Heart rhythm最新文献

{"title":"Aging of the Tricuspid Valvular Annulus detected using photon-counting detector computed tomography.","authors":"Hiroshi Morita, Koji Nakagawa, Satoshi Nagase, Yoshihisa Morimoto, Takuro Masuda, Akira Ueoka, Saori Asada, Masakazu Miyamoto, Norihisa Toh, Toru Miyoshi, Nobuhiro Nishii, Shinsuke Yuasa","doi":"10.1016/j.hrthm.2025.03.2002","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.03.2002","url":null,"abstract":"<p><strong>Background: </strong>The aortic root (Ao) compresses the heart in elderly patients, potentially influencing the conduction system and causing atrial tachyarrhythmias (ATAs). However, actual anatomical alterations in the right side of the heart because of Ao compression have not yet been fully evaluated.</p><p><strong>Objective: </strong>This study aimed to elucidate the alterations in the tricuspid valvular annulus (TVA) caused by Ao compression using a 3-dimensional endoscopic view of the heart constructed by photon-counting detector computed tomography (PCD-CT), an emerging medical technology.</p><p><strong>Methods: </strong>We analyzed 135 consecutive patients who underwent PCD-CT at our institute after excluding those with diseases that directly influenced the right heart.</p><p><strong>Results: </strong>Ao-compression caused significant TVA deformation. We defined severe TVA compression as the length of the TVA compressed by the aortic root ≥80% of the major axis of the TVA. Severe compression was more prevalent in elderly patients (age ≥ 75 years, 42%; p<0.01). The distance between the membranous septum and ostium of the coronary sinus was shortened, whereas the cavotricuspid isthmus (CTI) was elongated in older patients. The regression analysis identified aging as a significant contributor to TVA compression. The short minor and long major axes of the TVA, incidence of ATAs (70% vs. 45%, p<0.01), and atrioventricular conduction disturbances (38% vs. 15%, p<0.01) were more frequently observed in patients with severe compression.</p><p><strong>Conclusions: </strong>Ao-compression deforms the TVA and alters the anatomical relationship between the atrioventricular conduction system and the CTI. Therefore, Ao-compression may contribute to the occurrence of ATAs and conduction disturbances in older patients.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795340","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":"Electrocardiographic P-wave Parameters and Lifetime Atrial Fibrillation Risk: A Multi-Cohort Study.","authors":"Matthew W Segar, Kaleb Lambeth, Anna Rosenblatt, Robert D Paisley, Abdi Rasekh, Joanna Molina-Razavi, Mehdi Razavi, Ambarish Pandey, Mohammad Saeed","doi":"10.1016/j.hrthm.2025.03.2004","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.03.2004","url":null,"abstract":"<p><strong>Background: </strong>The P-wave on surface electrocardiogram (ECG) undergoes characteristic changes prior to developing atrial fibrillation (AF). However, the relationship between P-wave parameters and lifetime risk of AF remains poorly characterized.</p><p><strong>Objective: </strong>To determine the association between baseline ECG P-wave parameters and lifetime risk of AF.</p><p><strong>Methods: </strong>We conducted a pooled analysis of 25,508 participants from four prospective cohort studies. P-wave parameters were analyzed based on contemporary consensus criteria, including advanced interatrial block (IAB), P-terminal force in V1, P-wave axis, P-wave voltage in lead I, P-wave area in lead II, and P-wave dispersion. Using a modified Kaplan-Meier analysis accounting for competing risks, we calculated lifetime risk of AF stratified by individual and cumulative ECG abnormalities.</p><p><strong>Results: </strong>During follow-up, 2,877 participants (11.3%) developed AF. At index age 45, IAB showed the strongest association with lifetime AF risk (35.4% vs 23.9%), followed by lead II area (30.0% vs 24.6%) and P-wave dispersion >70ms (28.8% vs 23.6%). A dose-response relationship was observed with cumulative abnormalities: participants with 0-1 abnormalities had a lifetime risk of 222.9%, increasing to 27.0%, 30.7%, and 35.7% for 2, 3, and 4+ abnormalities, respectively. Participants with 4+ ECG abnormalities lived an average of 17.1 years free of AF compared to 21.7 years for those with none.</p><p><strong>Conclusions: </strong>Multiple P-wave parameters are associated with increased lifetime risk of AF, with a strong dose-response relationship for cumulative abnormalities. These findings suggest that comprehensive ECG analysis may enhance long-term AF risk assessment.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794384","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":"Secular trends in the incidence of atrial fibrillation across different ages and genders in Taiwan from 2001 to 2021.","authors":"Chi-Hsun Lien, Kung-Cheng Hsu, Yu-Kang Chang, Chien-Jung Chang, Ying-Ming Chiu, Hung-Yi Hsu","doi":"10.1016/j.hrthm.2025.03.2001","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.03.2001","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF), the most prevalent arrhythmia, is associated with an increased risk of stroke, systemic embolism, and death.</p><p><strong>Objectives: </strong>This study aimed to investigate the secular trends in AF incidence rates (IRs) among different age, gender and comorbiditysubgroups in a Chinese population from 2000 to 2021.</p><p><strong>Methods: </strong>This retrospective study used data from the National Health Insurance Research Database in Taiwan, determined AF cases using the International Classification of Diseases, 9^th and 10^th Revision, Clinical Modification codes, and calculated and stratified the annual age-standardized IRs by age, gender, and comorbidity status.</p><p><strong>Results: </strong>The total number of AF cases increased from 24,450 in 2000 to 32,817 in 2021, while the standardized IR (SIR) decreased from 170.62 to 112.38 per 100,000 person-years. Males demonstrated higher IRs than females across all age groups. The annual IRs substantially increased with age. IRs exhibited a declining trend, except in males aged 20-49 years and females aged 20-34 years. The trends of SIRs showed distinct patterns among patients with different comorbidity burdens. Individuals with lower comorbidity burden demonstrated lower SIRs and earlier declines in SIRs.</p><p><strong>Conclusion: </strong>This study reveals complex secular trends of AF incidence in the past 21 years, with decreasing overall SIRs but increasing annual IRs in younger populations. The intricate interplay between AF incidence, age, and gender emphasizes the need for age- and sex-specific strategies in AF prevention and management. The observed relationship between comorbidity burden and AF incidences suggests differential effectiveness of cardiovascular risk management across patient subgroups.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794729","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":"Extrastimuli-assisted Functional Mapping Improves Ventricular Tachycardia Ablation Outcomes: A Systematic Review, Meta-analysis, and Meta-regression.","authors":"Bruno Wilnes, Beatriz Castello-Branco, Eduardo Maia Martins Pereira, Luiza Marinho Lopes, Vivian Barroso Santos, Ana Clara Bicalho, Lucas Melo, Sara Regina Silva Cupertino, Anna Terra França, Marcos Roberto Queiroz França, Gustavo de Araújo Silva, Marina Pereira Mayrink, Isabella Moreira Gonzalez Fonseca, Reynaldo Castro de Miranda, José Luiz Padilha da Silva, Maria Carmo Pereira Nunes, Andre Assis Lopes do Carmo","doi":"10.1016/j.hrthm.2025.03.2000","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.03.2000","url":null,"abstract":"<p><strong>Background: </strong>In the context of VT ablation, functional electroanatomic mapping techniques may help identify arrhythmogenic substrates in scarred and normal voltage areas. Additionally, extrastimuli-assisted (dynamic) mapping may be more effective than intrinsic rhythm (static) approaches to uncover key ablation targets, potentially improving procedure outcomes.</p><p><strong>Objectives: </strong>To assess the efficacy and safety of functional mapping-assisted ventricular tachycardia (VT) ablation and compare procedural outcomes between dynamic and static mapping approaches.</p><p><strong>Methods: </strong>PubMed/MEDLINE, Scopus, Web of Science, and Cochrane databases were searched using MeSH terms \"Ventricular Tachycardia Ablation\", \"Functional Mapping\", \"Recurrence\", \"Complications\", and similar keywords. Meta-analyses of single proportions, rates, and means were performed, employing random-effects models and p<0.05. Subgroup analysis and meta-regression were performed.</p><p><strong>Results: </strong>We included 16 studies, covering 674 patients, with follow-up ranging from 6 to 38.1 ±29.7 months. Ischemic etiology comprised 490 (72.7%) patients, left ventricular ejection fraction (LVEF) varied from 25 ±10% to 41.5 ±13.8%. Dynamic mapping was used in 9 (57.1%) studies, 6 (37.5%) employed static techniques, and 1 (6.3%) used a mixed approach. Procedure duration (p=0.520) or complication incidence (p=0.110) were similar between dynamic and static mapping modalities. Dynamic mapping subgroup exhibited significantly lower VT recurrence rate when compared to the static mapping population (p<0.010). This result persisted on a meta-regression model adjusted for ischemic etiology and LVEF, demonstrating that dynamic functional mapping was independently associated with lower recurrence rates (p=0.005).</p><p><strong>Conclusion: </strong>Functional mapping demonstrated to be safe for VT ablation. Dynamic functional mapping independently associated with reduced post-ablation recurrence rates without significantly increasing procedure duration.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794707","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":"Surgical Neuromodulation Therapies to Prevent Postoperative Atrial Fibrillation: A Meta-Analysis, Meta Regression and Trial Sequential Analysis of Randomized Controlled Trials.","authors":"Leo N Consoli, Eren Cetinel, Pawel Lajczak, Ilias G Koziakas, Mir Wajid Majeed, Prajna Wijaya, Issa Salha, George Samanidis","doi":"10.1016/j.hrthm.2025.03.2003","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.03.2003","url":null,"abstract":"<p><strong>Background: </strong>Postoperative atrial fibrillation (POAF) occurs frequently after cardiac surgery and is associated with increased mortality.</p><p><strong>Objectives: </strong>Surgical neuromodulation therapies (SNMTs) have been explored as a preventive strategy, but their efficacy and safety remain uncertain.</p><p><strong>Methods: </strong>We searched PubMed, Embase and the Cochrane library for eligible randomized controlled trials. Meta-analysis was performed for primary (POAF) and secondary (hospital stay; complications; atrial fibrillation at 1 year; operation time; POAF burden; ICU stay) endpoints. Subgroup analysis was conducted for each technique. We compared endpoints using risk ratio (RR) for binary and mean difference for continuous outcomes. We calculated 95% confidence intervals for all outcomes. We carried out a trial sequential analysis for primary (POAF) and secondary (hospital stay; complications) endpoints. We conducted meta-regression for all covariates with at least 10 observations.</p><p><strong>Results: </strong>We included 20 trials (n=3348). Seven studied anterior fat pad (AFP) preservation, 5 pulmonary vein isolation (PVI), 2 ganglionic plexus (GP) ablation, 1 partial cardiac denervation (PCD) and 5 assessed epicardial injections. POAF incidence was lower in the SNMT group (RR 0.62 (0.48; 0.79), p < 0.001), driven by the AFP preservation, PCD and PVI subgroups. Epicardial injections were only effective in patients undergoing coronary surgery. SNMTs also reduced hospital stay (p=0.03). All meta-regression analyses were insignificant. In the trial sequential analysis, a positive effect for POAF was observed.</p><p><strong>Conclusions: </strong>This meta-analysis found a significant reduction in POAF incidence with implementation of AFP preservation, PCD and PVI. Epicardial injections were only effective for patients undergoing coronary bypass.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795096","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":"One year clinical and safety outcome of obese patients undergoing pulmonary vein isolation for atrial fibrillation with pulsed field ablation or cryoballoon ablation - a propensity matched analysis.","authors":"Sebastian Feickert, Smilla Wagner, Kristof Biernath, Hüseyin Ince, Jasmin Ortak, Andreas A Boehmer, Giuseppe D'Ancona, Niels Christian Ewertsen","doi":"10.1016/j.hrthm.2025.03.1999","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.03.1999","url":null,"abstract":"<p><strong>Background: </strong>Thermal-based ablation techniques, such as cryoballoon ablation (CBA), are widely used for pulmonary vein isolation (PVI) but show notable recurrence rates, particularly in obese patients. One possible reason is the reduced efficacy of thermal energy in tissues with significant epicardial fat, which can impede effective lesion formation and insulation of targeted areas.</p><p><strong>Objective: </strong>Pulsed field ablation (PFA) has shown promising results for atrial fibrillation (AF) treatment, providing effective isolation with a favorable safety profile. This study investigates the clinical and safety outcomes of PFA compared to CBA in obese patients with AF.</p><p><strong>Methods: </strong>This retrospective propensity-matched study included symptomatic paroxysmal and persistent AF patients with a body mass index (BMI) >30 kg/m² who underwent PFA or CBA at a single institution. Matching criteria included age, left atrial diameter, left ventricular ejection fraction, and AF type (paroxysmal vs. persistent), as well as pre-existing conditions such as diabetes, coronary artery disease, and hyperlipoproteinemia. Procedural workflows were standardized, focusing on PV isolation. Outcomes assessed were procedural efficiency, recurrence rates, and complications.</p><p><strong>Results: </strong>Post-matching revealed lower recurrence rates in the PFA group (25%) compared to the CBA group (42.9%, p=0.02). PFA was associated with significantly shorter left atrial (LA) time (33.8 min. vs. 49.7 min., p<0.01) and procedural time (46.8 min. vs. 69.3 min., p<0.01) than CBA, although fluoroscopy time showed no significant difference. Safety outcomes were similar across both groups.</p><p><strong>Conclusion: </strong>PFA offers an alternative to CBA in obese patients, with superior recurrence outcomes and shorter procedural durations post-matching in this single-center cohort. PFA may be a preferred approach for AF management in this high-risk population. Future randomized trials are warranted to validate these findings and optimize treatment protocols for obese AF patients.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794788","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":"Rethinking Anticoagulation After Bariatric Surgery: Direct Oral Anticoagulants vs. Warfarin in Atrial Fibrillation.","authors":"Emmanuel Otabor, Justin Lam, Laith Alomari, Abiodun Idowu, Festus Ibe, Yaman Jarrar, Jana Alomari","doi":"10.1016/j.hrthm.2025.03.1998","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.03.1998","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794724","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 modernized classification of cardiac anti-arrhythmic drugs: its application to clinical practice.","authors":"Ming Lei, Lin Wu, Derek A Terrar, Christopher L-H Huang","doi":"10.1016/j.hrthm.2025.03.1997","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.03.1997","url":null,"abstract":"<p><p>Cardiac arrhythmias pose a major public health problem and pharmacological intervention remains key to their therapy. The landmark Vaughan Williams (VW, 1970) classification utilizing known actions of then available anti-arrhythmic drugs (AADs) became and remains central to management, but requires revision in response to extensive subsequent advances. Our modernized antiarrhythmic drug (AAD) classification reflected and sought to facilitate such fundamental physiological and clinical development. We here respond to requests for an adaptation of our scheme specifically focussed at clinical practice. This adaptation: (1) improves accessibility of our original scheme to clinical practice, focussing on key AADs in clinical use rather than investigational new drugs (INDs) whilst still conserving and encompassing the classic VW scheme. We nevertheless (2) preserve a rational conceptual framework based on current understanding of the relevant electrophysiological events, their underlying cellular or molecular cardiomyocyte targets and the functional mechanisms they mediate. Additionally, (3) the adopted subclasses within each AAD class parallel clinical practice in including only subclasses containing established AADs, or approved potential off-label drugs, as opposed to those only including INDs. Finally, (4) the simplified scheme remains flexible, permitting drugs to be placed in multiple classes where required, and the future addition of classes and subclasses in the light of future investigations and clinical approvals. We thus derive from our comprehensive modernized AAD classification a more focussed and simpler scheme, for clinical use. This both modernizes but preserves the classic Vaughan Williams classification, and remains flexible accommodating for future developments.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788172","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":"","authors":"","doi":"10.1016/j.hrthm.2025.03.1882","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.03.1882","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795336","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":"Transseptal Puncture for Catheter Ablation of Atrial Fibrillation in Patients with Septal Occluder Devices.","authors":"Moneeb Khalaph, Philipp Lucas, Niklas Schenker, Andreas Rillig, Christian-Hendrik Heeger, Mustapha El Hamriti, Maxim Didenko, Sebastian Beyer, Denise Guckel, Thomas Fink, Vanessa Sciacca, Max Mörsdorf, Martin Braun, Maria Ivannikova, Werner Scholtz, Volker Rudolph, Guram Imnadze, Christian Sohns, Andreas Metzner, Philipp Sommer","doi":"10.1016/j.hrthm.2025.03.1996","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.03.1996","url":null,"abstract":"<p><strong>Background: </strong>Transseptal puncture (TSP) is critical for atrial fibrillation (AF) ablation. However, patients with atrial septal occluders (ASO) for atrial septal defects (ASD) or persistent foramen ovale (PFO) pose unique challenges.</p><p><strong>Objective: </strong>This study aimed to evaluate the peri- and post-procedural safety, AF recurrence, and incidence of newly developed ASD/PFO up to 12 months post-procedure.</p><p><strong>Methods: </strong>This multicenter, prospective observational study included 59 patients (mean age 61.2±12.1 years, 56% male) with drug-refractory AF who underwent pulmonary vein isolation (PVI) between 2019 and 2024. Of these, 38 had ASDs and 21 had PFOs, with ASOs in situ. All punctures (Single TSP) were performed under fluoroscopic guidance.</p><p><strong>Results: </strong>The majority of TSP-position in IAS related to the ASO was inferior-posterior to the ASO (66.1%) or inferior-anterior (23.7%). In the case of failure of the inferior part, puncture was performed in superior-posterior puncture (8.5%) or puncture through the occluder (1.7%). The mean ablation time was 14.9±8.4 minutes, including radiofrequency (83.0%), cryoballoon (11.9%), and pulsed-field ablation (5.1%). No major complications were observed, except for one transient phrenic nerve palsy during cryoballoon ablation, which recovered intra-procedurally. Voltage mapping revealed no additional substrate related to the occluder. During a 12-month follow-up, 7 patients (11.9%) experienced AF recurrence.</p><p><strong>Conclusion: </strong>TSP and PVI are safe and can be safely performed in patients with an ASO. No additional substrate related to the occluder was seen. While no direct comparison was made, outcomes align with existing literature. Further studies are needed.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788259","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}