapy defibrillators were implanted with the OmniaSecure lead in standard right ventricle (RV) locations and followed at pre-specified intervals along with CareLink™ remote monitoring transmissions, where available. Throughout follow-up, the lead was evaluated for safety, efficacy, and reliability along with sensing and detection performance. There were 643/657 (97.9%) patients successfully implanted with the OmniaSecure lead with mean follow-up of 18.2 ± 5.5 months. There was a 96.9% freedom from major study lead-related complications at 24 months. Inappropriate shock rate was 2.7 and 3.8% at 12 and 24 months, respectively. At 24 months, 17.6% of patients received appropriate therapies (shock and/or ATP) with a 76.5% ATP efficacy. There have been zero fractures during follow-up along with chronically stable pacing capture threshold, pacing impedance, and R-wave amplitudes. There were four patients with an adverse event related to PWOS (0.6%), none of which was associated with inappropriate shock. There were four patients with an adverse event related to TWOS (0.6%), of which three patients were associated with inappropriate shock (0.5%). Oversensing was resolved predominantly by programming the RV sensitivity to less sensitive settings. During VF induction at implant, 97.6% (120/123) of patients showed appropriate VF episode detection at the least sensitive setting of 1.2 mV, with the remaining having detection at more sensitive settings. In follow-up, 670 VT/VF episodes were appropriately detected and treated in 94 patients with a variety of RV sensitivities and no reports of under-detected episodes. Moreover, a virtual sensitivity analysis also showed no under-detection across different RV sensitivity programming.</p><p><strong>Conclusion: </strong>Chronic sensing performance of the OmniaSecure defibrillation lead demonstrated R-wave stability with a low rate of P-wave and T-wave oversensing, resolved predominantly by adjusting RV sensitivity. Further, VT/VF detection was successful and was not impacted when programmed to less sensitive settings. The OmniaSecure lead shows robust sensing and detection performance and programmability in ongoing follow-up.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12001238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699818","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":"Correction to: Feasibility of a 90-watt, 3-second radiofrequency application for superior vena cava isolation during atrial fibrillation ablation.","authors":"","doi":"10.1093/europace/euaf078","DOIUrl":"10.1093/europace/euaf078","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":"27 4","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779308","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":"The diagnostic role of pharmacological provocation testing in cardiac electrophysiology: a clinical consensus statement of the European Heart Rhythm Association and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC, the ESC Working Group on Cardiovascular Pharmacotherapy, the Association of European Paediatric and Congenital Cardiology (AEPC), the Paediatric & Congenital Electrophysiology Society (PACES), the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS).","authors":"Elijah R Behr, Bo Gregers Winkel, Bode Ensam, Alberto Alfie, Elena Arbelo, Colin Berry, Marina Cerrone, Giulio Conte, Lia Crotti, Cecilia M Gonzalez Corcia, Juan Carlos Kaski, Koonlawee Nademanee, Pieter G Postema, Silvia Priori, Vincent Probst, Georgia Sarquella-Brugada, Eric Schulze-Bahr, Rafik Tadros, Arthur Wilde, Jacob Tfelt-Hansen, Christian Wolpert, Alejandro Cuesta, Peter Damman, Dobromir Dobrev, Fabrizio Drago, Kristina Haugaa, Andrew Krahn, Ulrich Krause, Pier D Lambiase, Carlo Napolitano, Katja E Odening, Wataru Shimizu, Christian Veltmann","doi":"10.1093/europace/euaf067","DOIUrl":"10.1093/europace/euaf067","url":null,"abstract":"<p><p>The pharmacological provocation test is a pivotal tool in cardiac electrophysiology for the diagnosis of potential causes of sudden cardiac death, sudden cardiac arrest (SCA), arrhythmias, symptoms, or ECG abnormalities. The 2022 European Society of Cardiology Guidelines for the Treatment of Ventricular Arrhythmias and Prevention of Sudden Cardiac Death offered guidance on provocation testing but did not describe the indications and requirements in depth. This clinical consensus statement, led by the European Heart Rhythm Association and approved by major international stakeholders, aims to advise the general cardiologist and the arrhythmia expert who to test and when, where, and how to do it. The statement focuses on current practice for the diagnosis of subclinical arrhythmia syndromes and the causes of SCA, building upon the recommendations of the Guidelines. We address the sodium channel blocker provocation test for patients suspected of Brugada syndrome as well as the use of epinephrine, isoproterenol, adenosine, ergonovine, and acetylcholine.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12018878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751740","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 characteristics associated with steam pops in ablation index-guided radiofrequency ablation of atrial fibrillation.","authors":"Xue-Si Wang, Ze-Yang Wu, Qi Wu, De-Yong Long, Cai-Hua Sang, Chen-Xi Jiang, Wei Wang, Xin Zhao, Chang-Yi Li, Rong-Hui Yu, Nian Liu, Song-Nan Li, Xiao-Xia Liu, Xue-Yuan Guo, Song Zuo, Meng-Meng Li, Tong Liu, Wen-Li Dai, Ming-Yang Gao, Chang-Qi Jia, Man Ning, Li Feng, Wen-He Lv, Yu-Kun Li, Xiao-Ying Liu, Zhuo-Hang Du, Jia-Lin Li, Xin-Ru Li, Jian-Zeng Dong, Chang-Sheng Ma, Ri-Bo Tang","doi":"10.1093/europace/euaf084","DOIUrl":"10.1093/europace/euaf084","url":null,"abstract":"<p><strong>Aims: </strong>Steam pops present a significant concern during radiofrequency (RF) ablation of atrial fibrillation (AF). It is crucial to analyse the incidence and ablation characteristics associated with steam pops. This study aims to investigate the occurrence and potential predictors of steam pops.</p><p><strong>Methods and results: </strong>This study included 3263 patients with AF who underwent RF ablation. Patients with paroxysmal AF received bilateral circumferential pulmonary vein (PV) ablation, while those with persistent AF underwent additional linear ablation. The ablation parameters at the sites of steam pops were compared to those at adjacent anatomical locations. A total of 81 steam pops (2.5%) with one pericardial tamponade were recorded. Steam pops were observed at liner ablation sites: 6 (0.4%) at the mitral isthmus, 16 (0.9%) at the tricuspid isthmus (CTI), and 7 (0.5%) along the roofline. The most common sites of steam pops were the anterior edge of the left superior PV and the inferior vena cava side of the CTI. The impedance drop was significantly higher (18.2 ± 9.5 Ω vs. 13.5 ± 4.8 Ω, P < 0.001) at steam pop sites. The optimal cut-off points of impedance drop for predicting steam pops were > 9.5 Ω within the first 3 s, > 10.5 Ω within the first 5 s, > 13.5 Ω within the first 10 s, and > 18.5 Ω in the whole ablation, respectively.</p><p><strong>Conclusion: </strong>The incidence of steam pops during ablation of AF is infrequent. Impedance drop is the only ablation parameter that could predict the occurrence of steam pops.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802855","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":"Lifestyle and risk factor modification in atrial fibrillation: a European Heart Rhythm Association survey.","authors":"Mark T Mills, Piotr Futyma, Peter Calvert, Diego Penela, Laurent Roten, Laura Perrotta, Federico Migliore, Gregory Y H Lip, Dhiraj Gupta, Julian K R Chun","doi":"10.1093/europace/euaf075","DOIUrl":"10.1093/europace/euaf075","url":null,"abstract":"<p><strong>Aims: </strong>Lifestyle and risk factor modification (LRFM) forms a central pillar in the management of atrial fibrillation (AF). This European Heart Rhythm Association (EHRA) survey aims to assess current clinical practice regarding LRFM across EHRA countries.</p><p><strong>Methods and results: </strong>A 31-item questionnaire was developed and distributed amongst healthcare professionals via the EHRA and social media, between 23 September and 21 October 2024. Of 258 respondents from 28 countries, 39.9% reported that their healthcare system is badly or very badly designed to deliver meaningful LRFM. Risk factors that respondents felt least confident managing included psychological distress (42.2% of respondents not confident), sleep-disordered breathing (33.8%), and obesity (22.4%). Respondents estimated that 70% of patients with AF at their institution may benefit from exercise-based cardiac rehabilitation but that only 10% are referred for this. The most important barrier to cardiac rehabilitation in AF was identified as local programmes not accepting patients with AF only (42.1% of respondents). Despite 37.7% of respondents using a body mass index cut-off when deciding on catheter ablation suitability (with a mean cut-off of 36.7 ± 5.4 kg/m2), only 23.5% of patients with obesity are referred for formal dietary advice. Lack of patient motivation or engagement was identified as the most important barrier to weight loss (41.3% of respondents). Moreover, 89.6% of respondents routinely assess their patient's alcohol intake, whilst only 23.9% systemically assess for psychological distress and 16.5% for sleep-disordered breathing.</p><p><strong>Conclusion: </strong>Delivering comprehensive LRFM in AF poses significant challenges. Improvements to healthcare infrastructures are required to successfully implement meaningful LRFM.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11983686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742681","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":"MicroPort CRM considerations on Vega pacing lead performance.","authors":"Andrea Vincon","doi":"10.1093/europace/euaf060","DOIUrl":"10.1093/europace/euaf060","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11983385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669304","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":"Evaluation of a second-generation intercostal extravascular implantable cardioverter defibrillator lead with a pectoral pulse generator for sensing, defibrillation, and anti-tachycardia pacing.","authors":"Shephal K Doshi, Reinoud E Knops, Adrian Ebner, Michael Husby, Alan Marcovecchio, Rick Sanghera, Don Scheck, Martin C Burke","doi":"10.1093/europace/euaf044","DOIUrl":"10.1093/europace/euaf044","url":null,"abstract":"<p><strong>Aims: </strong>Intercostal extravascular implantable cardioverter defibrillator (EV-ICD) leads may work better in contact with the pericardium thereby directing pacing and defibrillation energy towards excitable myocytes. We report 3-month safety and performance outcomes with a second-generation intercostal EV-ICD lead paired with standard, commercially available ICD pulse generators (PGs).</p><p><strong>Methods and results: </strong>Subjects undergoing a transvenous ICD (TV-ICD) procedure received a concomitant intercostal EV-ICD lead system. The intercostal EV-ICD lead was connected sequentially to a PG in a left pectoral and then a left mid-axillary location. Extravascular ICD lead assessment included sensing and defibrillation of induced ventricular arrhythmias and pacing capture. The intercostal EV-ICD system was followed in a 'recording-only' mode and the control TV-ICD system in 'therapy delivery' mode to compare stored events. Devices were evaluated prior to hospital discharge, 2 weeks, 1 month, 2 months, and 3 months post-implant. Defibrillation testing was repeated prior to lead removal; 20/20 (100%) were successfully implanted (median implant time of 9 min). Two major lead complications were reported over a mean of 82 days: (i) lead movement and (ii) infection of both the TV-ICD and EV-ICD systems. Intraoperative pacing capture was achieved with the integrated bipolar configuration in 19 of 20 (95%) subjects. Pacing capture with the EV-ICD system was tolerated in all subjects, with over 90% feeling no pain after a 1-month recovery from the procedure. Induced VF episodes were sensed in all subjects and defibrillated successfully in 17 of 17 patients (100%) with a left mid-axillary PG and 19 of 20 patients (95%) with a left pectoral PG. Sensing and defibrillation were successful in 18 of 18 (100%) tested prior to lead removal.</p><p><strong>Conclusion: </strong>In this pilot experience with a second-generation intercostal EV-ICD lead implantation, sensing and defibrillation of induced VF were successful when paired with a standard ICD PG from either a left mid-axillary or pectoral pocket.</p><p><strong>Clinical trial registration: </strong>NCT number: NCT05791032; URL: https://clinicaltrials.gov/study/NCT05791032.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556300","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":"How harmful is right ventricular pacing? The question revived by the BioPace trial.","authors":"Mads Brix Kronborg, Niraj Varma, Jens Cosedis Nielsen","doi":"10.1093/europace/euaf005","DOIUrl":"10.1093/europace/euaf005","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":"27 3","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656596","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":"Time-dependent repolarization changes following left bundle branch area pacing vs. conventional biventricular pacing in patients with dyssynchronous heart failure.","authors":"Karin C Smits, Edoardo Bressi, Leonard M Rademakers, Jesse H J Rijks, Antonius M W van Stipdonk, Elien B Engels, Aaron Isaacs, Ben J M Hermans, Domenico Grieco, Justin G L M Luermans, Kevin Vernooy, Frits W Prinzen, Uyên Châu Nguyên","doi":"10.1093/europace/euaf034","DOIUrl":"10.1093/europace/euaf034","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425131","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}