Journal of Cardiovascular Electrophysiology最新文献

{"title":"Early Bleeding Risk After DOAC Initiation With Concomitant Amiodarone in Older Adults With Atrial Fibrillation.","authors":"Isadora D Guarino, Saman Nazarian","doi":"10.1111/jce.70440","DOIUrl":"10.1111/jce.70440","url":null,"abstract":"<p><strong>Background: </strong>Amiodarone is frequently co-prescribed with direct oral anticoagulants (DOACs) in atrial fibrillation (AF), but its impact on early bleeding risk after DOAC initiation in older adults remains uncertain. We evaluated short-term safety outcomes associated with concomitant amiodarone use at the time of DOAC initiation.</p><p><strong>Methods: </strong>We performed a retrospective propensity score matched cohort study using the TriNetX US Research Network (2015 to 2025). Adults aged 75 years or older with nonvalvular AF newly initiating a DOAC were included. Exposure was defined as amiodarone prescription or administration within 30 days before or on the DOAC start date. Patients were matched 1:1 on demographics, comorbidities, and baseline cardiovascular medications. Follow-up began 1 day after DOAC initiation and continued for 90 days. Primary outcomes were gastrointestinal (GI) bleeding and intracranial hemorrhage (ICH). Ischemic stroke was a secondary outcome.</p><p><strong>Results: </strong>After matching, 136,806 patients were included (68,403 per cohort), with all standardized mean differences < 0.1. Index-date DOAC exposures were predominantly apixaban (82.7%) and rivaroxaban (16.5%). Concomitant amiodarone use was associated with higher early bleeding risk. GI bleeding occurred in 2.3% vs 1.9% (HR 1.30, 95% CI 1.20 to 1.40), and ICH occurred in 0.4% vs 0.3% (HR 1.28, 95% CI 1.07 to 1.52). There was no significant difference in ischemic stroke (1.3% vs 1.5%; HR 0.91, 95% CI 0.83 to 1.01).</p><p><strong>Conclusions: </strong>Among adults aged 75 years or older initiating DOAC therapy, concomitant amiodarone exposure was associated with a modest but significant increase in 90-day GI bleeding and ICH without a detectable increase in ischemic stroke. These findings support careful medication review, dose selection, and early bleeding counseling when amiodarone is used with a DOAC in older adults.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"2119-2121"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13576617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Efficacy of Nighttime Versus Daytime Radiofrequency Catheter Ablation for Atrial Fibrillation: A Multicenter Cohort Study.","authors":"Zhuangzhuang Niu, Jiongchao Guo, Conghui Shang, Shaohui Wu, Weifeng Jiang, Xu Liu, Changhao Xu, Ying Meng","doi":"10.1111/jce.70485","DOIUrl":"10.1111/jce.70485","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare the incidence of post‑procedural complications in patients undergoing radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) performed during daytime versus nighttime hours.</p><p><strong>Methods: </strong>This retrospective study included 2951 patients who underwent AF ablation at three centers between 2019 and 2024. Based on procedure start time, patients were assigned to a daytime group (08:00-16:00, n = 1503) or a nighttime group (16:00-24:00, n = 1301). Propensity score matching (PSM) was used to balance baseline characteristics. The primary outcome was any complication within 3 months post‑ablation. Secondary outcomes included in‑hospital and post‑discharge complications (within 3 months) and freedom from atrial arrhythmia recurrence at 12 months.</p><p><strong>Results: </strong>Following 1:1 PSM, 1263 matched pairs were analyzed. The overall postoperative complication rate was significantly higher in the nighttime group than in the daytime group (4.99% vs. 2.30%; odds ratio [OR]: 2.23; 95% confidence interval [CI]: 1.43-3.49; p < 0.001). This elevated risk was consistent for both in-hospital complications (OR: 2.14; 95% CI: 1.23-3.72; p = 0.007) and post-discharge complications (OR: 2.32; 95% CI: 1.10-4.90; p = 0.027). Furthermore, there was no significant difference in the 12-month freedom from atrial arrhythmia recurrence between the two cohorts.</p><p><strong>Conclusions: </strong>Nighttime AF ablation is associated with a significantly increased risk of overall postoperative complications, highlighting procedural timing as a critical determinant of perioperative patient safety.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"2075-2082"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13576532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leadless Atrial Pacing at Bachmann's Bundle Guided by Electroanatomic Mapping and Intracardiac Ultrasound.","authors":"Erin S Harris, John R Power, Marc A Miller, Daniel R Musikantow, Srinivas Dukkipati, Vivek Y Reddy","doi":"10.1111/jce.70481","DOIUrl":"10.1111/jce.70481","url":null,"abstract":"<p><strong>Introduction: </strong>Leadless pacemakers (LPs) offer advantages over transvenous systems, but atrial LPs currently target the right atrial appendage (RAA), risking atrial dyssynchrony.</p><p><strong>Methods and results: </strong>We report five patients in whom electroanatomic mapping and intracardiac ultrasound guided LP implantation into Bachmann's bundle (BB), a site shown to improve interatrial conduction and reduce atrial fibrillation risk. In four of five patients, BB fixation was successful with low pacing thresholds and short P-wave duration. One patient required conversion to RAA pacing due to high BB pacing thresholds. No intraprocedural complications occurred.</p><p><strong>Conclusions: </strong>This series demonstrates the feasibility of leadless BB pacing, though technical challenges warrant further study.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"2063-2067"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13576553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mediastinal Air Entrapment During Extravascular ICD Implantation: A Preventable Cause of Elevated Shock Impedance.","authors":"Robert N Kerley, Sunil Kapur","doi":"10.1111/jce.70426","DOIUrl":"10.1111/jce.70426","url":null,"abstract":"<p><strong>Introduction: </strong>Elevated shock impedance during extravascular implantable cardioverter-defibrillator (EV-ICD) implantation may preclude defibrillation threshold (DFT) testing despite appropriate retrosternal lead position. We describe suspected mediastinal air entrapment as a reversible mechanism and a simple preventive strategy.</p><p><strong>Methods and results: </strong>During early EV-ICD implantation experience, two patients developed shock impedance > 200 Ω immediately after retrosternal lead placement, with associated sensing abnormalities. Lead repositioning did not normalize impedance, no pneumothorax was identified, and DFT testing was deferred. Shock impedance normalized spontaneously within 1-2 days, permitting successful DFT testing without lead revision. Transient mediastinal air entrapment along the defibrillation vector was suspected. A procedural modification was adopted in which 5-10 cm H₂O positive end-expiratory pressure was applied immediately before retrosternal introducer removal, followed by prompt EV-ICD lead advancement. Among five consecutive subsequent implantations using this approach, initial shock impedance remained within the expected range, permitting immediate DFT testing without lead repositioning or delay.</p><p><strong>Conclusion: </strong>Transient mediastinal air entrapment may cause elevated shock impedance during EV-ICD implantation. Positive end-expiratory pressure during introducer removal may mitigate this complication and facilitate reliable intraoperative DFT testing.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"2116-2118"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13576587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148360721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sub-Acute Re-Elevated Pacing Thresholds After Atrial Leadless Pacemaker Implantation.","authors":"Dongyan Wu, Le He, Fengmin Lu, Ying Shao, Yina Li, Enyuan Zhang, Henan Zhang, Jing Xu","doi":"10.1111/jce.70478","DOIUrl":"10.1111/jce.70478","url":null,"abstract":"<p><strong>Introduction: </strong>The safety and efficacy of the atrial leadless pacemaker (A-LP) with helix fixation have been demonstrated. Usually, elevated acute thresholds decrease gradually and normalize within 24 h. Here, we report a case of subacute re-elevation of pacing thresholds after hospital discharge.</p><p><strong>Case presentation: </strong>An 80-year-old female with a history of bradycardia underwent A-LP implantation. At the time of the procedure, the final pacing threshold (PT) was measured at 4.0 V/0.4 ms. On post-procedural Day 1, the PT at 0.4 ms pulse width decreased to 1.0 V. On Day 4, the PT was 1.0 V/0.4 ms prior to the patient's discharge. However, on Day 5, she was readmitted to the hospital due to the loss of atrial capture at the maximum output available after an intravenous administration of 150 mg amiodarone for atrial flutter. Over 3 days of monitoring, atrial PT was higher than 6 V/1.5 ms. A traditional DDD pacemaker was implanted due to recurrent sinus asystole associated with dizziness. At the 1-month follow-up, the PT of atrial A-LP was 0.5 V/0.4 ms. Two months later, an ambulatory Holter confirmed the stable and normal atrial capture of the A-LP after lowering the base rate of the DDD pacemaker. At the 3-month follow-up, PT of the A-LP remained 0.5 V/0.4 ms.</p><p><strong>Conclusion: </strong>Sub-acute re-elevated PT of the A-LP during the perioperative period may persist for more than 1 week and then normalize within 1 month. If PT re-elevation is suspected to be related to peri-electrode inflammation, a conservative approach with continued monitoring of threshold changes may be considered.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"2152-2156"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13576595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apparent Unmasking of Left Anterior Fascicular Ventricular Tachycardia After Prior Left Posterior Fascicular Ablation: Possible Alternative Exit From a Shared Septal Purkinje Substrate.","authors":"Robert Abed, Paul Yeung-Lai-Wah, Farzane Saedifard, Luka Petrovic, Emad Aziz, Davendra Mehta","doi":"10.1111/jce.70453","DOIUrl":"10.1111/jce.70453","url":null,"abstract":"<p><strong>Introduction: </strong>Fascicular ventricular tachycardia (FVT) is a Purkinje-mediated ventricular tachycardia classically associated with verapamil sensitivity and reentry within the left ventricular conduction network. Although catheter ablation is usually effective, recurrent tachycardia with a different fascicular QRS axis after prior ablation raises important mechanistic questions. Contemporary models suggest that the septal fascicular network may provide a shared, interconnected substrate with multiple potential fascicular exits.</p><p><strong>Case report: </strong>We report a 39-year-old man with complete heart block, pacemaker dependence, and prior ablation for left posterior fascicular ventricular tachycardia (LPFVT), who presented with recurrent incessant ventricular tachycardia and severe left ventricular dysfunction (left ventricular ejection fraction, 15%). The presenting arrhythmia demonstrated right bundle branch block morphology with a right inferior axis, consistent with left anterior fascicular ventricular tachycardia (LAFVT). Electrophysiology study revealed a 1:1 relationship between conduction-system activation and ventricular activation, with the earliest Purkinje potential 60 ms pre-QRS near the proximal septum, approximately 1.5 cm below the His bundle. Radiofrequency ablation at this site resulted in transient acceleration, rapid tachycardia termination, and noninducibility. The patient had complete arrhythmia suppression and recovery of left ventricular function to 50%-55%.</p><p><strong>Discussion: </strong>This case is best interpreted as apparent unmasking of an alternative fascicular exit from a shared septal Purkinje substrate after prior distal LPF ablation, rather than definitive proof of simple circuit transformation or rerouting. The septal fascicular network model provides a physiologically plausible framework for the emergence of a new fascicular VT morphology after ablation. However, alternative mechanisms remain plausible, including focal Purkinje automaticity, bundle branch/interfascicular reentry, and scar-related Purkinje VT.</p><p><strong>Conclusion: </strong>Recurrent FVT after prior distal fascicular ablation may reflect dynamic expression of a shared septal Purkinje network with alternative exits. Careful proximal septal and fascicular mapping is important, while mechanistic conclusions should remain appropriately cautious when definitive circuit evidence is lacking.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"2134-2142"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13576562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of Spatio-Temporal Dispersion Electrograms Using Complex Signal Identification-Labeled Abnormal Potential Areas in Patients With Persistent Atrial Fibrillation.","authors":"Kazuki Ito, Yoshihisa Naruse, Yuki Tokonami, Yutaro Kaneko, Makoto Sano, Yuichiro Maekawa","doi":"10.1111/jce.70400","DOIUrl":"10.1111/jce.70400","url":null,"abstract":"<p><strong>Introduction: </strong>Ablation targeting spatio-temporal dispersion electrograms (STDEs) in addition to pulmonary vein isolation (PVI) has been reported to reduce atrial fibrillation (AF) recurrence in patients with persistent AF.</p><p><strong>Background: </strong>However, STDE identification remains subjective. Complex Signal Identification (CSI), integrated into the CARTO 3 mapping system, automatically quantifies electrogram characteristics. We evaluated whether CSI parameters can accurately identify STDEs.</p><p><strong>Methods: </strong>We retrospectively analyzed intracardiac electrogram points from five consecutive patients who underwent catheter ablation for persistent AF using the CARTO 3 version 8 mapping system (Biosense Webster, Diamond Bar, CA, USA) between October and December 2024 to evaluate the ability of CSI parameters to identify STDEs. STDEs were identified and marked by the operator using an OCTARAY catheter.</p><p><strong>Results: </strong>A total of 4453 electrogram points obtained before ablation were analyzed. Among all CSI metrics, the fractionation score demonstrated the highest diagnostic accuracy. An optimal cutoff of 4.1 yielded an area under the curve (AUC) of 0.905 (95% CI: 0.892-0.918), with a sensitivity of 80.4%, specificity of 98.6%, positive predictive value of 94.1%, and negative predictive value of 93.1%. In contrast, complex duration (cutoff ≥ 50 ms), %cycle length (cutoff ≥ 15%), and complex onset (cutoff ≤ -32) showed AUCs of 0.613 (95% CI: 0.557-0.668), 0.599 (95% CI: 0.538-0.660), and 0.525 (95% CI: 0.461-0.589), respectively.</p><p><strong>Conclusion: </strong>A CSI fractionation score cutoff of 4.1 identified STDEs with high accuracy, suggesting that CSI-guided mapping may serve as a practical tool for adjunctive ablation beyond PVI.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"2112-2115"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13576592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148258153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Atrial Tachycardia Recurrence After Pulsed Field Ablation: Insights From Repeat Ablation Procedures.","authors":"Kohei Ukita, Roman Mamaev, Sascha Hatahet, Jan-Per Wenzel, Charlotte Eitel, Karl-Heinz Kuck, Roland Richard Tilz","doi":"10.1111/jce.70487","DOIUrl":"10.1111/jce.70487","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary vein isolation (PVI) using pulsed field ablation (PFA) for atrial fibrillation (AF) is becoming increasingly widespread. However, characteristics of atrial tachycardia (AT) recurrence after PFA remain unclear. We aimed to investigate characteristics of AT recurrence in comparison with AF recurrence after PFA-based PVI.</p><p><strong>Methods: </strong>We analyzed 60 consecutive patients who underwent repeat ablation for recurrent atrial tachyarrhythmia after initial PVI alone performed with a pentaspline PFA system. Patients were classified into an AT group (at least one AT episode before repeat ablation) and an AF group (AF recurrence only). Baseline characteristics, pulmonary vein (PV) reconnections, and recurrence-free rate after repeat ablation procedure were assessed.</p><p><strong>Results: </strong>The AT group consisted of 34 patients (57%). In the multivariate analysis, absence of PV reconnections was independently associated with AT recurrence (p = 0.037). All mappable ATs were macro-reentrant circuits and none were directly related to PVs. Recurrence-free rate after repeat ablation did not differ between AT and AF groups (p = 0.277). However, patients presenting in AT at the beginning of the repeat procedure had the most favorable outcomes, whereas those in AF had the poorest (p = 0.042).</p><p><strong>Conclusions: </strong>After PFA-based PVI, AT recurrence was characterized by lower PV reconnection rates and macro-reentrant circuits remote from the PVs, whereas AF recurrence was more frequently associated with PV reconnections. While overall outcomes after repeat ablation were comparable, baseline rhythm at the repeat procedure was associated with prognosis, underscoring the importance of tailored mapping and ablation strategies after PFA.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"2068-2074"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860238","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":"Brugada Syndrome in the Pediatric Population: Diagnostic Challenges and Clinical Outcome-Results of the German Multicenter Study COGIA.","authors":"Lea Lippert, Tobias Burkard, Franziska Markel, Volker Debus, Fridrike Stute, Anna Kamphues, Robert Dalla Pozza, Stefan Rupp, Maria B Gonzalez Y Gonzalez, Claudia Junge, Majed Kanaan, Kirstin Hoff, Anja Hanser, Sven Dittmann, Dominik Sebastian Westphal, Isabel Diebold, Sebastian Clauß, Stefanie Kessner, Marc-Phillip Hitz, Kolja Becker, Stefan Kääb, Peter Ewert, Michael Hofbeck, Wolfgang Wällisch, Sven Dittrich, Anselm Uebing, Stephan Neumann, Jan-Hendrik Nürnberg, Joachim Hebe, Rainer Kozlik-Feldmann, Philipp Beerbaum, Gunter Kerst, Eric Schulze-Bahr, Roman Gebauer, Gabriele Hessling, Cordula Maria Wolf","doi":"10.1111/jce.70484","DOIUrl":"https://doi.org/10.1111/jce.70484","url":null,"abstract":"<p><strong>Introduction: </strong>Diagnosis and treatment of children and adolescents with suspected Brugada syndrome (BrS) is challenging. Aim of the study was to evaluate the applicability of current diagnostic criteria for pediatric patients with suspected BrS in the German multicenter study COGIA and to assess clinical outcome.</p><p><strong>Methods: </strong>Data analysis of 76 pediatric patients from 12 German tertiary care centers. Primary outcome was defined by the occurrence of a major arrhythmic event (MAE), secondary outcome by symptoms, pharmacotherapy and implantation of devices. MAE was defined as sudden cardiac death (SCD), aborted cardiac arrest (ACA) and appropriate implantable cardioverter-defibrillator (ICD) therapy.</p><p><strong>Results: </strong>Criteria for BrS diagnosis were fulfilled in 39/76 pediatric patients (51.3%) according to ESC Guidelines, including 34 patients (44.7%) according to Shanghai Score. Genetic testing identified a (likely) pathogenic SCN5A variant in 31/66 tested children (47.0%) (14/30 with clinical diagnosis (46.7%) and 17/36 without clinical diagnosis (47.2%)). Twenty-four patients (31.6%) showed a spontaneous type 1 ECG pattern, in 6 patients (7.9%) it was induced by fever. Ajmaline challenge was positive in 19/25 patients (76.0%). Syncope occurred in 15 patients (19.7%) and an ICD was implanted in 7 pediatric patients (9.2%). Four patients (5.3%) experienced a MAE (ACA), all of them fulfilling diagnostic criteria. \"Symptoms at first consultation\" was identified as an independent risk factor for MAE in the whole cohort (HR = 11.3, p = 0.04).</p><p><strong>Conclusion: </strong>Establishing the diagnosis of BrS remains challenging in the pediatric cohort. MAE occurred in 5.3% of patients with suspected BrS. Symptoms at first consultation increased risk for MAE.</p><p><strong>Clinical trial registration: </strong>The study is registered at the German Clinical Trial Register (DRKS) of the Federal Institute for Drugs and Medical Devices (BfArM), DRKS-ID DRKS00028138.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860243","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 After Catheter Ablation in Patients With Structural Heart Disease and Ventricular Fibrillation.","authors":"Kenji Hashimoto, Samual Turnbull, Saurabh Kumar","doi":"10.1111/jce.70488","DOIUrl":"https://doi.org/10.1111/jce.70488","url":null,"abstract":"<p><strong>Introduction: </strong>In patients with ischemic cardiomyopathy (ICM), recurrent VF may be treated with catheter ablation by targeting triggering premature ventricular complexes (PVCs) and/or ventricular scar homogenization. Data on optimal ablation strategies in patients with non-ischemic cardiomyopathy (NICM) remain limited. This study aimed to compare ablation strategies and outcomes in patients with recurrent VF due to ICM versus NICM.</p><p><strong>Methods and results: </strong>We retrospectively analyzed consecutive patients with structural heart disease and recurrent VF undergoing catheter ablation. Catheter ablation was performed, including targeting the triggering and/or clinically frequent PVC, targeting any inducible ventricular tachycardia, and/or scar homogenization. Procedural characteristics, arrhythmogenic substrate features, and post-ablation clinical outcomes were compared between ICM and NICM groups. Forty-five patients were included (17 ICM, 28 NICM; mean age 60 ± 15 years; 87% male). PVC ablation was performed in 42% of ICM and 39% of NICM patients, while scar homogenization was undertaken in 76% and 57%, respectively. Left ventricular scar burden, assessed by bipolar and unipolar voltage mapping, was significantly greater in the ICM, whereas the prevalence of abnormal Purkinje potentials was similar between groups. VF-free survival after multiple procedures did not differ between groups, with estimated 1-year rates of 87 ± 9% in ICM and 85 ± 8% in NICM (log-rank p = 0.93).</p><p><strong>Conclusions: </strong>In patients with NICM and recurrent VF, catheter ablation targeting arrhythmogenic substrate-including unipolar low-voltage regions-combined with PVC ablation yields outcomes comparable to those in ICM, supporting this approach as a reasonable treatment strategy.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860326","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}