Europace最新文献

{"title":"Controversy: the blanking period after atrial fibrillation ablation is needed and should be maintained.","authors":"Helmut Pürerfellner, Stylianos Tzeis, John Mandrola","doi":"10.1093/europace/euaf203","DOIUrl":"10.1093/europace/euaf203","url":null,"abstract":"<p><p>The concept of a post-ablation 'blanking period' (typically 90 days) has long served as a clinical and regulatory buffer during which atrial arrhythmia recurrences are not considered indicative of procedural failure. This period was originally justified by transient electrophysiological instability due to oedema, inflammation, and autonomic fluctuations. However, recent data-particularly in the era of continuous rhythm monitoring and novel energy sources such as pulsed field ablation-have challenged the biological and prognostic neutrality of early recurrences. Several studies now suggest that arrhythmia episodes within the blanking period, especially beyond the first 30 days, may strongly predict long-term recurrence, thereby questioning the utility of maintaining a fixed observational window. This EP Europace Controversy article presents opposing viewpoints on the necessity of the blanking period in modern practice. Dr Stelios Tzeis argues in favour of preserving the blanking period, citing its role in minimizing unnecessary re-intervention and ensuring standardized trial endpoints. Conversely, Dr John Mandrola advocates for shortening or abandoning the blanking period, proposing a more individualized approach guided by arrhythmia timing, symptom burden, and ablation modality. The introduction, authored by Prof. Helmut Pürerfellner, sets the stage by reviewing the historical rationale, emerging evidence, and practical implications of this ongoing debate. As ablation techniques evolve and data accrue, reassessing the blanking period becomes essential. This Controversy aims to inform clinical practice, future trial design, and shared decision-making by juxtaposing two expert perspectives on a timely and consequential topic in atrial fibrillation management.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947737","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: Atrial cardiomyopathy revisited-evolution of a concept: a clinical consensus statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asian Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS).","authors":"","doi":"10.1093/europace/euaf248","DOIUrl":"10.1093/europace/euaf248","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":"27 10","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12507087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250231","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":"Genetic variants associated with ventricular arrhythmias during ajmaline test in Brugada syndrome.","authors":"Charles Audiat, Luigi Pannone, Antonio Sorgente, Pasquale Vergara, Domenico Giovanni Della Rocca, Ivan Eltsov, Gudrun Pappaert, Ingrid Overeinder, Gezim Bala, Alexandre Almorad, Erwin Ströker, Mark La Meir, Ali Gharaviri, Elke De Schutter, Jelle Vlaeminck, Christine Helsen, Sophie Uyttebroeck, Sonia Van Dooren, Laura Pölsler, Philippe Giron, Pedro Brugada, Andrea Sarkozy, Gian Battista Chierchia, Juan Sieira, Carlo de Asmundis","doi":"10.1093/europace/euaf162","DOIUrl":"10.1093/europace/euaf162","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":"27 10","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12526112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145298859","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: Distinct patterns of ventricular fibrillation onset in primary electrical diseases: insights from a retrospective multicentre registry.","authors":"","doi":"10.1093/europace/euaf259","DOIUrl":"10.1093/europace/euaf259","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":"27 10","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12518018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286008","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":"Device-lead abnormalities and function after transcatheter tricuspid valve replacement.","authors":"Muhannad Abbasi, Ammar M Killu, Christoff Van Niekerk, Abhishek Deshmukh, Malini Madhavan, Yong-Mei Cha, Siva K Mulpuru, Paul A Friedman, Kimberly Holst, Charanjit S Rihal, Mackram F Eleid, Alan Sugrue","doi":"10.1093/europace/euaf219","DOIUrl":"10.1093/europace/euaf219","url":null,"abstract":"<p><strong>Aims: </strong>The increasing adoption of transcatheter tricuspid valve replacement (TTVR) offers a promising therapeutic option for patients with severe tricuspid regurgitation. However, many of these patients have pre-existing cardiac implantable electronic devices (CIEDs), raising concerns about potential lead-related complications. Despite these concerns, limited data exist on the impact of TTVR on CIED integrity and function. This study aimed to evaluate the impact of TTVR on CIED lead function, including pacing thresholds, sensing, and impedance, in patients undergoing TTVR with the EVOQUE valve system.</p><p><strong>Methods and results: </strong>A retrospective observational study was conducted at Mayo Clinic Rochester, including 32 consecutive patients who underwent TTVR with pre-existing CIEDs. A total of 32 patients were included, with a mean age of 79.2 ± 8.4 years; 59% were female. A total of 62.5% had a permanent pacemaker, 12.5% had an implantable cardioverter-defibrillator, 15.6% had a cardiac resynchronization therapy pacemaker, and 9.4% had a cardiac resynchronization therapy defibrillator. Following TTVR, 10 (31%) of patients developed lead function changes during a median device follow-up of 210 days (IQR: 43-307 days). The right ventricular lead was primarily affected, with only one case involving an atrial lead. Neither the Ottawa score nor the anatomical lead position reliably predicted lead abnormality (P = 0.86 and P = 0.53, respectively). R-wave sensing changes were the most common lead change observed, affecting 55% of cases. In 67% of these cases, R-wave sensing alterations occurred as an isolated finding, with no significant change in impedance or thresholds, and were managed conservatively without any need for device reprogramming. Four patients (13%) had findings concerning for a lead insulation breach, in which one (3%) required a lead revision. Among five patients with follow-up exceeding 600 days, two patients exhibited a statistically significant gradual decline in impedance without other lead dysfunction, suggesting potential subclinical lead degradation.</p><p><strong>Conclusion: </strong>Transcatheter tricuspid valve replacement with the EVOQUE system in the setting of cardiac device leads is associated with lead function changes in 31%. The majority of lead-related changes were managed conservatively, but 13% of patients had findings concerning for an insulation breach. Future studies should focus on refining implantation techniques and defining optimal strategies for managing device-lead interactions in this population.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":"27 10","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12528984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145299343","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":"Timing of stroke risk reassessment in atrial fibrillation patients with a CHA2DS2-VA score of 0 or 1: the Norwegian AFNOR study.","authors":"Mariam Anjum, Inger Ariansen, Marius Myrstad, Lars J Kjerpeseth, Vidar Hjellvik, Eva Skovlund, Ingrid E Christophersen, Arnljot Tveit, Trygve Berge","doi":"10.1093/europace/euaf145","DOIUrl":"10.1093/europace/euaf145","url":null,"abstract":"<p><strong>Aims: </strong>Stroke risk in atrial fibrillation (AF) patients increases over time, but the optimal reassessment interval remains unclear. This study evaluated changes in the CHA2DS2-VA score in AF patients with low (score 0) or intermediate (score 1) stroke risk and explored appropriate reassessment intervals.</p><p><strong>Methods and results: </strong>Using Norwegian national registries (2011-18), 40 782 individuals with incident AF aged ≥18 years and a low or intermediate CHA2DS2-VA score were identified. Patients were followed from first AF diagnosis until an increase in the CHA2DS2-VA score, and the proportion with increased score was assessed across age groups. The number needed to reassess to detect one new CHA2DS2-VA risk factor was calculated at different time intervals after AF diagnosis. The CHA2DS2-VA score increased in 50% of patients after a median follow-up of 1.7 years. The proportion of patients with an increased CHA2DS2-VA score was 19% at 6 months, 25% at 1 year, and 40% at 3 years after AF diagnosis. At 1 year, the proportion of patients with a new risk factor was lower in those aged 18-44 years (8%) and 45-54 years (14%) compared to those aged >55 years (30%), with the number needed to reassess at 1 year being 12, 7, and 3 patients, respectively.</p><p><strong>Conclusion: </strong>New risk factors emerged in half of AF patients within 1.7 years. Age-specific differences underscore the need for tailored reassessment, suggesting a shorter interval of 6 months for patients ≥55 years and 1 year for those <55 years and routinely at age 65 and 75 years.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12509847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697915","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":"Sex- and maturation-specific challenges in paediatric athlete electrocardiographic interpretation: beyond current criteria.","authors":"Shiuan-Chih Chen, Chin-Feng Tsai","doi":"10.1093/europace/euaf237","DOIUrl":"10.1093/europace/euaf237","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12528983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130176","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":"Jailed or freed? The lead dilemma in transcatheter tricuspid valve replacement.","authors":"Pascal Defaye, Peggy Jacon, Sandrine Venier","doi":"10.1093/europace/euaf235","DOIUrl":"10.1093/europace/euaf235","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12528981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130236","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":"Prevalence and relation to training of electrocardiographic findings in Caucasian children and adolescents 8- to 18-year-old practicing competitive sport.","authors":"Francesca Graziano, Amedeo De Antoni, Dorottya Balla, Laura Manfrin, Edoardo Oscar Genta, Laura Brusamolin, Franco Giada, Marco Scorcu, Nora Sydo, Luigi Gerbino, Silvia Compagno, Bela Merkely, Hajnalka Vago, Domenico Corrado, Alessandro Zorzi","doi":"10.1093/europace/euaf180","DOIUrl":"10.1093/europace/euaf180","url":null,"abstract":"<p><strong>Aims: </strong>Training frequently induces electrocardiographic (ECG) changes that mimic heart diseases, requiring specific criteria for interpretation. Paediatric athletes represent a unique population as training-induced changes and those due to sexual maturation interact, and specific criteria may be needed. We aimed to assess the prevalence and its relation to training of ECG abnormalities in young athletes aged 8-18 years.</p><p><strong>Methods and results: </strong>We included 2458 young apparently healthy Caucasian athletes undergoing pre-participation screening. Electrocardiographic abnormalities were classified according to the 2017 International criteria (IC) by adding fragmented QRS and low QRS voltages in limb leads. A subgroup analysis was conducted to test the differences according to a 12-year-old age cut-off, the threshold for IC application. Common (>5%) findings included only mild sinus bradycardia (55-60 b.p.m.), early repolarization, incomplete right bundle branch block, voltage criteria for either left or right ventricular hypertrophy and T-wave inversion in V1-V3 before the age of 12. A heart rate of 50-55 b.p.m., first-degree atrioventricular block, right-axis deviation, and T-wave inversion in V1-V3 in athletes 12- to 16-year-old were uncommon (1-5%) and their prevalence was modulated by age, gender, and/or training status. All other ECG findings were rare (<1%). Ten (0.4%) athletes received an at-risk cardiovascular disease diagnosis including 6 with rare and 1 with uncommon ECG abnormalities: 3 of 7 were classified as normal by IC.</p><p><strong>Conclusion: </strong>Paediatric athletes exhibit less prominent ECG changes than their adult counterparts, requiring specific criteria. The significance of certain ECG patterns should be evaluated considering age, sex, and training level.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12510321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854909","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":"Dynamic changes of artificial intelligence estimated electrocardiographic age and sex predicts recurrence after atrial fibrillation catheter ablation.","authors":"Hanjin Park, Oh-Seok Kwon, Jaemin Shim, Daehoon Kim, Je-Wook Park, Yun-Gi Kim, Hee Tae Yu, Tae-Hoon Kim, Jae-Sun Uhm, Jong-Il Choi, Boyoung Joung, Moon-Hyoung Lee, Hui-Nam Pak","doi":"10.1093/europace/euaf221","DOIUrl":"10.1093/europace/euaf221","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12510311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091469","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}