Journal of Cardiovascular Electrophysiology最新文献

{"title":"Pacemaker Indications and Long-Term Stability of Pacing Indices in Heart Transplant Recipients.","authors":"Pablo Fernández de-Aspe, Raquel Vázquez-García, Alejandro Used-Gavín, Jorge L Rodríguez-Garrido, Ignacio Mosquera-Pérez, María J Paniagua-Martín, Eduardo Barge-Caballero, Gonzalo Barge-Caballero, David Couto-Mallón, Daniel Enríquez-Vázquez, María García-Vieites, José Manuel Vázquez-Rodríguez, María G Crespo-Leiro, Enrique Ricoy-Martínez","doi":"10.1111/jce.16671","DOIUrl":"https://doi.org/10.1111/jce.16671","url":null,"abstract":"<p><strong>Background: </strong>Approximately 10% of heart transplant (HT) recipients require a pacemaker (PM) implant. Despite graft-related complications such as rejection, cardiac allograft vasculopathy and fibrosis, there is no evidence on the long-term stability of pacing indices. Moreover, one of the most common indications for PM implant is early post-transplant sinus node dysfunction (SND), although this is reversible in many cases.</p><p><strong>Methods and results: </strong>A retrospective observational study including all HT recipients at our institution who underwent permanent PM implantation between April 1991 and January 2023 was conducted. The incidence of PM implantation, indications for PM implantation and changes in pacing indices were evaluated. A total of 861 adult HT were performed (92.1% using bicaval anastomosis technique), and 46 received a permanent pacemaker (cumulative incidence 5.3%) over a median follow-up of 7.9 years (IQR 2.5-15.1 years). Only one patient (2%) received a PM due to early post-HT SND. The median PM follow-up time was 5.4 years (IQR 2.0-8.1 years). Atrial and ventricular leads showed an initial impedance drop (p < 0.001 both) and an initial capture threshold increase (p < 0.001 and p = 0.003, respectively) with subsequent stabilization. R-wave amplitude remained stable, but there was a drop in P-wave amplitude (p = 0.026).</p><p><strong>Conclusions: </strong>Pacing indices remained stable and showed a behavior similar to that of native hearts except for a progressive decrease in P-wave amplitude, suggesting the need to aim for the highest possible P-wave amplitude during implantation.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insight Into Early Recurrences After Pulsed-Field Ablation for Atrial Fibrillation: Results From a Multicenter Experience.","authors":"Antonio Bisignani, Francesco Solimene, Saverio Iacopino, Marco Polselli, Antonio Dello Russo, Claudio Tondo, Antonio Rossillo, Sakis Themistoclakis, Ruggero Maggio, Maurizio Russo, Mario Volpicelli, Vincenzo Schillaci, Marco Schiavone, Jacopo Colella, Michela Casella, Maurizio Malacrida, Giulio Zucchelli, Stefano Bianchi","doi":"10.1111/jce.16670","DOIUrl":"https://doi.org/10.1111/jce.16670","url":null,"abstract":"<p><strong>Background: </strong>Factors contributing to early recurrence after atrial fibrillation (AF) ablation, particularly with pulsed-field ablation (PFA), are poorly understood.</p><p><strong>Purpose: </strong>This study aimed to evaluate the significance of early recurrence and identify factors associated with its occurrence, focusing on predicting late recurrence in AF patients treated with PFA.</p><p><strong>Methods: </strong>A total of 620 consecutive patients referred for their first paroxysmal or early persistent AF ablation underwent the procedure using the FARAPULSE PFA system (Boston Scientific) across 10 centers. Early recurrence was defined as atrial arrhythmia of > 30-s duration during the 3-month blanking period, and any recurrence beyond 3 months was considered as late recurrence.</p><p><strong>Results: </strong>In total, 44 (7.1%) patients experienced early recurrences (median time to recurrence: 56 [22-75] days). At multivariate logistic analysis adjusted for baseline confounders larger left atrial volume index (LAVi) (1.03, 1.01-1.06, p = 0.0034) was significantly associated with early recurrences. In total, 113 (18.2%) patients experienced late recurrences. Factors independently associated with late recurrences included age (1.03, 1.01-1.05, p = 0.0077), sleep apnea (3.17, 1.73-5.81, p = 0.002), and early recurrences (3.26, 2.01-5.29, p < 0.0001). Early recurrences were associated to late recurrences also in paroxysmal AF only patients (40.0% vs. 16.9%, p < 0.0001).</p><p><strong>Conclusion: </strong>In this cohort of AF patients undergoing PFA, early recurrences significantly increased the risk of late recurrences, highlighting their potential as a predictive marker for long-term outcomes. Moreover, larger LAVi was associated with early recurrences.</p><p><strong>Trial registration: </strong>Advanced TecHnologies For SuccEssful AblatioN of AF in Clinical Practice (ATHENA). URL: http://clinicaltrials.gov/. Identifier: NCT05617456.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Increased Cryoballoon Size on the Left Atrium, Superior Vena Cava, and Phrenic Nerve.","authors":"Yukihiro Inamura, Osamu Inaba, Takamitsu Takagi, Yuhei Isonaga, Shinichi Tachibana, Hiroaki Ohya, Akira Sato, Shinsuke Miyazaki, Junichi Nitta, Tetsuo Sasano","doi":"10.1111/jce.16673","DOIUrl":"https://doi.org/10.1111/jce.16673","url":null,"abstract":"<p><strong>Background: </strong>POLARx FIT is a size-adjustable cryoballoon, but its effect on isolation area and phrenic nerve injury (PNI) is not fully understood. This study aimed to compare the effects of 28 and 31 mm cryoballoon on the left atrium (LA), superior vena cava (SVC), and PNI incidence.</p><p><strong>Methods and results: </strong>Thirty-one cases of paroxysmal atrial fibrillation treated with POLARx FIT were analyzed. SVC voltage mapping and septal sleeve length measurements were performed before pulmonary vein (PV) isolation. A 28 mm balloon was used to isolate four PVs, followed by SVC and LA mapping. Additional ablation of the superior PVs was performed with a 31 mm balloon, and remapping was conducted. The isolation area of the LA, SVC sleeve length, and PNI incidence were compared before treatment, after the 28 mm treatment, and after the 31 mm treatment. The residual LA posterior wall area was significantly smaller with the 31 mm balloon compared to the 28 mm balloon (p < 0.01), with a significant increase in isolation area on the right side of the PVs after 31 mm treatment (p = 0.03). SVC sleeve length progressively shortened with increasing balloon size, showing a significant reduction between pretreatment and after the 31 mm treatment (p = 0.02). No consistent association was observed between balloon size and PNI.</p><p><strong>Conclusions: </strong>The larger cryoballoon expanded the LA posterior wall isolation area and had a greater effect on the SVC. Balloon size and PNI have shown inconsistent results.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implantable Defibrillators: Which Is the Best Device for Each Patient?","authors":"Graham Peigh, Bradley P Knight","doi":"10.1111/jce.16646","DOIUrl":"https://doi.org/10.1111/jce.16646","url":null,"abstract":"<p><p>The first viable alternative to surgical implantation of an epicardial defibrillator system for secondary prevention of sudden cardiac death (SCD) was a single chamber transvenous implantable cardioverter defibrillator (ICD). Thanks to technological advancements over the past 40 years, electrophysiologists now have several options when determining the optimal type of ICD to provide protection against SCD, including the number of leads implanted, whether a patient meets indications for cardiac resynchronization, and if the patient would benefit from an extravascular device. In this review, we will detail the breadth of options for commercially available ICD therapy to provide guidance on which device is best suited for specific patient populations.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New-Onset Device-Detected Atrial Fibrillation in Patients With Atrial Floating Dipole Implantable Cardioverter-Defibrillators: A Propensity Score-Matched Comparison With Conventional Dual-Chamber Systems.","authors":"Gianfranco Mitacchione, Antonio Curnis, Eduardo Celentano, Giovanni Rovaris, Antonella Battista, Massimiliano Marini, Paolo Della Bella, Vincenzo Ezio Santobuono, Mauro Biffi, Luca Tomasi, Matteo Baroni, Luca Bontempi, Gerardo Nigro, Emilio Di Lorenzo, Donatella Ruggiero, Fabio Franculli, Patrizia Pepi, Miguel Viscusi, Davide Saporito, Matteo Bertini, Gaetano Senatore, Stefano Pedretti, Domenico Pecora, Giovanni Battista Forleo, Francesco Solimene, Valerio Giordano, Riccardo Sacchi, Daniele Giacopelli, Alessio Gargaro, Fabrizio Caravati","doi":"10.1111/jce.16666","DOIUrl":"https://doi.org/10.1111/jce.16666","url":null,"abstract":"<p><strong>Background: </strong>Device-detected subclinical atrial fibrillation (DDAF) is a significant risk factor for major cardiovascular events, especially in implantable cardioverter-defibrillator (ICD) recipients. The DX ICD, which utilizes a single ventricular lead with a floating atrial dipole, has demonstrated superior performance in diagnosing DDAF compared to conventional single-lead ICDs. However, comparisons between DX and dual-chamber (DDD) ICDs for atrial monitoring are limited.</p><p><strong>Objective: </strong>To compare the incidence of newly detected DDAF in patients without an indication for atrial pacing who received either a DX or a standard DDD ICD.</p><p><strong>Methods: </strong>Remote transmissions from the Italian Home Monitoring Expert Alliance dataset were analyzed. DDAF incidence for different burden cutoffs ( ≥ 15 min, ≥ 6 h, and ≥ 24 h) was compared between groups using propensity score (PS) matching to adjust for baseline characteristics.</p><p><strong>Results: </strong>In a cohort of 1329 patients (527 with DX ICD and 802 with DDD ICD), 30.7% experienced DDAF lasting ≥ 15 min, 22.3% ≥ 6 h, and 14.0% ≥ 24 h during a median follow-up of 4.5 years. DDAF incidence was lower in the DX ICD group for all burden cutoffs (p < 0.0001). However, after PS matching, DDAF rates were similar between groups, with no significant differences (p ≥ 0.36). Multivariate analysis identified age and 1-month right ventricular pacing percentage as predictors of DDAF across all burden cutoffs, with no effect based on device type or programmed basic rate.</p><p><strong>Conclusion: </strong>In patients without atrial pacing indication or history of clinical atrial fibrillation at implantation, the DX ICD demonstrated DDAF detection capabilities comparable to DDD ICDs in a real-world setting.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulsed-Field Ablation for Persistent Atrial Fibrillation in EU-PORIA Registry.","authors":"Jun Hirokami, Kyoung Ryul Julian Chun, Stefano Bordignon, Shota Tohoku, Kars Neven, Tobias Reichlin, Yuri Blaauw, Jim Hansen, Raquel Adelino, Alexandre Ouss, Anna Füting, Laurent Roten, Bart A Mulder, Martin H Ruwald, Roberto Mené, Pepijn van der Voort, Nico Reinsch, Thomas Kueffer, Serge Boveda, Elizabeth M Albrecht, Boris Schmidt","doi":"10.1111/jce.16583","DOIUrl":"https://doi.org/10.1111/jce.16583","url":null,"abstract":"<p><strong>Background: </strong>Real-life data on efficacy and safety of pulsed-field ablation (PFA) using the pentaspline multi-electrode catheter in symptomatic atrial fibrillation (AF) patients is still scarce.</p><p><strong>Objective: </strong>This study aims to assess the efficacy and safety of PFA in patients with persistent AF.</p><p><strong>Methods: </strong>Data from early commercial use across seven European centers were collected in a registry. To confirm the efficacy and safety of extra pulmonary vein (PV) ablation, patients were categorized into two groups: those undergoing pulmonary vein isolation (PVI) alone and those receiving additional ablation. Procedural and follow-up data were collected.</p><p><strong>Results: </strong>The study included 448 patients (347 PVI only, 101 PVI + α). In the PVI + α group, extra PV ablation included left atrial posterior wall isolation (87%), mitral isthmus ablation (37%), and cavo-tricuspid isthmus ablation (3%). At 1-year follow-up, the PVI only group showed significantly fewer atrial tachyarrhythmia recurrences compared to PVI + α group (69% vs. 56%, p = 0.013). While AF recurrence did not significantly differ (25% vs. 28%, p = 0.713), PVI + α group had a significantly higher atrial tachycardia recurrence (8% vs. 22%, p < 0.001). Major complications occurred in 2.0% versus 1.0% (PVI only vs. PVI + α), including pericardial tamponade (6 vs. 0; p = 0.345) and stroke (1 vs. 1; p = 0.400).</p><p><strong>Conclusions: </strong>PVI plus extra PV ablation using a pentaspline PFA catheter is associated with a higher incidence of atrial tachycardia recurrences. For persistent AF, a simpler approach of performing only PVI may be more effective.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Impact of Steerable Sheaths for Paroxysmal Atrial Fibrillation Catheter Ablation: The INSIGHT Study.","authors":"Yasuo Okumura, Tsunesuke Kono, Akira Mizukami, Osamu Inaba, Yuji Wakamatsu, Daisuke Yamagishi, Satoshi Nakamura, Takumi Arashiro, Akira Sato, Yi Wang, Atsushi Kobori","doi":"10.1111/jce.16658","DOIUrl":"https://doi.org/10.1111/jce.16658","url":null,"abstract":"<p><strong>Introduction: </strong>In atrial fibrillation (AF) ablation procedures, the CARTO VIZIGO Bidirectional Guiding Sheath has previously shown promising results in reducing fluoroscopy times without compromising clinical effectiveness or safety compared with non-steerable sheaths.</p><p><strong>Methods: </strong>This non-randomized, multicenter, retrospective cohort study (INSIGHT) aimed to determine the real-world impact of the VIZIGO sheath on procedural efficiency, clinical effectiveness, and safety in paroxysmal AF (PAF) catheter ablation. Consecutive adults who underwent de novo radiofrequency (RF) ablation for PAF with a non-VIZIGO sheath (January 2019-July 2021) or VIZIGO sheath (January 2020-July 2021) were included. Procedural characteristics, primary adverse events (PAEs), and 12-month effectiveness (freedom from repeat ablation or recurrent atrial arrhythmia) were evaluated.</p><p><strong>Results: </strong>Of 199 patients included (mean age, 69.7 years; 59.3% male), 97 had ablation with a VIZIGO sheath and 102 with a non-VIZIGO sheath. Significantly shorter mean times were achieved in the VIZIGO vs. non-VIZIGO group for time to left PVI (18.1 ± 7.5 vs. 19.9 ± 5.6 min, p = 0.046), right PVI (16.5 ± 6.1 vs. 23.1 ± 9.9 min, p < 0.001), total PVI (34.6 ± 9.7 vs. 42.9 ± 11.4 min, p = 0.002), and fluoroscopy time (7.3 ± 10.4 vs. 18.3 ± 13.3 min, p < 0.001). Mean fluoroscopy dose was significantly lower (45.9 ± 112.0 vs. 139.5 ± 251.5 mGy, p < 0.001) with VIZIGO vs. non-VIZIGO sheaths. Catheter stability was comparable between groups. PAE rates were similar in the VIZIGO (3.1%) and non-VIZIGO (4.9%) groups. Freedom from repeat ablation and recurrent atrial arrhythmia at 12 months were also similar in the two groups.</p><p><strong>Conclusion: </strong>These real-world data demonstrate that use of the VIZIGO sheath in PAF ablation procedures allows for significantly lower fluoroscopy time and dose with significantly shorter PVI isolation time, without compromising acute and long-term effectiveness or safety.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes and Atrial Fibrillation: Insight From Basic to Translational Science Into the Mechanisms and Management.","authors":"Bharat K Kantharia, Mohammadreza Tabary, Lingling Wu, Xinyu Wang, Bharat Narasimhan, Dominik Linz, Jordi Heijman, Xander H T Wehrens","doi":"10.1111/jce.16655","DOIUrl":"https://doi.org/10.1111/jce.16655","url":null,"abstract":"<p><p>In spite of significant progress made in the management in recent decades, atrial fibrillation (AF) continues to cause increased mortality and significant morbidities, including heart failure and stroke. Diabetes mellitus (DM) is an independent risk factor for AF, and adds risks to increased mortality and hospitalizations when present along with AF. The pathophysiology of AF related to DM is complex with many inter-related factors. Atrial cardiomyopathy (atriopathy) related to structural changes from subcellular abnormalities and fibrosis, coupled with cardiac mechanical dysfunction, abnormal ion expression, dysregulation of the renin-angiotensin-aldosterone system and the autonomic nervous system function, play crucial roles in genesis and progression of AF. In this review, we discuss insights from basic to translational science into the mechanisms and management related to AF associated with DM.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do All Roads Lead to the City? Evaluating Urban-Rural Differences in Cardiac Implantable Electronic Device Infection in the United States.","authors":"Khidir Dalouk, Peter M Jessel","doi":"10.1111/jce.16669","DOIUrl":"https://doi.org/10.1111/jce.16669","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Role of Intraoperative Impedance in Midterm Pacing Threshold Elevation: Insights From Aveir VR Leadless Pacemaker Implantations.","authors":"Takehiro Nomura, Kennosuke Yamashita, Michio Nagashima, Rei Kuji, Yosuke Mizuno, Daiki Kumazawa, Kosuke Onodera, Kenji Ando","doi":"10.1111/jce.16639","DOIUrl":"https://doi.org/10.1111/jce.16639","url":null,"abstract":"<p><strong>Introduction: </strong>Leadless pacemakers (LPs) are a valuable treatment for bradycardia, with the Aveir offering advanced features, including a protective sleeve and active fixation. This study investigated the intraoperative factors during Aveir VR implantations that predict midterm pacing capture threshold (PCT) elevations and proposed strategies for optimizing the outcomes.</p><p><strong>Methods and results: </strong>This retrospective study included 67 patients who underwent Aveir VR implantations in two Japanese facilities between March and June 2023, with a 360-day follow-up. The impedance and PCT were measured three times during the procedure (premapping, during the tether mode, and at the end of the procedure). A PCT elevation was defined as that > 1.5 V/0.4 ms during follow-up. PCT elevations were observed in 7 patients (10.4%), all with sinus node dysfunction. The impedance during the tether mode (Imp^te) and end of the procedure (Imp^end) was significantly lower in patients with a PCT elevation (p < 0.001). The receiver operating characteristic curve analysis demonstrated that the Imp^te (AUC: 0.868) and Imp^end (AUC: 0.857) effectively predicted PCT elevations, with a cutoff of > 380 Ω associated with a lower incidence of PCT elevations. For the Imp^te, the sensitivity was 85.7% and specificity 90.0%. Moreover, a high impedance during premapping (AUC: 0.892) predicted an Imp^te > 380 Ω, and when the premapping impedance was > 430 Ω, all cases had an Imp^te > 380 Ω. The median number of days until the PCT elevation was 40 (range: 1-321 days), and in 3 out of 7 patients, PCT elevations were observed more than 270 days after the implantation.</p><p><strong>Conclusion: </strong>The higher impedance during the implantation was a strong predictor of a midterm favorable PCT. Those findings highlighted the potential for impedance-guided strategies to optimize implantations and output settings. The occurrence of PCT elevations beyond 270 days underscored the need for long-term monitoring and individualized follow-up strategies. Further studies are needed to validate these findings and explore their clinical impact.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}