Heart rhythm最新文献

{"title":"Impact of atrial fibrillation and atrial fibrillation therapies on sports performance in athletes","authors":"Ali K. Khan MD, PhD ,&nbsp;Hyon Jae Lee MD, FHRS ,&nbsp;Mellanie True Hills BS ,&nbsp;Melissa Moss BA ,&nbsp;Brenna Lara JD ,&nbsp;Raymond Baumann PhD ,&nbsp;Cynthia Brandt MD, MPH ,&nbsp;Rachel Lampert MD, FHRS","doi":"10.1016/j.hrthm.2024.11.020","DOIUrl":"10.1016/j.hrthm.2024.11.020","url":null,"abstract":"<div><h3>Background</h3><div>It has been hypothesized that both atrial fibrillation (AF) and medications for AF are poorly tolerated in athletes.</div></div><div><h3>Objective</h3><div>The purpose of this study was to determine the impact of AF and AF treatments on sports performance.</div></div><div><h3>Methods</h3><div>An Internet-based survey, initiated via StopAfib.org, queried the impact of AF and treatment modalities on sports performance, training, and symptoms. Performance (rated in comparison to personal best), frequency of training, and competition were compared before onset of AF symptoms vs when symptoms at worst, via paired Wilcoxon, and then similarly compared in relation to participants’ AF treatments.</div></div><div><h3>Results</h3><div>Between May 13, 2019, and February 29, 2020, 1055 athletes responded (78% male, median age 61–70 years). The sports most reported were cycling (25%) and running (20%). Development of AF was associated with declining sports performance, competition, and training frequency. Of 565 participants who detrained, 31% reported no change in symptoms, 56% reported decreased frequency, and 13% reported no further AF. Among athletes who received treatment, ablation was associated with greater improvement in sports performance than use of medications. Of 262 athletes currently taking medication, 27% reported that it was completely effective, 58% partially effective, and 15% not effective. Of 653 athletes who have taken medication currently and/or in the past, 43% reported side effects, most commonly fatigue, low energy, or decreased athletic performance.</div></div><div><h3>Conclusion</h3><div>Athletes reported that AF was associated with worsening sports performance. Among AF treatment modalities, ablation was associated with the greater reported improvement in sports performance than use of medications, which also had a high frequency of side effects.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2562-2569"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanisms of ventricular tachycardias with a 1:1 His-V relation in patients with heart disease","authors":"Shunsuke Uetake MD,&nbsp;William G. Stevenson MD, FHRS,&nbsp;Travis D. Richardson MD,&nbsp;Arvindh N. Kanagasundram MD, FHRS,&nbsp;Kanae Hasegawa MD,&nbsp;Masaaki Kurata MD,&nbsp;Daisuke Togashi MD,&nbsp;Salah H. Alahwany MD,&nbsp;Tiffany Hu MD,&nbsp;Giovanni E. Davogustto MD,&nbsp;Zachary T. Yoneda MD,&nbsp;Sharon T. Shen MD,&nbsp;Jay A. Montgomery MD,&nbsp;Harikrishna Tandri MD, FHRS","doi":"10.1016/j.hrthm.2025.02.044","DOIUrl":"10.1016/j.hrthm.2025.02.044","url":null,"abstract":"<div><h3>Background</h3><div>Ventricular tachycardia (VT) with a 1:1 V-His relation can be seen in bundle branch reentry or with passive retrograde activation from scar-related VT or reentry using left ventricular Purkinje fascicles.</div></div><div><h3>Objective</h3><div>This study aimed to review the frequency with which 1:1 V-His relation occurs and to identify differentiating characteristics of these arrhythmias, including new measures obtained during right ventricular (RV) pacing based on orthodromic His–proximal right bundle potential (HisRB) capture and the stimulus to HisRB (S-HisRB) interval approximating RV electrogram to His interval (Egm-HisRB_<em>VT</em>).</div></div><div><h3>Methods</h3><div>This was a retrospective review of induced VTs that had a HisRB potential recorded while pacing from the distal right ventricle.</div></div><div><h3>Results</h3><div>From 147 patients, 158 VTs were analyzed. A 1:1 V to HisRB was observed in 86 VTs (54%): 18 bundle branch reentrant VTs (BBR-VTs), 8 LV fascicular/Purkinje-related reentrant VTs (FPVTs), and 60 scar-related reentrant VTs (SRR-VTs). The HisRB-QRS_<em>VT</em> was &gt;135 ms, falling within the QRS in 87% of SRR-VTs, and 30–135 ms in all BBR-VTs (<em>P</em> &lt; .001). With RV pacing, the HisRB remained 1:1 in 100% of BBR-VTs and 23 (69.7%) of 33 SRR-VTs. An S-HisRB of &gt;135 ms combined with S-HisRB – Egm-HisRB_<em>VT</em> difference &lt;30 ms was specific for BBR-VT. In FPVTs, the HisRB-QRS timing was more variable, and RV pacing was helpful in distinguishing these from BBR-VTs.</div></div><div><h3>Conclusion</h3><div>Retrograde HisRB activation is common in all forms of VT. HisRB timing and new features based on consideration of orthodromic HisRB activation during RV pacing can help distinguish BBR-VT, SRR-VT, and FPVT.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2497-2506"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing and managing a mortality and morbidity program in the electrophysiology lab: An essential component of quality","authors":"Bruce A. Koplan MD, MPH, FHRS ,&nbsp;Anne Marie Smith MBA ,&nbsp;John N. Catanzaro MD, MBA, FHRS","doi":"10.1016/j.hrthm.2025.05.026","DOIUrl":"10.1016/j.hrthm.2025.05.026","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages e1024-e1025"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echocardiographic response from left bundle branch area pacing optimized cardiac resynchronization therapy (LOT-CRT) vs traditional CRT","authors":"Gaurav A. Upadhyay MD, FHRS ,&nbsp;Marek Jastrzębski MD, PhD ,&nbsp;Paul Foley MBChB, MDRes, FRCP ,&nbsp;Badrinathan Chandrasekaran BSc, MD Res, FCRP ,&nbsp;Zachary Whinnett MD, PhD, FHRS ,&nbsp;Robert D. Schaller DO, FHRS ,&nbsp;Rafał Gardas MD ,&nbsp;Travis Richardson MD, FHRS ,&nbsp;Pawel Moskal MD ,&nbsp;D’Anne Kudlik MS ,&nbsp;Robert W. Stadler PhD ,&nbsp;Patrick Zimmerman PhD ,&nbsp;James Burrell MS ,&nbsp;Robert Waxman MS ,&nbsp;Richard N. Cornelussen PhD ,&nbsp;Jonathan Lyne MD ,&nbsp;Bengt Herweg MD, FHRS ,&nbsp;Pugazhendhi Vijayaraman MD, FHRS","doi":"10.1016/j.hrthm.2025.04.026","DOIUrl":"10.1016/j.hrthm.2025.04.026","url":null,"abstract":"<div><h3>Background</h3><div>Traditional cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) may be less effective in patients with nonspecific intraventricular conduction delay (NIVCD). Left bundle branch area pacing (LBBAP) combined with left ventricular (LV) coronary venous lead pacing (LOT-CRT) may be more effective in these patients.</div></div><div><h3>Objective</h3><div>We assessed the echocardiographic response of LOT-CRT in patients with left bundle branch block (LBBB) or NIVCD and compared it with a propensity-matched BVP cohort.</div></div><div><h3>Methods</h3><div>Patients with conventional CRT indications and preferentially NIVCD were recruited. Echocardiographic parameters, including absolute percentage change in LV ejection fraction (LVEF) and relative percentage change in LV end-systolic volume (LVESV), were evaluated at implantation and 6-month follow-up. The BVP cohort was from an independent study, selected using 1:1 propensity-matching. LOT-CRT patients were subclassified into “successful LOT-CRT” (LBBAP; presence of r’ in electrode electrocardiography [ECG] V1) and “deep septal optimized therapy” (DOT-CRT) (functional deep septal capture).</div></div><div><h3>Results</h3><div>LOT-CRT patients (N = 34; age 64 years, women 38%, NIVCD 47%, LBBB 53%, implantable cardiac monitor 21%, QRSd 175 ms, and LVEF 27.6%) had significantly greater LVEF improvement (16.1% vs 6.1%; <em>P</em> &lt;.01) and LVESV reduction (−43.5% vs −20.9%; <em>P</em> &lt;.01) compared with BVP patients. After adjusting for baseline characteristics, LOT-CRT patients still had significantly greater LVEF improvement (7.5%; <em>P</em> &lt;.01) and LVESV reduction (18.4%; <em>P</em> &lt;.01) than BVP patients. The response was consistent across LBBB and NIVCD subgroups. LOT-CRT patients with QRS ≥ 171 ms showed greater benefit (<em>P</em> = .04; both LVEF and LVESV). No significant differences were observed between successful LOT-CRT and DOT-CRT.</div></div><div><h3>Conclusion</h3><div>LOT-CRT resulted in superior LVEF and LVESV improvements compared with BVP in NIVCD and LBBB patients and enhanced CRT response.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2616-2624"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The vestigial fold in humans: Characterization of a potential novel target for selective cardiac sympathetic denervation","authors":"Takanori Sato MD, PhD ,&nbsp;Michael C. Fishbein MD ,&nbsp;Peter Hanna MD, PhD, FHRS ,&nbsp;Olujimi A. Ajijola MD, PhD, FHRS ,&nbsp;Kalyanam Shivkumar MD, PhD, FHRS ,&nbsp;Shumpei Mori MD, PhD","doi":"10.1016/j.hrthm.2025.03.1957","DOIUrl":"10.1016/j.hrthm.2025.03.1957","url":null,"abstract":"<div><h3>Background</h3><div>The vestigial fold is an epicardial structure related to the posterior hilum of the heart, containing the remnant of the left superior vena cava. It is the superior continuation of the ligament/vein of Marshall. Although neural structures along the human ligament/vein of Marshall have been characterized, those within the human vestigial fold remain unexplored.</div></div><div><h3>Objective</h3><div>This study aimed to characterize the neural structures within the human vestigial fold.</div></div><div><h3>Methods</h3><div>Twelve human vestigial fold samples (67% men, 50.0 ± 12.7 years) were analyzed. Nerve fascicles ≥ 50 μm in diameter were counted and characterized by immunohistochemistry staining. Percentage area of sympathetic, parasympathetic, and sensory nerve fibers (axons) within individual nerve fascicles was measured.</div></div><div><h3>Results</h3><div>A total of 87 nerve fascicles were analyzed. The size of the vestigial fold averaged 12.7 ± 5.1 mm in length and 3.6 ± 1.7 mm in width. Each vestigial fold contained 7.3 ± 4.2 nerve fascicles (102.0 ± 51.8 μm in diameter). The minimum distance from the epicardium to nerve fascicles was 487.1 ± 440.2 μm. Immunohistochemistry showed sympathetic predominance (Percentage area within each fascicle; sympathetic 16.9 ± 12.7%, parasympathetic 1.6 ± 1.0%, and sensory 1.2 ± 1.0%, <em>P</em> &lt; .001). Representative whole-mount staining of the tissue-cleared sample also confirmed 3-dimensional distribution of the predominant sympathetic nerve fascicles within the vestigial fold.</div></div><div><h3>Conclusion</h3><div>The vestigial fold predominantly contains sympathetic nerve fascicles. This epicardial structure is a potential novel target for selective human cardiac sympathetic denervation, especially in cases with uncontrollable ventricular arrhythmia arising from the inferior left ventricle.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2711-2721"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical impact of surgical left atrial appendage occlusion during cardiac surgery in patients in sinus rhythm: A meta-analysis","authors":"Samuel Burton MRes ,&nbsp;Rayyan Ahmed ,&nbsp;Nicola King PhD ,&nbsp;Alexander Reynolds MRes ,&nbsp;Amit Modi FRCS(CTh) ,&nbsp;Sanjay Asopa FRCS(CTh)","doi":"10.1016/j.hrthm.2025.03.1975","DOIUrl":"10.1016/j.hrthm.2025.03.1975","url":null,"abstract":"<div><h3>Background</h3><div>The clinical efficacy of surgical occlusion of the left atrial appendage in patients with sinus rhythm undergoing cardiac surgery remains controversial.</div></div><div><h3>Objective</h3><div>This meta-analysis aims to evaluate the impact of left atrial appendage occlusion (LAAO) on early and late outcomes in sinus rhythm patients undergoing cardiac surgery.</div></div><div><h3>Methods</h3><div>Screened and selected studies were sourced from PubMed, Embase, and Web of Science databases, following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Early clinical outcomes were pooled using odds ratio, and long-term outcomes were extracted from Kaplan-Meier curves to reconstruct individual time-to-event patient data and allow for proportional hazards regression. Bias-treated data were selected when available.</div></div><div><h3>Results</h3><div>Six studies, comprising 2742 patients, were included from the initial 1431 reports. Pooling of data demonstrated no significant association between LAAO and the development of postoperative atrial fibrillation (odds ratio 1.157; 95% confidence interval [CI] 0.904–1.481; I² = 46%; <em>P</em> = .246). Reconstruction of Kaplan-Meier data revealed greater freedom from cerebrovascular events in the LAAO group than in the no-LAAO group (hazard ratio 0.482; 95% CI 0.361–0.643; <em>P</em> &lt; .001). The LAAO group also demonstrated improved midterm survival (hazard ratio 0.701; 95% CI 0.554–0.886; <em>P</em> = .003).</div></div><div><h3>Conclusion</h3><div>This meta-analysis has demonstrated an improved freedom from cerebrovascular events and a midterm survival benefit in sinus rhythm patients undergoing cardiac surgery and surgical LAAO. This meta-analysis does not demonstrate an increased occurrence of postoperative atrial fibrillation in the LAAO group. Larger randomized controlled trials, stratified by cardiac pathology, are required to validate these findings.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages 2595-2602"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognosis for loss-of-function vs hot-spot variants in RBM20-related cardiomyopathy","authors":"Alexis Hermida MD, PhD ,&nbsp;Flavie Ader PharmD, PhD ,&nbsp;Guillaume Jedraszak MD, PhD ,&nbsp;Louis Vogel MD ,&nbsp;Gilles Millat MD ,&nbsp;Christophe Beyls MD, PhD ,&nbsp;Nicolas Martin MD ,&nbsp;Agathe Vernier MD ,&nbsp;Philippe Charron MD, PhD ,&nbsp;Estelle Gandjbakhch MD, PhD","doi":"10.1016/j.hrthm.2025.06.009","DOIUrl":"10.1016/j.hrthm.2025.06.009","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages e1040-e1042"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The mitral valve complex: A complex trap to be avoided by cardiac electrophysiologists—A systematic review","authors":"Hussam Ali MD ,&nbsp;Ahmad Abdelrady Abdelsalam Farghaly MD ,&nbsp;Robert H. Anderson MD ,&nbsp;Pierpaolo Lupo MD ,&nbsp;Sara Foresti MD ,&nbsp;Guido De Ambroggi MD ,&nbsp;Riccardo Bessi MD ,&nbsp;Silvia Magnani MD ,&nbsp;Riccardo Cappato MD, FHRS","doi":"10.1016/j.hrthm.2025.06.013","DOIUrl":"10.1016/j.hrthm.2025.06.013","url":null,"abstract":"<div><div>Catheter entrapment within the mitral valve<span><span> complex (MVC) is a rare but serious complication during left heart catheterization. A systematic review—the first on this topic—was conducted using PubMed and Embase databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, to identify cases of catheter entrapment within the MVC during electrophysiological procedures. Forty-six patients predominantly undergoing </span>catheter ablation of atrial tachyarrhythmias (71.7%) were included. Circular mapping catheters were the most frequently entrapped materials (50%), followed by ablation and multispline catheters. Ablation catheters were mostly entrapped when advanced retrogradely, while multispline catheter entrapment was exclusively observed in patients with mechanical valves. Percutaneous management was successful in 47.8% of patients, one-third of whom required retrieval of embolized catheter segments. Surgery was necessary in 52.2% of patients, including valve surgery in 30.4%. Awareness of this potential complication and application of preventive strategies are essential when mapping or ablating adjacent to the MVC.</span></div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages e1007-e1016"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External validation of atrial fibrillation risk prediction tools in a racially diverse cohort of patients with hypertrophic cardiomyopathy","authors":"Henry Pronovost MD ,&nbsp;Ali Asghar Kassamali ,&nbsp;Jeff Ehmsen MD, PhD ,&nbsp;Bryana Rivers MS, CGC ,&nbsp;Alessio Gasperetti MD, PhD ,&nbsp;Katherine C. Wu MD ,&nbsp;Ethan Rowin MD ,&nbsp;Jose A. Madrazo MD ,&nbsp;Richard T. Carrick MD, PhD","doi":"10.1016/j.hrthm.2025.05.046","DOIUrl":"10.1016/j.hrthm.2025.05.046","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation<span><span> (AF) is the most common sustained arrhythmia in patients with </span>hypertrophic cardiomyopathy (HCM). The 2024 American Heart Association/American College of Cardiology guidelines recommend validated clinical tools such as the HCM-AF score for individualized assessment of AF risk. To date, these tools have been validated only in predominantly white HCM patient populations.</span></div></div><div><h3>Objective</h3><div>This study aimed to compare the performances of published AF risk prediction tools in a racially diverse cohort of patients with HCM.</div></div><div><h3>Methods</h3><div>This was a retrospective study of patients with HCM without previous AF evaluated at the Johns Hopkins HCM Center. Assessments of AF risk were generated using the HCM-AF score and other non-HCM-specific risk scores (C2HEST, HARMS2-AF, CHA₂DS₂-VASc, and CHARGE-AF). Patients were followed longitudinally for the development of new-onset, clinically significant AF. Discrimination was assessed using concordance-based c-statistics.</div></div><div><h3>Results</h3><div>A total of 631 patients with HCM were included, with a mean age of 55.9 ± 15.3 years; 49.7% were women, 64.7% were white, 24.1% were black, and 11.2% identified with other nonwhite race. During a median follow-up of 3.1 years, new AF was diagnosed in 18.9% of patients. The HCM-AF score demonstrated better risk discrimination (c-statistic 0.72) than other non-HCM-specific risk scores (c-statistics 0.56–0.67) and effectively stratified patients into low-risk (0.9% AF/year), medium-risk (3.4% AF/year), and high-risk groups (7.4% AF/year). Discrimination of AF risk by the HCM-AF score was similar for white (c-statistic 0.71) and nonwhite patients (c-statistic 0.74).</div></div><div><h3>Conclusion</h3><div>The HCM-AF score demonstrated good AF risk discrimination in a diverse cohort of patients with HCM, outperforming alternative non-HCM-specific AF risk scores and validating its use in nonwhite HCM populations.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages e841-e848"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and safety of single-pulse ablation in 20 patients with atrial fibrillation","authors":"Peter Loh MD, PhD ,&nbsp;Marijn H.A. Groen PhD ,&nbsp;Karim Taha MD, PhD ,&nbsp;Birgitta K. Velthuis MD, PhD ,&nbsp;Herma H. Fidder MD, PhD ,&nbsp;A. Vink MD, PhD ,&nbsp;Fred H.M. Wittkampf PhD ,&nbsp;Pieter A.F.M. Doevendans MD, PhD ,&nbsp;René van Es PhD","doi":"10.1016/j.hrthm.2025.05.054","DOIUrl":"10.1016/j.hrthm.2025.05.054","url":null,"abstract":"<div><h3>Background</h3><div>Single-pulse ablation leads to irreversible electroporation (IRE) and has been introduced as a nonthermal ablation technology for pulmonary vein isolation (PVI). First-in-human studies demonstrated the acute feasibility and safety of IRE PVI.</div></div><div><h3>Objective</h3><div>This study aimed to further investigate the safety of single-pulse ablation for PVI.</div></div><div><h3>Methods</h3><div>Twenty patients with symptomatic atrial fibrillation underwent single-pulse PVI under conscious sedation. Nonarcing, nonbarotraumatic, 6 ms, 200 J IRE applications were delivered via a custom 14-polar circular IRE ablation catheter with a variable hoop diameter (16–27 mm). Adenosine testing was performed after a 30-minute waiting period. On day 1 after ablation, patients underwent esophagoscopy and brain magnetic resonance imaging (MRI) (diffusion-weighted imaging/fluid-attenuated inversion recovery).</div></div><div><h3>Results</h3><div>In 20 patients, all pulmonary veins could be successfully isolated with a mean of 11.8 ± 1.4 IRE applications per patient. One pulmonary vein reconnection occurred during adenosine testing; reisolation was achieved with 2 additional IRE pulses. No periprocedural complications were observed. Brain MRI on day 1 after ablation showed punctate asymptomatic lesions in 3 of 20 patients (15%). At follow-up MRI, the lesion disappeared in 1 patient whereas 1 lesion persisted in the other 2 patients. Esophagoscopy on day 1 showed an asymptomatic esophageal lesion in 1 of 20 patients (5%); at repeat esophagoscopy on day 22, the lesion had resolved completely.</div></div><div><h3>Conclusion</h3><div>Acute electrical PVI could be achieved safely and rapidly. Acute silent cerebral lesions were detected in 3 of 20 patients (15%) and may be caused by ablation or changes of therapeutic and diagnostic catheters over a single transseptal access.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 10","pages":"Pages e866-e874"},"PeriodicalIF":5.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}