Europace最新文献

{"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>Background: </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 centers and involved a limited number of operators. The electrophysiological findings and outcomes in patients undergoing repeat ablation after an initial PF ablation for AF are incompletely understood.</p><p><strong>Methods: </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).</p><p><strong>Results: </strong>At 22 centers, 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% (LSPV), 28% (LIPV), 33% (RSPV) and 32% (RIPV). 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 ≥30s 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 (HR 1.241 (95% CI 1.534-1.005 CI); 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":7.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic position and sudden cardiac death: A Danish nationwide study.","authors":"Toke Stahl Jacobsen, Tobias Skjelbred, Lars Køber, Bo Gregers Winkel, Thomas Hadberg Lynge, Jacob Tfelt-Hansen","doi":"10.1093/europace/euaf001","DOIUrl":"https://doi.org/10.1093/europace/euaf001","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to examine differences in incidence rates of all-cause mortality (ACM) and sudden cardiac death (SCD) in persons of differing socioeconomic position (SEP).</p><p><strong>Methods: </strong>All deaths in Denmark from 01-01-2010 to 31-12-2010 (1 year) were included. Autopsy reports, death certificates, discharge summaries and nationwide health registries were reviewed to identify cases of SCD. SEP was measured as either household income or highest achieved educational level and analysed separately. Hazard rates were calculated using univariate and multivariable Cox regression model adjusting for age, sex, and selected comorbidities.</p><p><strong>Results: </strong>A total of 53452 deaths were included of which 6820 were classified as SCDs. Incidence rates of ACM and SCD increased with age and were higher in the lower SEP groups. The greatest difference in SCD incidence was found between the low and high education level groups with an incidence rate ratio of 5.1 (95% CI 3.8-6.8). The hazard ratios for ACM and SCD were significantly higher for low SEP groups independently of comorbidities. Compared with the highest income group, the low-income group had adjusted hazard ratios of ACM and SCD that were 2.17 (2.01-2.34) and 1.72 (1.67-1.76) respectively.</p><p><strong>Conclusion: </strong>We observed an inverse association between both income and education level and the risk of ACM and SCD in the general population, which persisted independently of baseline comorbidities. Our results indicate a need for further research into the mechanisms behind socioeconomic disparities in healthcare and targeted preventative strategies.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002610","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":"Etiology and hemodynamic patterns of orthostatic hypotension in a tertiary syncope unit.","authors":"Madeleine Johansson, Boriana S Gagaouzova, Ineke A van Rossum, Roland D Thijs, Viktor Hamrefors, J Gert van Dijk, Artur Fedorowski","doi":"10.1093/europace/euaf017","DOIUrl":"https://doi.org/10.1093/europace/euaf017","url":null,"abstract":"<p><strong>Background: </strong>Orthostatic hypotension (OH) is an important differential diagnosis in unexplained syncope. Neurogenic OH (nOH) has been postulated to differ from non-neurogenic OH (non-nOH), yet pathophysiological differences are largely unexplored. We aimed to investigate etiology and tilt table test (TTT)-induced hemodynamic responses in symptomatic OH patients.</p><p><strong>Methods: </strong>We performed a retrospective study analyzing patients referred for unexplained syncope or highly symptomatic orthostatic intolerance with TTT-verified classical OH (cOH). Medical records were analyzed for the presumptive etiology of cOH. Fifty-two patients (mean age 73±9 years, 46% women) with good quality TTT recordings were divided into three groups on clinical grounds: nOH, non-nOH, and mixed OH. The log-ratio (LR) method was applied to compare the decrease in mean arterial pressure (MAPLR) and corresponding contributions of heart rate (HRLR), stroke volume (SVLR) and total peripheral resistance (TPRLR) during the upright phase of TTT.</p><p><strong>Results: </strong>The prevalence of cOH was 12 (23%) nOH, 14 (27%) non-nOH and 26 (50%) mixed OH. No difference in MAPLR was observed among the three groups during the 4th upright minute of TTT (nOH: -0.10±0.04 vs. non-nOH: -0.07±0.05 and vs. mixed OH: -0.06±0.05, p=0.10). The contributions of HRLR, SVLR and TPRLR to the drop in MAPLR did not differ between groups (all p>0.05).</p><p><strong>Conclusions: </strong>One-half of highly symptomatic OH patients had mixed OH, whereas one-quarter had either pure neurogenic, or non-neurogenic OH, respectively. Different forms of OH were indifferentiable based on hemodynamic responses during TTT, questioning the clinical utility of such classification. Larger studies are needed to confirm these findings.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002514","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 trial of atrial fibrillation ablation using real time tissue optical assessment to predict pulsed field lesion durability.","authors":"Raphael P Martins, Giorgi Papiashvili, Askar Sabirov, Sherzod Sabirov, David Herranz, Christophe Bailleul, Atul Verma","doi":"10.1093/europace/euaf009","DOIUrl":"https://doi.org/10.1093/europace/euaf009","url":null,"abstract":"<p><strong>Background: </strong>Loss of bipolar electrograms immediately after pulsed field ablation (PFA) makes lesion durability assessment challenging.</p><p><strong>Objective: </strong>The aim of this trial (NCT06700226) was to evaluate a novel ablation system that can optically predict lesion durability by detecting structural changes in the tissue during ablation.</p><p><strong>Methods: </strong>Patients with paroxysmal atrial fibrillation underwent pulmonary vein isolation (PVI) using PFA (AblaView®, MedLumics). Using polarization sensitive optical coherence reflectometry (PS-OCR), reflective characteristics of myocardial tissue and visualization of real-time contrast between healthy tissue and ablated tissue using a drop in tissue birefringence (BiR) was assessed. Wide antral PVI was performed using single point irrigated PFA (unipolar, 1800V, 3 trains, 21sec). Remapping was performed at 3 months. Primary efficacy outcome was the ability of PS-OCR to predict lesion durability at 3-month remapping. Serious adverse events were recorded.</p><p><strong>Results: </strong>Ten patients were included. In total, 38/40 PVs could be isolated with the system. The mean drop of BiR was 17.3±11.5%. Dragging across the ablation lines showed a persistent drop in BiR. During the remap procedures (9/10 patients), 15 PVs (41.7%) were found to be electrically reconnected. The mean loss of BiR during the index ablation for durable lesions was 20.9%, while only 10.1% BiR loss was observed during the index ablation for reconnected areas (p<0.001). None of the points with ≥17% loss of birefringence was found to be reconnected.</p><p><strong>Conclusions: </strong>This first in human study supports the use of real-time drop in tissue BiR for lesion assessment during PFA delivery and its procedural safety.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002531","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":"Early Versus Late Atrial Fibrillation Recurrence After Pulsed Field Ablation: Insights From the admIRE Trial.","authors":"Luigi Di Biase, Vivek Y Reddy, Marwan Bahu, David Newton, Christopher F Liu, William H Sauer, Sandeep Goyal, Vivek Iyer, Devi Nair, Jose Osorio, Moussa Mansour, Hugh Calkins, Oussama Wazni, Andrea Natale","doi":"10.1093/europace/euaf007","DOIUrl":"https://doi.org/10.1093/europace/euaf007","url":null,"abstract":"<p><strong>Background and aims: </strong>Studies have shown correlations between early recurrence (ER) and late recurrence (LR) of atrial arrhythmia after ablation with thermal technologies. This admIRE trial (NCT05293639) subanalysis aims to analyze ER versus LR in patients with paroxysmal atrial fibrillation (PAF) undergoing pulsed field ablation (PFA).</p><p><strong>Methods: </strong>Patients with symptomatic paroxysmal atrial fibrillation and ≥1 transtelephonic monitoring transmission during the blanking period were included (n=169). ER was defined as documented recurrence in the blanking period (days 1-90), and LR as recurrence in the evaluation period (days 91-365). Freedom from 12-month recurrence was estimated using Kaplan-Meier method. A Cox proportional-hazards regression model, with ER as the primary factor, and adjusted for age, sex, and body mass index, was used to estimate hazard ratios (HRs) and 95% CI.</p><p><strong>Results: </strong>ER was observed in 20.1% (31/169) of patients (66.1±7.1 years, 35.5% female, 46.6±48.4-month PAF history). Time to first documented ER was 49 (37-61) days. Occurrence of LR was 16.7% (23/138) in patients without ER, 71.0% (22/31) in those with ER, and 87.0% (20/23) in patients whose ER onset occurred within the first 2 months. Twelve-month freedom from documented recurrence was significantly lower in patients with ER at 29.0% (95% CI, 13.1%-45.0%), versus 82.5% (95% CI, 75.9-89.1%) in those without ER (adjusted HR, 7.9; 95% CI, 4.1-15.1; P<0.001).</p><p><strong>Conclusion: </strong>This admIRE subanalysis demonstrated that PAF patients who experience ER after PFA are at a substantially higher risk for LR. The optimal duration of the blanking period post PFA need further assessments.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002512","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":"EP Europace: The Journey Continues, Looking Ahead to 2025 and Beyond Greetings from the New Editor-in-Chief.","authors":"Giuseppe Boriani","doi":"10.1093/europace/euaf006","DOIUrl":"https://doi.org/10.1093/europace/euaf006","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946899","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":"Stereotactic cardiac radiotherapy for refractory ventricular tachycardia in structural heart disease patients: a systematic review.","authors":"Amulya Gupta, Zeeshan Sattar, Nourhan Chaaban, Sagar Ranka, Cameron Carlson, Farhad Sami, Clifford G Robinson, Phillip S Cuculich, Seth H Sheldon, Madhu Reddy, David Akhavan, Amit Noheria","doi":"10.1093/europace/euae305","DOIUrl":"10.1093/europace/euae305","url":null,"abstract":"<p><strong>Aims: </strong>Among patients with structural heart disease with ventricular tachycardia (VT) refractory to medical therapy and catheter ablation, cardiac stereotactic body radiotherapy (SBRT) is a paradigm-changing treatment option. This study aims to assess the efficacy of cardiac SBRT in refractory VT by comparing the rates of VT episodes, anti-tachycardia pacing (ATP) therapies, and implantable cardioverter-defibrillator (ICD) shocks post-SBRT with pre-SBRT.</p><p><strong>Methods and results: </strong>We performed a comprehensive literature search and included all clinical studies reporting outcomes on cardiac SBRT for VT. Treatment efficacy was evaluated as random-effects pooled rate-ratios of VT episodes, ATP therapies and ICD shocks post-SBRT (after 6-week blanking) and pre-SBRT, with patients serving as their own controls. Post-SBRT overall survival was assessed using Kaplan-Meier method. We included 23 studies published 2017-24 reporting on 225 patients who received cardiac SBRT, with median follow-up 5.8-28 months. There was significant heterogeneity among the studies for all three efficacy endpoints (P < 0.00001). The random-effects pooled rate-ratios of VT episodes, ATP therapies and ICD shocks post- vs. pre-SBRT were 0.10 (95% CI 0.06, 0.16), 0.09 (0.05, 0.15), and 0.09 (0.05, 0.17), respectively (all P < 0.00001). The most common reported complications included pericardial (8.0%, including 0.9% late oesophagogastro-pericardial fistula) and pulmonary (5.8%). There was no change in left ventricular ejection fraction post-SBRT (P = 0.3) but some studies reported an increase in mitral regurgitation. The combined 3-, 12-, and 24-month overall patient survival was 0.86 (0.80, 0.90), 0.72 (0.65, 0.78), and 0.57 (0.47, 0.67), respectively.</p><p><strong>Conclusion: </strong>Among patients with refractory VT in context of structural heart disease, VT burden and ICD shocks are dramatically reduced following cardiac SBRT. The overall mortality in this population with heart failure and refractory VT receiving palliative cardiac SBRT remains high.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881717","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: Optimization of decrementing evoked potential mapping for functional substrate identification in ischaemic ventricular tachycardia ablation.","authors":"","doi":"10.1093/europace/euae302","DOIUrl":"https://doi.org/10.1093/europace/euae302","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":"27 1","pages":""},"PeriodicalIF":7.9,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946895","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":"Use of single-chamber atrial pacemakers post-DANPACE: an analysis using national data.","authors":"Paul A Scott, Ian J Wright, Daniel I Bromage, Chris Plummer, Mark de Belder, Mark Dayer, Francis D Murgatroyd","doi":"10.1093/europace/euae290","DOIUrl":"10.1093/europace/euae290","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":"27 1","pages":""},"PeriodicalIF":7.9,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051990","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":"Analysis of unscheduled remote monitoring transmissions from patients with cardiac implantable electronic devices attending a heart failure service.","authors":"Nick S R Lan, Alicia Donovan, James Lambert, Lawrence Dembo, Amit Shah, Vimal Patel","doi":"10.1093/europace/euae297","DOIUrl":"10.1093/europace/euae297","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827854","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}