Heart rhythm最新文献

{"title":"Pulmonary vein narrowing after voltage-guided adjunctive pulmonary vein sleeve pulsed field ablation.","authors":"Takehito Sasaki, Taiki Masuyama, Kentaro Minami, Shingo Yoshimura, Suguru Nishiuchi, Akiko Kodama, Kojiro Hattori, Kenichi Kaseno, Nobusada Funabashi, Shigeto Naito, Kohki Nakamura","doi":"10.1016/j.hrthm.2026.10.028","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.028","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) for pulmonary vein (PV) isolation (PVI) has been associated with a low risk of PV stenosis when performed using the standard ostial workflow. However, the risk of PV narrowing after adjunctive PV sleeve PFA remains insufficiently evaluated.</p><p><strong>Objective: </strong>To assess PV narrowing after voltage-guided adjunctive PV sleeve PFA.</p><p><strong>Methods: </strong>We retrospectively studied 147 patients who underwent an initial pentaspline PFA-based PVI for atrial fibrillation. In addition to standard ostial PVI, voltage-guided PFA applications were delivered to target PV sleeve potentials identified on pre-ablation voltage mapping. Contrast-enhanced computed tomography was performed before and approximately six months after ablation. PV cross-sectional areas (PVAs) were measured at predefined levels, and the maximum PVA reduction rate was defined as ΔPVA. Significant PV narrowing was defined as ΔPVA ≥25%.</p><p><strong>Results: </strong>Post-ablation PVA was significantly smaller than pre-ablation PVA at all PV sites. The median ΔPVA was 5.4%, 6.4%, 4.6%, and 4.0% in the left superior, left inferior, right superior, and right inferior PVs, respectively, and differed significantly among the four PV sites (P = 0.012). No significant PV narrowing was observed in this cohort.</p><p><strong>Conclusions: </strong>In patients undergoing an initial PFA-based PVI, no significant PV narrowing was observed approximately six months after voltage-guided adjunctive PV sleeve PFA using a pentaspline catheter. Further controlled studies with larger populations and longer follow-up are needed to better characterize the safety and clinical utility of this strategy.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244413","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":"Sex-based differences in bi-atrial voltage in atrial fibrillation: a multimodal and digital twin approach to distinguish physiological variation from pathological remodelling.","authors":"Neil Bodagh, Vinush Vigneswaran, Ali Gharaviri, Irum Kotadia, Magda Klis, Nilanka N Mannakkara, Kestutis Maciunas, Arno Von Kietzell, Megan Bell, Hayley Cuthbert, Matthew Wright, John Whitaker, Christopher A Rinaldi, Anoop Shetty, Shaumik Adhya, Gurpreet Dhillon, Roy Jogiya, Una Buckley, David Jones, Zhong Chen, Amedeo Chiribiri, Neil R Grubb, Chris Lang, Cesario Pancinha, Michelle C Williams, Steven Niederer, Shouvik Haldar, Mark O'Neill, Steven E Williams","doi":"10.1016/j.hrthm.2026.10.046","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.046","url":null,"abstract":"<p><strong>Background: </strong>Sex-based differences in atrial voltage have been reported in atrial fibrillation (AF), but it is unclear whether these differences reflect pathological remodelling or physiological variation.</p><p><strong>Objective: </strong>To assess sex-based differences in voltage, contextualised by complementary measures of substrate remodelling and AF mechanisms.</p><p><strong>Methods: </strong>A multicentre, prospective study was conducted in patients scheduled for AF ablation. Bi-atrial voltage mapping was combined with electrophysiological assessment, structural and functional assessment using cardiac MRI, and mechanistic interrogation using patient-specific digital twins. Propensity score matching was used to account for baseline differences between sexes. Exploratory receiver operating characteristic analysis was conducted to estimate sex-specific mean left atrial voltage cutoffs based on 12-month arrhythmia recurrence status.</p><p><strong>Results: </strong>Seventy patients (62±12 years; 31% female) were included. Women demonstrated lower mean bipolar voltages than men, with this difference persisting after 1:1 propensity score matching (n=44) in both left (1.66±0.71mV versus 2.12±0.55mV, p=0.028) and right atria (1.79±0.49mV versus 2.20±0.59mV, p=0.025). Propensity score-matched analyses revealed no significant differences in other structural, functional, or electrophysiological parameters, with digital twin analyses demonstrating no significant differences in AF termination, phase singularity count, wave dynamics, or response to virtual ablation. Women had lower mean left atrial voltage cutoffs calibrated to 12-month arrhythmia recurrence status than men (1.74mV versus 2.26mV).</p><p><strong>Conclusions: </strong>Women with AF exhibit lower bi-atrial voltages despite comparable substrate characteristics and AF mechanisms, suggesting that observed voltage differences may reflect physiological variation rather than pathological remodelling. Sex-specific voltage thresholds may improve the accuracy of substrate assessment and facilitate personalised treatment.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244429","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":"Day-Night Patterns of Wearable-Derived Electrocardiographic Age and Left Atrial Remodeling in Atrial Fibrillation-Naïve Individuals.","authors":"Seung Hyun Park, Juhyun Jin, Jongwoo Kim, Dongha Lee, Daein Kim, Jaeseong Jang, Hee Tae Yu, Seng Chan You, Boyoung Joung","doi":"10.1016/j.hrthm.2026.10.036","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.036","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence-derived electrocardiographic (AI-ECG) age is conventionally treated as a static marker. Its diurnal dynamics and structural correlates in individuals without atrial fibrillation (AF) remain unknown.</p><p><strong>Objective: </strong>To characterize diurnal AI-ECG age patterns, their reproducibility, and associations with left atrial (LA) remodeling.</p><p><strong>Methods: </strong>We analyzed continuous wearable ECGs from two prospective registries (NCT05119725, NCT05355948). In 499 AF-naïve participants with ≥48-hour recordings, AI-ECG age was estimated every 10 minutes. Unsupervised clustering identified day-night trajectories, summarized by day-night difference (ΔAge) into Restorative (>0.6 years) or Disrupted (≤0.6 years) phenotypes. Reproducibility was evaluated across sequential periods. Age- and sex-adjusted associations of binary and continuous ΔAge with LA volume index (LAVI) were pooled in a cross-sectional echocardiographic substudy (n=122).</p><p><strong>Results: </strong>Three trajectories emerged in both registries. Restorative prevalence was 47.6%-50.2%. Agreement between two consecutive 48-hour periods was 75.8% (κ = 0.516; 95% CI, 0.395-0.631); 6- to 8-day intraclass correlation coefficients were 0.51-0.54. The Disrupted phenotype was associated with higher LAVI (pooled mean difference, 5.54 mL/m²; 95% CI, 1.11-9.98; P = .014) and greater odds of LA enlargement (LAVI ≥40 mL/m²; pooled odds ratio, 3.68; 95% CI, 1.45-9.29; P = .006). Per 1-SD higher ΔAge, LAVI was lower (β, -2.89 mL/m²; P = .007) and LA enlargement less likely (odds ratio, 0.53; P = .004).</p><p><strong>Conclusion: </strong>Wearable-derived AI-ECG age exhibits a reproducible day-night pattern. A Disrupted phenotype is associated with adverse LA remodeling. Because reproducibility remains insufficient for individual-level classification, prospective outcome-based validation is warranted.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244305","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":"Transvenous Lead Extraction Without Dedicated Surgical Back up in Low-Risk Patients.","authors":"Wissam Mekary, Neal Bhatia, Faisal M Merchant, Mikhael F El-Chami","doi":"10.1016/j.hrthm.2026.10.042","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.042","url":null,"abstract":"<p><strong>Background: </strong>Transvenous lead extraction (TLE) is associated with major complications that could require immediate surgical rescue. These procedures are performed in an EP lab or hybrid OR with the presence of a surgical team on standby. We have designed an institutional protocol that permits performance of TLE in low-risk situations, in an EP lab without dedicated surgical back-up.</p><p><strong>Objectives: </strong>To investigate outcomes of TLE in low-risk patients METHODS: We retrospectively identified patients who underwent low-risk TLE at Emory Healthcare between 2010-23. Low-risk TLE were defined as an extraction of a pacing or ICD lead with a dwell time >= 1 and <= 5 years or a lead < 1 year that required extraction tools.</p><p><strong>Results: </strong>Among 482 patients who met the criteria, the average lead age was 2.8 ± 1.2 years. The mean number of targeted leads per patient was 1.6±0.7. Extraction tools were required in 33.1% of cases. Major complications occurred in 0.83% of patients (n=4): 2 pericardial effusions requiring pericardiocentesis, 1 pneumothorax and 1 death from cardiogenic shock in an end stage heart failure patient. The patients with pericardial effusions and pneumothorax were part of a procedure that required lead revisions and the insertion of 1 or more new leads. No patients required surgical rescue.</p><p><strong>Conclusion: </strong>This study suggests that, in selected \"low-risk\" patients, TLE can be performed safely in an experienced EP lab at centers with on-site cardiac surgery but without a dedicated surgical standby team, potentially reducing resource utilization in resource-limited healthcare environments.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244385","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":"Effect of telemedicine-based integrated management of atrial fibrillation in village clinics on recurrent nonfatal cardiovascular events: a secondary analysis of the MIRACLE-AF trial.","authors":"Wen Liu, Mingfang Li, Xiaolu Di, Ming Chu, Shimeng Zhang, Gang Yang, Zhihang Peng, Gregory Y H Lip, Minglong Chen","doi":"10.1016/j.hrthm.2026.10.037","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.037","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is an increasing public health challenge, particularly among rural older adults, where awareness and treatment remain inadequate. While the MIRACLE-AF trial demonstrated that telemedicine-based, village doctor-led integrated care reduced cardiovascular mortality or first major cardiovascular events, its impact on recurrent nonfatal cardiovascular events remains unknown.</p><p><strong>Objective: </strong>To evaluate the effect of the MIRACLE-AF care model on recurrent nonfatal cardiovascular events.</p><p><strong>Methods: </strong>We conducted a secondary analysis of the MIRACLE-AF trial (NCT04622514), a cluster-randomized controlled trial enrolling 1,039 rural patients aged ≥65 years with confirmed AF across 30 village clinics over 36 months. Village clinics were randomized 1:1 to village doctor-led telemedicine integrated care or enhanced usual care. The primary outcome was recurrent nonfatal events over 36 months, including strokes, hospitalizations for worsening heart failure or acute coronary syndrome, and emergency visits for AF, analyzed using a conditional frailty model.</p><p><strong>Results: </strong>Among 1039 patients (mean age 75.8 ± 5.7 years; 44.3% female), the intervention experienced fewer cardiovascular events than the control (118 events in 82 patients [15.65%] vs. 173 events in 122 patients [23.69%]). The observed recurrent event rates were 6.75 and 9.11 per 100 patient-years, respectively. The estimated hazard ratio was 0.76 (95% CI, 0.583-1.004; p = 0.053), indicating that the difference did not reach statistical significance.</p><p><strong>Conclusion: </strong>Although the overall difference did not reach statistical significance, directional trends consistently favored telemedicine-based integrated care, suggesting a potential reduction in recurrent cardiovascular event burden. Larger studies with longer follow-up are needed to confirm these findings.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244339","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":"A Technique for Slack Formation During Proximal Left Bundle Branch Pacing With a Lumenless Defibrillation Lead.","authors":"Yousaku Okubo, Shogo Miyamoto, Yukiko Nakano","doi":"10.1016/j.hrthm.2026.10.041","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.041","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244342","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":"Incidence, Modifiable Risk Factors, and Management of Cardiomyopathy After Ventricular Leadless Pacemaker Implantation.","authors":"Thomas Van Weyenbergh, Rik Willems, Gabor Vörös, Bert Vandenberk, Patricia Poels, Axel Dorrestijn, Christophe Garweg","doi":"10.1016/j.hrthm.2026.10.022","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.022","url":null,"abstract":"<p><strong>Background: </strong>Leadless ventricular pacemakers (LPM) provide only RV pacing, which may lead to pacing-induced cardiomyopathy (PICM). It is unclear whether LPM implant site or atrioventricular synchronous pacing using the Micra AV device influence PICM occurrence.</p><p><strong>Objective: </strong>To evaluate the incidence of cardiomyopathy after LPM implantation and explore the association of implant site and AV-synchronous pacing with cardiomyopathy risk and LVEF evolution.</p><p><strong>Methods: </strong>This single-center retrospective study included 401 patients implanted with an LPM (Micra AV n=145) between July 2015 and March 2025. PICM was defined as cardiomyopathy (≥10% LVEF decline to <50%) in the presence of >20% ventricular pacing, where pacing was considered the primary cause. Risk factors for cardiomyopathy and LVEF evolution were assessed using Cox regression and mixed-effects modelling.</p><p><strong>Results: </strong>Over a median follow-up of 33.0 months, all-cause cardiomyopathy occurred in 13.6% (4.8%/year), while PICM was identified in 5.5% (1.9%/year). RVOT implantation was independently associated with a lower incidence of all-cause cardiomyopathy (HR 0.48, P=0.019), and a slower LVEF decline (-0.56%/year vs -1.43%/year, P=0.013) compared with mid-septal implantation. Device type (Micra AV vs VR) was not associated with clinical outcomes or LVEF evolution. Among patients developing cardiomyopathy, 92.7% were medically treated, with 57.9% achieving ≥10% LVEF improvement, and 36.8% complete recovery. CRT upgrade was uncommon (7.3%).</p><p><strong>Conclusion: </strong>Cardiomyopathy occurred in a substantial proportion of LPM recipients. RVOT implantation was associated with lower cardiomyopathy incidence and slower LVEF decline, whereas Micra AV implantation did not improve clinical outcomes. However, higher AV synchrony was linked to slower LVEF deterioration.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238137","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":"Impact of Surrounding Fluid Impedance on Contact Sensing Vulnerabilities and Staining Depth During Pulsed Field Ablation.","authors":"Saki Yamano, Tetsuma Kawaji, Misaki Naka, Ryuta Ishida, Masashi Kato, Takafumi Yokomatsu, Shinji Miki","doi":"10.1016/j.hrthm.2026.10.025","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.025","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238161","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":"Temporal Changes in LGE-CMR Enhancement After Monopolar Biphasic Focal Pulsed Field Ablation for Pulmonary Vein Isolation.","authors":"Maximilian Moersdorf, Mathias Forkmann, Michel Abou-Khalil, Sonia Busch, Dominik Linz, Nassir Marrouche, Philipp Sommer, Christian Sohns, Christian Mahnkopf","doi":"10.1016/j.hrthm.2026.10.021","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.021","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) has emerged as a novel non-thermal ablation modality for pulmonary vein isolation (PVI) in atrial fibrillation (AF). While chronic lesion formation after PFA has been described, data regarding acute lesion characteristics and lesion maturation remain limited.</p><p><strong>Objective: </strong>To characterize acute and chronic lesion formation following focal point-by-point PFA for PVI using serial late-gadolinium-enhancement cardiovascular-magnetic-resonance-imaging (LGE-CMR).</p><p><strong>Methods: </strong>Six consecutive patients with symptomatic paroxysmal or persistent AF underwent index PFA-guided PVI using the CENTAURI system and a focal point-by-point lesion delivery strategy. LGE-CMR was performed 1 day and 90±10 days after ablation. Quantitative assessment of regional and global left atrial (LA) enhancement was performed using a standardized segmentation protocol. Changes in enhancement burden and LA dimensions were analyzed between imaging timepoints.</p><p><strong>Results: </strong>Among six patients at mean age 65±7 years, five patients (83%) had paroxysmal AF. Acute PVI was achieved in all patients without procedural complications. Serial LGE-CMR demonstrated substantial temporal changes between acute and chronic imaging. Enhancement within the right pulmonary vein (PV) region decreased from 3.3±2.2% to 0.8±0.8%(p=0.030), while the proportion of enhanced tissue decreased from 24.1±13.5% to 5.7±5.8%(p=0.017). Similar reductions were observed around the left PVs (4.4±3.1%vs.1.4±1.2%, p=0.064). Posterior wall enhancement decreased from 2.4±1.1% to 0.3±0.3%(p=0.007) and global LA enhancement from 12.8±6.2% to 3.3±1.6%(p=0.013), while LA volume remained unchanged.</p><p><strong>Conclusion: </strong>Serial LGE-CMR demonstrated substantial enhancement reduction of acute lesions following focal point-by-point PFA for PVI, which remained largely confined to the PV antra and adjacent posterior wall, providing novel in-human insights into lesion maturation following focal PFA delivery.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224128","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":"High-Frequency Electrograms Abolition as a Valuable Target for Remap During Ventricular Tachycardia Ablation. The HF REMAP Study.","authors":"Filippo Maria Cauti, Daniele Valente, Michele Magnocavallo, Nicolò Martini, Danilo Ricciardi, Francesco Fioravanti, Nikita Tanese, Pietro Rossi, Domenico Giovanni Della Rocca, Andrea Radinovic, Lorenzo Rampa, Federico Calore, Giovanni Peretto, Alberto Barengo, Paolo Della Bella","doi":"10.1016/j.hrthm.2026.10.020","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.020","url":null,"abstract":"<p><strong>Background: </strong>peak frequency (PF) analysis has recently emerged as a novel tool to assess electrogram properties through their frequency spectrum. PF is an indirect marker of local myocardial activity, and its reduction after radiofrequency ablation reflects effective tissue modification.</p><p><strong>Objective: </strong>our study aims to evaluate PF analysis as an objective method to validate lesion efficacy during ventricular tachycardia (VT) ablation.</p><p><strong>Methods: </strong>we retrospectively analyzed 43 (out of 247) consecutive patients who underwent VT ablation between January 2023 and December 2024, using the EnSite X mapping system with Advisor HD Grid catheter (Abbott, Minneapolis, USA). Complete pre- and post-ablation high-density sinus rhythm maps were obtained. PF analysis was applied offline to quantify the residual high-frequency (HF) electrogram burden, expressed as a percentage of the ablated area. Patients were stratified according to residual HF burden, and outcomes were assessed with Kaplan-Meier survival analysis and Cox regression analysis.</p><p><strong>Results: </strong>During a median follow-up of 372 days, 11 patients reached the primary endpoint (VT recurrence or arrhythmic storm). Patients with <70% residual HF post-ablation had significantly higher VT-free survival (≈90% at 12 months) compared to those with ≥70% residual HF (≈25%; log-rank p<0.001). Cox regression confirmed residual HF ≥70% as an independent predictor of recurrence (HR 13.36; 95% CI 3.52-50.7; p<0.001).</p><p><strong>Conclusion: </strong>PF analysis during re-mapping provides an operator-independent, reproducible tool to validate lesion efficacy. A low post-ablation residual HF burden is associated to a significantly increased VAs-free survival rate.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224090","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}