Europace最新文献

{"title":"Acute durability of cavotricuspid isthmus block after pulsed electric field ablation: randomized comparison of two pentaspline catheter configurations (SECTION trial).","authors":"Predrag Stojadinović, Dan Wichterle, Alan Bulava, Jiří Plášek, Štěpán Havránek, Petr Peichl, Nicoletta Ventrella, Josef Marek, Eva Borišincová, Petr Štiavnický, Jana Hašková, Robert Čihák, Josef Kautzner","doi":"10.1093/europace/euaf234","DOIUrl":"10.1093/europace/euaf234","url":null,"abstract":"<p><strong>Aims: </strong>Cavotricuspid isthmus (CTI) ablation is commonly performed alongside catheter ablation of atrial fibrillation (AF). However, the acute efficacy of the CTI ablation using the pentaspline catheter and pulsed electric field (PEF) energy has not been systematically evaluated. This randomized study assessed the acute efficacy and extent of haemolysis associated with CTI ablation when performed using two different configurations of the pentaspline catheter.</p><p><strong>Methods and results: </strong>A total of 178 patients (age 65 ± 10 years, 66% of males) undergoing PEF ablation of the CTI in conjunction with AF ablation were randomly assigned to receive ablation using either the basket configuration (n = 95) or the flower configuration (n = 83) of the pentaspline catheter. The CTI ablation was performed before left atrial ablation. It was guided by intracardiac echocardiography, and bidirectional block was confirmed by pacing manoeuvres. Venous blood samples to assess haemolytic biomarkers were collected before and immediately after the CTI ablation. The groups were broadly comparable in baseline characteristics. The flower group demonstrated superior procedural efficiency, with fewer applications required to achieve a CTI block (3.4 ± 3.1 vs. 8.0 ± 4.1, P < 0.001), a shorter time to block (96 ± 289 vs. 177 ± 192 s, P < 0.001), and fewer total applications (10.1 ± 3.4 vs. 13.3 ± 5.1, P < 0.001). Acute reconduction occurred in 20% of cases overall, but was significantly lower in the flower group (6% vs. 32%, P < 0.001; hazard ratio: 0.14, 95% confidence interval: 0.06-0.40). Haemolysis was notably lower in the flower group, with significantly less post-procedural free haemoglobin (154 ± 112 vs. 210 ± 115 mg/L, P < 0.001). One case of transient ST elevations occurred in the flower group without clinical consequence.</p><p><strong>Conclusion: </strong>Pulsed electric field ablation of the CTI using the flower configuration of the pentaspline catheter demonstrated higher acute efficacy in achieving CTI block and a more favourable safety profile regarding haemolysis compared to the basket configuration. This is likely due to the larger footprint and improved tissue contact of all electrodes, minimizing the leakage of PEF energy into the blood pool.</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/PMC12510328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130246","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":"Redefining the anatomy of the triangle of Koch for the implantation of a dual-chamber single-capsule leadless pacemaker.","authors":"Pierre Ollitrault, Jonaz Font, Thomas Foulon, Luis Ferreira Nunes, Virginie Ferchaud, Maxime Dupont, Arnaud Pellissier, Mayane Al Khoury, Paul Milliez, Laure Champ-Rigot","doi":"10.1093/europace/euaf239","DOIUrl":"10.1093/europace/euaf239","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/PMC12510308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148032","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":"Direct oral anticoagulants in very elderly and high-bleeding-risk patients with atrial fibrillation often excluded from oral anticoagulation therapy: a nationwide population-based cohort study.","authors":"Young-Hae Go, So-Ryoung Lee, Eue-Keun Choi, Hyo-Jeong Ahn, Kyung-Do Han, Seil Oh, Gregory Y H Lip","doi":"10.1093/europace/euaf230","DOIUrl":"10.1093/europace/euaf230","url":null,"abstract":"<p><strong>Aims: </strong>In the Edoxaban Low-Dose for Elder Care Atrial Fibrillation Patients (ELDERCARE-AF) trial, very low-dose edoxaban (15 mg once daily) showed better efficacy and positive net clinical benefit compared with placebo in very elderly, high-bleeding-risk patients with atrial fibrillation (AF). However, there are limited data to generalize these results into daily practice. We aimed to investigate the optimal oral anticoagulant (OAC) strategy for the best net clinical benefit in ELDERCARE-AF-like patients.</p><p><strong>Methods and results: </strong>We used the Korean nationwide claims database to identify AF patients aged ≥80 years from 2014 to 2017 who had one or more ELDERCARE-AF trial inclusion criteria. The risks of ischaemic stroke, major bleeding, all-cause death, and net clinical outcome were evaluated. Primarily, we compared patients without OAC therapy (non-OAC group) to patients with direct OAC (DOAC) therapy (DOAC group), using a propensity score weighting method. A total of 23 858 patients were included (no OAC: 16 575; warfarin: 2390; DOAC: 4893). Among the DOAC group, 69% used low dose, and 9% used very low dose. Compared with the non-OAC group, the DOAC group showed lower risks of ischaemic stroke (hazard ratio, 95% confidence interval: 0.81, 0.68-0.96) and all-cause death (0.91, 0.86-0.96) and a higher risk of major bleeding (1.44, 1.21-1.70). The DOAC group was associated with a lower risk of net clinical outcome compared with the non-OAC group (0.93, 0.88-0.98).</p><p><strong>Conclusion: </strong>In very elderly, high-bleeding-risk patients with AF, DOACs that were prescribed in usual clinical practice showed better effectiveness and positive net clinical benefit compared with no OAC treatment.</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/PMC12510312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184836","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":"Left bundle branch pacing in patients with structural heart disease: personalizing cardiac resynchronization therapy.","authors":"Jacqueline Joza, Justin Luermans, Vartan Mardigyan, Haran Burri, Marek Jastrzębski, Pugazhendhi Vijayaraman, Kevin Vernooy","doi":"10.1093/europace/euaf154","DOIUrl":"10.1093/europace/euaf154","url":null,"abstract":"<p><p>Biventricular pacing remains the cornerstone of cardiac resynchronization therapy (CRT) in patients with heart failure, with well-established benefits. Left bundle branch pacing (LBBP) offers a physiologic alternative by engaging the native conduction system to restore synchrony and has generated significant enthusiasm. However, the growing adoption of LBBP should be tempered by recognition that a one-size-fits-all approach may not address the underlying substrate, particularly in those with intraventricular conduction delay. While a less-than-optimal LBBP implant may be sufficient in bradycardia patients, its adequacy in heart failure patients, who may require more precise consideration of conduction disease, remains uncertain. This review gives a comprehensive framework for integrating LBBP into CRT, including pre-implant, intraprocedural, and post-implant assessment. It also provides practical guidance on when to pursue LBBP alone, when to supplement with a coronary sinus lead, and when to consider conventional biventricular pacing, with an emphasis on a personalized approach to the underlying conduction substrate for maximal therapeutic benefit.</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/PMC12530354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728990","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":"Coronary vasospasm during pulsed field focal ventricular ablation with solid tip catheter.","authors":"Kazuto Hayasaka, Petr Peichl, Nicoletta Ventrella, Josef Marek, Peter Štiavnický, Eva Borišicová, Jana Hašková, Predrag Stojadinovič, Robert Čihák, Dan Wichterle, Josef Kautzner","doi":"10.1093/europace/euaf226","DOIUrl":"10.1093/europace/euaf226","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/PMC12510325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091499","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":"Evolution of implantable cardioverter-defibrillator shock therapy in children in the era of optimized ICD programming and remote monitoring.","authors":"Robin A Bertels, Eric Boersma, Martijn D Zeggelaar, Sophie A F van Dongen, Arend D J Ten Harkel, Lieselot van Erven, Cynthia Smeding, Beatrijs Bartelds, Gert van den Berg, Ewout P Boesaard, Rohit E Bhagwandien, Sing-Chien Yap, Reinoud E Knops, Nico A Blom, Janneke A E Kammeraad","doi":"10.1093/europace/euaf240","DOIUrl":"10.1093/europace/euaf240","url":null,"abstract":"<p><strong>Aims: </strong>Implantable cardioverter defibrillator (ICD) therapy is effective in preventing sudden cardiac death in children. Unnecessary shocks should be avoided. ICD programming strategies and remote monitoring have been proven to be effective in preventing ICD shock therapy in adults; the present study evaluates the effectiveness in children.</p><p><strong>Methods and results: </strong>Retrospective multi-centre study, including children with transvenous or epicardial ICD implantation. During follow-up data on ICD shocks, programming variables and remote monitoring were collected. One hundred sixteen children were included, median age 13.4 years (min-max 0.3-18) and median follow-up 5.2 years (IQR 3.7-6.6), 53 with an ICD implanted before 2010 and 63 after 2010. The total appropriate and inappropriate annual shock rate decreased from 10.5 to 8% [difference in mean cumulative function (MCF) P = 0.008], 7.8 to 5.8% (MCF P = 0.036), and 4.3 to 2.6% (MCF P = 0.28), respectively, without increase in cardiac-related death. Remote monitoring was associated with a decrease of total shocks (MCF P = 0.013) and appropriate shocks (MCF P = 0.052). The ventricular fibrillation (VF) zone was programmed higher (≥210 bpm) at the time of appropriate vs. inappropriate shocks (86 vs. 79%; P = 0.0016), with no significant change in VF zone programming after 2010 compared to before 2010 (90 vs. 76%; P = 0.142) and in patients with vs. without shocks (79 vs. 89%; P = 0.243).</p><p><strong>Conclusion: </strong>The incidence of ICD shocks has significantly decreased in children with implantation after 2010, which appears to be multifactorial. A changed programming behaviour and remote monitoring are associated with this decrease and support its use in strategies to prevent unnecessary shocks in children.</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/PMC12525143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191439","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":"Performance of DOAC and HAS-BLED scores in predicting major bleeding in Asian patients with non-valvular atrial fibrillation receiving direct oral anticoagulants.","authors":"Yi-Hsin Chan, Yi-Wei Kao, Shao-Wei Chen, Tze-Fan Chao","doi":"10.1093/europace/euaf251","DOIUrl":"https://doi.org/10.1093/europace/euaf251","url":null,"abstract":"<p><strong>Background and aims: </strong>The direct oral anticoagulant (DOAC) score was recently developed to predict bleeding risk in patients with atrial fibrillation (AF) receiving oral anticoagulants. However, limited data show inconsistent results comparing its performance to the conventional HAS-BLED score in Asian populations with non-valvular AF receiving DOACs.</p><p><strong>Methods: </strong>We enrolled 21,142 patients with non-valvular AF receiving DOACs from a multicenter database in Taiwan (June 2012-December 2021). The primary endpoint was major bleeding events. Major bleeding events were defined according to the ISTH criteria. Areas under receiver operating characteristic curves (AUCs) were calculated for each score, with differences assessed using DeLong test.</p><p><strong>Results: </strong>A total of 21,142 AF patients (mean age 75.9±11.0 years; 41% female) treated with DOAC were included in the analysis. Major bleeding events occurred in 681 patients in one-year follow-up (3.66%/year). There were 82(0.43%/year) intracranial hemorrhage event occurred. Both the DOAC and HAS-BLED scores are associated with a significant risk of major bleeding event, with only modest predictive performance (AUC <0.7). The DOAC score showed a slightly but statistically significantly higher AUC compared with the HAS-BLED score (AUC:0.670, [95 %CI:0.650-0.689]) vs. 0.642, [0.623-0.663]; P<.001). Results from several reclassification analyses favored the DOAC score. Both the two scores showed a good calibration for the low to intermediate risk categories, while the two bleeding risk scores both overestimate the risk of major bleeding risk for the high risk categories. Subgroup analyses indicated that the superiority of DOAC score over HAS-BLED score is primarily driven by elderly patients (≥75 years) and prediction in risk of gastrointestinal bleeding.</p><p><strong>Conclusions: </strong>The DOAC score, which employs a more granular scoring system compared to the HAS-BLED score, may enable finer bleeding risk discrimination among Asian patients with non-valvular AF receiving DOAC therapy.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225283","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":"Peri-procedure and Mid-Long Term Effects of Pulsed Field Ablation vs. Thermal Ablation (Cryo- or Radiofrequency) on Autonomic Nervous System Function in Atrial Fibrillation: A Systematic and Quantitative Pooled-Analysis with Potential Implications for Patient Selection (The PULSE-COLD-HEAT-ANS Collaboration).","authors":"Sebastian Graeger, Sanjiv M Narayan, Christian Meyer, Dominik Linz, Andreas Rillig, Maura M Zylla, Ramin Ebrahimi, Firat Duru, Laura Perrotta, Kars Neven, Christian-Hendrik Heeger, Martin H Ruwald, Piotr Futyma, Bart A Mulder, Gozal Mirzayeva, Márcio Galindo Kiuchi, Martin Martinek, Helmut Pürerfellner, Serge Boveda, Yuehui Yin, Gang Yang, Hailei Liu, Minglong Chen, Boris Schmidt, Julian K R Chun, Mu Qin, Xumin Hou, Xu Liu, Jingquan Zhong, Shaojie Chen","doi":"10.1093/europace/euaf242","DOIUrl":"https://doi.org/10.1093/europace/euaf242","url":null,"abstract":"<p><strong>Background/aim: </strong>Ablation modalities differ in their mechanisms of action, tissue specificity, and collateral effects-particularly on the cardiac-autonomic-nervous-system. This study aimed to compare the autonomic effects of pulsed field ablation (PFA) versus thermal ablation (TA) in patients with atrial fibrillation (AF) through a pooled-analysis.</p><p><strong>Methods: </strong>A systematic search of PubMed and Embase was conducted through April 5, 2025, to identify comparative studies. The primary outcome was increase-in-heart-rate (IHR) after ablation, and the secondary outcome was increase in serum S100B (IS100B), a marker of neural injury.</p><p><strong>Results: </strong>Eight studies involving 1007 AF patients were included (mean age: 63,39 ± 10,75 years; 36.3% female; maximum follow-up: 12 months). Baseline characteristics, including the use of antiarrhythmic drugs, were similar between the PFA and TA groups. Pooled-analysis showed that PFA was associated with a significantly lower IHR compared to TA (PFA: 4.41 ± 8.86 bpm vs. TA: 10.81 ± 10.46 bpm; p < 0.00001). This difference persisted at midterm (3-6 months) and long-term (12 months) follow-up and remained consistent across age, sex, and different TA modalities (cryoballoon vs. radiofrequency). Correspondingly, the IS100B was significantly less pronounced after PFA (PFA: 33.27 ± 9.46 pg/ml vs. TA: 97.53 ± 31.88 pg/ml; p < 0.00001).</p><p><strong>Conclusions: </strong>PFA-based pulmonary-vein-isolation in patients with AF results in a smaller post-procedural IHR and less S100B release, suggesting reduced neural damage and less disruption of the autonomic nervous system compared to TA. These effects are sustained through mid- to long-term follow-up and may have potential implications for patient selection and individualized ablation strategies.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184878","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":"Prospective Validation of SURPOINT Index for Creating Atrial Scar Using MRI.","authors":"Kyoichiro Yazaki, Eugene Kwan, Yuki Ishidoya, Gregory J Stoddard, Derek J Dosdall, Leenhapong Navaravong, Christopher Andrew Groh, Benjamin A Steinberg, T Jared Bunch, Ravi Ranjan","doi":"10.1093/europace/euaf243","DOIUrl":"https://doi.org/10.1093/europace/euaf243","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184852","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":"Wall thickness-guided Persistent Atrial Fibrillation ablation: Have we found the Holy Grail?","authors":"Karan Saraf, Carlos Morillo","doi":"10.1093/europace/euaf241","DOIUrl":"https://doi.org/10.1093/europace/euaf241","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184889","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}