Journal of Arrhythmia最新文献

{"title":"Comment on “Utility of a Novel 12-Lead ECG Criterion for Localizing Manifest Right-Sided Accessory Pathways: A Derivation Study”","authors":"Sidra Afzal,&nbsp;Nimra Afzal,&nbsp;Sana Afzal","doi":"10.1002/joa3.70338","DOIUrl":"10.1002/joa3.70338","url":null,"abstract":"<p>We read with great interest the recent study proposing the PR/QRS ratio as a new ECG criterion for locating manifested right-sided accessory pathways (APs) [<span>1</span>] The effort to improve noninvasive localization of APs, especially high-risk septal pathways, is commendable. It impacts patient counseling, procedural planning, and risk reduction.</p><p>While the study shows promising accuracy at 88.8% with a strong area under the curve of 0.878, several methodological and clinical considerations need discussion.</p><p><i>1: Derivation Without External Validation</i>: The study used a single-center group to derive the PR/QRS ratio. Prediction models developed in one dataset are likely to overfit, which can inflate reported accuracy. External validation in independent populations is important to see if the measure works reliably across different patient groups [<span>2</span>].</p><p><i>2: Comparative Benchmarking</i>: The authors did not directly compare the PR/QRS ratio with established ECG localization algorithms, as shown in previous studies [<span>3</span>] It is important to determine whether the new criterion provides additional value over existing methods to evaluate its clinical usefulness.</p><p><i>3: Sample Characterization</i>: Right-sided APs include sub-regions: anteroseptal, mid-septal, and posteroseptal. The distribution of these subtypes can impact diagnostic accuracy. If some subtypes are underrepresented, the reported sensitivity and specificity might not show real-world performance. Offering detailed subgroup data would help clarify generalizability.</p><p><i>4: Inter-observer Reproducibility</i>: ECG measurements, especially QRS and PR intervals, are subject to intra and inter-observer variability. Without formal evaluation, the reliability of this criteria in daily clinical practice remains unclear.</p><p><i>5: Clinical Applicability and Limitations</i>: One reason the PR/QRS ratio works well—hitting 88.8% accuracy—is it responds clearly to typical patterns. Yet when hearts already show damage or odd electrical signals, how it behaves remains unclear [<span>4</span>]. Past attempts found location predictions often miss the mark under those conditions [<span>5</span>]. That uncertainty means testing must come first, especially where anatomy complicates readings.</p><p>Putting it together, the PR/QRS ratio offers a fresh take on an issue doctors face every day. Tackling those earlier concerns—like testing in outside settings, how it stacks up against current methods, consistent results across trials, and its behavior in different patient groups—could make this work more likely to move into real-world care without risk.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p><p>Data sharing not applicable to this article as no datasets were generated or analysed during the current study.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70338","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147668565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial Fibrillation Ablation in Patients With Heart Failure and Preserved Ejection Fraction: Faux Pas, Great Absences, and New Hopes","authors":"Nicola Tarantino,&nbsp;Samuel J. Apple,&nbsp;Luigi Di Biase","doi":"10.1002/joa3.70321","DOIUrl":"10.1002/joa3.70321","url":null,"abstract":"&lt;p&gt;We read with great interest the updated metanalysis by Wani et al. [&lt;span&gt;1&lt;/span&gt;] of catheter ablation for atrial fibrillation (AF) in patients with heart failure with preserved ejection fraction.&lt;/p&gt;&lt;p&gt;The authors include a larger population and more soberly acknowledge the limitations of the findings compared to prior work. Their results provide reassurance to clinicians concerned about worsening left ventricular diastolic dysfunction following AF ablation, as shown by a reduction in heart failure hospitalizations, which aligns with previous observations of transient left atrial dysfunction.&lt;/p&gt;&lt;p&gt;Despite these strengths, some conceptual and methodological challenges remain similar to those observed in a previous analysis and merit further consideration.&lt;/p&gt;&lt;p&gt;First and foremost, the authors attribute the reduction in stroke incidence solely to the restoration of sinus rhythm. We would like to highlight a different perspective: a &lt;i&gt;mediator&lt;/i&gt; exists between the intervention and the outcome. Patients who undergo catheter ablation may be more likely to attend closer follow-up visits that emphasize adherence to oral anticoagulants. Similar adherence differences have been observed in patients undergoing percutaneous coronary intervention, rather than medical therapy alone, for acute coronary syndrome [&lt;span&gt;2&lt;/span&gt;]. Post-operative follow-up visits, therefore, may &lt;i&gt;mediate&lt;/i&gt; this association. In addition, patients selected for catheter ablation may be more likely to comply with medical recommendations, potentially introducing &lt;i&gt;adherence bias&lt;/i&gt;. Thus, the observed reduction in stroke may reflect both rhythm control and differences in follow-up intensity and patient selection.&lt;/p&gt;&lt;p&gt;Second, the review does not adequately address procedural safety. Although all-cause hospitalization might be a surrogate marker of post-operative comorbidity, it does not really address the question of how much riskier the ablation is compared to medical management in this population. Although there are discrepancies in the burden and types of complications with medical management, making a direct comparison incongruent, at least three cited articles reported data on safety outcomes [&lt;span&gt;3-5&lt;/span&gt;]. While insufficient for pooled analysis, a descriptive summary would have offered a more balanced assessment of both benefits and risks.&lt;/p&gt;&lt;p&gt;Third, the analysis of AF recurrence reports results that appear inconsistent with clinical practice. Besides the misinterpretation of the &lt;i&gt;p&lt;/i&gt;-value = 0.11 in the paragraph “AF recurrence”, which was then appropriately reworded in the “Discussion”, it is also relevant that 13.2% of the cohort analyzed by Xie et al. was treated with surgical ablation, and 62% of the patients from the same cohort had persistent AF [&lt;span&gt;3&lt;/span&gt;]. Furthermore, the study by Patel et al. [&lt;span&gt;6&lt;/span&gt;] includes data from 2010 onward, encompassing an era marked by little to no literature on contact force catheters, ablation indice","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70321","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147668343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A New Mechanistic Insight Into Macro-Reentrant Atrial Tachycardia in a Patient With Modified Fontan Circulation","authors":"Peter C. Murray,&nbsp;Intisar Ahmed,&nbsp;Krishnakumar Nair","doi":"10.1002/joa3.70334","DOIUrl":"10.1002/joa3.70334","url":null,"abstract":"<p>Fontan flutter: an unusual example of an atrial tachycardia circuit in a patient with atrio-pulmonary connection (APC) conduit. The tachycardia circuit propagates around the base of the conduit (encircled by the arrows, showing direction of propagation from earliest [red] to latest [purple]). Radiofrequency ablation was delivered (red dots) and tachycardia terminated on ablation at the green arrow.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70334","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147668280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caution in Interpreting the Absence of Appropriate ICD Therapies in Pediatric Primary Prevention","authors":"Sami Ullah Khan,&nbsp;Syed Huzaifa Khan,&nbsp;Muhammad Faizan Khan","doi":"10.1002/joa3.70332","DOIUrl":"10.1002/joa3.70332","url":null,"abstract":"&lt;p&gt;We read with interest the article by Bjeloševič et al. [&lt;span&gt;1&lt;/span&gt;], describing a 14-year nationwide experience with implantable cardioverter-defibrillator (ICD) implantation in pediatric patients. The authors supply valuable data on indications, complications, and outcomes in a relatively underrepresented European setting. However, we wish to raise several methodological considerations that merit further discussion.&lt;/p&gt;&lt;p&gt;First, caution is warranted when interpreting the absence of appropriate ICD shocks in the primary-prevention subgroup. While the study suggests that the lack of observed therapies may reflect uncertainty regarding the benefit of ICD implantation for primary prevention, it is also notable that the primary prevention group included only 10 patients with relatively limited follow-up. Such small cohorts may be underpowered to reliably detect ventricular arrhythmias, which are clinically important but often occur at low absolute rates among pediatric populations. As a result, the absence of observed shocks might reflect constraints on sample size and follow-up duration rather than provide evidence against the effectiveness of primary-prevention ICD therapy. Previous registry analyses of pediatric ICD recipients have demonstrated that appropriate device therapies occur at relatively low rates and are often captured only with larger populations and longer observation periods [&lt;span&gt;2, 3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Second, the substantial heterogeneity of underlying cardiac conditions within the cohort may further limit the understandability of the reported outcomes. The study population included patients with diverse diagnoses such as long QT syndrome, hypertrophic cardiomyopathy, catecholaminergic polymorphic ventricular tachycardia, and congenital heart disease, each linked with markedly different arrhythmic risks and clinical trajectories. Pooled analysis without disease-specific stratification may therefore substantially confound the observed incidence of appropriate ICD therapies. Contemporary investigations have emphasized the importance of disease-specific analyses in pediatric ICD populations, particularly as evolving device programming strategies continue to influence shock incidence [&lt;span&gt;4, 5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In brief, this nationwide cohort yields valuable data collected on pediatric ICD implantation. However, the absence of appropriate therapies in the primary-prevention subgroup should be interpreted cautiously, given the limited sample size and follow-up duration, while the heterogeneous disease composition of the cohort may independently confound outcome estimates. These considerations accentuate the importance of adequately powered, disease-specific analyses when evaluating the effectiveness of ICD therapy in pediatric primary prevention.&lt;/p&gt;&lt;p&gt;All authors have read and approved the final manuscript.&lt;/p&gt;&lt;p&gt;The authors have nothing to report.&lt;/p&gt;&lt;p&gt;Transparency statement: The corresponding author (Sami Ullah Khan) affirms th","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70332","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147668330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dancing Leadless Pacemaker: Dislodgement of a Ventricular Screw-In Leadless Pacemaker Driven by Severe Tricuspid Regurgitation","authors":"Kazuki Shimojo,&nbsp;Itsuro Morishima,&nbsp;Yasunori Kanzaki","doi":"10.1002/joa3.70335","DOIUrl":"10.1002/joa3.70335","url":null,"abstract":"<p>Following successful right ventricular septal fixation, the leadless pacemaker abruptly dislodged under the influence of a severe tricuspid regurgitant jet. Alternating regurgitant and inferior vena cava inflow forces produced a characteristic to-and-fro oscillation between the right atrium and inferior vena cava, with eventual successful retrieval after migration into the distal coronary sinus.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13057419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Transmural Lesion Formation and Steam-Pop Occurrence During Bipolar Ablation—Ex Vivo Porcine Model","authors":"Hisaki Makimoto,&nbsp;Masashi Kamioka,&nbsp;Tomonori Watanabe,&nbsp;Hiroaki Watanabe,&nbsp;Toshiya Kakurai,&nbsp;Naoki Suda,&nbsp;Takafumi Okuyama,&nbsp;Ayako Yokota,&nbsp;Takahiro Komori,&nbsp;Tomoyuki Kabutoya,&nbsp;Asuka Makimoto,&nbsp;Yasushi Imai,&nbsp;Kazuomi Kario","doi":"10.1002/joa3.70337","DOIUrl":"10.1002/joa3.70337","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Bipolar radiofrequency (RF) ablation can create deeper myocardial lesions than unipolar ablation, yet its optimal settings remain undefined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To develop and validate predictive models for lesion transmurality and steam-pop occurrence during bipolar ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ex vivo bipolar ablation was applied to porcine myocardium (5–20 mm thickness) with catheters placed bilaterally at 45-degree and 10-g contact-force. RF power (20–50 W) and duration (20–180 s) were systematically varied. Generalized linear models (GLM) were trained on 194 applications to predict transmurality and steam-pop from RF energy, tissue thickness, initial bipolar impedance, 5-s impedance drop (absolute and percentage [PercentImpDrop5]), and RF duration; 111 independent applications served as the validation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Training yielded 95 transmural lesions (49%) and 11 steam-pops (5.7%). For transmurality, the model incorporating RF energy, RF duration, initial impedance, and tissue thickness achieved an area under the receiver-operating characteristics curve (AUC) of 0.95 (95% CI 0.91–0.99) with 88% sensitivity and 100% specificity. Omitting tissue thickness markedly degraded performance (AUC 0.68; DeLong, <i>p</i> = 0.003). For steam-pop, the model combining RF energy and PercentImpDrop5 showed the best discrimination (AUC 0.90 [0.82–0.97], sensitivity 84%, specificity 90%); notably, PercentImpDrop5 alone achieved comparable accuracy (AUC 0.89).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Tissue thickness is the dominant determinant of transmural lesion formation, whereas early impedance drop serves as a reliable real-time indicator of steam-pop risk during bipolar RF ablation. These algorithms may help standardize bipolar ablation protocols by enabling prospective titration of energy delivery based on tissue characteristics and intraprocedural impedance monitoring.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Not All “Idiopathic” PVCs Are Benign: Concealed Long QT Syndrome Unmasked by RVOT PVC Ablation","authors":"Khuong Dang Tran,&nbsp;Ngoc Dinh Son Nguyen,&nbsp;Li-Wei Lo,&nbsp;Son Cao Luong","doi":"10.1002/joa3.70330","DOIUrl":"10.1002/joa3.70330","url":null,"abstract":"<p>A young woman undergoing ablation for presumed idiopathic RVOT PVC developed torsades de pointes and was diagnosed with concealed LQT1. Subtle rate-dependent repolarization abnormalities on pre-ablation ECG may signal LQT1; careful ECG scrutiny is essential before intervention, as not all PVCs from the RVOT are benign.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Two ICE-Guided Transseptal Puncture Strategies for Zero-Fluoroscopy AF Ablation—A Randomized Controlled Trial","authors":"Chun-Kai Chen,&nbsp;An-Li Yu,&nbsp;Su-Huan Chang,&nbsp;Yen-Siou Chen,&nbsp;Chih-Chieh Yu,&nbsp;Ling-Ping Lai","doi":"10.1002/joa3.70322","DOIUrl":"10.1002/joa3.70322","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Transseptal puncture (TSP) is a critical step in left atrial (LA) access for atrial fibrillation (AF) ablation. Intracardiac echocardiography (ICE) combined with electroanatomical mapping now enables zero-fluoroscopy TSP in experienced practice. Two ICE-guided TSP strategies are used in contemporary clinical settings; however, their efficiency, safety, and learning curves have not been directly compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective randomized controlled trial was conducted at National Taiwan University Hospital between February 2023 and April 2024. Patients undergoing first-time AF ablation were randomized to two TSP strategies: Protocol A advanced the transseptal sheath from the superior vena cava to the fossa ovalis under ICE guidance, whereas Protocol B used a mapping catheter to identify the fossa and guide sheath positioning. Procedural duration, TSP metrics, and learning curve were assessed. Patients were followed for periprocedural complications and AF recurrence for one year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-three patients were enrolled (mean age 63.2 ± 9.8 years, 72.1% male). Zero fluoroscopy was achieved in all procedures, with no complications or crossover. Protocol A demonstrated shorter initial TSP times than Protocol B (8.5 ± 3.7 vs. 12.0 ± 5.4 min, <i>p</i> = 0.018). Protocol B exhibited a steeper learning curve, achieving comparable efficiency after approximately 10 cases. Both strategies achieved successful LA access and 100% pulmonary vein isolation, with no differences in complication rates or one-year AF recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Both ICE-guided strategies are safe and effective for zero-fluoroscopy TSP. Protocol A offers greater early efficiency, whereas Protocol B demonstrates rapid adaptability, supporting practical positioning of these complementary strategies in radiation-free AF ablation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right Bundle Branch Conduction in Left Bundle Branch Area Pacing","authors":"Takefumi Fujito,&nbsp;Kento Erata,&nbsp;Naoto Noumura,&nbsp;Atsushi Mochizuki,&nbsp;Masato Furuhashi","doi":"10.1002/joa3.70331","DOIUrl":"10.1002/joa3.70331","url":null,"abstract":"<p>The electrical activation during left bundle branch area pacing can penetrate into the right bundle branch, resulting in right ventricular activation. These findings suggest that conventional ECG indicators for confirming left bundle branch capture should be reconsidered when the right bundle branch contributes to right ventricular activation.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Efficacy of Pulsed Field Ablation for Atrial Fibrillation in Older Patients: An Observational Study at a Large Tertiary Centre in Australia","authors":"Francis J. Ha,&nbsp;Duron Prinsloo,&nbsp;Hui Chen Han,&nbsp;Nitesh Nerlekar,&nbsp;Adam J. Brown,&nbsp;Emily Kotschet","doi":"10.1002/joa3.70336","DOIUrl":"10.1002/joa3.70336","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Older patients have been under-represented in clinical trials of atrial fibrillation (AF) ablation. The safety of pulsed field ablation (PFA) in this cohort is not known.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted an observational study of consecutive patients undergoing PFA with a pentaspline catheter (Farapulse, Boston Scientific) for AF at a tertiary centre comparing procedural and clinical outcomes in patients aged ≥ 75 years (older cohort) versus &lt; 75 years (younger cohort). Baseline demographics, procedural characteristics, complications, and clinical outcomes were collected. Arrhythmia recurrence was defined as AF, atrial flutter, or atrial tachycardia &gt; 30 s at any follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>564 consecutive patients underwent de novo PFA for AF between 2022 and 2025; 65 patients were aged ≥ 75 years (11.5%) (median age 77 years; younger cohort median age 62 years). The older cohort had a higher incidence of hypertension, vascular disease, lower eGFR, and lower body mass index (<i>p</i> &lt; 0.01 for all). There was no difference in lesion set or procedural time. There was no difference in overall major procedural complications (1.5%–1.6%; <i>p</i> = 0.97); however, older patients had more major vascular complications (3.1% vs. 0.2%; <i>p</i> = 0.003), pulmonary oedema (3.1% vs. 0.4%; <i>p</i> = 0.02), and transient renal impairment when assessed (<i>p</i> = 0.007). At median follow-up 6.3–7.0 months, there was no difference in freedom from arrhythmia recurrence between the older and younger cohorts (69.8% and 73.2%; <i>p</i> = 0.66).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pulsed field ablation for AF can be performed in older patients with acceptable procedural safety and clinical outcomes. Clinical trials are needed to further determine the safety and efficacy of PFA in older patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13052308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}