Journal of Cardiovascular Electrophysiology最新文献

{"title":"Safety and Efficacy of Pulsed Field Ablation for Cavotricuspid Isthmus-Dependent Flutter: A Systematic Literature Review.","authors":"Juan F Rodriguez-Riascos, Hema Srikanth Vemulapalli, Padmapriya Muthu, Poojan Prajapati, Wilber Su, Win-Kuang Shen, Arturo M Valverde, Komandoor Srivathsan","doi":"10.1111/jce.16719","DOIUrl":"https://doi.org/10.1111/jce.16719","url":null,"abstract":"<p><p>Cavotricuspid isthmus ablation (CTI) is a first-line therapy in patients with typical atrial flutter. With the advent of pulsed field (PF) as a new energy source, we sought to evaluate the use of PF for CTI ablation. A systematic literature search was conducted on the use of PF for CTI-flutter up to December 2024. A meta-analysis was performed for studies reporting pooled data, while individual case reports were reviewed and summarized. The mean number of PF applications, acute success rate, and prevalence of coronary vasospasm were evaluated. Eleven studies with pooled data from 155 patients were included. All patients had an acute block of the CTI. The mean number of PFA applications was 7.78 (95% CI 6.53-9.48). The incidence of ST-elevation was 0.04% (95% CI 0-2.23%). Subclinical vasospasm was documented in 45% (95% CI 32%-59%) of patients who underwent periprocedural coronary angiography. Prophylactic use of nitrates showed a trend toward reducing the incidence of subclinical vasospasm (RR 0.24, 95% CI 0.06-1.06, p = 0.059). Twelve cases with patient-level data were included; six reported complications, including ST elevation and conduction disturbances. PFA for CTI flutter demonstrates high acute success; however, evidence regarding the durability of the block is limited. Clinical vasospasm with ST segment elevation is uncommon but can lead to life-threatening complications. The incidence of subclinical vasospasm is high, and nitrates tend toward reducing this phenomenon. To date, the role of PFA for this condition appears to be limited.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144158861","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":"An Interesting Response During Left Bundle Branch Area Pacing: Electrophysiological Insights.","authors":"Anindya Ghosh, Chenni S Sriram, Kartikeya Bhargava, Raghav Bansal, Ulhas M Pandurangi","doi":"10.1111/jce.16749","DOIUrl":"https://doi.org/10.1111/jce.16749","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159312","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":"Efficacy and Safety of Pulsed-Field Versus High-Power Short-Duration Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis With Reconstructed Time-to-Event Data.","authors":"Ahmed Mazen Amin, Mustafa Turkmani, Saman Al Barznji, Sanghamitra Mohanty, Rachel M Kaplan, Jeffrey Winterfield, Dhanunjaya Lakkireddy, Pasquale Santangeli, Luigi Di Biase, Andrea Natale","doi":"10.1111/jce.16728","DOIUrl":"https://doi.org/10.1111/jce.16728","url":null,"abstract":"<p><strong>Background: </strong>Pulsed-field ablation (PFA) and high-power short-duration (HPSD) ablation (45-90 W) are emerging technologies in atrial fibrillation (AF) treatment, both achieving durable pulmonary vein isolation. We aim to investigate the efficacy and safety of PFA versus HPSD ablation.</p><p><strong>Methods: </strong>We comprehensively searched PubMed, Web of Science (WOS), Scopus, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) through July 2024. Pairwise meta-analysis with reconstructed time-to-event analysis were performed using R version 4.3.1 (PROSPERO ID: CRD42024576031).</p><p><strong>Results: </strong>Seven observational studies, including 1904 patients, were included. PFA was significantly associated with lower atrial tachyarrhythmia recurrence compared to HPSD ablation (45-90 W) at the longest follow-up (RR: 0.73, 95% CI [0.60, 0.88], p < 0.01). Subgroup analysis revealed a significant reduction in atrial tachyarrhythmia recurrence with PFA versus HPSD ablation (45-50 W) (RR: 0.69, 95% CI [0.54, 0.88], p < 0.01), but not compared to vHPSD ablation (70-90 W). Reconnected pulmonary vein rates were significantly lower with PFA compared to HPSD (45-50 W) (p = 0.03), while no significant difference was observed compared to vHPSD (70-90 W). PFA was significantly associated with reduced procedural duration (MD: -33.15 with 95% CI [-40.93, -25.36], p < 0.01) and left atrial dwell time (MD: -32.16 with 95% CI [-45.55, -18.77], p < 0.01), although fluoroscopy time increased (MD: 7.48 with 95% CI [4.29, 10.68], p < 0.01) compared to HPSD ablation (45-90 W). Safety profiles were comparable, but pericarditis rates were significantly lower with PFA versus HPSD (45-50 W) (p = 0.003) and vHPSD (70-90 W) (p = 0.019). Kaplan-Meier analysis showed a 28% lower risk of atrial tachyarrhythmia recurrence with PFA compared to HPSD ablation (45-90 W) (HR: 0.72, 95% CI [0.57, 0.91], p = 0.006) over an 18-month follow-up.</p><p><strong>Conclusion: </strong>PFA and HPSD ablation (45-90 W) are effective and safe for AF ablation. PFA was significantly associated with lower atrial tachyarrhythmia recurrence, shorter procedural duration, reduced left atrial dwell time, increased fluoroscopy time, and comparable safety, with lower rates of pericarditis compared to HPSD ablation.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144158714","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":"Complex Fractionated Atrial Electrograms, Dispersion, and Voltage in Persistent Atrial Fibrillation: Implications for Electrogram-Guided Ablation.","authors":"Hailei Liu, Ashkan Ehdaie, Eugenio Cingolani, Archana Ramireddy, Eric D Braunstein, Xunzhang Wang, Sumeet S Chugh, Michael M Shehata","doi":"10.1111/jce.16738","DOIUrl":"https://doi.org/10.1111/jce.16738","url":null,"abstract":"<p><strong>Background: </strong>Various methods have been used to identify substrate of persistent atrial fibrillation (PeAF) including complex fractionated atrial electrograms (CFAEs), electrogram dispersion, and low-voltage areas (LVAs). This study aims to investigate their relationship and changes following ablation.</p><p><strong>Methods and results: </strong>Consecutive patients with PeAF undergoing catheter ablation were prospectively recruited. High-density left atrial mapping was employed. Repeat mapping was performed after pulmonary vein and posterior wall isolation (PVI + PWI) if atrial fibrillation persisted. Dispersion tags were automatically annotated using a commercially available artificial intelligence system. A total of 32 patients (mean age 64.8 ± 9.7 years, 26 male) were included. In CFAE regions, 93.1 ± 7.5% of the surface had voltage > 0.5 mV, compared to only 17.5 ± 24.5% in the non-CFAE regions. Nearly all dispersion tags (99.3 ± 1.6%) were located within CFAE regions. Postablation mapping (N = 24) revealed a reduction in both CFAE and dispersion tags, prolongation of atrial cycle length, and de-escalation of CFAE sub-types, even in areas remote from ablation targets. During a median follow-up period of 9.0 ± 1.9 months, among the nine patients with CFAE de-escalations across all five regions, only one (11.1%) experienced recurrence. In contrast, eight out of the remaining 15 patients (53.3%) experienced recurrence (p = 0.039).</p><p><strong>Conclusion: </strong>Dispersion is associated with CFAEs, predominantly reflecting areas of normal voltage. Regional reductions in CFAE and dispersion burden may occur outside of the directly targeted ablation areas. Post-procedural de-escalation of electrograms across the left atrium might suggest a potential indicator for PVI + PWI responders; however, further studies are warranted.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144158186","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 Recurrence-to-Repeat Ablation Time on Long-Term Efficacy and Safety of Patients With Paroxysmal Atrial Fibrillation: Time Matters.","authors":"Yuen Hoong Phang, Ting-Yung Chang, Shih-Lin Chang, Yenn-Jiang Lin, Li-Wei Lo, Yu-Feng Hu, Fa-Po Chung, Chin-Yu Lin, Ling Kuo, Chih-Min Liu, Shih-Ann Chen","doi":"10.1111/jce.16742","DOIUrl":"https://doi.org/10.1111/jce.16742","url":null,"abstract":"<p><strong>Background: </strong>Rhythm control with catheter ablation has been established in the management of atrial fibrillation (AF), but the recurrence of AF remains significant. Several studies have demonstrated the benefits of repeat catheter ablation in patients with recurrent AF. However, the optimal timing for repeat ablation to minimize adverse atrial remodeling following recurrence has not been adequately investigated. In this study, we aimed to determine if an optimal timing for repeat catheter ablation existed in patients with recurrent AF.</p><p><strong>Method: </strong>We retrospectively screened 1131 patients receiving AF ablation at Taipei Veterans General Hospital and enrolled patients with paroxysmal AF undergoing repeat ablation procedures. Finally, 65 patients were enrolled for further analysis and patients are separated into two groups according to analysis of receiver operating characteristic (ROC) curve of recurrence to repeat ablation time (RAT).</p><p><strong>Result: </strong>After analysis, the optimal RAT was 222 days, around 7.5 months, with a sensitivity of 56% and a specificity of 78% for 2nd recurrence. KM survival curve also demonstrated Group 2 (RAT ≥ 222) had higher recurrence of atrial arrhythmias after 2nd ablation (p = 0.01). In multivariable analysis, RAT was shown to be an independent predictor of long-term outcome in patient with AF.</p><p><strong>Conclusion: </strong>Our study suggests that early repeat ablation might be advantageous in managing AF, extending arrhythmia-free intervals, and potentially preventing progression to more persistent arrhythmic forms. Given AF's progressive nature, these results advocate for early intervention strategies aimed at minimizing adverse atrial remodeling and enhancing quality of life for patients.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150438","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":"Periprocedural Safety of Interventional Electrophysiological Procedures in Octogenarians and Nonagenarians.","authors":"Vanessa Sciacca, Jakob Feldt, Laura Rottner, Christian-Hendrik Heeger, Christian Sohns, Bruno Reissmann, Ardan M Saguner, Francesco Santoro, Roland R Tilz, Tilman Maurer, Andreas Rillig, Feifan Ouyang, Dominik Linz, Kevin Vernooy, Philipp Sommer, Arian Sultan, Stephan Willems, Karl-Heinz Kuck, Andreas Metzner, Thomas Fink","doi":"10.1111/jce.16689","DOIUrl":"https://doi.org/10.1111/jce.16689","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation is an established treatment for cardiac arrhythmia. There is a lack of data on invasive electrophysiological (EP) procedures in aged patients.</p><p><strong>Methods: </strong>Consecutive patients ≥ 80 years who underwent catheter ablation or left atrial appendage closure procedures between January 2005 and December 2017 in a high-volume center were retrospectively studied and compared to a matched control group of individuals < 80 years of age.</p><p><strong>Results: </strong>The aged group consisted of 486 patients who underwent 566 procedures at a mean age of 82.7 ± 2.5 years (range 80-95 years). A cohort of 480 patients aged < 80 years (mean age 64.1 ± 13.3 years) with 566 procedures served as a control group. Performed procedures were atrial arrhythmia ablation including atrial fibrillation treatment (n = 366, 64.7%), cavotricuspid isthmus ablation (n = 139, 24.6%), ablation of ventricular arrhythmias (n = 57, 10.1%), and left atrial appendage closure (n = 12, 2.1%). There were numerically more procedures with major complications after treatment of elderly patients (32 [5.7%] vs. 21 [3.5%] procedures, p = 0.12), as well as numerically more procedures accompanied by intrahospital deaths (6 [1.1%] vs. 1 [0.2%] procedure, p = 0.12). The rate of minor complications was significantly higher in aged patients as compared to younger controls (31 [5.1%] vs. 17 [20%] procedures, p = 0.039).</p><p><strong>Conclusion: </strong>Invasive EP procedures in octogenarians and nonagenarians are feasible, however a significantly higher incidence of minor periprocedural complications and a trend toward more severe complications and intrahospital fatalities were observed compared to younger patients. These findings support an individual risk-benefit assessment for elderly individuals before invasive EP treatments are conducted.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150448","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":"Imaging-Aided VT Ablation. Long-Term Results From a Pilot Study.","authors":"Benjamin Sacristan, Hubert Cochet, Benjamin Bouyer, Romain Tixier, Josselin Duchateau, Nicolas Derval, Thomas Pambrun, Marine Arnaud, Jan Charton, Geoffroy Ditac, Allan Plant, John Fitzgerald, Soumaya Sdiri-Cheniti, Laurens Verhaege, Michel Montaudon, Mélèze Hocini, Michel Haissaguerre, Maxime Sermesant, Pierre Jais, Frederic Sacher","doi":"10.1111/jce.16741","DOIUrl":"https://doi.org/10.1111/jce.16741","url":null,"abstract":"<p><strong>Background: </strong>Ventricular tachycardia (VT) ablation has become a cornerstone of patient care, especially for post-MI VT. Several strategies have proven effective for achieving rhythm control in this population, but the workflow is highly variable and depends on the physician's experience.</p><p><strong>Aim: </strong>This study describes the initial systematic experience of VT ablation targeting wall thickness heterogeneity on a cardiac computed tomography (CT) scanner used as a surrogate for mapped VT isthmii.</p><p><strong>Methods: </strong>Consecutive patients with post-MI VT, a CT scan, and a first VT ablation were included from January 2017 to May 2022. Targets were identified based on wall thickness heterogeneity. After image integration, ablation with > 10 grams, 40-50 W was performed with the aim of blocking the CT channels/render them non-capturable. Only then was inducibility tested. Inducible VT, if any, were conventionally mapped and ablated with the aim of reaching non-inducibility.</p><p><strong>Results: </strong>Thirty-nine patients (97.4% male, age: mean LVEF 35 ± 10%) were included. The mean number of identified CT Channels was 3.6 ± 1.8/patient. Non-inducibility was achieved in 19 (48.7%) of patients after initial imaging-guided ablation, while at least one VT could be induced in 19 (48.7%). Among these patients, 4 had VT related to unblocked or reconnected CT-determined VT channels, and 15 from other areas (border zone), typically with faster cycle length. After further mapping and ablation, 3 (7.7%) patients remained inducible. Mean radiofrequency time was 35 ± 19 min for CT Channels ablation, with an additional 11 ± 8 min for supplementary ablation (global mean RF time 35 ± 19 min). With a mean follow-up of 47.8 ± 24.3 months, 61.9% (95% CI: 44.0%-75.5%) remained VT free.</p><p><strong>Conclusion: </strong>CT-guided ablation represents a feasible and safe strategy for VT ablation in patients with an ischemic cardiomyopathy.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150217","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 Evaluation of Superior Vena Cava Isolation as an Adjunct to Pulmonary Vein Re-Isolation During Paroxysmal Atrial Fibrillation Repeat Procedures.","authors":"Benjamin De Becker, Louisa O'Neill, Gabriela Hilfiker, Maarten De Smet, Clara Francois, Milad El Haddad, René Tavernier, Mattias Duytschaever, Jean-Benoît Le Polain De Waroux, Sébastien Knecht","doi":"10.1111/jce.16708","DOIUrl":"https://doi.org/10.1111/jce.16708","url":null,"abstract":"<p><strong>Background: </strong>The superior vena cava (SVC) is a prominent non-pulmonary vein trigger of atrial fibrillation (AF). Its isolation has been shown to be effective in paroxysmal AF (PAF) originating from SVC.</p><p><strong>Objective: </strong>In this study, focusing on repeat procedures for recurrent PAF post-PVI, we aimed to evaluate the added value of empirical SVC isolation to PV antral re-isolation, when at least one PV reconnection is demonstrated.</p><p><strong>Methods: </strong>Patients with recurrent PAF referred for redo procedures, and exhibiting PV reconnection, were randomly assigned to undergo either PVI alone (group 1) or PVI and SVC isolation (group 2). The primary outcome was the recurrence rate at 1-year while procedural time, fluoroscopy time, complications rate, and the presence of scar during LA mapping were secondary outcomes.</p><p><strong>Results: </strong>Eighty-two patients were randomized in the study (39 in group 1 and 43 in group 2). The median age was 65 ± 9 in group 1 and 62 ± 11 in group 2 (p = 0.3). The time from first AF episode to the repeat procedure was 76 and 52 months, respectively (p = 0.7). 31 patients in group 1 and 35 patients in group 2 had more than one reconnected vein. There were no significant differences in procedural and fluoroscopy times between groups. At 12-months, freedom from atrial tachyarrhythmia was achieved in 69% patients in group 1% and 76% patients in group 2 (HR 0.7, 95% CI: 0.3-1.7).</p><p><strong>Conclusion: </strong>It is unknown whether empirical addition of SVC isolation to PVI improves freedom of recurrence for the treatment of recurrent PAF after previous PVI. Given the small study population, the addition of SVC isolation requires further investigation in a larger randomized trial.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127775","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":"A Modular Approach for Leadless Pacing.","authors":"Wissam Mekary, Sonya Vijayvargiya, Celine Mouawad, Neal K Bhatia, Anand D Shah, Stacy B Westerman, Michael S Lloyd, Miguel A Leal, Faisal M Merchant, Mikhael F El-Chami","doi":"10.1111/jce.16740","DOIUrl":"https://doi.org/10.1111/jce.16740","url":null,"abstract":"<p><strong>Introduction: </strong>The AVEIR leadless pacemaker (LP) is a novel device that can function as a single atrial/ventricular or dual-chamber pacemaker. The introduction of single-chamber atrial LP has allowed electrophysiologists to treat patients with sinus node dysfunction with this device instead of implanting a dual-chamber transvenous pacemaker.</p><p><strong>Methods: </strong>We retrospectively identified all patients who underwent AVEIR LPs' implantation at Emory Healthcare between 2022 and 2025. Baseline characteristics, indications for pacing, and procedure outcomes were retrieved from electronic medical records. The device's electrical characteristics were reported from routine interrogations done at our device clinic.</p><p><strong>Results: </strong>Between 2022 and 2025, 89 patients underwent implantation of 37 single-chamber atrial AVEIR, 34 single-chamber ventricular AVEIR, and 18 dual-chamber devices. Patients were followed for a median duration of 4.7 months [2;9]. The rate of major complications was 3.4% and minor complications 1.1%. Two patients with ventricular LP required upgrade to cardiac resynchronization therapy-defibrillator (CRT-D) due to pacing-induced cardiomyopathy (2.3%). One patient (2.7%) with a standalone atrial LP developed atrial fibrillation with slow ventricular response requiring the addition of a ventricular LP 10 months postimplantation.</p><p><strong>Conclusion: </strong>In our center, we adopted a modular pacing approach for leadless pacing. This strategy focuses on minimizing the amount of hardware in the heart. This reduces complications such as perforation and dislodgment while optimizing battery longevity, which is affected by i2i communication.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127766","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":"Taking a Detour: Step-by-Step Alternative Approaches to Transseptal Access.","authors":"Worawan B Limpitikul, Vincent Wu, Kei Yamada, Gregory F Michaud, William J Hucker, Moussa Mansour, E Kevin Heist, Alan Hanley","doi":"10.1111/jce.16711","DOIUrl":"https://doi.org/10.1111/jce.16711","url":null,"abstract":"<p><p>Transseptal puncture via a femoral vein and inferior vena cava (IVC) is a commonly performed procedure in multiple electrophysiology studies that require access to the left atrium or left ventricle. However, the standard approach is impossible in certain anatomies with IVC obstruction, such as congenital IVC interruption with azygos continuation and acquired obstruction. Here, we describe a step-by-step approach to alternative methods for transseptal access, including the transhepatic approach and superior approach from either the internal jugular vein or axillary vein. With careful review of multi-modal imaging and multidisciplinary preprocedural planning, these methods are feasible and safe alternatives to transseptal access.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126203","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}