Europace最新文献

{"title":"A double paradox: End stage renal disease: high thromboembolic and bleeding risk management using a device with risks of thromboembolism and bleeding.","authors":"Tatjana Potpara, A John Camm","doi":"10.1093/europace/euaf238","DOIUrl":"https://doi.org/10.1093/europace/euaf238","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130211","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":"Repeat in situ ablation versus extensive ablation for recurrent persistent atrial fibrillation.","authors":"Mu Qin, Shiyi Wang, Ziliang Song, Feng Zhang, Nannan Chen, Yu Zhang, Yang Liu, Weifeng Jiang, Shaohui Wu, Xumin Hou, Xu Liu","doi":"10.1093/europace/euaf232","DOIUrl":"https://doi.org/10.1093/europace/euaf232","url":null,"abstract":"<p><strong>Aims: </strong>Repeat ablation strategies for persistent atrial fibrillation (PerAF) are less well studied than initial ablation strategies. The efficacy of repeat ablation remains unclear, particularly regarding the potential advantages of extra-pulmonary vein (PV) extensive ablation compared with in situ ablation.</p><p><strong>Methods and results: </strong>Patients with recurrent PerAF were randomized (1:1) to receive extra-PV extensive ablation (EXT group, n = 66) or repeat PV isolation (PVI) and linear ablation as the first procedure (In situ group, n = 66). The primary endpoint was freedom from atrial fibrillation (AF)/atrial tachycardia (AT) episodes lasting >30 s at 12 months. At 12 months, 44 patients (66.7%) in the EXT group were free from AF/AT recurrence, in contrast to 32 patients (48.5%) in the In situ group (log-rank P = 0.037; hazard ratio [HR] 0.587 [95% confidence interval [CI], 0.348-0.992]). The freedom from AF recurrence rate was significantly higher in the EXT group than in the In situ group (77.3% vs 60.6%, log-rank P = 0.027; HR 0.509 [95% CI, 0.278-0.932]).The safety endpoints showed no significant difference between the two groups (4.5% vs 6.1%, P = 0.716).</p><p><strong>Conclusions: </strong>Among patients with PerAF undergoing repeat ablation, the EXT group demonstrated superior clinical efficacy compared with the In situ group, indicating that PV reconnection and linear lesion reconduction may not constitute the predominant mechanisms driving AF recurrence. These may still contribute significantly, but targeting additional non-PV substrates further improves outcomes.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112238","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":"Contemporary Strategies for Repeat Ablation of Atrial Fibrillation: A European Heart Rhythm Association Survey.","authors":"Sergio Conti, Ante Anic, Giulio Conte, Christian Heeger, Jarkko Karvonen, Andreas Metzner, Mark T Mills, Martina Nesti, Diego Penela, Rui Providencia, Laurent Roten, Martin H Ruwald, Kostantinos Vlachos, Maura M Zylla, Julian K R Chun","doi":"10.1093/europace/euaf231","DOIUrl":"https://doi.org/10.1093/europace/euaf231","url":null,"abstract":"<p><strong>Aims: </strong>Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. However, the optimal strategy during repeat ablation is not clear. This European Heart Rhythm Association (EHRA) survey aims to assess real-world ablation strategies in patients undergoing repeat AF ablation.</p><p><strong>Methods and results: </strong>A 25-item questionnaire was distributed amongst healthcare professionals via EHRA between May 22nd and June 21st, 2024. Of 211 respondents from 43 countries, 58.1% of respondents planned a redo after multiple symptomatic recurrences of atrial arrhythmias. Most repeat procedures (68.0%) are performed within 3 months after the decision for re-intervention. 3D mapping and radiofrequency (RF) catheters with contact force (CF) sensing are the most common modality used for repeat ablation. In patients with more than one pulmonary vein (PV) reconnection, most commonly re-isolation of the PVs plus individualized substrate-based ablation is performed (62.2%). When empirical ablation is performed, the most common targets include cavotricuspid isthmus (22.5%), posterior wall isolation (20.7%), left atrial roofline (16.1%), anterior line (12.9%), superior vena cava (8.6%), and vein of Marshall (8.6%). In patients without PV reconnection at repeat procedure, substrate mapping/individualized ablation is the preferred strategy (77.9%). No additional right atrial ablation beyond the CTI was reported. The majority of respondents (60.7%) consider rate-control after ≥3 failed ablations.</p><p><strong>Conclusions: </strong>Real-world strategies for repeat AF ablation show significant variability. 3D mapping and CF-guided RF ablation are commonly utilized. Re-PV isolation and substrate-based ablation are the predominant approaches. However, the optimal strategy beyond durable PVI remains to be further evaluated.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112298","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":"Clinical Complexity in Patients with Atrial Fibrillation: Exploring Differential Risk Profiles from European and Asian Cohorts.","authors":"Andrea Galeazzo Rigutini, Tommaso Bucci, Michele Rossi, Enrico Tartaglia, Amir Askarinejad, Giulio Francesco Romiti, Cecilia Becattini, Giuseppe Boriani, Hung-Fat Tse, Tze-Fan Chao, Gregory Y H Lip","doi":"10.1093/europace/euaf229","DOIUrl":"https://doi.org/10.1093/europace/euaf229","url":null,"abstract":"<p><strong>Background and aims: </strong>Clinical complexity (CC) in atrial fibrillation (AF) reflects overlapping risk factors that raise vulnerability to both thromboembolism and bleeding. Ethnic differences in the expression of CC remain poorly characterized.</p><p><strong>Methods: </strong>We performed a post-hoc analysis of the EORP-AF and APHRS-AF registries. CC was defined as a CHA₂DS₂-VASc score ≥2 plus ≥1 of: (i) age ≥75 and BMI <23 kg/m², (ii) chronic kidney disease, or (iii) prior major bleeding. Multivariable logistic regression identified predictors of CC, oral anticoagulant (OAC) use, and rhythm control. The primary outcome was a composite of all-cause death and major adverse cardiovascular events (MACE), defined as cardiovascular death, acute coronary syndromes, and thromboembolic events. Secondary outcomes included each individual component and major bleeding. Associations were assessed using Cox regression models.</p><p><strong>Results: </strong>Among 14,055 patients, 2,794 (19.9%) met CC criteria (mean age 77±9 years; 46% female). Compared to Europeans, Asian patients with CC had a distinct clinical profile and were less likely to receive OAC (OR 0.75, 95%CI 0.57-1.01) or rhythm control (OR 0.53, 95%CI 0.41-0.69). CC was independently associated with increased risk of composite outcome (HR 1.55, 95%CI 1.35-1.77), all-cause death (HR 1.65, 95% CI 1.42-1.93), MACE (HR 1.50, 95%CI 1.26-1.80), cardiovascular death (HR 1.81, 95%CI 1.40-2.36), and major bleeding (HR 2.02, 95%CI 1.47-2.77). The excess risk of the composite outcome was greater in Asians (HR 2.28, 95%CI 1.57-3.32) than in Europeans (HR 1.51, 95%CI 1.31-1.75; p-interaction=0.036).</p><p><strong>Conclusion: </strong>Among AF patients with CC, those enrolled in Asia exhibited marked differences in clinical profiles, management strategies, and outcomes, suggesting greater vulnerability to CC in the Asian population.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091454","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":"Systematic, randomized atrial fibrillation screening using detailed phenotyping with a risk prediction model combined with patch electrocardiogram in a Swedish population aged 65 years or older: the CONSIDERING-AF trial.","authors":"Emelie Rakai, Farzaneh Etminani, Ninia Younan, Anton Andersson, Maria Andersson, Torbjörn Vik, Stefan Kunkel, Anna Sundin, Johan Holm, Angelo Modica, Helena M Linge, Purvee Parikh, Manish Wadhwa, Johan Engdahl, Emma Sandgren","doi":"10.1093/europace/euaf190","DOIUrl":"10.1093/europace/euaf190","url":null,"abstract":"<p><strong>Aims: </strong>Atrial fibrillation (AF), often asymptomatic and underdiagnosed, is an independent risk factor for ischaemic stroke. A knowledge gap remains regarding the optimal target population and method to use for AF screening. We aimed to test whether screening for AF using a machine learning-based risk prediction model (RPM) and 14-day continuous patch electrocardiogram (ECG) (Philips ePatch) in high-risk individuals ≥ 65 years is more effective than standard care.</p><p><strong>Methods and results: </strong>Individuals ≥ 65 years were assigned to general or RPM cohort. The general cohort was randomized to control or invitation. In the RPM cohort, high-risk individuals, identified by RPM, were randomized to control or invitation. The primary outcome was 6-month AF incidence, analysed as intention-to-invite, comparing RPM + invitation with general + control. Of the 2960 randomized individuals, participation was 43% (632/1480) in invitation arms. Atrial fibrillation incidence was higher in RPM + invitation than in general + control arm (3.8%, 28/740 vs. 0.7%, 5/740; P < 0.001), yielding a risk ratio of 5.6, [95% confidence interval (2.2, 14.4)], and a number needed to invite of 32. Atrial fibrillation was more often detected in RPM + invitation than in general + invitation arm (1.1%, 8/740; P < 0.001), but not more often than in RPM + control arm (2.2%, 16/740; P = 0.07). No difference was found between general + invitation and general + control arms (1.1%, 8/740 vs. 0.7%, 5/740; P = 0.40).</p><p><strong>Conclusion: </strong>Among high-risk individuals ≥ 65 years, the combination of a machine learning-based RPM and long-term ECG recording was superior to standard care in identifying new AF cases.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947567","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":"Dual energy for pulmonary vein isolation using focal ablation technology integrated with a three-dimensional mapping system: SmartfIRE 12-month results.","authors":"Tom De Potter, Daniel Scherr, Helmut Pürerfellner, Gediminas Račkauskas, Jim Hansen, Johan Vijgen, Thomas Phlips, Sebastien Knecht, Gabor Szeplaki, Hugo Van Herendael, Mads Brix Kronborg, Benjamin Berte, Martin Ruwald, Georgios Kollias, Peter Lukac, Tiffany Tan, Mattias Duytschaever","doi":"10.1093/europace/euaf174","DOIUrl":"10.1093/europace/euaf174","url":null,"abstract":"<p><strong>Aims: </strong>The multicentre, single-arm SmartfIRE study assessed the safety and effectiveness of the novel dual-energy THERMOCOOL SMARTTOUCH SF (DE STSF) contact-force sensing catheter with multimodality generator to deliver radiofrequency (RF) and unipolar biphasic pulsed field (PF) ablation. Three-month follow-up showed a 100% acute success rate with an acceptable safety profile. Results at 12 months postablation are summarized here.</p><p><strong>Methods and results: </strong>Patients with symptomatic paroxysmal atrial fibrillation underwent pulmonary vein isolation with the recommendation of PF ablation at posterior/inferior and RF ablation at the anterior/ridge/carina segments. The 12-month effectiveness endpoint was freedom from documented symptomatic and asymptomatic atrial arrhythmia on or off antiarrhythmic therapy (assessed by electrocardiogram, remote arrhythmia monitoring, and 24-h Holter), including acute procedural failures. Safety was assessed as the incidence of serious adverse events (SAEs) related to device and/or procedure. Quality of life was evaluated via Atrial Fibrillation Effect on Quality-of-Life (AFEQT) scores, and healthcare utilization was assessed as hospitalization for cardiovascular events and antiarrhythmic drug (AAD) use. Of 149 patients enrolled, 140 had the study catheter inserted (safety population analysis set), and 136 met the eligibility criteria and had ablation energy delivered (per-protocol analysis set). Freedom from symptomatic and asymptomatic atrial arrhythmia at 12 months was 71.5% (84.2% when using standard-of-care monitoring only). The clinical success rate (freedom from symptomatic arrhythmia) was 86.4%, and single procedural success was 81.0% (n = 136). The rate of device- and/or procedure-related SAEs was 3.6% (5/140 patients; two cardiac tamponades, two pulmonary vein stenosis, one anaphylactic shock). At 12 months, the overall AFEQT score increased by a median 26.9 points vs. baseline. Cardiovascular hospitalization rate reduced from 20.1 to 11.9% during the 12 months before vs. after ablation, respectively. The use of Class I/III AAD decreased from 60.3% at baseline to 23.9% at 6-12 months postablation. Post hoc analysis showed that patients with high adherence to recommended inter-tag distance and PF/RF index during ablation (n = 47) had a 12-month freedom from atrial arrhythmia recurrence of 86.9%, while the remaining patients (n = 88) had a rate of 64.0%.</p><p><strong>Conclusion: </strong>The 12-month follow-up of the SmartfIRE study demonstrated the effectiveness, safety, and healthcare benefits of ablation using the DE STSF platform.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov Identifier: NCT05752487(https://clinicaltrials.gov/study/NCT05752487).</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834520","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":"Prospective evaluation of carbon dioxide as a contrast medium in pacemakers or defibrillators carriers for venous angiography (SPARKLING pilot study).","authors":"Alberto Spadotto, Maria Carelli, Giulia Massaro, Cristian Martignani, Matteo Ziacchi, Mauro Biffi, Igor Diemberger","doi":"10.1093/europace/euaf172","DOIUrl":"10.1093/europace/euaf172","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834524","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":"Pharmacologic parasympathetic withdrawal to facilitate activation mapping and ablation of infrequent intraprocedural premature ventricular contractions.","authors":"Andrew Abboud, Jeffrey Hedley, Nolan Hight, Jakub Sroubek, Justin Lee, Koji Higuchi, Arwa Younis, Hiroshi Nakagawa, Mandeep Bhargava, Ayman Hussein, Mohamed Kanj, Tyler Taigen, Bryan Baranowski, Oussama Wazni, Walid I Saliba, Pasquale Santangeli, Shady Nakhla","doi":"10.1093/europace/euaf218","DOIUrl":"10.1093/europace/euaf218","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12480207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091467","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":"Trends and disparities in the global burden of atrial fibrillation and flutter in early-onset and older-age populations.","authors":"Lin Xia, Yifan Lu, Yu Liu, Tao Huang, Jikai Zhao, Liming Yu, Yuji Zhang, Zongtao Yin, Huishan Wang","doi":"10.1093/europace/euaf186","DOIUrl":"10.1093/europace/euaf186","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947558","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":"Impact of pulse duration on cardiac electroporation: nanosecond pulses enhance cardiomyocyte selectivity and promote a Raman-detected shift towards apoptotic cell death.","authors":"Pamela W Sowa, Aleksandra Mariyanats, Aleksander Kiełbik, Anne-Katrin Rohlfing, Vitalij Novickij, Ferdinand Kollotzek, Manuel Sigle, Julia Marzi, Katja Schenke-Layland, Oliver Borst, Meinrad P Gawaz","doi":"10.1093/europace/euaf217","DOIUrl":"10.1093/europace/euaf217","url":null,"abstract":"<p><strong>Aims: </strong>Pulsed field ablation (PFA), a cardiac ablation technique using microsecond pulsed electric fields (µsPEF), is widely used in clinical settings, while nanosecond pulsed electric fields (nsPEF) have recently entered clinical trials. Selective ablation of cardiomyocytes over endothelial cells is critical to prevent adverse remodelling, arrhythmias, and thrombosis, yet comparative data on nsPEF vs. µsPEF remain limited. This study investigates the cytotoxic effects and cell death mechanisms induced by nsPEF and µsPEF in cardiac and endothelial cells.</p><p><strong>Methods and results: </strong>Human cardiomyocytes and endothelial cells were exposed to varying electric field intensities with nsPEF and µsPEF using custom-built automated setup to assess permeabilization and cell death. Raman spectroscopy evaluated biochemical changes in cardiomyocytes following electroporation. Ex vivo epicardial ablation was performed on murine hearts using customized electrodes. Maximal cardiomyocyte death occurred 24 h after both pulse types in vitro. Ex vivo, both pulse types produced visible myocardial lesions as early as 1 h post-exposure, with lesion size progressively increasing up to 4 h. Microsecond pulsed electric fields induced significantly greater endothelial damage (ED50: 1.18 kV/cm) than damage to cardiomyocytes (ED50: 1.28 kV/cm), whereas nsPEF affected both cell types equally (ED50: 7.27 kV/cm vs. 7.24 kV/cm). Raman spectroscopy analysis of exposed cells indicated that µsPEF predominantly triggered necrotic or unregulated cell death, while nsPEF exposure was associated with regulated, apoptotic cell death.</p><p><strong>Conclusion: </strong>Pulse duration critically determines electroporation selectivity and downstream death pathways. Nanosecond pulsed electric fields favoured regulated cell death and cardiomyocyte selectivity, highlighting its potential to improve the safety and durability of PFA.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091429","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}