Journal of Cardiovascular Electrophysiology最新文献

{"title":"A Puzzling Supraventricular Rhythm: A Diagnostic and Therapeutic Challenge.","authors":"Hussam Ali, Guido De Ambroggi, Riccardo Cappato","doi":"10.1111/jce.70537","DOIUrl":"https://doi.org/10.1111/jce.70537","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227829","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":"Performing Catheter Ablation for Atrial Fibrillation Without On-Site Cardiothoracic Surgery: Time to Step on the Pedal or Pump the Brakes?","authors":"Jim W Cheung","doi":"10.1111/jce.70534","DOIUrl":"https://doi.org/10.1111/jce.70534","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227799","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":"Safety and Outcomes of Percutaneous Vegetation Aspiration During Transvenous Lead Extraction: A Multicenter Experience.","authors":"Haran Yogasundaram, Wissam Mekary, Mikhael F El-Chami, Kevin M Trulock, Christopher A Healy, David Wilson, Ryan Brunetti, Rohit Mehta, Satish K Misra, Divyang R Patel, Erich L Kiehl, Francis E Marchlinski, Robert D Schaller","doi":"10.1111/jce.70530","DOIUrl":"https://doi.org/10.1111/jce.70530","url":null,"abstract":"<p><strong>Background: </strong>Transvenous lead extraction (TLE) for cardiac implantable electronic device infection has high procedural success, but with a 1-year mortality approaching 25%. Potential mechanisms include septic embolization and persistent infected lead casts or \"ghosts.\" Percutaneous mechanical aspiration of lead-related vegetations during TLE is a potential strategy to reduce vegetation burden, but safety and outcomes data are limited.</p><p><strong>Objectives: </strong>To describe a multicenter experience utilizing percutaneous vegetation aspiration during TLE, including vegetation characteristics, procedural techniques, complications, and outcomes.</p><p><strong>Methods: </strong>A retrospective multicenter registry included patients undergoing aspiration of lead-related masses at the time of TLE between 2016 and 2024 across six institutions. Clinical, microbiologic, and procedural data were collected. Vegetation size and outcomes were assessed using transesophageal or intracardiac echocardiography.</p><p><strong>Results: </strong>Fifty-three patients (62 ± 14 years, 28% female) underwent aspiration of 63 vegetations during extraction of 114 leads (mean dwell time 9.0 ± 8.2 years). Indications included bacteremia in 44 (83%), fungemia in 4 (8%), fever of unknown origin in 1 (2%), and aseptic thrombus debulking in 4 (8%). Mean vegetation size was 2.8 ± 1.8 cm. Aspiration devices included Penumbra Indigo (34%), Inari FlowTriever (30%), and AngioVac (36%). Complete aspiration occurred in 40 patients (75%). TLE achieved complete success in 49 (92%) and clinical success in 52 (98%). Major complications related to aspiration occurred in 2 patients (4%). After a median follow-up of 139 days, 10 patients (19%) died.</p><p><strong>Conclusions: </strong>Percutaneous vegetation aspiration during TLE appears feasible and generally safe. However, mortality following extraction for device-related infection remains substantial, and the impact of adjunctive aspiration on outcomes requires further study.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193847","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":"The Pear Strategy for Two-Ring Pulmonary Vein Isolation: Antral and Sleeve Ablation Using a Balloon-in-Basket Pulsed Field Ablation Catheter","authors":"Melanie A. Gunawardene,&nbsp;Andrea Urbani,&nbsp;Lukas Urbanek,&nbsp;Julia Alexandra Marx,&nbsp;Joseph Kheir,&nbsp;Julia Lurz,&nbsp;Matteo Rocchetti,&nbsp;David Schaack,&nbsp;K. R. Julian Chun,&nbsp;Boris Schmidt","doi":"10.1111/jce.70489","DOIUrl":"10.1111/jce.70489","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pulsed field ablation (PFA) has emerged as a promising energy source for atrial fibrillation (AF) catheter ablation. This study aimed to describe the adoption and workflow optimization of a novel balloon-in-basket PFA catheter using a two rings balloon and pear strategy for pulmonary vein isolation (PVI), the pear workflow.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive all-comer patients with AF underwent PFA using the balloon-in-basket PFA catheter under deep sedation. The pear workflow comprised a two-step PVI protocol: (1) four antral PFA applications guided by initial PV angiography to confirm PV occlusion and lesion overlap through rotational deployment, followed by (2) two distal, pear-shaped balloon applications targeting the PV sleeves. Three-dimensional electroanatomic mapping with impedance-based contact assessment was utilized. Procedural parameters, acute efficacy, and safety were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty patients (62% paroxysmal AF, 42% female, mean age 68 ± 10 years) were enrolled. All PVs were successfully isolated. Median procedural and fluoroscopy times were 50 min (IQR 41–50) and 7.2 min (IQR 5.8–11.4), respectively, without significant change over the study course (50 vs. 47 min for patients 1−25 and 26−50, respectively, <i>p</i> = 0.26). Additional ablation was performed in four patients, and concomitant left atrial appendage closure was performed in three. No major or minor complications occurred. Transient phrenic nerve stunning was observed in two patients, resolving before procedure completion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The pear two-step strategy enables rapid, efficient, and safe PVI using a balloon-in-basket PFA catheter, which, despite its anatomically based design, offers procedural versatility through integrated mapping with a minimal learning curve.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 10","pages":"2298-2307"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900537","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":"Safety of Flecainide and Propafenone in Patients With Atrial Fibrillation and Structural Heart Disease","authors":"Shreyas Singireddy,&nbsp;Sami Shoura,&nbsp;Darshine Venugopal,&nbsp;Ragavendar Saravanabavanandan,&nbsp;Kyle Coombes,&nbsp;Timir Baman,&nbsp;Siddharth Shah","doi":"10.1111/jce.70470","DOIUrl":"10.1111/jce.70470","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Class Ic antiarrhythmic drugs (AADs) have been contraindicated in patients with structural heart disease since the 1991 Cardiac Arrhythmia Suppression Trial (CAST), which demonstrated increased mortality in post-myocardial infarction patients with ventricular ectopy and reduced ejection fraction. Contemporary guidelines extend this prohibition broadly to coronary artery disease (CAD), heart failure, and other structural heart disease, yet CAST enrolled a narrow population, and the totality of post-CAST evidence across structural heart disease has never been comprehensively synthesized.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To systematically evaluate the safety of class Ic AADs (flecainide and propafenone) compared with alternative antiarrhythmic strategies in patients with atrial fibrillation (AF) and structural heart disease, with CAD as the principal prespecified subgroup.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We searched PubMed, Embase, Cochrane Library, and Web of Science from inception through May 2026 for studies comparing class Ic AAD use with class III AADs, amiodarone, or no antiarrhythmic therapy in patients with AF and structural heart disease (CAD, heart failure, or left ventricular hypertrophy). The primary endpoint was ventricular arrhythmia (VA); secondary endpoints were all-cause mortality and major adverse cardiovascular events (MACE). The primary analysis pooled all structural heart disease populations; CAD was the principal prespecified subgroup, and a test for subgroup differences (CAD vs. non-CAD) was performed. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using restricted maximum likelihood (REML) random-effects models with the Hartung–Knapp adjustment. Heterogeneity was assessed with &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; and Cochran &lt;i&gt;Q&lt;/i&gt; statistics.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Seven studies (&lt;i&gt;N&lt;/i&gt; = 35 886) met inclusion criteria; six contributed to quantitative pooling. In the primary analysis across all structural heart disease populations, class Ic AAD use was not associated with increased ventricular arrhythmia risk (pooled HR 0.73; 95% CI 0.51–1.03; &lt;i&gt;p&lt;/i&gt; = 0.065; &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 88.6%; &lt;i&gt;k&lt;/i&gt; = 5), and no individual study reported a statistically significant increase in VA risk. All-cause mortality was numerically lower but did not reach significance after the Hartung-Knapp adjustment (HR 0.47; 95% CI 0.21–1.01; &lt;i&gt;k&lt;/i&gt; = 5); MACE was significantly lower with class Ic use (HR 0.54; 95% CI 0.39–0.75; &lt;i&gt;p&lt;/i&gt; = 0.010; &lt;i&gt;k&lt;/i&gt; = 4). The CAD subgroup was directionally concordant and showed no ","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 10","pages":"2251-2260"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148653887","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":"Relationship Between Nonuniform Isochrone-Area in Late Activation Mapping and Arrhythmogenic Substrates Related to Atrial Fibrillation","authors":"Tomonori Watanabe,&nbsp;Masashi Kamioka,&nbsp;Hisaki Makimoto,&nbsp;Takafumi Okuyama,&nbsp;Hiroaki Watanabe,&nbsp;Ayako Yokota,&nbsp;Takahiro Komori,&nbsp;Tomoyuki Kabutoya,&nbsp;Hitoshi Hachiya,&nbsp;Yasushi Imai,&nbsp;Kazuomi Kario","doi":"10.1111/jce.70417","DOIUrl":"10.1111/jce.70417","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Arrhythmogenic substrates within the atrial myocardium may contribute to the initiation of atrial fibrillation (AF). The relationship between nonuniform isochrone-areas in late activation mapping and arrhythmogenic substrates remains undetermined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Sixty-two patients (66 ± 10 years, 47 males, non-paroxysmal AF [<i>n</i> = 30], second ablation procedure [<i>n</i> = 8]) who undergoing catheter ablation for AF were enrolled. High-density left atrial (LA) activation mapping was performed during atrial pacing after pulmonary vein (PV) isolation. Late activation mapping was retrospectively reconstructed. Nonuniform isochrone-areas were defined as regions of nonuniform and mottled conduction-zones characterized by the crowding of ≥ 3 color-isochrones within a 1-cm radius in late activation mapping. The relationship between nonuniform isochrone-areas and arrhythmogenic substrates associated with AF was evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Non-PV triggers were identified in 11 patients (AF-triggers:12; short runs of premature atrial complexes:4), located in the LA wall (posterior:7; anterior:6; septum:2; roof:1). Patients with non-PV triggers had significantly more nonuniform isochrone-areas than those without (median [interquartile range] 5.0 [3.0–6.0] vs. 2.0 [1.0–4.0], <i>p</i> &lt; 0.001). In multivariate logistic analysis for the presence of non-PV triggers, after adjusting for confounders such as non-paroxysmal AF, heart failure-history, and presence of low-voltage areas, the presence of nonuniform isochrone-areas on the LA low-posterior wall was an independent indicator for the presence of non-PV triggers (odds ratio: 6.9 [95% CI:1.1–44.1], <i>p</i> = 0.040). Of the 52 nonuniform isochrone-areas observed in the 11 patients with non-PV triggers, 20 areas corresponded to non-PV trigger sites.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Identification of nonuniform isochrone-areas located on LA low-posterior wall in late activation mapping may indicate the potential source for non-PV triggers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 10","pages":"2183-2192"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148360799","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":"The Characteristics of Vagal Response During Radiofrequency Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation With Heart Failure","authors":"Erpeng Liang,&nbsp;Weifeng Song,&nbsp;LuLu Kang,&nbsp;Yuexia Ren,&nbsp;Lihui Zheng,&nbsp;Ke Chen","doi":"10.1111/jce.70428","DOIUrl":"10.1111/jce.70428","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Vagal response (VR) was thought to the successful rate in catheter ablation of atrial fibrillation (AF). However, little is known about VR during pulmonary vein isolation (PVI) in AF and heart failure (HF). This study aims at investigating the incidence, risk factors and clinical outcomes of VR during PVI in paroxysmal AF with HF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 551 paroxysmal AF patients were enrolled and classified according to HF status: without HF, HF with preserved, reduced and mildly reduced ejection fraction. The VR was defined as atrioventricular block, asystole or an increase in the R-R interval by 50% during ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>VR had the same occurrence rate between patients without HF and those with HFpEF (63 [20.5%] vs. 22 [18.9%], <i>p</i> = 0.722). However, VR were less frequently observed in HFmrEF and HFrEF(3 [5.0%] and 2 [2.9%], <i>p</i> = 0.004 and &lt; 0.001 compared with without HF, respectively). Left ventricular EF ≥ 50% was independently associated with intraprocedural VR by multivariable analysis (<i>p</i> = 0.007). Patients with HFrEF or HFmrEF showed a higher mean and slower heart rate with decreased heart rate variability than those without HF. After 18.3 ± 7.4 months' follow-up, 2 of 22 (9.0%) HFpEF patients with VR and 12 of 94 (12.8%) without VR had AF recurrence (<i>p</i> = 0.942). Four HFrEF or HFmrEF patients with VR maintained sinus rhythm during 18.3 ± 4.9 months' follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Intraprocedural VR is not uncommon in HFpEF but is rarely observed in HFmrEF and HFrEF. Autonomic nervous system remodeling in HF, manifesting as a decrease in heart rate variability, might be the underlying reason. VR does not indicate a better clinical outcome in HFpEF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 10","pages":"2193-2202"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411895","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":"Clinical Outcomes of Different Stroke Prevention Strategies in Patients With Inadvertent Left Atrial Appendage Electrical Isolation","authors":"Shaohui Wu,&nbsp;Jiongchao Guo,&nbsp;Juan Du,&nbsp;Shiyi Wang,&nbsp;Zhuangzhuang Niu,&nbsp;Bosheng Xu,&nbsp;Yunyi Li,&nbsp;Weifeng Jiang,&nbsp;Yu Zhang,&nbsp;Mu Qin,&nbsp;Xu Liu","doi":"10.1111/jce.70423","DOIUrl":"10.1111/jce.70423","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Inadvertent left atrial appendage electrical isolation (LAAEI) during persistent atrial fibrillation (AF) ablation increases thromboembolic risk. The optimal antithrombotic strategy for these patients remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to compare the safety and efficacy of left atrial appendage closure (LAAC) performed within 3 months after catheter ablation versus long-term postoperative received direct oral anticoagulants (DOACs) in patients with persistent AF who experienced inadvertent LAAEI during catheter ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The single-center retrospective analysis included 225 patients with inadvertent LAAEI during persistent AF ablation between January 2019 and March 2024. After propensity score matching (PSM), 144 patients were analyzed: 72 received LAAC (LAAC group), and 72 received DOACs (DOAC group). Outcomes, including bleeding and thromboembolic events, were assessed over a mean follow-up of 827 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The LAAC group had significantly fewer non-procedure-related major and clinically relevant nonmajor bleeding events compared to the DOAC group (HR = 0.417, 95% CI: 0.181–0.960, <i>p</i> = 0.034). Thromboembolic events were similar (HR = 0.246, 95% CI: 0.071–0.851, <i>p</i> = 0.205). Atrial arrhythmia recurrence rates were comparable (HR = 0.939, 95% CI: 0.587–1.502, <i>p</i> = 0.054). Normal LAA function was observed in 41.67% of the DOAC group, while the LAAC group had two cases of device-related thrombus resolved with anticoagulation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LAAC within 3 months after catheter ablation may reduce bleeding risk while maintaining efficacy comparable to long-term DOACs in patients with inadvertent LAAEI. LAAC represents a safe and effective strategy for this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 10","pages":"2212-2221"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470822","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":"Accurate Diagnosis of Atrioventricular Nodal Reentrant Tachycardia With Very Short His-Atrial Interval and Earliest Activation in the Proximal Coronary Sinus","authors":"Yuji Wakamatsu,&nbsp;Shu Hirata,&nbsp;Koichi Nagashima,&nbsp;Hitoshi Mori,&nbsp;Osamu Inaba,&nbsp;Shunsuke Kuroda,&nbsp;Kazuhisa Matsumoto,&nbsp;Ryuta Watanabe,&nbsp;Naoto Otsuka,&nbsp;Moyuru Hirata,&nbsp;Masanaru Sawada,&nbsp;Yuji Saito,&nbsp;Yasuo Okumura","doi":"10.1111/jce.70467","DOIUrl":"10.1111/jce.70467","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Differential diagnoses in atrioventricular nodal reentrant tachycardia (AVNRT) with His-atrial (HA) interval of &lt; 70 ms and earliest atrial activation site (EAAS) in the proximal coronary sinus (pCS) include slow-fast AVNRT with inferior deviation of the fast pathway (FP) and slow-slow AVNRT with a lower common pathway (LCP). Therefore, we examined the electrophysiological and anatomical characteristics distinguishing slow-fast AVNRT with inferior FP deviation from slow-slow AVNRT with an LCP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Analyzed were 32 AVNRTs with HA intervals of &lt; 70 ms and EAAS in pCS. During ablation at the EAAS, patients with atrio-His (AH) interval prolongation leading to abandonment (<i>n</i> = 7) were classified as slow-fast AVNRT phenotype, while those with successful ablation without AH prolongation (<i>n</i> = 25) were classified as slow-slow AVNRT phenotype.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Triple antegrade AVN physiology, dual retrograde AVN physiology, and AH block during AVNRT were observed only in the slow-slow AVNRT group. A ΔHA &gt; 15 ms occurred more often in the slow-slow AVNRT group (82% vs. 17%, <i>p</i> = 0.009). The AH_VP-AH_AVNRT—defined as the AH interval during right ventricular overdrive pacing minus that during AVNRT—was shorter in the slow-slow AVNRT group (24 ± 24 vs. 1 ± 15 ms, <i>p</i> = 0.02). The His-EAAS distance was shorter in the slow-fast AVNRT group (7.3 ± 2.3 vs. 16.9 ± 4.9 mm, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In cases of AVNRT with an HA interval &lt; 70 ms and EAAS in the pCS, the slow-slow AVNRT phenotype is more prevalent than the slow-fast AVNRT phenotype. The shorter AH_VP-AH_AVNRT and the His-EAAS distance may help differentiate them.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 10","pages":"2241-2250"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148653842","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":"Effect of Right Ventricular Endocardial Versus Epicardial Leads on Outcomes in Patients With Tricuspid Valve Prosthesis","authors":"Mohammad Sabra,&nbsp;Jasneet Devgun,&nbsp;Felix D. Nguyen,&nbsp;Faiza Ahmed,&nbsp;Elsheikh Abdelrahim,&nbsp;Hassan Nemeh,&nbsp;Waddah Maskoun","doi":"10.1111/jce.70482","DOIUrl":"10.1111/jce.70482","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Endocardial right ventricular (EnRV) leads are described as a potential cause of native tricuspid valve regurgitation (TR). Need for cardiac pacing after tricuspid valve surgery is common, but little is known about the postoperative consequences of EnRV compared to epicardial right ventricular (EpiRV) lead implantation after tricuspid valve repair (TVr) or bioprosthetic tricuspid valve replacement (bTVR). This study aimed to assess TR, lead function, and risk of infection in patients with a tricuspid valve prosthesis followed by EnRV versus EpiRV lead implant.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We retrospectively reviewed all patients with RV lead post-TVr or bTVR at our hospital between January 2000 and January 2022. These were divided into two groups: Group 1 included patients with EnRV lead and Group 2 included patients with EpiRV lead. The primary outcome was the change in TR and RV lead function at follow-up. Level of TR was scored as 0 = none/trivial, 1 = mild, 2 = moderate, and 3 = severe. Pacing threshold change (ΔV ± SD), need for revision or extraction, and death at follow-up were noted.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Sixty-five patients were identified: Group 1 included 53 patients (56% female, 81% atrial fibrillation, 94% TVr, and 6% bTVR) and Group 2 included 12 patients (67% female, 42% atrial fibrillation, 42% TVr, and 58% bTVR). In Group 2, 58% had a prior RV lead extracted intraoperatively due to lead-related TR versus 0% in Group 1. In Group 1, the mean time from surgery to RV lead implant, last echocardiogram, and last device interrogation were 24, 52, and 72 months respectively, versus 0, 62, and 63 months for Group 2, respectively. TR worsened in Group 1 in 55% of TVr patients (mean 0.97 level). When compared to Group 2, worsening TR was significantly higher in Group 1 versus Group 2 (&lt;i&gt;p&lt;/i&gt; = 0.028), particularly after TVr and not bTVR. Nine patients (18%) in Group 1 had worsening TR to moderate severity compared to 0 patients in Group 2. RV lead threshold significantly worsened in Group 2 versus Group 1 (55.5% vs. 3.7%, &lt;i&gt;p&lt;/i&gt; = 0.003); RV threshold increased significantly by Δ 1.18 ± 2.05 V versus Δ 0.11 ± 0.34 V (&lt;i&gt;p&lt;/i&gt; = 0.026). The average threshold at follow-up in Group 2 was 2.02 ± 2.13 V versus 0.74 ± 0.27 V for Group 1 (&lt;i&gt;p&lt;/i&gt; = 0.003). Lead extraction occurred in 8% of patients in Group 1 (25% endocarditis and 75% lead failure/malfunction) and 17% in Group 2 (100% endocarditis). There was a total of 29 deaths (Group 1: 43%, mean follow-up of 72 months vs. Group 2: 50%, mean follow-up of 63 months, &lt;i&gt;p&lt;/i&gt; = 0.754).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Con","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 10","pages":"2308-2316"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912126","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}