Europace最新文献

{"title":"Personalized pulmonary vein isolation guided by left atrial wall thickness for persistent atrial fibrillation ablation: the PeAF-by-LAWT randomized trial.","authors":"Giulio Falasconi, Diego Penela, David Soto-Iglesias, Alessia Chiara Latini, Federico Landra, Emanuele Curti, Pietro Francia, Andrea Saglietto, Dario Turturiello, Daniel Viveros, Aldo Bellido, Jose Alderete, Fatima Zaraket, Paula Franco, Stefano Valcher, Francesco Amata, Chiara Valeriano, Carlo Gigante, Lucio Teresi, Bruno Tonello, Roberta Mea, Lautaro Sánchez-Mollá, Carmine De Lucia, Marina Huguet, Óscar Cámara, José-Tomás Ortiz-Pérez, Julio Martí-Almor, Antonio Berruezo","doi":"10.1093/europace/euaf163","DOIUrl":"https://doi.org/10.1093/europace/euaf163","url":null,"abstract":"<p><strong>Background: </strong>A personalized pulmonary vein isolation(PVI) approach aimed at ablation index(AI)titration according to MDCT-derived left atrial wall thickness(LAWT) maps reported high effectiveness and efficiency outcomes for persistent atrial fibrillation(PeAF) ablation. To date, no randomized trials have compared this approach with the standard CLOSE protocol.</p><p><strong>Objectives: </strong>This non-inferiority randomized controlled trial sought to compare a LAWT-guided PVI with CLOSE protocol-based for PeAF(NCT05396534). Primary endpoint was freedom from atrial arrhythmias recurrence. Secondary endpoints were major complication rate, procedure time, radiofrequency time, and first-pass PVI rate.</p><p><strong>Methods: </strong>Consecutive patients referred for first-time PeAF ablation were randomized on a 1:1 basis. In the by-LAWT arm, the AI was titrated according to local LAWT, and the ablation line was personalized to avoid the thickest regions at PV antrum. In the CLOSE arm, LAWT information was not available to the operator; the ablation was performed according to the CLOSE study settings: AI ≥400 at the posterior wall and ≥550 at the anterior wall.</p><p><strong>Results: </strong>156 patients were included. At 12-month follow-up, no significant difference occurred in atrial arrhythmia-free survival between groups(p=0.50). In the by-LAWT group a significant reduction in procedure time(60.5vs.80.0 minutes; p<0.01) and RF time(14.4vs.28.6 minutes; p<0.01) was observed. No difference was observed regarding first-pass PVI(p=0.72) and major complication rate(p=0.99).</p><p><strong>Conclusions: </strong>The PeAF-by-LAWT trial is the first prospective randomized study to demonstrate that a personalized LAWT-guided PVI for PeAF ablation is non-inferior to the standard CLOSE protocol in terms of arrhythmia-free survival, while significantly improving procedural efficiency. The study was not powered to detect differences in safety outcomes.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834521","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":"Circumferential pulmonary vein isolation with adjunctive linear ablation vs. circumferential pulmonary vein isolation alone for long-standing persistent atrial fibrillation: a randomized pilot study.","authors":"Yeqian Zhu, Yan Dong, Qiushi Chen, Li Jiang, Yuan He, Nishant Yadav, Kejiang Cao, Fengxiang Zhang","doi":"10.1093/europace/euaf176","DOIUrl":"10.1093/europace/euaf176","url":null,"abstract":"<p><strong>Aims: </strong>This prospective randomized controlled trial investigated the comparative efficacy and safety of circumferential pulmonary vein isolation (CPVI) combined with modified linear ablation (CPVI-MLA) vs. standalone CPVI in patients with long-standing persistent atrial fibrillation (LSPAF).</p><p><strong>Methods and results: </strong>In this single-centre pilot trial, 134 LSPAF patients were randomized to the CPVI-MLA (n = 67) or CPVI-only (n = 67) groups. The CPVI-MLA protocol integrated four components: (i) ethanol infusion targeting the ligament of Marshall; (ii) complete CPVI; (iii) extended lesion sets (posterior wall isolation, dual isthmus ablation); and (iv) substrate modification [left atrial intima adjoining coronary sinus (LAI-CS) and superior vena cava isolation (SVCI)]. A 24 h Holter monitoring was performed at the 1st, 3rd, and 6th month follow-up visits, with 7-day Holter monitoring at the 12th month follow-up visit. The primary endpoint was freedom from atrial tachyarrhythmias (≥ 30 s) after the initial 3-month blanking period post-index procedure, without antiarrhythmic drugs. After a mean follow-up of 14.5 ± 9.1 months, 76.1% (51/67) in the CPVI-MLA group and 65.7% (44/67) in the CPVI-only group achieved the primary endpoint (P = 0.32). However, the CPVI-MLA group demonstrated significantly higher atrial fibrillation (AF)-free survival rate (91.0 vs. 76.1%, P = 0.049), while atrial tachycardia/atrial flutter-free survival rates were comparable (83.5 vs. 88.1%, P = 0.45). The CPVI-MLA strategy required longer ablation time (68.6 ± 12.3 vs. 49.4 ± 10.3 min, P < 0.001) and fluoroscopy exposure (14.9 ± 9.8 vs. 9.3 ± 6.7 min, P < 0.001). Serious adverse events were rare and similar between groups (1.5 vs. 0%, P = 1.00).</p><p><strong>Conclusion: </strong>In patients with LSPAF, the CPVI-MLA strategy significantly improved freedom from AF compared with CPVI alone, although it did not improve overall sinus rhythm maintenance rate. This strategy may offer a refined approach for complex AF ablation, warranting further validation in larger trials.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12395555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834517","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":"Two-year outcomes of left bundle branch area pacing versus traditional right ventricular pacing in middle-aged adults: a registry-based trial.","authors":"Matteo Bertini, Luca Canovi, Francesco Vitali, Lina Marcantoni, Gianni Pastore, Mario Volpicelli, Orlando Munciguerra, Mauro Biffi, Matteo Ziacchi, Luca Rossi, Valeria Carinci, Paolo Sirugo, Paolo Pastori, Jacopo Francesco Imberti, Pier Luigi Pellegrino, Erminia Guerriero, Biagio Sassone, Enrico Bertagnin, Giuseppe Coppola, Michele Malagù, Cristina Balla, Giorgia Azzolini, Gloria Zuccari, Francesco Zanon, Giuseppe Boriani, Marco Zuin","doi":"10.1093/europace/euaf181","DOIUrl":"https://doi.org/10.1093/europace/euaf181","url":null,"abstract":"<p><strong>Aims: </strong>Prolonged right ventricular pacing (RVP) increases the risk of cardiomyopathy, atrial fibrillation, heart failure (HF), and mortality. This registry-based trial compared left bundle branch area pacing (LBBAP) with RVP in patients younger than 65 years.</p><p><strong>Methods and results: </strong>Using the ConTempoRary Cardiac Stimulation in Clinical practicE: lEft, BivEntriculAr, Right, and conDuction System Pacing (TREEBEARD) registry (NCT06324682), patients were randomized 1:1 to LBBAP or RVP. The primary endpoint was a composite of cardiovascular (CV) death and HF hospitalization (HFH); secondary endpoints included individual components and all-cause mortality. A total of 344 patients (mean age 58.5 years, 215 males, 172 per arm) were included. At 2 years, the primary composite endpoint occurred in 6.3% of LBBAP vs. 12.7% of RVP patients (HR, 0.78; 95% CI, 0.59-0.87), representing a 22% risk reduction. Subgroup analyses aligned with primary findings. Left bundle branch area pacing significantly reduced HFH risk (HR, 0.79; 95% CI, 0.63-0.86) but showed no difference in CV mortality (HR, 1.02; 95% CI, 0.79-1.32) or all-cause mortality (HR, 1.00; 95% CI, 0.72-1.38).</p><p><strong>Conclusion: </strong>Left bundle branch area pacing significantly lowered the 2-year composite of CV death and HFH compared to RVP in patients aged <65 years old. However, it did not reduce CV or all-cause mortality individually compared to RVP.</p><p><strong>Clinical trial registration: </strong>TREEBEARD (NCT06324682).</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":"27 8","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12396185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947671","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":"Repeat procedures after pulsed field ablation for atrial fibrillation: MANIFEST-REDO study.","authors":"Daniel Scherr, Mohit K Turagam, Philippe Maury, Yuri Blaauw, Pepijn van der Voort, Petr Neuzil, Tobias Reichlin, Andreas Metzner, Johan Vijgen, Josef Kautzner, Serge Boveda, Ante Anic, Jim Hansen, Martin Manninger, Philipp Sommer, Frederic Anselme, Stephan Willems, Thomas Deneke, Roland Tilz, Daniel Steven, Reza Wakili, Pierre Jais, Moritoshi Funasako, Thomas Arentz, Anne Rollin, Bart A Mulder, Alexandre Ouss, Jan Petru, Thomas Kueffer, Marc D Lemoine, Pieter Koopman, Petr Peichl, Raquel Adelino, Zrinka Jurisic, Martin Ruwald, Anna-Sophie Eberl, Christian Sohns, Arnaud Savoure, Karin Nentwich, Melanie Gunawardene, Christian-Hendrik Heeger, Arian Sultan, Jan-Eric Bohnen, Jana Kupusovic, Nicolas Derval, Heiko Lehrmann, Emmanuel Ekanem, Vivek Y Reddy","doi":"10.1093/europace/euaf012","DOIUrl":"10.1093/europace/euaf012","url":null,"abstract":"<p><strong>Aims: </strong>Initial clinical studies of pulsed field ablation (PFA) to treat atrial fibrillation (AF) indicated a >90% durability rate of pulmonary vein isolation (PVI). However, these studies were largely conducted in single centres and involved a limited number of operators. We aimed to describe the electrophysiological findings and outcomes in patients undergoing repeat ablation after an initial PF ablation for AF.</p><p><strong>Methods and results: </strong>In the MANIFEST-REDO study, we investigated patients who underwent repeat ablation due to clinical recurrence-AF or atrial tachycardia (AT)-following first-ever PVI with a pentaspline PFA catheter (Farawave, Boston Scientific Inc.). At 22 centres, 427 patients (age 64 ± 11 years; 37% female) were included. Of note, the recurrent arrhythmia leading to the repeat ablation was paroxysmal AF (51%), persistent AF (30%), or AT (19%). At the repeat procedure, the PV reconnection rates were 30% (left superior pulmonary vein), 28% (left inferior pulmonary vein), 33% (right superior pulmonary vein), and 32% (right inferior pulmonary vein). In 45% of patients, all PVs were durably isolated at the beginning of the repeat procedure, with the previous use of any imaging or mapping modality being univariately associated with durable PVI. After a post-redo follow-up period of 284 (90-366) days, the primary effectiveness endpoint (freedom from documented AF/AT lasting ≥30 s after 3-month blanking without class I/III antiarrhythmic drugs or symptoms) was achieved in 65% of patients, with significant differences between groups (PAF 65% vs. PersAF 56% vs. AT 76%; P = 0.04). Persistent AF as recurrent arrhythmia after the initial PFA ablation predicted AT/AF recurrence after repeat ablation [hazard ratio 1.241 (95% confidence interval 1.534-1.005); P = 0.045]. The procedural complication rate was 2.8%.</p><p><strong>Conclusion: </strong>In repeat procedures for AF/AT performed after an index procedure with PFA for AF, PV reconnections are not uncommon. Repeat procedures can be performed safely and with an acceptable subsequent success rate.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12344414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002609","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":"Venous thromboembolisms and stroke risk in patients with atrial fibrillation: a nationwide cohort study.","authors":"Eero Jalli, Jussi Jaakkola, Ville Langén, K E Juhani Airaksinen, Olli Halminen, Jukka Putaala, Pirjo Mustonen, Jari Haukka, Juha Hartikainen, Miika Linna, Elis Kouki, Mika Lehto, Konsta Teppo","doi":"10.1093/europace/euaf155","DOIUrl":"10.1093/europace/euaf155","url":null,"abstract":"<p><strong>Aims: </strong>Little is known about the association of venous thromboembolisms (VTEs) on the risk of ischaemic stroke (IS) in patients with atrial fibrillation (AF). Nevertheless, both pulmonary embolism (PE) and deep venous thromboembolism (DVT) are often included in the calculation of the CHA2DS2-VASc score, which is used for stroke risk stratification. Therefore, we conducted this nationwide retrospective cohort study to evaluate whether a history of VTE is associated with an increased risk of IS in patients with AF.</p><p><strong>Methods and results: </strong>The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) registry-linkage study includes all patients in Finland with incident AF from 2007 to 2018. The IS rates and rate ratios were computed for patients with and without a history of VTE. We identified 271 500 patients with new-onset AF, of whom 4.6% had prior VTE, while 1.9% had a history of PE and 3.1% a history of DVT. The crude incidence of IS was slightly higher in patients with a history of VTE compared to patients without a history of VTE, but after adjusting for baseline factors, VTE was not associated with the rate of IS [adjusted incidence rate ratio with 95% confidence interval for any VTE 1.05 (0.98-1.13), for PE 1.01 (0.91-1.13), and for DVT 1.09 (1.00-1.18)]. There was no temporal change in these associations during the study period.</p><p><strong>Conclusion: </strong>A history of VTEs was not associated with an increased risk of IS, suggesting that they do not need to be considered in the stroke risk stratification of patients with AF.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12365899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728991","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":"Total atrial conduction time predicts new-onset atrial fibrillation in patients with transthyretin amyloid cardiomyopathy.","authors":"Beatrice Dal Passo, Matteo Arzenton, Anna Cantone, Gioele Fabbri, Jacopo Bonini, Gabriele Guidi Colombi, Angelo Melpignano, Federico Marchini, Carmen Izzo, Rita Pavasini, Matteo Bertini, Gianluca Campo, Matteo Serenelli","doi":"10.1093/europace/euaf164","DOIUrl":"10.1093/europace/euaf164","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12395425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764709","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":"Different underlying aetiologies in patients presenting with ventricular tachycardia fulfilling task force criteria for arrhythmogenic right ventricular cardiomyopathy: initial suspicion based on the 12-lead electrocardiogram.","authors":"Jarieke C Hoogendoorn, Laurens P Bosman, Jeroen F van der Heijden, Arthur A Wilde, Maarten P van den Berg, Sing-Chien Yap, J Peter van Tintelen, Dennis Dooijes, Anneline S J M Te Riele, Katja Zeppenfeld","doi":"10.1093/europace/euaf136","DOIUrl":"https://doi.org/10.1093/europace/euaf136","url":null,"abstract":"<p><strong>Aims: </strong>The task force criteria (TFC) for arrhythmogenic right ventricular cardiomyopathy (ARVC) are highly sensitive but lack specificity. Atypical RV involvement (aRVi) may indicate different underlying aetiologies and prognosis, requiring specific therapeutic interventions. We aimed to evaluate the role of the baseline 12-lead ECG for initial suspicion of aRVi.</p><p><strong>Methods: </strong>From the Netherlands Heart Institute Arrhythmogenic Cardiomyopathy (NHI-ACM) registry, patients were selected who (i) fulfilled TFC for definite ARVC, (ii) presented with sustained ventricular tachycardia (VT), and (iii) underwent genetic testing. The first available ECG after VT was evaluated. PR prolongation ≥220 ms and/or a surface area of the maximum R'-wave in V1-V3 of ≥1.65 mm2 was defined as an aRVi-ECG. Patients with an ARVC-related pathogenic/likely pathogenic variant (P/LP+) were classified as 'ARVC'. Data of P/LP- were reviewed by an expert panel and classified as either 'ARVC' or 'different aetiology' based on consensus.</p><p><strong>Results: </strong>A total of 159 patients were included (122 P/LP+ and 37 P/LP- patients). Nineteen patients had an aRVi-ECG [11 (9%) P/LP+ vs. 8 (22%) P/LP-, P = 0.038]. Of the P/LP- patients, 17 (46%) were classified as 'different aetiology' (e.g. myocarditis, ischaemia, sarcoidosis), including all 8 patients with an aRVi-ECG. Among the P/LP+ patients with an aRVi-ECG, 46% carried the p.Arg14del phospholamban pathogenic variant, and 64% died compared to 15 and 19% of P/LP+ patients without an aRVi-ECG, respectively (both P < 0.01).</p><p><strong>Conclusion: </strong>In P/LP- patients presenting with VT and fulfilling TFC, an aRVi-ECG should raise suspicion for a different underlying aetiology. In P/LP+ patients, an aRVi-ECG may identify those with poor outcome.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":"27 8","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12365759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947546","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":"Practical compendium of antiarrhythmic drugs: a clinical consensus statement of the European Heart Rhythm Association of the European Society of Cardiology.","authors":"Jose L Merino, Juan Tamargo, Carina Blomström-Lundqvist, Giuseppe Boriani, Harry J G M Crijns, Dobromir Dobrev, Andreas Goette, Stefan H Hohnloser, Gerald V Naccarelli, James A Reiffel, Jacob Tfelt-Hansen, Marcel Martínez-Cossiani, A John Camm, Jesus M Almendral Garrote, Beata Średniawa, Piotr Kułakowski, Irina Savelieva, Tatjana Potpara, Bulent Gorenek, Jose L Zamorano","doi":"10.1093/europace/euaf076","DOIUrl":"10.1093/europace/euaf076","url":null,"abstract":"<p><p>The European Heart Rhythm Association Practical Compendium of Anti-arrhythmic Drugs (AADs) offers advice on these drugs, focusing on their clinical use and the global impact of cardiac arrhythmias. This document aims to provide practical instructions to clinicians in arrhythmia management through pharmacological strategies. The compendium highlights persistent challenges in arrhythmia treatment, including clinical constraints, procedural risks, and the complexity of certain arrhythmias. Notably, atrial fibrillation is highly prevalent, and the demand for invasive treatment often surpasses the capacity of existing healthcare systems. As a result, pharmacological management remains essential. This is particularly relevant for patients with cardiac implantable electronic devices or channelopathies, where ablation is often not a suitable option. Anti-arrhythmic drugs play a pivotal role in these scenarios. The compendium introduces the ABC framework for AAD therapy: A (Appropriate therapy), for patients in whom AADs are the best therapeutic option; B (Backup therapy), as adjunctive treatment to invasive procedures, such as catheter ablation; and C (Complementary therapy), in combination with other therapies. The document provides detailed insights into the mechanisms of action, efficacy, safety profiles, and drug interactions of each class of AADs. Additionally, the compendium covers practical considerations, including initiation, combination strategies, monitoring, follow-up, special populations, and adverse effect management, with an emphasis on pro-arrhythmia risk mitigation. It also explores the integration of AADs with other therapeutic modalities, promoting a synergistic approach to optimize patient outcomes. In summary, this compendium serves as an indispensable resource for clinicians, offering practical advice and evidence-based insights to navigate the complexities of arrhythmia management effectively.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751737","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":"Premature ventricular contraction-induced ventricular dysfunction in children without structural heart disease: a systematic review and meta-analysis.","authors":"Francesco Flore, Michele Lioncino, Marianna Cicenia, Daniele Garozzo, Cristina Raimondo, Corrado Di Mambro, Massimo Stefano Silvetti, Fabrizio Drago","doi":"10.1093/europace/euaf167","DOIUrl":"10.1093/europace/euaf167","url":null,"abstract":"<p><strong>Aims: </strong>Premature ventricular contractions (PVCs) in paediatric patients often present a benign course. However, a minority of patients may develop left ventricular (LV) dysfunction, and risk factors are still under debate. The aim of this systematic review and meta-analysis was to analyse the prevalence of PVC-induced cardiomyopathy (CMP) and understand the risk factors in paediatric patients with PVCs and structurally normal hearts.</p><p><strong>Methods and results: </strong>A systematic search strategy was performed to identify original reports published between 1 January 2000 and 31 August 2024. Studies including adult patients and patients with cardiomyopathies, congenital heart diseases, or channelopathies were excluded. Seventeen studies were included and comprised 1.701 patients, with a mean age of 11.4 years. The mean burden of PVCs across the included studies was 16% (12.2-19.7). Left ventricular systolic dysfunction occurred in 40 patients, and they showed older age at presentation. Premature ventricular contraction burden emerged as significant risk factor for PVC-induced CMP (mean burden among patients with and without LV dysfunction 32.5 and 15.47%, respectively). Shorter coupling intervals and longer QRS duration were predictors in a few studies. No major adverse cardiovascular events occurred. Left ventricular dysfunction recovered in all but one patient after spontaneous or pharmacologically induced PVC reduction. Class IC drugs showed greater efficacy than other drugs.</p><p><strong>Conclusion: </strong>Premature ventricular contraction-induced CMP is rare in children, and PVC burden is the key determinant of risk. The threshold burden associated with LV dysfunction is higher in paediatric patients than in adults. Most patients with PVC-induced CMP experience normalization of LV function during follow-up.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12395427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834522","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":"Atrial fibrillation burden and symptom, quality of life, and healthcare resource utilization after cryoballoon ablation in persistent atrial fibrillation.","authors":"Muhan Yeo, So-Ryoung Lee, JungMin Choi, Kyung-Yeon Lee, Hyo-Jeong Ahn, Soonil Kwon, Ji Hyun Lee, Youngjin Cho, Il-Young Oh, Hong-Euy Lim, Min-Soo Cho, Gi-Byoung Nam, Seil Oh, Young-Keun On, Eue-Keun Choi","doi":"10.1093/europace/euaf150","DOIUrl":"10.1093/europace/euaf150","url":null,"abstract":"<p><strong>Aims: </strong>To investigate the relationship between continuously monitored atrial fibrillation (AF) burden after cryoballoon ablation (CBA) and improvements in AF-related symptoms, quality of life (QoL), and AF-related healthcare resource utilization (HCRU) in early persistent AF.</p><p><strong>Methods and results: </strong>This secondary analysis of the multicentre COOL-PER trial included patients with early persistent AF who underwent CBA and continuous monitoring via an implantable loop recorder. Post-CBA AF burden was defined as the percentage of time in AF between 9- and 12-month after CBA, categorized as <0.1%, 0.1 to <10%, and ≥10%. Symptom improvement was assessed using the European Heart Rhythm Association symptom score and QoL with the SF-36 survey. AF-related HCRU was defined as rhythm control interventions after the 90-day blanking period and cardiovascular-related hospitalizations or emergency room visits. Among 130 patients (mean baseline AF burden 77 ± 34%), AF burden significantly decreased post-CBA, with 50.0% achieving <0.1%, 28.5% in 0.1 to <10%, and 21.5% ≥ 10%. Symptom improvement rate was highest in the <0.1% group (89.2%), followed by the 0.1 to <10% (78.4%) and ≥10% (46.4%) groups (P < 0.001). Significant QoL improvement was observed in the <0.1% and 0.1 to <10% groups but not in the ≥10% group. Rhythm control interventions and cardiovascular-related hospitalizations or emergency room visits were more frequent in the ≥10% group (29%, 43%) than in the 0.1 to <10% (5.4%, 22%) and <0.1% (1.5%, 7.7%) groups (both P < 0.001).</p><p><strong>Conclusion: </strong>In early persistent AF, lower AF burden 1-year post-CBA was associated with greater AF-related symptom improvement, significant QoL enhancement, and reduced HCRU during follow-up.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":"27 8","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12395340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947550","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}