Journal of Cardiovascular Electrophysiology最新文献

{"title":"Impact of Left Bundle Branch Area Pacing on Echocardiographic Parameters and Symptoms: Data From the Conduction System Pacing Italian Network Group (C-SING) Study.","authors":"Gabriele Dell'Era, Pietro Palmisano, Daniela Dugo, Francesco Raffaele Spera, Alessandro Paoletti Perini, Gianluca Mirizzi, Luca Poggio, Luca De Mattia, Amato Santoro, Massimo Magnano, Matteo Baroni, Francesco Solimene, Davide Castagno, Donatella Ruggiero, Luca Tomasi, Antonio Rapacciuolo, Marcello Giudice, Giovanni Rovaris, Aldo Coppolino, Renzo Venanzio Iulianella, Valerio Giordano, Alessandra Tordini, Erika Taravelli, Gennaro Miracapillo, Enrico Boggio, Mario Volpicelli, Paolo Sabbatani, Francesco Pentimalli, Gianluca Manzo, Leonardo Marinaccio, Paola Napoli, Daniele Giacopelli, Giuseppe Patti","doi":"10.1111/jce.70355","DOIUrl":"https://doi.org/10.1111/jce.70355","url":null,"abstract":"<p><strong>Introduction: </strong>Left bundle branch area pacing (LBBAP) has emerged as a physiologic alternative to conventional right ventricular and biventricular pacing, yet large real-world evidence remains limited. We aimed to assess changes in ventricular function and symptoms after LBBAP in patients with different clinical indications.</p><p><strong>Methods and results: </strong>Consecutive patients discharged with confirmed LBBAP across 29 Italian centers underwent evaluation of echocardiographic parameters and New York Heart Association (NYHA) functional class at follow-up. A total of 697 patients were included: 532 with a bradycardia indication and 165 with a heart failure (HF) indication, assessed at a median follow-up of 12.4 months. In the bradycardia group, left ventricular ejection fraction (LVEF) showed a slight improvement from 55% (interquartile range, 50-60) to 56% (52-60) (p = 0.027). Paced-induced cardiomyopathy (PICM), defined as a ≥ 10% absolute LVEF reduction to < 50%, occurred in 3% of patients. Loss of LBBAP capture (p = 0.025) and lower LBBAP percentage (p = 0.024) were independent predictors of PICM. In the HF group, LVEF improved from 35% (30-41) to 45% (36-52) (p < 0.001). Overall, 61.8% were classified as responders (LVEF increase ≥ 5%), rising to 73.8% among patients with ≥ 12 months of follow-up. Higher LBBAP pacing percentage and absence of coronary artery disease independently predicted response. NYHA functional class improved significantly in both groups.</p><p><strong>Conclusions: </strong>In this large real-world cohort, LBBAP was associated with meaningful improvements in ventricular function and symptoms in both bradycardia and HF populations. A high percentage of effective LBBAP capture is essential for optimizing outcomes, supporting its role as an effective physiologic pacing strategy.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838384","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":"Intranodal Atrioventricular Nodal Reentrant Tachycardia Mimicking Junctional Tachycardia.","authors":"Tomomasa Takamiya, Kensuke Fujiwara, Takashi Miyamoto, Shinsuke Miyazaki, Tetsuo Sasano","doi":"10.1111/jce.70360","DOIUrl":"https://doi.org/10.1111/jce.70360","url":null,"abstract":"<p><strong>Introduction: </strong>Differentiating atrioventricular nodal reentrant tachycardia (AVNRT) from non-reentrant junctional tachycardia (JT) can be challenging.</p><p><strong>Methods and results: </strong>In this case, regular narrow QRS complex tachycardia with simultaneous activation of the atrium and ventricle was reproducibly induced following an atrio-His interval jump by a single atrial extrastimulus, initially suggesting typical slow-fast AVNRT. During tachycardia, however, atrial activation and the His-atrial interval spontaneously changed without affecting the tachycardia cycle length. An \"atrial-His-His-atrial\" response to atrial overdrive pacing, late-coupled atrial premature depolarizations (APDs) that failed to reset tachycardia via slow pathway conduction, and early-coupled APDs that reset tachycardia via fast pathway conduction without terminating tachycardia, favored JT. Finally, slow pathway ablation rendered tachycardia non-inducible.</p><p><strong>Conclusion: </strong>Intranodal AVNRT mimicking JT, which postulates an intranodal reentrant circuit with intervening conduction between the fast and slow pathways, can explain all of these findings and thus be differentiated from JT.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815594","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":"Left Bundle Branch Area Pacing versus Deep Septal Pacing in Patients After Transcatheter Aortic Valve Replacement.","authors":"Liangzhen Qu, Xueting Duan, Han Chen","doi":"10.1111/jce.70361","DOIUrl":"https://doi.org/10.1111/jce.70361","url":null,"abstract":"<p><strong>Background: </strong>Left bundle branch area pacing (LBBAP) has been reported to improve long-term clinical outcomes in patients requiring permanent pacemaker implantation (PPMI) after transcatheter aortic valve replacement (TAVR). Deep septal pacing (DSP) has emerged as a potential alternative to LBBAP.</p><p><strong>Objective: </strong>This study investigated whether short-term and long-term clinical outcomes differ between LBBAP and DSP in post-TAVR patients.</p><p><strong>Methods: </strong>Consecutive patients undergoing LBBAP or DSP following TAVR were retrospectively included at our institution. Short-term clinical outcomes (1-year follow-up) were assessed by echocardiographic measures of reverse remodeling and changes in QRS duration and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. For long-term outcomes, the primary composite endpoint was all-cause mortality or heart failure hospitalization (HFH). Secondary endpoints included HFH and improvement in New York Heart Association (NYHA) class (≥ 2 grades).</p><p><strong>Results: </strong>A total of 82 patients (39 LBBAP and 43 DSP) were observed for a mean duration of 731.8 days. There was no significant difference between two groups in the risk of primary endpoint (23.1% vs. 23.3%, adjusted hazard ratio [aHR] 0.61; 95% CI: 0.23-1.61, p = 0.315) and HFH (17.9% vs. 20.9%, aHR 0.64; 95% CI: 0.22-1.82; p = 0.402). However, LBBAP was a robust predictor of NYHA class improvement compared to DSP (53.8% vs. 27.9%, aHR 2.23; 95% CI: 1.03-4.87, p = 0.043), especially when left bundle branch (LBB) capture was independently confirmed (aHR 2.74, p = 0.006). Both modalities were similarly effective in improving electromechanical and biochemical parameters, including LVEF, LVEDD, QRS duration, and NT-proBNP (all p > 0.05).</p><p><strong>Conclusion: </strong>LBBAP and DSP yield comparable risks for the primary composite endpoint and HFH, yet LBBAP provides superior symptomatic relief. Confirmation of left bundle branch capture is advisable to optimize clinical benefits. Liangzhen Qu and Xueting Duan contributed equally to this manuscript.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815612","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":"Prospective Trial of Radiofrequency Catheter Ablation of High Dominant Frequencies After Pulmonary Vein Isolation in Non-Paroxysmal Atrial Fibrillation (PAD-AF Trial): A Multicenter, Randomized Clinical Trial.","authors":"Koji Kumagai, Tomoaki Hasegawa, Daisuke Kutsuzawa, Yuichi Hanaki, Masahide Harada, Hitoshi Hachiya, Yuhi Hasebe, Kazuki Noda, Minoru Yambe, Hirohito Metoki, Kazutaka Aonuma","doi":"10.1111/jce.70357","DOIUrl":"https://doi.org/10.1111/jce.70357","url":null,"abstract":"<p><strong>Background: </strong>The role of dominant frequency (DF)-guided ablation after pulmonary vein isolation (PVI) in persistent atrial fibrillation (AF) remains uncertain. We evaluated the clinical and mechanistic impact of DF mapping in a multicenter randomized study.</p><p><strong>Methods and results: </strong>In this multicenter, prospective study, 103 patients were enrolled. Patients with high-DF sites (≥ 7 Hz) were randomized 1:1 to PVI plus DF ablation (DF group, n = 32) or PVI alone (PVI group, n = 32). Patients without high-DF sites (< 7 Hz, n = 39) underwent PVI only (non-DF group; exploratory cohort). The primary endpoint was freedom from documented AF recurrence without antiarrhythmic drugs (AADs) at 12 months. AF-free survival off AADs was 81.3% in the DF group versus 68.9% in the PVI group (p = 0.228) at 12 months. Arrhythmia-free survival with or without AADs was 78.1% versus 65.6% (p = 0.263). The non-DF group showed the most favorable outcomes (83.3%, p = 0.065 vs PVI group). No adverse events were associated with DF mapping or ablation. Multivariate analysis identified right atrial (RA) low-voltage area extent (HR 1.031, 95% CI 1.005-1.058, p = 0.018) and LA diameter (HR 0.899, 95% CI 0.816-0.991, p = 0.032) as independent predictors of recurrence.</p><p><strong>Conclusions: </strong>In this multicenter randomized trial, adjunctive DF-guided ablation following PVI did not result in a statistically significant improvement in arrhythmia-free survival compared with PVI alone. However, the absence of high-DF sites was associated with favorable outcomes, and RA low-voltage burden emerged as an independent predictor of recurrence, supporting the potential mechanistic value of DF mapping and highlighting the prognostic importance of right atrial structural remodeling.</p><p><strong>Trial registration: </strong>UMIN000042543.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815578","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":"Dominant Frequency Mapping as a Functional Tool for Substrate-Guided Ventricular Tachycardia Ablation.","authors":"Selim M Zor, Wiert Hoeksema, Bart Baselmans, Michiel J B Kemme, Pieter G Postema, Pranav Bhagirath","doi":"10.1111/jce.70356","DOIUrl":"https://doi.org/10.1111/jce.70356","url":null,"abstract":"<p><strong>Introduction: </strong>Accurate identification of arrhythmogenic substrate is essential for successful ventricular tachycardia (VT) ablation, yet existing electrogram-based methods are limited by far-field interference and operator dependence. Dominant frequency (DF) mapping offers a stimulus-independent alternative, but existing implementations lack anatomically integrated workflows with quantitative assessment of spatial concordance.</p><p><strong>Methods: </strong>The objective of this study is to develop and evaluate a computational workflow for DF mapping with three-dimensional anatomical integration in patients undergoing substrate-guided VT ablation. We retrospectively analyzed 12 patients (mean age 57.5 ± 18.0 years; 75% male) with ischemic or non-ischemic cardiomyopathy. Intracardiac electrograms from SmartTouch or Pentaray catheters were segmented, transformed into the frequency domain, and thresholded using case-specific histograms. DF activity was projected onto patient-specific ventricular meshes, and spatial correspondence with operator-defined ablation sites was quantified using continuous proximity metrics (soft recall, soft precision) and receiver operating characteristic (ROC) analysis.</p><p><strong>Results: </strong>DF analysis was successful in all cases, with projection errors < 4 mm. DF activity showed high soft recall (0.776-0.999) and variable soft precision (0.025-0.754). ROC AUC values ranged from 0.622 to 0.953, exceeding baseline in all cases. SmartTouch data generally yielded higher recall and greater separation between ablation and non-ablation points.</p><p><strong>Conclusion: </strong>DF mapping with anatomical integration is feasible across catheter types and demonstrates consistent spatial concordance with operator-defined VT ablation targets. This stimulus-independent workflow can be applied to routine mapping data and provides a framework for quantitative assessment of spatial relationships with procedural targets. DF values were case-specific and not comparable across patients, catheter types, or institutions. Prospective evaluation in larger cohorts is warranted.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815519","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":"Manifest Preexcitation-Related Cardiac Dysfunction in the Absence of Tachyarrhythmia: A Systematic Review of Literature.","authors":"Mansoor Rahman, Zaid Abuimweis, Ahmad Alayyat, Zinah A Bairmani, Muhammad Haseeb Ul Rasool, Sundal Aziz, Waqas Ullah, Behzad B Pavri","doi":"10.1111/jce.70350","DOIUrl":"https://doi.org/10.1111/jce.70350","url":null,"abstract":"<p><p>Cardiac dysfunction secondary to manifest ventricular pre-excitation via accessory pathways (AP) in the absence of tachyarrhythmias is rarely studied. To evaluate pathophysiology, AP location impact, diagnostic approach, and role of catheter ablation (CA) in pre-excitation-related cardiac dysfunction without tachyarrhythmias. Electronic databases were queried for WPW/pre-excitation and cardiac dysfunction-related studies without age restrictions. A total of 34 studies met inclusion criteria, including 27 case reports/series (42 patients, 62% female) and 7 observational studies (412 participants, 41% female). Pediatric patients age ranged from infancy to 21 years and adults from 20 to 59 years. Right septal and right free-wall APs were most commonly associated with cardiomyopathy. Heart failure predominated in pediatric presentations, whereas adults most often exhibited asymptomatic LV dysfunction. Intra-LV dyssynchrony, particularly when accompanied by septal dyskinesia, emerged as a consistent pathophysiologic feature. Two-dimensional strain echocardiography (2D-STE) reliably identified LV dysfunction, localized AP, and assessed response to CA. Although cardiac function mostly normalized after successful AP ablation, irreversible myocardial changes have been reported. Preexcitation-related cardiac dysfunction in the absence of tachyarrhythmias, appears to be mediated primarily by intra-LV dyssynchrony and is most commonly associated with right-sided and septal APs. 2D-strain imaging is a useful diagnostic tool. CA typically restores cardiac function, however, irreversible myocardial changes can occur. Therefore, close surveillance and consideration of early ablation in patients with evidence of dyssynchrony are warranted. Large prospective cohort studies can further validate these findings.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772304","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":"Lead Extraction and Outcomes in Frail Patients With Cardiac Implantable Electronic Device Infections in the United States.","authors":"Vishwesh Bharadiya, Siddharth Agarwal, Karol Quelal Analuisa, Shivaraj P Patil, Naiya Mainigi, Zain Ul Abideen Asad, Muhammad Bilal Munir, Daniel C DeSimone, Christopher V DeSimone, Abhishek J Deshmukh","doi":"10.1111/jce.70347","DOIUrl":"https://doi.org/10.1111/jce.70347","url":null,"abstract":"<p><strong>Introduction: </strong>Frailty is increasingly recognized as an important determinant of outcomes in cardiovascular disease, yet its population-level impact among patients hospitalized with cardiac implantable electronic device (CIED) infections remains incompletely defined. We examined the prevalence of frailty and its association with clinical outcomes and utilization of transvenous lead removal (TLR) in a contemporary national cohort.</p><p><strong>Methods and results: </strong>We analyzed the National Readmissions Database from 2016-2021 to identify adults hospitalized for CIED infections. Frailty was defined using the Johns Hopkins adjusted clinical groups frailty-defining diagnoses. Of 288,402 patients hospitalized with CIED infections, 25.1% were classified as frail. Frail patients experienced significantly higher in-hospital mortality (10.8% vs. 4.6%), 30-day mortality (9.2% vs. 5.5%), complications, longer length of stay, lower rates of discharge home, and higher 30-day readmissions compared with non-frail patients (all p < 0.01). TLR was performed less frequently in frail patients (10.8% vs. 13.4%; adjusted odds ratio [aOR] 0.80, 95% CI 0.76-0.83). On adjusted analyses, TLR was independently associated with lower in-hospital mortality, 30-day mortality, and 30-day readmissions in both frail and non-frail patients.</p><p><strong>Conclusion: </strong>Among patients hospitalized with CIED infections, TLR was independently associated with lower mortality and readmissions in both frail and non-frail patients, despite lower utilization in frail individuals. Frailty was common (25.1%) and independently associated with significantly worse outcomes. These findings highlight important associations between frailty, treatment patterns, and outcomes that warrant prospective evaluation.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772314","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":"Temporary Loss of Pacemaker Capture During Focal Pulsed Field Ablation: A Case of Reversible Lead-Energy Interactions.","authors":"Daniel Joseph Gonzalez, Rahul Devathu, Kushal Chatterjee, Erick Godinez, Samhith Kambampati, Aaryamaan Verma, Muhammad Fazal, Tasmeen Hussain, Tina Baykaner","doi":"10.1111/jce.70308","DOIUrl":"https://doi.org/10.1111/jce.70308","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) is increasingly used for atrial arrhythmia ablation and is considered safe in patients with cardiac implantable electronic devices, though intraprocedural lead interactions remain undercharacterized.</p><p><strong>Case: </strong>We report a 75-year-old woman with a dual-chamber pacemaker who underwent focal PFA for recurrent atrial tachycardia using a 9-mm lattice-tip catheter. Immediately following PFA near the superior vena cava-right atrial junction, atrial lead capture was lost with transient right atrial lead threshold elevation and T-wave oversensing. All parameters normalized within 1 h.</p><p><strong>Conclusions: </strong>This case highlights reversible lead-energy interactions and the importance of real-time device monitoring when ablating near indwelling leads.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772298","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 a Dual-Lead Technique on Procedural Success of Left Bundle Branch Pacing.","authors":"Yousaku Okubo, Junji Maeda, Shogo Miyamoto, Shunsuke Ishida, Naoki Ishibashi, Shunsuke Miyauchi, Sho Okamura, Takehito Tokuyama, Noboru Oda, Yukiko Nakano","doi":"10.1111/jce.70353","DOIUrl":"https://doi.org/10.1111/jce.70353","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771938","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":"Wide-Area Superior Vena Cava Isolation Using a Circular Pulsed Field Ablation Catheter Guided By Spontaneous Conduction Block Lines: A Comparative Study With Radiofrequency Ablation.","authors":"Tomoyuki Arai, Rintaro Hojo, Yoshiaki Mizunuma, Takafumi Sasaki, Koichiro Yamaoka, Hirofumi Kujiraoka, Masao Takahashi, Seiji Fukamizu","doi":"10.1111/jce.70352","DOIUrl":"https://doi.org/10.1111/jce.70352","url":null,"abstract":"<p><strong>Aims: </strong>The superior vena cava (SVC) is a frequent non-pulmonary vein trigger in atrial fibrillation (AF). Adjunctive SVC isolation (SVCi) may reduce AF recurrence; however, radiofrequency (RF) ablation carries risks such as phrenic nerve palsy (PNP) and sinus node dysfunction (SND). Pulsed field ablation (PFA) offers myocardial selectivity, but clinical data using a circular PFA catheter guided by spontaneous block lines remain limited.</p><p><strong>Methods and results: </strong>This single-centre retrospective study included 85 patients who underwent adjunctive SVCi (RF n = 45, PFA n = 40). RF ablations were performed from August 2023 to December 2024, and PFA was introduced in January 2025. Spontaneous block lines were identified using the EnSite X mapping system and incorporated into ablation planning. SVC isolation was achieved in all patients. First-pass success was higher with PFA (97.5% vs. 84.4%, p = 0.06). PFA required fewer applications (4.4 ± 2.4 vs. 14.2 ± 6.3, p < 0.01) and a shorter procedural duration (368 ± 350 vs. 847 ± 656 s, p < 0.01), with similar isolation area (14.0 ± 6.9 vs. 14.2 ± 6.3 cm², p = 0.42). Transient PNP occurred in one PFA case and none with RF. Transient SND occurred in four PFA and two RF cases; all resolved spontaneously, and no persistent complications were observed. During follow-up, atrial fibrillation recurrence rates were low and comparable between groups (7.5% vs. 8.9%, p = 0.81). Among patients undergoing repeat ablation, SVC reconnection was infrequent.</p><p><strong>Conclusions: </strong>Wide-area SVCi using a circular PFA catheter guided by spontaneous block lines is feasible and efficient. PFA reduced procedure time and ablation burden while maintaining comparable efficacy and low complication rates. This strategy provides an anatomically rational, reproducible approach for adjunctive SVCi in AF ablation workflows.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772281","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}