Journal of Arrhythmia最新文献

{"title":"Unforeseen beneficial effect of successful PVC ablation: Achieving migraine attack control without medication","authors":"Yakup Yunus Yamanturk MD,&nbsp;Muhammed Emin Teker MD,&nbsp;Gozde Cansu Yilmaz MD,&nbsp;İrem Muge Akbulut MD,&nbsp;Basar Candemir MD","doi":"10.1002/joa3.70117","DOIUrl":"https://doi.org/10.1002/joa3.70117","url":null,"abstract":"<p>Successful catheter ablation of frequent PVCs in a patient with PVC-induced cardiomyopathy resulted in a marked improvement in left ventricular ejection fraction (LVEF), accompanied by complete resolution of migraine with aura attacks. This case illustrates both cardiac and neurological benefits of PVC burden reduction through ablation.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558302","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":"Return-to-play in athletes with transvenous and subcutaneous implantable cardiac defibrillator: A meta-analysis","authors":"Rifqi Rizkani Eri MD,&nbsp;Sania Zahrani MD,&nbsp;Prasetyo Andriono MD,&nbsp;Haikal Balweel MD,&nbsp;Novaro Adeneur Tafriend MD,&nbsp;Agus Harsoyo MD, PhD","doi":"10.1002/joa3.70131","DOIUrl":"https://doi.org/10.1002/joa3.70131","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Arrhythmia in athletes can be career-threatening, and those with implantable cardioverter-defibrillators (ICDs) face significant challenges in returning to play due to concerns about safety, efficacy, and arrhythmic risk. Since the last meta-analysis, additional studies have been published, providing updated data that suggest both transvenous and subcutaneous ICDs (S-ICDs) may allow for a safe return to sports through individualized decision-making. This meta-analysis aimed to reassess the safety and efficacy of ICDs in athletes returning to play.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis were conducted following the PRISMA guidelines. Six cohort studies including 1183 athletes with ICDs were analyzed, with five of them on transvenous ICDs and one on S-ICD. Primary outcomes included rates of appropriate and inappropriate shocks, shock-related physical injury, cardiac adverse events, and sports discontinuation. Subgroup and sensitivity analyses were performed to explore heterogeneity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The pooled rate of appropriate shocks was 13% (95% CI 0.11–0.16), while inappropriate shocks occurred in 4% (95% CI 0.02–0.11). No shock-related physical injuries or cardiac adverse events during or shortly after sports were reported (0%). The rate of sports discontinuation was 2%, increasing to4% after sensitivity analysis. Transvenous ICDs showed lower inappropriate shock rates compared to S-ICD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ICD use in athletes returning to play appears safe, with low adverse event rates and minimal sports discontinuation. These findings support tailored return-to-play decisions based on arrhythmia type, ICD programming, and psychological support, aligning with the 2024 HRS Class IIa recommendation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70131","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537182","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":"Impact of tablet-induced electromagnetic interference on abdominal cardiac devices: A study based on simulated patients","authors":"Yo Kajiyama M.D.,&nbsp;Yusuke Kita M.D.,&nbsp;Mayu Iwabuchi M.E.,&nbsp;Tomomi Sekine M.E.,&nbsp;Keishi Ogura M.E","doi":"10.1002/joa3.70136","DOIUrl":"https://doi.org/10.1002/joa3.70136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Electromagnetic interference (EMI) between tablet computers (tablets) and cardiac implantable electronic devices (CIEDs) in the abdomen of adults remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We aimed to determine the magnetic flux density (MFD) of tablets, measure the distance at which EMI was triggered, and assess the susceptibility of abdominally implanted CIEDs to EMI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We studied 17 tablets and 2 CIED models. The measured MFD of tablets was 638 Gauss. EMI occurred at a 3.2 cm distance. A simulated patient using a tablet experienced EMI episodes for 357.2 s in 10 min.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Tablets may generate sufficient MFD to induce EMI in abdominally implanted CIEDs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70136","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524482","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":"Intracardiac echocardiography versus transesophageal echocardiography guidance on left atrial appendage occlusion in patients with atrial fibrillation: A systematic review and meta-analysis","authors":"Ubaid Khan MD,&nbsp;Ahmed Mazen Amin MBBCh,&nbsp;Zuhair Majeed MD,&nbsp;Muhammad Haris Khan MBBS,&nbsp;Mahmoud Shaaban Abdelgalil MBBCh,&nbsp;Muhammad Mubariz MD,&nbsp;Shrouk Ramadan MBBCh,&nbsp;Muhammad Imran MBBS,&nbsp;Ahmed Raza MBBS,&nbsp;Muhammad Naveed Ur Rehman MBBS,&nbsp;Syed Hassnain Zafar Bukhari MBBS,&nbsp;Ahmad Talal Asif MD,&nbsp;Fahad Hassan Gunjial MBBS,&nbsp;Junaid Ali MD,&nbsp;Anum Nawaz MBBS","doi":"10.1002/joa3.70115","DOIUrl":"https://doi.org/10.1002/joa3.70115","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Intracardiac echocardiography (ICE) is an innovative technique that has emerged as an alternative to transesophageal echocardiography (TEE) to guide the implantation of a left atrial appendage occlusion (LAAO) device in patients with nonvalvular atrial fibrillation (AF) who cannot tolerate anticoagulants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>We aim to review the clinical efficacy and safety of ICE compared to TEE to guide the implantation of LAAO devices in patients with AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted comprehensive searches across PubMed, CENTRAL, Web of Science, Scopus, and EMBASE until March 2024. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, along with a 95% confidence interval (CI). This systematic review and meta-analysis was registered with PROSPERO ID: CRD42024542537.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 19 studies involving 44,706 patients. ICE was associated with a statistically significant high procedure success rate compared to TEE (RR: 1.0055 with 95% CI [1.0006, 1.0104], <i>p</i> = 0.01), but there was no difference in procedure duration (MD: 3.07 with 95% CI [−4.67, 10.80], <i>p</i> = 0.44) between the two groups. However, compared to the ICE group, patients undergoing LAAO under TEE guidance required more than one device more often (RR: 1.39 with 95% CI [1.23, 1.57], <i>p</i> &lt; 0.01). The TEE group also reported a reduced incidence of pericardial effusion compared to the ICE group (RR: 0.65 with 95% CI [0.50, 0.85], <i>p</i> &lt; 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our meta-analysis concluded that ICE can be a viable alternative to TEE for guiding LAAO, particularly in patients unsuitable for general anesthesia. It can also reduce the need for GA and adverse effects and resources associated with it, require fewer devices, and demonstrate comparable safety and efficacy outcomes, though it may increase the risk of pericardial effusion. Further prospective trials are warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70115","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519959","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 left atrial access through GORE CARDIOFORM ASD occluder using an integrated transseptal wire system after failed RF needle approach","authors":"Yuko Suzuki MD,&nbsp;Keijiro Nakamura MD, PhD,&nbsp;Takayuki Shimizu MD,&nbsp;Masako Asami MD,&nbsp;Hidehiko Hara MD, PhD","doi":"10.1002/joa3.70123","DOIUrl":"https://doi.org/10.1002/joa3.70123","url":null,"abstract":"<p>An integrated transseptal wire system enabled successful left atrial access through the elastic resistance posed by a large GORE CARDIOFORM ASD occluder after failed RF needle attempt, allowing large-bore cryoballoon sheath advancement via sequential sheath technique for atrial fibrillation ablation without procedural complications.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514770","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":"Impact of magnetic fields from tablets, laptops, smartphones, and household/leisure magnets on cardiac implantable electronic devices","authors":"Norio Kamitani,&nbsp;Aya Miyazaki MD, PhD,&nbsp;Satoko Tomida,&nbsp;Keita Shimizu,&nbsp;Nodoka Ohira,&nbsp;Keisyun Kondo,&nbsp;Hiromichi Miura,&nbsp;Daishi Koyama,&nbsp;Shigehiko Tominaga,&nbsp;Ryuta Henmi MD, PhD,&nbsp;Ryo Sugiura MD, PhD,&nbsp;Hiroshi Masui","doi":"10.1002/joa3.70106","DOIUrl":"https://doi.org/10.1002/joa3.70106","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardiac implantable electronic devices (CIEDs) activate the magnet response at a magnetic flux density of ≥10 gauss (G), which may cause unintended pacing, leading to discomfort or even severe arrhythmias. Information processing devices have recently incorporated magnets, which may activate the magnet mode in patients with abdominally implanted devices, subcutaneous implantable cardioverter-defibrillators (ICDs), or extravascular ICDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We investigated the effects of the magnetic fields generated by information processing devices (tablets, laptops, and smartphones) and household/leisure magnets on 13 models of CIEDs, analyzing their association with magnet mode activation in different manufacturers' CIEDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The tested magnet materials exhibited a maximum magnetic flux density of 290–1360 G. The magnetic flux density distribution in the information processing devices was as follows: accessory connectors, speakers, cameras, and microphones (<i>p</i> = 0.0001). The median activation distances for the magnet mode were 6.5 (range, 4–15), 5 (4–11.3), and 0.01 (activated only when attached; 0–7) mm for tablets and laptops, smartphones, and household/leisure magnets, respectively (<i>p</i> &lt; 0.0001). The maximum distance at which the magnetic flux density decreased below 10 G was the longest for tablets and laptop computers at 18 mm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Information processing devices and household/leisure magnets can affect CIEDs when placed in close proximity. Among the devices tested, magnet mode activation did not occur at distances of ≥20 mm. Considering the increasing prevalence of information processing devices and the growing adoption of nonthoracic CIED placements, raising awareness among patients about potential interactions is crucial.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70106","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519618","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":"Mid-term effects on sinus node function following additional empirical superior vena cava isolation in atrial fibrillation patients with sick sinus syndrome","authors":"Miwa Kanai MD, PhD,&nbsp;Satoshi Higuchi MD, PhD,&nbsp;Masayuki Sakai MD,&nbsp;Yuko Matsui MD,&nbsp;Shun Hasegawa MD,&nbsp;Daigo Yagishita MD, PhD,&nbsp;Morio Shoda MD, PhD,&nbsp;Junichi Yamaguchi MD, PhD","doi":"10.1002/joa3.70126","DOIUrl":"https://doi.org/10.1002/joa3.70126","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The safety of including superior vena cava isolation (SVCI) along with pulmonary vein isolation (PVI) in atrial fibrillation (AF) patients with sick sinus syndrome (SSS) remains uncertain, as this decision is often left to the discretion of individual physicians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>In this retrospective study, 94 AF patients with SSS, who underwent PVI without prior pacemaker placement, were divided into two groups: those with (<i>n</i> = 67, age 66.0 ± 9.3 years, male 61%) and without (<i>n</i> = 27, age 66.6 ± 10.0 years, male 63%) additional empirical SVCI. SVCI was performed at 25–35 W, 10–20 mm superior to the earliest sites of activation during sinus rhythm. The primary endpoint compared atrial tachyarrhythmia (ATA) recurrence, pacemaker avoidance, and 24-hour ambulatory monitoring results between the SVCI and non-SVCI groups. Preprocedure minimum heart rate (SVCI 37.6 ± 11.6 Bpm vs. non-SVCI 37.0 ± 9.9 Bpm, <i>p</i> = 0.74) and maximum pause (SVCI 4.2 ± 2.7 Sec vs. non-SVCI 3.6 ± 2.8 Sec, <i>p</i> = 0.15) were not different between the two groups. During 36 months of follow-up after the last procedure, ATA recurrence rates (SVCI 33% vs. non-SVCI 34%, <i>p</i> = 0.82) and pacemaker avoidance rates (SVCI 84% vs. non-SVCI 93%, <i>p</i> = 0.32) Were Comparable between the two groups. At 36 months after the last procedure, minimum heart rate (SVCI 48.7 ± 10.2 bpm vs. non-SVCI 47.4 ± 8.3 bpm, <i>p</i> = 0.52) and maximum pause (SVCI 1.6 ± 1.0 sec vs. non-SVCI 1.6 ± 0.6 sec, <i>p</i> = 0.33) remained similar between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this study, the addition of SVCI did not significantly increase the need for pacemaker implantation or lead to sinus node dysfunction in AF patients with SSS compared to PVI alone.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70126","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514706","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":"Left atrial intramural hematoma following right atrial catheter ablation: A rare case involving coronary sinus injury","authors":"Mina Hatsuno MD, PhD,&nbsp;Ken Kobayashi MD,&nbsp;Kenta Tsutsui MD, PhD,&nbsp;Yuji Watari MD, PhD,&nbsp;Ken Kozuma MD, PhD","doi":"10.1002/joa3.70129","DOIUrl":"https://doi.org/10.1002/joa3.70129","url":null,"abstract":"<p>Left atrial intramural hematoma (LAIH) is an exceedingly rare complication that occurs following catheter ablation in the right atrium. The present case is the first to implicate coronary sinus catheter manipulation—rather than left atrial intervention—as a potential mechanism of LAIH.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70129","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514771","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":"Long-term outcome of lesion size index-guided high-power ablation with high-density mapping for pulmonary vein isolation in patients with paroxysmal atrial fibrillation","authors":"Ming-Jen Kuo MD,&nbsp;Shih-Lin Chang MD, PhD,&nbsp;Jin-Long Huang MD, PhD,&nbsp;Yenn-Jiang Lin MD, PhD,&nbsp;Yu-Cheng Hsieh MD, PhD,&nbsp;Li-Wei Lo MD, PhD,&nbsp;Yu-Feng Hu MD, PhD,&nbsp;Fa-Po Chung MD, PhD,&nbsp;Cheng-Hung Li MD, PhD,&nbsp;Chin-Yu Lin MD, PhD,&nbsp;Ting-Yung Chang MD,&nbsp;Ling Kuo MD,&nbsp;Cheng-I Wu MD,&nbsp;Chih-Min Liu MD,&nbsp;Shin-Huei Liu MD,&nbsp;Yu-Shan Huang MD,&nbsp;Shih-Ann Chen MD","doi":"10.1002/joa3.70127","DOIUrl":"https://doi.org/10.1002/joa3.70127","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Data on the long-term outcomes and procedural details of the lesion size index-guided high-power ablation strategy (HP-LSI) are limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Eighty patients were retrospectively assigned to the high-power with time-restricted ablation strategy (fixed at 10 s per lesion), while 67 patients were assigned to the high power LSI-guided strategy (anterior wall LSI at least 5.0, posterior wall LSI 4.5). The 1-year AF recurrence rate and various procedural details were compared between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The HP-LSI group exhibited a significantly lower rate of AF recurrence (14.9% vs. 32.5%; HR: 0.36, 95% CI: 0.16–0.83; <i>p</i> = 0.016). Additionally, fewer gaps were identified in various PV segments in the HP-LSI group following the initial pass of PV circumferential ablation. The radiofrequency time, LA dwelling time, and skin-to-skin time were shorter, and the first-pass isolation rates for both pulmonary veins were higher in the HP-LSI group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The HP-LSI ablation strategy is associated with a significantly lower AF recurrence rate and improved procedural efficiency, suggesting its potential as a preferred strategy for PVI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70127","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514772","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":"Critical appraisal of electrogram-based depth estimation and lesion assessment in ventricular ablation","authors":"Brijesh Sathian PhD,&nbsp;Javed Iqbal RN, MBA,&nbsp;Hanadi Al Hamad MD","doi":"10.1002/joa3.70122","DOIUrl":"https://doi.org/10.1002/joa3.70122","url":null,"abstract":"&lt;p&gt;We read with interest the article by Jeong et al. titled “Quantitative analyses of the distal bipolar electrogram for focal premature ventricular contraction ablation” published in the Journal of Arrhythmia.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; While the authors present novel quantitative parameters for analyzing bipolar electrograms, several of their key conclusions warrant critical examination against established research findings.&lt;/p&gt;&lt;p&gt;The authors propose that a 4 mm depth threshold distinguishes “true” near-field from far-field bipolar electrograms, calculating this based on a 9.8 ms timing difference and an assumed conduction velocity of 40 cm/s. However, this conclusion conflicts with substantial evidence regarding ventricular conduction velocities and radiofrequency lesion characteristics. Recent extensive reviews prove that there is a great variability in human ventricular conduction velocities, where longitudinal velocities vary between 50 and 95 cm/s and transverse velocities range between 14 and 45 cm/s.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The value of 40 cm/s assumed by the authors seems to be quite smaller than the measured values, which may overestimate the distance reflected by their time differences.&lt;/p&gt;&lt;p&gt;Moreover, the investigation of the depth of the lesions made by radiofrequency ablation proves that efficient lesions are made up to 3–5 mm. Contact force, however, is a major determinant of lesion dimensions, with the depth of the lesion assuming a power function (Lesion depth = 3.17 × CF&lt;sup&gt;0.14&lt;/sup&gt;).&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; The author used magnetic navigation sources with inherently lower contact force that could have produced shallower lesions than their postulated 4 mm threshold, and could be the reason why ablations failed in some places classified as “far-field”.&lt;/p&gt;&lt;p&gt;The authors conclude that the extent of fractionation does not have any definite implication in differentiating between successful and unsuccessful ablation sites, as it has been the practice in focal PVC ablation. Such observation is contrary to numerous reports that have shown the significance of fractionated electrograms in the ablation of ventricular arrhythmias. Large-scale studies using ultrahigh-density mapping have shown that highly fractionated potentials (&gt;10 fractionations) are consistently found in all critical ventricular tachycardia isthmus areas during substrate mapping.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; While the authors correctly note that idiopathic focal PVCs differ mechanistically from scar-related ventricular tachycardia, recent evidence suggests that local substrate abnormalities, reflected by electrogram fractionation, may still play important roles in focal PVC origins.&lt;/p&gt;&lt;p&gt;Although the authors give their reasoning only to bipolar electrograms, discrediting unipolar recordings as of “limited utility,” this opinion is not corroborated with the new data on the complementary nature of bipolar–unipolar analysis. Emerging evidence has suggested that particu","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144515106","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}