Journal of Arrhythmia最新文献

{"title":"Posterior Wall Involvement During Pulmonary Vein Isolation Using the Farapulse System.","authors":"Maria Teresa Izquierdo de Francisco, Josep Navarro-Manchon, Oscar Cano Perez, Javier Navarrete Navarro, Carmen Arveras Martinez, Fransciso Javier Chorro Gasco, Luis Martinez-Dolz, Joaquin Osca Asensi","doi":"10.1002/joa3.70171","DOIUrl":"10.1002/joa3.70171","url":null,"abstract":"<p><strong>Background: </strong>First approved PFA (Pulsed-Field-Ablation) system for pulmonary vein isolation (PVI) has been Farapulse PFA system. The aim was to assess the characteristics of the lesion made by the Farapulse system and its influence on the clinical results.</p><p><strong>Methods: </strong>First 76 consecutive patients referred for PVI and treated with the Farapulse PFA system were included. A voltage and an activation map were performed before and after PVI. An imaginary middle line was measured between the two carinas. Fusion on the posterior wall was defined when the contralateral ablation areas were connected. We arbitrarily defined a narrow corridor as one that measured < 20 mm of healthy tissue (voltage > 0.5 mV).</p><p><strong>Results: </strong>Post-PVI mapping revealed an unexpected narrow corridor in the posterior wall in 12 (15%) and fusion in 18 (23%) patients. The multivariate analysis revealed that the only independent predictor was the length of the middle inter-carinas line. The length of the middle posterior line was significantly shorter in patients with affectation of the posterior wall (62 ± 2 vs. 71 ± 3 mm, <i>p</i> = 0.0001). ROC curve showed that a middle line cutoff value of 65 mm offered a sensitivity and specificity of 80% and 70% (AUC: 0.82; 95% CI: 0.59-0.84). A corridor < 10 mm is associated with slow conduction velocity below 0.7 m/s, but narrow corridor or fusion were not associated with atrial fibrillation recurrences.</p><p><strong>Conclusions: </strong>30 (40%) patients showed narrow corridor or fusion on the posterior wall. The only independent predictor was the length of the middle inter-carina line.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":"e70171"},"PeriodicalIF":1.7,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816737","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":"Critique on \"Impact of Catheter Ablation for Ventricular Tachycardia on Left Ventricular Ejection Fraction in Patients With Structural Heart Disease\".","authors":"Romaisa Kunwar, Maira Hamid, Javed Iqbal, Brijesh Sathian","doi":"10.1002/joa3.70165","DOIUrl":"10.1002/joa3.70165","url":null,"abstract":"","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":"e70165"},"PeriodicalIF":1.7,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12332181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816736","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":"Unipolar Signal Augmentation as a Novel Marker of Tissue Contact in Pulsed Field Ablation.","authors":"Yasuyuki Takada, Junichi Kamoshida, Muryo Terasawa, Kazuhiro Satomi, Yoshinao Yazaki","doi":"10.1002/joa3.70168","DOIUrl":"10.1002/joa3.70168","url":null,"abstract":"<p><p>A positive deflection following the atrial P wave in unipolar electrograms serves as a practical surrogate marker for catheter-tissue contact during pulsed field ablation; correlating with effective lesion formation across diverse anatomical regions.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":"e70168"},"PeriodicalIF":1.7,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816739","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":"Sex Differences in Impacts of Alcohol Consumption on Prevalent Atrial Fibrillation.","authors":"Yasuharu Matsunaga-Lee, Yasuyuki Egami, Ayako Sugino, Noriyuki Kobayashi, Masaru Abe, Hiroaki Nohara, Shodai Kawanami, Koji Yasumoto, Naotaka Okamoto, Masamichi Yano, Masami Nishino","doi":"10.1002/joa3.70169","DOIUrl":"10.1002/joa3.70169","url":null,"abstract":"<p><strong>Background: </strong>High levels of alcohol consumption are a well-established risk factor for atrial fibrillation (AF). Although women currently tend to regulate alcohol intake more strictly than men, it remains unclear whether alcohol consumption should be regulated differently between sexes to prevent AF. This study investigated sex differences in alcohol-related AF risk.</p><p><strong>Methods: </strong>Among 224 759 admissions in the Inpatient Clinico-Occupational Database of the Rosai Hospital Group (ICOD-R) from 32 hospitals across Japan in 2021, 123 852 participants were included. Using this cross-sectional dataset based on information collected at the time of hospital admission, associations between prevalent AF and alcohol consumption data, including drinking frequency, daily average drinks, and lifetime total alcohol intake, were investigated in women and men.</p><p><strong>Results: </strong>Women comprised 49% of participants; 3.7% had prevalent AF. Frequent drinking (≥ 4 days/week), high daily intake (≥ 2 drinks/day), and high lifetime consumption (≥ 65 drink-years) were associated with increased prevalent AF in both sexes. In men, low daily intake (< 2 drinks/day) (OR 1.21, 95% CI 1.09-1.34) and low lifetime consumption (< 65 drink-years) (OR 1.22, 95% CI 1.10-1.36) were linked to prevalent AF, but not in women. Significant sex interactions were observed in the association between alcohol intake and prevalent AF (drinking frequency: <i>p</i> = 0.035; lifetime total intake: <i>p</i> = 0.004).</p><p><strong>Conclusion: </strong>This large-scale study did not find that men had a lower risk of prevalent AF at lower levels of alcohol consumption compared to women. The more lenient alcohol consumption limits currently applied to men, relative to women, may warrant reconsideration.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":"e70169"},"PeriodicalIF":1.7,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12331870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816738","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":"Toward ED Based Cardio Oncology Pathways From a Nationwide Arrhythmia Cohort","authors":"Yalcin Golcuk","doi":"10.1002/joa3.70167","DOIUrl":"https://doi.org/10.1002/joa3.70167","url":null,"abstract":"&lt;p&gt;The landmark study by Kobayashi and Kusano [&lt;span&gt;1&lt;/span&gt;] provides invaluable insights into arrhythmia patterns among cancer patients using Japan's nationwide JROAD-DPC database. Despite the rising incidence of cardiovascular complications in oncology patients, few large-scale studies have examined arrhythmia profiles across cancer subtypes and treatment trajectories in real-world emergency settings. As emergency physicians (EPs) managing acute cardio-oncologic complications, we commend this study and wish to highlight three findings with critical implications for emergency care, along with opportunities to strengthen clinical translation.&lt;/p&gt;&lt;p&gt;The significantly higher rate of emergency admissions among cancer patients with arrhythmias (58.9% vs. 57.6% in non-cancer patients; &lt;i&gt;p&lt;/i&gt; &lt; 0.05) underscores a growing challenge for emergency departments (EDs). This finding aligns with global trends showing increasing cardiovascular emergencies related to malignancy due to aging populations and the widespread use of cardiotoxic therapies [&lt;span&gt;2&lt;/span&gt;]. However, the underlying factors contributing to these admissions—whether related to arrhythmia severity, cancer progression, or gaps in outpatient care—remain insufficiently explored. Clarifying these drivers could enable the implementation of targeted interventions such as rapid-access cardio-oncology clinics or ED-based clinical triggers, including recurrent arrhythmia or recent chemotherapy exposure, for early cardiology consultation.&lt;/p&gt;&lt;p&gt;The predominance of atrial fibrillation or flutter (AF/AFL) among cancer-associated arrhythmias, comprising 70.6% of cases, has direct implications for acute management in the ED [&lt;span&gt;3&lt;/span&gt;]. While the authors report lower anticoagulant use among cancer patients, EPs frequently face complex therapeutic dilemmas. Rhythm control may be constrained by QT-prolonging chemotherapies, and anticoagulation decisions must be cautiously balanced against risks of bleeding, especially in the context of thrombocytopenia or mucosal tumors. ED-specific algorithms would benefit from integrating oncology-informed variables such as current drug profiles, platelet counts, and malignancy characteristics to individualize AF management.&lt;/p&gt;&lt;p&gt;The observed frequencies of pneumonia (7.41%) and sepsis (2.26%) as clinical triggers for arrhythmia underscore the role of systemic inflammation in acute cardiac dysrhythmias. In the ED, febrile presentations in oncology patients often signal infection-related arrhythmogenic potential [&lt;span&gt;4&lt;/span&gt;]. Embedding arrhythmia screening protocols, such as mandatory electrocardiograms for patients with febrile neutropenia, within sepsis bundles may support early detection of tachyarrhythmias and timely antimicrobial or hemodynamic intervention.&lt;/p&gt;&lt;p&gt;This study's use of nationwide claims data effectively captures broad epidemiologic trends; although coding limitations restrict the granularity of arrhythmia etiology and disease trajecto","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70167","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144782277","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":"Letter to the Editor Regarding “Differing Impacts of Cardiac Implantable Electronic Device Leads on Tricuspid Regurgitation”","authors":"Syed Sardar Shah,&nbsp;Ziad Khan,&nbsp;Attiq Ur Rehman,&nbsp;Shah Nawaz,&nbsp;Saleem Jan","doi":"10.1002/joa3.70162","DOIUrl":"https://doi.org/10.1002/joa3.70162","url":null,"abstract":"<p>I read with great interest the recent article by Leon, S. A., Austin, M. A., Parikh, C., Ahmad, D., Tchantchaleishvili, V., and Pavri, B. B. titled “Differing impacts of cardiac implantable electronic device leads on tricuspid regurgitation” (<i>Journal of Arrhythmia</i> 2025;41:e70133). Their insights into how different types and positions of CIED leads can affect the heart are truly valuable. I appreciate that they acknowledged the study's limitations, such as relying on a single operator, the retrospective design, and the small number of participants [<span>1</span>]. However, I believe there are a few more points worth considering to fully understand and interpret their findings. I hope that future studies can address these concerns, perhaps through prospective, multicenter designs with standardized imaging and detailed device information, which would really help clarify the actual impact of CIED leads on how the tricuspid valve functions. I commend the authors for their significant contribution to this field and encourage further exploration of this important clinical topic.</p><p>Here are some additional thoughts:</p><p>The ICD group had significantly lower baseline left ventricular ejection fraction (LVEF) and higher rates of right ventricular (RV) dilation and dysfunction compared to the pacemaker groups. These pre-existing structural abnormalities are well-known contributors to functional tricuspid regurgitation (TR) and may complicate the relationship between device lead type and TR progression. Without multivariable adjustment, the worsening TR observed may reflect disease severity rather than lead characteristics [<span>2, 3</span>].</p><p>The broad grouping of devices into ICD, RV-PM, and His-PM overlooks differences in lead design, number of coils, stiffness, and positioning. Different lead models or materials may exert varied mechanical forces on the tricuspid apparatus. A more detailed device-level analysis would provide much clearer conclusions [<span>4</span>].</p><p>TR severity was classified based on echocardiographic reports using qualitative terms (mild, moderate, severe), which are inherently subjective. Current guidelines recommend more precise multiparametric quantification (e.g., vena contracta width, PISA method), which reduces interobserver variability and misclassification bias [<span>5</span>].</p><p>The interval between device implantation and follow-up echocardiography varied significantly from 11 to 47 months. This inconsistency introduces a potential confounding factor from interim clinical events, such as heart failure progression or medication changes, which may influence TR severity independently of the device [<span>6</span>].</p><p>The authors declare no conflicts of interest.</p><p>Leon SA, Austin M, Nasher N et al., “Differing Impacts of Cardiac Implantable Electronic Device Leads on Tricuspid Regurgitation,” <i>Journal of Arrhythmia</i>, https://doi.org/10.1002/joa3.70133.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70162","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144782766","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":"The Utility of Notched P-Wave on the Occurrence of Ventricular Fibrillation in Patients With Brugada Syndrome.","authors":"Keisuke Yonezu, Tetsuji Shinohara, Masaki Takahashi, Taisuke Harada, Kazuki Mitarai, Masayuki Takano, Kei Hirota, Ichitaro Abe, Hidekazu Kondo, Akira Fukui, Hidefumi Akioka, Yasushi Teshima, Naohiko Takahashi","doi":"10.1002/joa3.70164","DOIUrl":"10.1002/joa3.70164","url":null,"abstract":"<p><strong>Background: </strong>Risk stratification for ventricular fibrillation (VF) in patients with Brugada syndrome (BrS) remains a significant clinical challenge. Atrial fibrillation (AF) is relatively common in BrS, suggesting arrhythmogenic abnormalities in both the atria and ventricles. The purpose of this study was to investigate the relationship between P-waveforms and VF occurrence in patients with BrS.</p><p><strong>Method: </strong>Eighty-two patients with BrS were retrospectively evaluated and classified into two groups based on the occurrence of VF during the overall clinical course: VF occurrence (<i>n</i> = 34) and VF nonoccurrence (<i>n</i> = 48). The relationship between VF occurrence and parameters on 12-lead electrocardiogram (ECG) at the initial visit, prior to any drug administration, was analyzed.</p><p><strong>Results: </strong>During a median follow-up of 75.0 months, VF occurred in 23 patients, including 19 recurrent and four new cases. Multivariable logistic regression identified notched P-wave as an independent risk factor for VF occurrence in all models (odds ratios 6.45-8.45; all <i>p</i> < 0.01). Depending on the model, symptomatic BrS, early repolarization pattern, and fragmented QRS were also independently associated with VF. Kaplan-Meier analysis showed a significantly lower incidence of VF in patients with BrS who have neither a history of VF nor a notched P-wave (<i>p</i> < 0.0001).</p><p><strong>Conclusions: </strong>Notched P-wave on 12-lead ECG is a significant risk factor for the occurrence of VF in patients with BrS. Notched P-wave in patients with BrS may indicate the presence of an underlying arrhythmogenic substrate predisposing to VF.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":"e70164"},"PeriodicalIF":1.7,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12328242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799178","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":"Incidence of Rapid Rate Non-Sustained and Sustained Ventricular Tachycardia in Implantable Cardioverter-Defibrillator Recipients and Its Correlation With Heart Failure Guideline-Directed Medical Therapy Compliance","authors":"Muhammad Taha Khan,&nbsp;Ghazala Irfan,&nbsp;Sarim Ansari,&nbsp;Zubair Mumtaz,&nbsp;Faisal Qadir,&nbsp;Azam Shafquat","doi":"10.1002/joa3.70156","DOIUrl":"https://doi.org/10.1002/joa3.70156","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ventricular arrhythmias are prevalent among heart failure with reduced ejection fraction (HFrEF) patients. Rapid rate non-sustained ventricular tachycardia (RR-NSVT) and sustained ventricular tachycardia (VT) can be detected on implantable cardioverter-defibrillator (ICD) interrogation due to discrimination algorithms that differentiate supra-ventricular from ventricular tachycardia. This study aims to assess the incidence of RR-NSVT and sustained VT on ICD interrogation and their correlation with HFrEF guideline-directed medical therapy (GDMT) compliance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p><i>Design</i>Cross-sectional, analytical study. <i>Setting</i>Heart rhythm device clinic, Electrophysiology department, National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. <i>Participants</i>Patients implanted with dual chamber ICD or cardiac resynchronization therapy defibrillator (CRT-D), aged 18 years or above with HFrEF. <i>Outcome Measure</i>Covariates included demographics, comorbidities, medications, GDMT compliance, and cardiac rhythm device parameters. Incidence of RR-NSVT, sustained VT, and their correlation with HFrEF GDMT compliance was assessed using multivariate logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Study evaluated 139 patients. Men 77.7%. The mean age was 56.4 ± 13.9 years. The mean LV ejection fraction was 26.4% ± 5.5%. 109 (78.4%) were GDMT compliant (94.3% on beta-blockers, 93.5% on renin-angiotensin inhibitors, 71.9% on aldosterone antagonists, and 15.8% on SGLT-2 inhibitors). RR-NSVT episodes were observed in 54 (38.8%) patients, out of whom 37 had RR-NSVT despite GDMT compliance, although this correlation was not statistically significant. Twelve (8.6%) patients had sustained VT, which was significantly less common with GDMT compliance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>More than one-third of participants had RR-NSVT episodes despite HFrEF GDMT compliance. These patients also had associated sustained VT episodes, the occurrence of which was significantly less with GDMT compliance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70156","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144782767","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":"Pulsed-Field Ablation Versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation: A Systematic Review and Meta-Analysis","authors":"Inês Martins Esteves,&nbsp;Vinicius Bittar de Pontes,&nbsp;Thierry Trevisan,&nbsp;Sebastian Jaramillo,&nbsp;Wilton F. Gomes","doi":"10.1002/joa3.70158","DOIUrl":"https://doi.org/10.1002/joa3.70158","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pulsed-field ablation (PFA) is a nonthermal alternative to radiofrequency ablation (RFA) for patients with atrial fibrillation (AF). However, the role of PFA compared to RFA in patients with paroxysmal AF (PAF) remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the efficacy and safety of PFA and RFA in adult patients with PAF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis were conducted following the Cochrane methodology and reported in accordance with PRISMA guidelines. The PubMed, Embase, and Cochrane databases were searched through February 2025 for studies comparing PFA and RFA in adults with PAF. The outcomes of interest included procedure time, 1-year success rate, and major complications. All the statistical analyses were performed via R version 4.5 with a random effects model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One randomized controlled trial (RCT) and five observational studies comprising 3163 patients with PAF were included, of whom 972 (30.7%) underwent PFA. The follow-up time ranged from 12 to 30 months. PFA was associated with a significantly shorter procedure time (MD –39.15 min; 95% CI –58.19 to −20.11, <i>p</i> &lt; 0.01), but a significantly longer fluoroscopy time (MD 10.75 min; 95% CI 5.58–15.92, <i>p</i> &lt; 0.01) as compared with RFA. There were no statistically significant differences in terms of the 1-year success rate (RR 1.04; 95% CI 0.77–1.41, <i>p</i> = 0.79) and major complications (RR 0.95; 95% CI 0.60–1.52, <i>p</i> = 0.83) between PFA and RFA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this meta-analysis, PFA was associated with a reduced operative time and an increased fluoroscopy time, with comparable 1-year efficacy and overall safety profiles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>PROSPERO number: CRD420251000165</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70158","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767481","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":"Management of device embolization following left atrial appendage closure: Two cases and a review of the literature","authors":"Ahmet Kivrak MD,&nbsp;Ahmet Hakan Ates MD,&nbsp;Ugur Canpolat MD,&nbsp;Mert Dogan MD,&nbsp;Cem Coteli MD,&nbsp;Hikmet Yorgun MD,&nbsp;Mehmet Levent Sahiner MD,&nbsp;Ergun Barıs Kaya MD,&nbsp;Kudret Aytemir MD","doi":"10.1002/joa3.70139","DOIUrl":"https://doi.org/10.1002/joa3.70139","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Device embolization (DE) following left atrial appendage closure (LAAC) is a severe but uncommon complication, and limited data address optimal management strategies for this condition. This review presents two cases of device embolization (DE) following LAAC and discusses risk factors, incidence, and management strategies through a literature-based approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive literature review was conducted, including studies focused on DE after LAAC, examining percutaneous and surgical retrieval techniques, procedural success, and patient outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results and Conclusion</h3>\u0000 \u0000 <p>DE incidence ranges from 0.6% to 1.5%, with improper device sizing and anatomical factors as primary risk factors. Percutaneous retrieval, through transseptal or transarterial approaches, demonstrates high procedural success rates, while surgical retrieval remains an option for complex cases. Our review suggests that with experienced operators, tailored percutaneous strategies effectively manage DE following LAAC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144751193","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}