Journal of Arrhythmia最新文献

{"title":"Correction to “Pacing the Impossible: ICE- and Voltage-Guided Atrial Leadless Pacemaker Implantation in Double Mechanical Valve Disease”","authors":"","doi":"10.1002/joa3.70453","DOIUrl":"10.1002/joa3.70453","url":null,"abstract":"<p>\u0000 <span>K. Ngarmukos</span>, <span>N. Prasitlumkum</span>, <span>P. Rattanawong</span>, “ <span>Pacing the Impossible: ICE- and Voltage-Guided Atrial Leadless Pacemaker Implantation in Double Mechanical Valve Disease</span>,” <i>Journal of Arrhythmia</i> <span>42</span>, no. <span>4</span> (<span>2026</span>): e70405, https://doi.org/10.1002/joa3.70405.\u0000 </p><p>We recently noticed a typographical error regarding the patient's age in the first sentence of our published manuscript. The phrase “A 60-year-old woman” should be corrected to “A 46-year-old woman.”</p><p>We apologize for this error.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976284","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":"Risks of Appropriate Implantable Cardioverter Defibrillator Therapy and Hospitalization Are Increased Around Device-Detected Atrial High-Rate Episodes Longer Than 6 min","authors":"Nanna Nørgaard,&nbsp;Christoffer Tobias Witt,&nbsp;Mads Brix Kronborg,&nbsp;Jens Cosedis Nielsen","doi":"10.1002/joa3.70448","DOIUrl":"10.1002/joa3.70448","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The prognostic significance of device-detected atrial high-rate episodes (AHRE) in patients with implantable cardioverter defibrillator (ICD) remains poorly understood. We aimed to evaluate whether device-detected AHRE ≥ 6 min is temporally associated with appropriate ICD therapy and cardiac hospitalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We studied consecutive patients with dual chamber or cardiac resynchronization therapy ICD with predominantly sinus rhythm and followed with remote monitoring (RM). Risk of ICD therapy and hospitalization was compared inside a 60-day peri-AHRE period (from 30 days before to 30 days after AHRE detection) with risk outside the peri-AHRE period. We included appropriate ICD therapies only. Adjusted extended Cox model with time-varying exposure analysis was used to assess potential associations between AHRE and ICD therapies and hospitalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 882 patients. Median age 67 years [interquartile range; 59–73], 81% male, 76% had coronary artery disease, and 61% CRT-D. The 30-day risk of appropriate ICD shock was 0.8% inside the peri-AHRE period compared with 0.2% outside the peri-AHRE period (adjusted hazard ratio [aHR] 3.04; 95% confidence interval [CI]: 1.67–5.52; <i>p</i> &lt; 0.001). The 30-day risk of any appropriate ICD therapy was increased inside compared with outside the peri-AHRE period (1.2% vs. 0.4%, aHR 1.71 [95% CI: 1.14–2.57], <i>p</i> = 0.01). Cardiac hospitalization was higher inside the peri-AHRE period (3.1% vs. 1.0%, aHR 1.42 [95% CI: 1.05–1.92], <i>p</i> = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The risk of appropriate ICD shock is three-fold elevated during a 60-day period surrounding AHRE detection. A comparable temporal pattern was noted for cardiac hospitalizations, supporting that AHREs may indicate clinical worsening of heart disease.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13558661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930006","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":"Expert Consensus Statement: Committee on Implantable Devices and Committee on Social Issues, Japanese Heart Rhythm Society (JHRS) Statement on Remote Monitoring of Cardiac Implantable Electronic Devices","authors":"Eiichi Watanabe,&nbsp;Nobuhiro Nishii,&nbsp;Akiko Maeda,&nbsp;Yoshiro Sakai,&nbsp;Katsuhito Fujiu,&nbsp;Makoto Suzuki,&nbsp;Ritsushi Kato,&nbsp;Haruhiko Abe,&nbsp;Takashi Noda,&nbsp;Hiroshi Tada,&nbsp;Masahiko Takagi","doi":"10.1002/joa3.70437","DOIUrl":"https://doi.org/10.1002/joa3.70437","url":null,"abstract":"<p>Remote monitoring (RM) has been established as a standard tool for the management of patients with cardiac implantable electronic devices (CIEDs), offering advantages such as early event detection, fewer routine outpatient visits, and reduced mortality. As RM becomes more common, its appropriate implementation and the need for safe, efficient management have become increasingly important. This statement of the Japanese Heart Rhythm Society (JHRS) provides comprehensive guidance for medical professionals and device manufacturers involved in RM. Specifically, it outlines recommendations on personnel placement, workflow optimization, patient and caregiver education, alert notification settings, physiological parameter monitoring, and insurance claims. It also addresses the responsibilities of device manufacturers, the use of third-party resources, and strategies for reducing workload based on alert notifications. Recommendation classes and evidence levels were determined by the consensus of the writing team, and the proposed recommendations were reviewed and peer-reviewed by the JHRS' Committee on Implantable Devices.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70437","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860067","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":"Evaluation of Hemolysis Risk, Renal Function, and Safety Among Two Pulsed Field Ablation Systems: A Systematic Review and Meta-Analysis","authors":"Abdalrahman Al-Slaimieh,&nbsp;Ibrahim Ghayada,&nbsp;Rand Al-Huneidy,&nbsp;Mohammad Shahin,&nbsp;Khaled Abukhalaf,&nbsp;Waleed Alomari,&nbsp;Khaled Marwa,&nbsp;Saeed Abdel Kamel,&nbsp;Yahya Almazaraa,&nbsp;Mohammad Hajjiri,&nbsp;Abdallah Al-Ani","doi":"10.1002/joa3.70450","DOIUrl":"https://doi.org/10.1002/joa3.70450","url":null,"abstract":"<p>This study investigated the hemolysis risk, renal, and safety outcomes between two pulsed field ablation (PFA) systems. A systematic review and meta-analysis were performed using PubMed, Cochrane, and ScienceDirect databases for all studies comparing circular to pentaspline PFA systems. Pooled markers evaluated included procedural characteristics, haptoglobin, lactate dehydrogenase (LDH), bilirubin, hemoglobin, and creatinine, with glomerular filtration rate (GFR) and safety markers qualitatively discussed. A total of 11 studies were included, comprising 1517 individuals. While differences in procedural, left atrial dwelling, and fluoroscopy times were statistically insignificant between the two PFA systems, the pentaspline system was significantly associated with lower post-procedural haptoglobin levels (SMD: 0.59; 95% CI: 0.25 to 0.93), higher LDH (SMD: −0.87; 95% CI: −1.49 to −0.253), and higher bilirubin levels (SMD: −0.77; 95% CI: −1.13 to −0.42) compared to circular catheters. No significant differences were observed in total hemoglobin levels (SMD: 0.13; 95% CI: −0.17 to 0.44; <i>p</i> = 0.206) or the magnitude of creatinine change (SMD: −0.02; 95% CI: −0.07 to 0.030; <i>p</i> = 0.270) between the systems. However, the incidence of acute kidney injury (AKI) was more pronounced in the pentaspline cohort with five documented cases, and more peri/post-procedural complications were recorded for the pentaspline system than for circular catheters. Pentaspline systems were associated with more pronounced laboratory markers of hemolysis, although clinically significant renal dysfunction remained uncommon and evidence regarding clinical consequences remains limited. Future studies are encouraged to standardize both reporting and data collection procedures to facilitate direct comparisons and tests of validity.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70450","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859906","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":"Nationwide Lifespan Trends in Cardiac Implantable Electronic Device Strategies in Japan: Age-Dependent Changes in Transvenous and Epicardial Systems","authors":"Aya Miyazaki,&nbsp;Gaku Izumi,&nbsp;Shuhei Fujita,&nbsp;Tsugutoshi Suzuki,&nbsp;Hiroshi Suzuki,&nbsp;Jun Yoshimoto,&nbsp;Keiko Toyohara,&nbsp;Yasunobu Hayabuchi,&nbsp;Masahiko Takagi","doi":"10.1002/joa3.70408","DOIUrl":"https://doi.org/10.1002/joa3.70408","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Nationwide epidemiological studies of cardiac implantable electronic devices (CIEDs) encompassing multiple device types and strategies remain limited in Japan, particularly regarding epicardial lead use and pediatric populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed the first nationwide analysis of CIED implantation trends using the National Database of Health Insurance Claims, including transvenous (TV)/epicardial (Epi) systems for pacemakers, implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy (CRT), and CRT-defibrillators (CRTDs), as well as leadless pacemakers, subcutaneous ICDs (S-ICDs), and epicardial lead use. Epicardial lead and pediatric characteristics were supplemented using industry data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In fiscal year 2023, implantation rates per 100 000 population were 29.69 for TV-pacemakers, 7.06 for leadless pacemakers, 2.42 for TV-ICDs, 0.889 for S-ICDs, 1.20 for TV-CRT, and 1.69 for TV-CRTDs. Rates for epicardial systems were lower, at 0.173 for Epi-pacemakers, 0–0.007 for Epi-ICDs, 0.024 for Epi-CRT, and 0.027 for Epi-CRTDs, while epicardial lead use was 0.545. S-ICD use increased across age groups, whereas TV-ICD implantation declined (all <i>p</i> &lt; 0.001). Implantation of TV and leadless pacemakers, TV-CRT, and TV-CRTDs increased over time (all <i>p</i> &lt; 0.001). Epicardial lead use showed a bimodal age distribution, peaking in pediatric and elderly populations, and declined in older adults while remaining stable in children and adults aged 20–49 years (<i>p</i> &lt; 0.001). Pediatric CIED volumes were low, with several ICD, CRT, and CRTD procedures annually.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CIED strategies in Japan demonstrate age-dependent variation. Epicardial systems remain indispensable in pediatric and congenital heart disease care, whereas alternative technologies are increasingly adopted in older adult populations, reflecting evolving lifespan-related device strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70408","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860174","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":"Successful Termination of Slow Atrial Tachycardia With 1:1 Atrioventricular Conduction Using a Pacemaker Atrial Antitachycardia Pacing Algorithm","authors":"Keiko Toyohara,&nbsp;Morio Shoda","doi":"10.1002/joa3.70444","DOIUrl":"10.1002/joa3.70444","url":null,"abstract":"<p>A transvenous dual-chamber pacemaker successfully terminated relatively slow atrial tachycardia with 1:1 atrioventricular conduction using atrial antitachycardia pacing after unsuccessful catheter ablation in a patient with complex congenital heart disease.\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 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812774","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":"Smoking and Risk of Atrial Fibrillation Recurrence After Catheter Ablation: A Meta-Analysis and Meta-Regression","authors":"Frengki Prabowo Saputro Wijayanto,&nbsp;Artha Maressa Theodora Simanjuntak,&nbsp;Muhammad Reva Aditya,&nbsp;Alifian Arkan Zaky Kusnadi,&nbsp;Alphatar Magnus Jonathan Tambunan,&nbsp;Harmony Tiffany Clay,&nbsp;Erlangga Dief Putra Hamam,&nbsp;Christopher Daniel Tristan,&nbsp;Raymond Pranata","doi":"10.1002/joa3.70452","DOIUrl":"10.1002/joa3.70452","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide. Although catheter ablation is an established rhythm-control strategy, recurrence remains frequent. Smoking is a potentially modifiable risk factor, but its impact on post-ablation AF recurrence remains uncertain. This study evaluated the association between smoking status and AF recurrence following catheter ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Six databases were searched up to March 2026. Studies including patients with AF undergoing first-time catheter ablation and reporting recurrence outcomes stratified by smoking status were included. Sensitivity, subgroup, and meta-regression analyses were performed. Publication bias was evaluated using Egger's test and trim-and-fill analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>Twenty-two studies comprising 6047 participants were included. Smoking was associated with a significantly increased risk of AF recurrence following catheter ablation (OR 1.42, 95% CI: 1.09–1.85; <i>p</i> = 0.0096), with substantial heterogeneity (<i>I</i>² = 65.8%). Sensitivity analysis confirmed the robustness of the findings (OR 1.35, 95% CI: 1.05–1.73). No significant small-study effects were detected (Egger's <i>p</i> = 0.4280), although trim-and-fill analysis attenuated the association to borderline significance. Meta-regression identified body mass index (BMI) as a significant moderator, with a weaker association observed in populations with higher BMI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Smoking is associated with a modest but significant increase in the risk of AF recurrence after catheter ablation. Future studies should evaluate the impact of smoking intensity, duration, and cessation on ablation outcomes using patient-level data.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812176","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":"Anatomical Challenges During Left-Sided Accessory Pathway Ablation in a Patient With Pectus Carinatum","authors":"Shonda Ng,&nbsp;Shih-Lin Chang,&nbsp;Danica Ann D. Leycano,&nbsp;Li-Wei Lo,&nbsp;Shih-Ann Chen","doi":"10.1002/joa3.70451","DOIUrl":"https://doi.org/10.1002/joa3.70451","url":null,"abstract":"<p>In a patient presenting with Wolff-Parkinson-White syndrome and pectus carinatum, cardiac rotation rendered conventional RAO and LAO views unreliable during left-sided accessory pathway ablation. Customized fluoroscopic views with caudal angulation allowed for successful ablation, supporting pre-procedural CT imaging to plan for patient specific fluoroscopic angles.\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 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70451","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784466","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":"Imaging-Guided Versus Conventional Ventricular Tachycardia Ablation in Ischemic Cardiomyopathy: A Systematic Review and Meta-Analysis","authors":"Sabbir Ahmed,&nbsp;Khalid Sawalha,&nbsp;Mohamed Sharief,&nbsp;Ahmed Ammar","doi":"10.1002/joa3.70449","DOIUrl":"https://doi.org/10.1002/joa3.70449","url":null,"abstract":"<p>Advanced cardiac imaging can characterize infarct substrate and guide ablation strategy and lesion delivery during ventricular tachycardia (VT) ablation, but its incremental benefit over conventional strategies in ischemic cardiomyopathy (ICM) remains uncertain. We compared imaging-guided with conventional VT ablation in adults with ICM. This PRISMA-compliant systematic review and meta-analysis was registered in PROSPERO (CRD420261399180). MEDLINE, Cochrane CENTRAL, and Scopus were searched from January 1, 2016, through May 21, 2026, with citation tracking. Comparative analyses were restricted to ICM populations or extractable ICM subgroups. The primary outcome was VT recurrence, pooled using random-effects risk ratios (RRs); single-arm imaging-guided cohorts were summarized descriptively. Four comparative studies included 316 patients, of whom 134 underwent imaging-guided ablation and 182 underwent conventional ablation. Imaging-guided ablation was associated with lower VT recurrence (pooled RR 0.53, 95% confidence interval 0.36–0.79; <i>p</i> = 0.002; <i>I</i>² = 0%), with consistent effects across imaging modalities and study designs. Major complications were infrequent and numerically similar between groups, although sparse events and heterogeneous definitions precluded pooling. Three additional single-arm imaging-guided studies reported favorable VT-free or event-free survival, acceptable safety, and high acute non-inducibility, but were not used to infer comparative efficacy. In patients with ICM undergoing scar-related VT ablation, imaging-guided ablation was associated with lower VT recurrence without an apparent increase in major complications; given the limited comparative evidence, these findings are hypothesis-generating rather than practice-changing. Larger multicenter randomized trials are required to confirm the magnitude of benefit and define patient selection, imaging modality, and integration strategy.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70449","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784467","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":"Clinical Outcomes of Pulsed Field Vs. Thermal Ablation for Paroxysmal Atrial Fibrillation: Systematic Review and Meta-Analysis of Randomized Evidence","authors":"Asad Ali Ahmed Cheema,&nbsp;Reshail Asif,&nbsp;Unsa Arif,&nbsp;Manahil Malik,&nbsp;Sarah Misbah,&nbsp;Eraj Nadeem,&nbsp;Muhammad Iftikhar Alam,&nbsp;Deep Birjani,&nbsp;Syed Umair Ahmed,&nbsp;FNU Hamna,&nbsp;Hadia Haseeb Ahmad,&nbsp;Fizza Sajid,&nbsp;Shahrukh Nadeem,&nbsp;Zaitoon Hanif,&nbsp;Abu Huraira Bin Gulzar","doi":"10.1002/joa3.70446","DOIUrl":"https://doi.org/10.1002/joa3.70446","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Pulsed field ablation (PFA) is a non-thermal alternative to conventional thermal ablation for paroxysmal atrial fibrillation (AF). We conducted an updated systematic review and meta-analysis of randomized evidence comparing efficacy, safety, and procedural outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed/MEDLINE and the Cochrane Central Register of Controlled Trials were searched from inception through March 2026 for randomized controlled trials (RCTs) comparing PFA with thermal ablation in adults undergoing first catheter ablation for paroxysmal AF. Risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs) were pooled using random-effects models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four RCTs enrolling 1 393 patients were included. PFA showed no statistically detectable difference in 12-month treatment success (RR, 1.04; 95% CI, 0.97 to 1.12; <i>I</i>² = 7%), recurrent atrial arrhythmias (RR, 1.00; 95% CI, 0.77 to 1.29; <i>I</i>² = 42%), or composite serious adverse events (RR, 0.71; 95% CI, 0.32 to 1.57; I² = 7%). PFA shortened procedure time (MD, −22.42 min; 95% CI, −33.44 to −11.39; I² = 91%) and LA dwell time (MD, −25.73 min; 95% CI, −34.66 to −16.79; <i>I</i>² = 92%), but increased fluoroscopy time (MD, 7.34 min; 95% CI, 0.39 to 14.30; <i>I</i>² = 98%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Across the included trial configurations, 12-month efficacy estimates did not differ detectably. Sparse safety events and wide confidence intervals precluded equivalence claims. Pooled procedure and LA dwell times favored PFA, but platform, comparator, and workflow heterogeneity limit generalizability. Procedural findings are exploratory and should not be interpreted as direct energy-specific effects.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70446","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784993","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}