Journal of Cardiovascular Electrophysiology最新文献

{"title":"Progression of Tricuspid Regurgitation After Cardiac Implantable Electronic Device Implantation and Its Impact on Mortality and Hospitalization: A Single-Center Cohort Study.","authors":"Ahmet Can Urgancı, Filiz Özerkan Çakan, Evrim Şimşek","doi":"10.1111/jce.70532","DOIUrl":"https://doi.org/10.1111/jce.70532","url":null,"abstract":"<p><strong>Introduction: </strong>Tricuspid regurgitation (TR) progression is a recognized complication of cardiac implantable electronic device (CIED) implantation, yet its prognostic impact on long-term clinical outcomes remains incompletely defined.</p><p><strong>Methods and results: </strong>In this single-center retrospective cohort, 303 patients undergoing CIED implantation between 2005 and 2023 were followed for a median of 4.8 years. TR severity was assessed echocardiographically at baseline and 12 months. The primary endpoint was TR progression (≥ 1-grade worsening); secondary endpoints were all-cause mortality, cardiovascular hospitalization, their composite, and progression to severe TR, analyzed by Kaplan-Meier and Cox regression. TR progressed in 103 patients (34.0%), regressed in 33 (10.9%), and remained stable in 167 (55.1%), a net rightward shift (p < 0.001). Progression differed by device type (p = 0.031): among the larger subgroups, VVI-ICD showed the greatest net progression (31.8% worsened vs. 6.9% improved; p < 0.001) and CRT-D the highest regression (18.8%). During follow-up, 67 patients (22.1%) died and 164 (54.1%) were hospitalized. Overall TR progression was not independently associated with mortality (HR 1.118, p = 0.693) but independently predicted cardiovascular hospitalization (HR 1.640, p = 0.003) and the composite endpoint (HR 1.480, p = 0.014). On unadjusted analysis, progression specifically to severe TR (n = 15) was associated with increased mortality (HR 1.99, p = 0.024) and cardiovascular hospitalization (HR 2.45, p < 0.001).</p><p><strong>Conclusion: </strong>TR progression occurs in approximately one-third of CIED recipients within the first year and independently predicts cardiovascular hospitalization. Progression to severe TR identifies a higher-risk subset, supporting routine post-implant echocardiographic surveillance.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182163","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":"Intracardiac Echocardiography for Procedural Guidance of Left Atrial Appendage Occlusion From Right Atrium: A Subgroup From a Multicenter Randomized Controlled Trial With Two Intracardiac Echocardiography Imaging Systems","authors":"Bijun Huang,&nbsp;Ziyong Hao,&nbsp;Yashu Kuang,&nbsp;Jian Wang,&nbsp;Huiming Chu,&nbsp;Zhongping Ning,&nbsp;Haiying Li,&nbsp;Wei Ma,&nbsp;Xiwen Zhang,&nbsp;Ben He,&nbsp;Jing Xu,&nbsp;Lisheng Jiang","doi":"10.1111/jce.70450","DOIUrl":"10.1111/jce.70450","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Intracardiac echocardiography (ICE)-guided left atrial appendage occlusion (LAAO) from left atrium under local anesthesia showed potential advantages over transesophageal echocardiography (TOE). This study sought to demonstrate the intraprocedural efficiency and safety of LAAO with ICE guidance in right atrium.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In a multicenter randomized controlled trial to assess whether the imaging quality of a novel DynaSight ICE system (SONOSEMI, Shenzhen, China) is noninferior to the SoundStar (Biosense Webster, USA), a sub-group analysis was performed in patients who underwent LAAO under local anesthesia with ICE guidance in right atrium.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-three of 66 in the DynaSight group and 30 of 67 in the SoundStar group were performed LAAO with ICE guidance in right atrium. There were no statistical differences between two groups in baseline characteristics including demographics, cardiovascular comorbidities, CHA2DS2-VASc score, and HAS-BLED score. Both ICE systems had similar clear image qualities according to multi-plane assessments for home view, atrial septum and left atrium, and judgments for occluders including displaying location and resolution. There was comparable procedural successful rate for device implantation (100% in the DynaSight group vs. 96.67% in the SoundStar group, <i>p</i> = 0.4762) and occurrence of major peri-procedural complications including tamponade, device embolism, death, major bleeding, and ischemic stroke/transient ischemic attack/systemic embolism (0 of 33 in the DynaSight group vs. 3 of 30 in the SoundStar group, <i>p</i> = 0.1022).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The DynaSight ICE system has the same clear image quality as the SoundStar, which-guided LAAO with the catheter in right atrium is intraprocedural effective and safe for device implantation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 10","pages":"2203-2211"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411843","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":"Baseline Echocardiographic Parameters Associated With Post-Pacing Cardiomyopathy in Patients With Normal Left Ventricular Ejection Fraction Undergoing Pacemaker Implantation for Atrioventricular Block","authors":"Andrew E. Volio,&nbsp;Katelyn R. Bennett,&nbsp;Nicholas W. Bradley,&nbsp;James Co,&nbsp;Sean M. Muir,&nbsp;Sophie G. Murdock,&nbsp;Arun K. Tewari,&nbsp;John G. Hatanelas,&nbsp;Auroa Badin,&nbsp;Anish K. Amin,&nbsp;Nagesh Chopra","doi":"10.1111/jce.70454","DOIUrl":"10.1111/jce.70454","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 &lt;p&gt;In patients with atrioventricular (AV) block and left ventricular ejection fraction (LVEF) of &gt; 50%, dual-chamber pacemaker (DCPM) implantation remains the standard of care. However, in this population the relationship between other baseline echocardiographic parameters and the development of post-pacing cardiomyopathy (PPCMP) remains poorly defined.&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 identify preimplant echocardiographic parameters associated with the development of PPCMP in patients with normal LVEF undergoing DCPM implantation for AV block.&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;Among 140 consecutive patients who underwent DCPM implant for AV block between January 1st 2016 and December 31st, 2019, data from 111 patients with available follow-up through December 31, 2024, was retrospectively analyzed. PPCMP was defined as a 10% reduction in LVEF and/or absolute LVEF &lt; 50% with an average ventricular pacing burden of ≥ 20%.&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;Of 140 patients, 111 with complete data were included (mean age: 76 ± 10 years; 55% male and 88% white). Preimplant LVEF was 61 ± 4% with echocardiogram performed 2(0–26) days before DCPM implant. Over a mean follow-up of 4 ± 2.3 years, 46 patients (41%) developed PPCMP (LVEF%: 45[35–50] vs 62[58–64]; &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Preimplant left atrial (LA) dimension (cm; 4.3[3.8–4.5] vs 3.8[3.5–4.3]; &lt;i&gt;p&lt;/i&gt; = 0.03) and LA dimension index (mL/m&lt;sup&gt;2&lt;/sup&gt;; 38 ± 12 vs 32 ± 11; &lt;i&gt;p&lt;/i&gt; = 0.008) were larger in patients who developed PPCMP. Among PPCMP patients, LVEF reduction correlated inversely with mitral annular septal and lateral E/e′ ratios (&lt;i&gt;r&lt;/i&gt; = −0.33, &lt;i&gt;p&lt;/i&gt; = 0.03 and &lt;i&gt;r&lt;/i&gt; = −0.34, &lt;i&gt;p&lt;/i&gt; = 0.04, respectively), early diastolic mitral inflow velocity (&lt;i&gt;r&lt;/i&gt; = −0.34, &lt;i&gt;p&lt;/i&gt; = 0.02) and LA size (&lt;i&gt;r&lt;/i&gt; = −0.35, &lt;i&gt;p&lt;/i&gt; = 0.01). Larger LA size also correlated with higher E/e′ ratios (&lt;i&gt;r&lt;/i&gt; = 0.4, &lt;i&gt;p&lt;/i&gt; &lt; 0.02) but not with history of AF, HTN, obesity and mitral valve disease. In multivariable regression analyses, each 1-cm increase in LA size was associated with a 5.54-fold higher hazard of first heart failure (HF) admission (Cox, &lt;i&gt;p&lt;/i&gt; = 0.0008) and a ~125% increase in total HF admissions (Poisson, &lt;i&gt;p&lt;/i&gt; = 0.006) during the study period.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Among patients with normal LV systolic function undergoing DCPM for AV block, pre-existing LV diastolic dysfunction, reflected by larger LA size, elevated E/e′ ratios, and higher early diastolic mitral inflow velocity, is strongly associated with development","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 10","pages":"2232-2240"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497655","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 Presentation and Prognosis of Pathogenic Variants in Young-Onset Atrial Fibrillation","authors":"Nicholas D'Elia,&nbsp;Mariana Dragas,&nbsp;Frank Bevacqua,&nbsp;Dylan Jape,&nbsp;Kenneth Cho,&nbsp;Rose Crowley,&nbsp;Jeremy William,&nbsp;Romaniya Fernando,&nbsp;Sachin Iyer,&nbsp;Sandeep Prabhu,&nbsp;Stacey Peters,&nbsp;Mark Perrin,&nbsp;Tina Thompson,&nbsp;Hitesh Patel,&nbsp;Kunal Verma,&nbsp;Lucinda Salmon,&nbsp;Megan Cotter,&nbsp;Jonathan Kalman,&nbsp;Peter Kistler,&nbsp;Aleksandr Voskoboinik","doi":"10.1111/jce.70483","DOIUrl":"10.1111/jce.70483","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Young-onset atrial fibrillation (AF) is increasingly recognized as a clinically distinct entity and heritable mechanisms may contribute to disease onset. Although pathogenic monogenic variants are increasingly identified in this population, their clinical phenotype and prognostic significance remain incompletely defined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We sought to characterize the spectrum of genetic variants in patients with young-onset AF diagnosed at age 45 years or younger, identify clinical predictors of pathogenic variants, and evaluate their association with long-term clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicentre retrospective cohort study included adults with AF first diagnosed at age 45 years or younger who underwent clinical genetic testing across three tertiary centers in Melbourne, Australia. Variants were re-assessed using contemporary American College of Medical Genetics and Genomics/Association for Molecular Pathology criteria and classified as pathogenic/likely pathogenic (P/LP) or negative/variant of uncertain significance (VUS). Baseline clinical characteristics, electrocardiographic findings, cardiac imaging, and long-term outcomes were compared between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 58 patients who underwent genetic testing, 30 (52%) had a pathogenic or likely pathogenic monogenic variant. The most frequent variants involved <i>TTN</i> (<i>n</i> = 8, 13.8%) and <i>LMNA</i> (<i>n</i> = 6, 10.3%), followed by <i>MYBPC3</i> and <i>MYH7</i> (each <i>n</i> = 3, 5.2%). Family history of AF or cardiomyopathy was more common in the P/LP than the negative/VUS group (76.7% vs. 46.4%, <i>p</i> = 0.030) and was independently associated with a pathogenic variant (OR 3.90; 95% CI 1.28–13.0; <i>p</i> = 0.020). Patients with pathogenic variants more frequently had first-degree atrioventricular block (20.0% vs. 0.0%; <i>p</i> = 0.024). Implantable cardioverter-defibrillator implantation was more frequent in P/LP patients (53.6% vs. 25.0%; <i>p</i> = 0.05), whereas mortality, stroke, post-ablation AF recurrence, and pacemaker implantation were similar.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this highly selected young-onset AF cohort referred for genetic testing, pathogenic monogenic variants were common. There was a significant proportion of patients suffering adverse long-term events.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 10","pages":"2280-2288"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793702","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":"Localization of Non-Pulmonary Vein Trigger of Atrial Fibrillation in Relation to Atrial Low Voltage Area","authors":"Shunsuke Kawai,&nbsp;Arihide Okahara,&nbsp;Masaki Tokutome,&nbsp;Hirohide Matsuura,&nbsp;Daisuke Yakabe,&nbsp;Tomoka Masunaga,&nbsp;Taishi Yamamoto,&nbsp;Kazuo Sakamoto,&nbsp;Yasuhiro Oga,&nbsp;Yasushi Mukai","doi":"10.1111/jce.70502","DOIUrl":"10.1111/jce.70502","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We previously reported that non-pulmonary vein (PV) triggers of atrial fibrillation (AF) often arise from low-voltage areas (LVAs) in the left atrium (LA). However, the specific spatial relationship between trigger sites and distribution of LVAs has not been fully elucidated. This study aimed to analyze the relationship on a site-specific basis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>Out of 1428 patients with AF undergoing catheter ablation, 187 (13.1%) who tested positive for non-PV triggers were enrolled. The spatial relationship between each trigger site and left atrial LVAs was evaluated. The study population included 121 men (66%), 110 patients with non-paroxysmal AF (59%), and 93 undergoing re-do sessions (50%). Mean age, eGFR, BNP, BMI, LAD, and LVEF were 68 ± 11 years, 59.9 ± 18.5 mL/min/1.73m², 116.6 ± 281.4 pg/mL, 23.3 ± 3.6 kg/m², 41.7 ± 6.5 mm, and 59 ± 7.8%, respectively. Non-PV trigger sites could not be identified in 18 cases due to lack of reproducibility. In the remaining 169 cases, single non-PV triggers were identified in 140 cases (82.8%), while 29 cases (17.2%) exhibited multiple triggers. Of the 99 LA non-PV triggers evaluated, 61 (61.6%) originated within an LVA. Half of the remaining non-PV triggers from intact areas were from the vicinity of LVAs. Specifically, more than half of the posterior/septal/inferior triggers arose from LVAs, whereas all anterior/roof triggers originated from LVAs. Patients were categorized into six groups based on trigger location: thoracic vein (superior vena cava, coronary sinus, and patent left superior vena cava), right atrium (RA), septum, LA, multiple triggers, and unidentified triggers. At the 24-month follow-up, the atrial tachyarrhythmia-free rate was significantly lower in the unidentified and multiple trigger groups (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LA non-PV triggers are closely associated with LVAs, particularly in the LA roof and anterior walls, though this association is less consistent in the posterior, septal, and inferior walls. Voltage mapping patterns may facilitate localization and detection of non-PV trigger sites in the LA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 10","pages":"2332-2340"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963276","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":"Multicatheter Comparison of Very High-Power Short-Duration Radiofrequency Ablation Lesions","authors":"Samual Turnbull,&nbsp;Michael A. Barry,&nbsp;Timothy G. Campbell,&nbsp;Kasun De Silva,&nbsp;Ashwin Bhaskaran,&nbsp;Pierre Qian,&nbsp;Eddy Kizana,&nbsp;Saurabh Kumar","doi":"10.1111/jce.70421","DOIUrl":"10.1111/jce.70421","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Very high-power short-duration (vHPSD) radiofrequency ablation (RFA) is an alternative strategy for pulmonary vein isolation. However, rapid temperature rises may cause complications. The QDOT Micro is designed to detect temperature rises for automatic power and irrigation flow adjustments. We compared how differences in ablation electrode design between three RFA catheters impact vHPSD lesions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>vHPSD RFA was performed within a validated gel tank model. Four-second ablations were delivered with stable contact force using the QDOT, SmartTouch, and TactiFlex SE at 60, 70, 80, and 90 watts, positioned perpendicular (90°), oblique (45°), and parallel (0°) to the ablation target, utilizing 0.9% and 0.45% “half-normal” saline (HNS) irrigation. The SmartTouch and TactiFlex were operated in power-controlled mode, and each configuration was repeated three times, with images captured every second to characterize lesions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 216 vHPSD lesions were delivered. At 90 W, 90°, and 0.9% saline, the QDOT produced lesions with a mean depth of 1.93 mm. The TactiFlex produced shallower lesions, with a mean depth of 1.88 mm (<i>p</i> = 0.02), and the SmartTouch produced the deepest, with a mean depth of 2.37 mm (<i>p</i> &lt; 0.001). The mean diameter of QDOT lesions, at 4.63 mm, was comparable to TactiFlex lesions (4.58 mm, <i>p </i>= 0.8), whilst the SmartTouch lesions were significantly wider than both the QDOT and TactiFlex (6.04 mm, <i>p</i> &lt; 0.001). Steam-pop risk, based on lesion temperature, was lowest for the TactiFlex.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>vHPSD lesions produced with the QDOT achieved greater dimensions and temperatures than those with the TactiFlex under controlled conditions, suggesting a difference in the cooling profile of the ablation electrodes. vHPSD with the SmartTouch or 0.45% HNS are likely to increase the risk of steam pops.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 10","pages":"2163-2172"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345558","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":"Low Voltage Areas in the Left Atrium After Sole Pulmonary Vein Isolation as a Predictor of Atrial Fibrillation Recurrence—Based on Sequential Voltage Map Analysis Using High-Density Mapping Catheters","authors":"Satoshi Hara,&nbsp;Shigeki Kusa,&nbsp;Naoyuki Miwa,&nbsp;Yoshikazu Sato,&nbsp;Tadanori Nakata,&nbsp;Taiki Ishizawa,&nbsp;Tetsuo Sasano,&nbsp;Hitoshi Hachiya","doi":"10.1111/jce.70463","DOIUrl":"10.1111/jce.70463","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Low-voltage areas (LVA) in the left atrium (LA) have been linked to atrial fibrillation (AF) recurrence. However, prior studies lacked high-density mapping catheter (HMDC) mapping, included non-pulmonary vein isolation (PVI) ablation strategies, and did not follow temporal progression of LVA in individuals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>We retrospectively analyzed 1661 AF patients who had undergone initial ablation using PVI alone, and in whom voltage maps of the LA had been created with HDMCs. We investigated the relationship between LVA size (Small-LVA group: LVA &lt; 5 cm² and Extensive-LVA group: LVA ≥ 5 cm²) and AF recurrence. HDMCs were again used to map the LA at the time of the re-do ablation. A total of 711 patients met our inclusion criteria (Small-LVA 554, Extensive-LVA 157). During the mean follow-up period of 643.6 ± 490.5 days, 21% of Small-LVA patients (<i>n</i> = 117) and 33% of Extensive-LVA patients (<i>n</i> = 52) experienced recurrence (<i>p</i> &lt; 0.005), of whom 106 (63%) underwent redo ablation. Belonging to the Extensive-LVA group was predictive of AF recurrence both after the initial ablation and after the redo ablation. They also exhibited greater non–PV related recurrence. Time-dependent progression of LVA was observed in 32 patients with a mean increase of 4.7 ± 5.1 cm² and was significantly more frequent in the Extensive-LVA group. This progression was not linked to AF recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We used high-density mapping to evaluate left atrial LVA in patients who had only received PVI, and demonstrated LVA influence on AF recurrence and recurrence patterns.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 10","pages":"2270-2279"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793695","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":"Terminal S Wave Pattern in Lead V3 as a Simple Marker for Ventricular Tachycardia Risk Stratification in Patients With Repaired Tetralogy of Fallot","authors":"Yuki Matsuoka,&nbsp;Miyako Igarashi,&nbsp;Naoto Kawamatsu,&nbsp;Yuto Iioka,&nbsp;Yoshihiro Harano,&nbsp;Yuki Komatsu,&nbsp;Tomoko Machino-Ohtsuka,&nbsp;Hiro Yamasaki,&nbsp;Tomoko Ishizu","doi":"10.1111/jce.70468","DOIUrl":"10.1111/jce.70468","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Patients with repaired tetralogy of Fallot (rTOF) remain at risk of ventricular tachycardia (VT). This risk is most commonly related to slow conduction within the septal isthmus, which is defined as the region between the ventricular septal defect (VSD) patch and adjacent valvular annuli. While assessment of septal isthmus conduction currently requires invasive electrophysiological mapping, the 12-lead electrocardiogram (ECG) may offer a noninvasive alternative. Therefore, the present study aimed to identify ECG markers reflecting septal isthmus conduction properties and evaluate their ability to predict isthmus conduction characteristics and VT inducibility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>In five patients with rTOF undergoing septal isthmus ablation, 12-lead ECGs obtained before and after ablation were compared to identify candidate ECG markers. The identified marker was validated in an independent cohort of 23 patients stratified according to septal isthmus conduction properties into normal conduction (Normal, <i>n</i> = 5), slow-conducting isthmus (SCI, <i>n</i> = 10), and conduction block (Block, <i>n</i> = 8) groups. The results indicated that the terminal S wave (TSW) in lead V3 became more prominent after ablation compared with that before ablation. In the validation cohort, V3 TSW was categorized as absent, small (&lt; 0.1 mV), or large (≥ 0.1 mV), and the TSW patterns differed significantly among the groups (<i>p</i> &lt; 0.001). Specifically, absent TSW was dominant in the Normal group (4/5, 80%), small TSW was the most frequent in the SCI group (7/10, 70%), and large TSW was predominant in the Block group (7/8, 87.5%). Small TSW predicted SCI with 70% sensitivity and 85% specificity (<i>p</i> = 0.013), whereas large TSW predicted Block with 88% sensitivity and 80% specificity (<i>p</i> = 0.006). Moreover, large TSW predicted VT non-inducibility with high specificity and high positive predictive value (<i>p</i> = 0.019).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study indicates that V3 TSW is a simple, noninvasive ECG marker reflecting septal isthmus conduction properties in rTOF, suggesting its potential utility for VT risk stratification.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 10","pages":"2261-2269"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jce.70468","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706491","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":"Long-Term Performance of Single-Chamber Atrioventricular-Synchronous Leadless Pacing: Results From 4 Years of Serial Follow-up","authors":"Sem Briongos-Figuero,&nbsp;Álvaro Estévez-Paniagua,&nbsp;Ana Sánchez-Hernández,&nbsp;Silvia Jiménez-Loeches,&nbsp;Eloy Gómez-Mariscal,&nbsp;Elena Sánchez-López,&nbsp;Beatriz Jiménez-Gutiérrez,&nbsp;Miguel Eduardo Jauregui-Abularach,&nbsp;David Vaqueriza-Cubillo,&nbsp;Roberto Muñoz-Aguilera","doi":"10.1111/jce.70490","DOIUrl":"10.1111/jce.70490","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Micra AV enables atrioventricular (AV)–synchronous pacing by sensing atrial mechanical contraction (A4) using device's accelerometer. Short-term studies showed good AV synchrony (AVS), but long-term data are lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Within the OPTIVALL cohort, we identified patients implanted with a first-generation Micra AV (June 2020–February 2024) who remained in sinus rhythm and programmed in VDD for ≥ 1 year. Device-derived AVS was collected annually (tracking index and total AVS = AM-VP + AM-VS) up to 4 years. A4 amplitude was recorded at each visit. A subgroup underwent 24-h Holter-ECG to assess ambulatory AVS at long-term follow-up. Atrial sensing had been optimized early after implant with no further adjustment at follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 54 implanted patients, 44 met inclusion criteria. Median (IQR) total AVS remained stable over time: 90.6% (85.4%–93.6%), 90.6% (83.1%–92.1%), 89.2% (84.3%–92.2%), and 89.3% (86.2%–91.6%) at 1, 2, 3, and 4 years, respectively (<i>p</i> = 0.789). Median (IQR) tracking index was 94.3% (88.9%–97.1%), 93.0% (85.0%–98.0%), 90.2% (84.4%–98.0%), and 90.0% (87.0%–93.9%) (<i>p</i> = 0.059). Median (IQR) A4 signal amplitude was 3.1 (2.0–5.1), 5.1 (2.1–5.1), 3.7 (1.9–5.1), and 5.1 (2.5–5.1) m/s² (<i>p</i> = 0.993). In 20 patients with 24-h Holter-ECG at 2.7 ± 1.1 years, ambulatory AVS was 85.5% (80.0%–90.7%) and was comparable to the 3-month value (87.9% (76.8%–93.1%); <i>p</i> = 0.811).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>When atrial sensing is optimized early, Micra AV can provide high and stable AV-synchronous pacing for up to 4 years, with preserved A4 signal amplitude.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 10","pages":"2289-2297"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887508","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":"Ablation of AV Nodal Reentrant Tachycardia in Octogenarians: Safety and Efficacy in a Large Comprehensive Single-Center Analysis","authors":"Hauke Engelke,&nbsp;Kristina Wasmer,&nbsp;Christian Veltmann,&nbsp;Sebastian Fink,&nbsp;Jan Schrickel,&nbsp;Adrian Reinhardt,&nbsp;Henning Jansen","doi":"10.1111/jce.70500","DOIUrl":"10.1111/jce.70500","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common supraventricular tachycardia and is generally considered benign, with excellent outcomes following catheter ablation. However, data on procedural safety and efficacy in very elderly patients (≥ 80 years), who often present with multiple comorbidities and increased procedural risk, remain limited. This study aimed to evaluate acute efficacy and complication rates of slow pathway ablation or modulation (SPA/SPM) in octogenarians treated at a high-volume electrophysiology center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed all consecutive octogenarian patients undergoing first-time SPA/SPM for AVNRT between 2001 and 2024. The primary efficacy endpoint was non-inducibility of AVNRT at the end of the procedure. Safety endpoints included atrioventricular block (AVB), pericardial effusion, and vascular access complications. Clinical outcomes were compared with a large institutional cohort of 6,020 patients undergoing SPA/SPM across all age groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 106 octogenarian patients (mean age 83.6 years) were included. Acute procedural success was achieved in 104 patients (98.1%). Two procedures were terminated prematurely due to transient AV conduction disturbances. Post-procedural AVB occurred in two patients, requiring permanent pacemaker implantation in one case. Pericardial effusion requiring pericardiocentesis occurred in two patients. Four patients developed significant bleeding or vascular access complications, with one requiring surgical intervention. Mean hospital stay was 1.3 days. Compared with the overall cohort, complication rates were higher in octogenarians (AVB: 1.9% vs. 0.12%; pericardial effusion: 1.9% vs. 0.08%; bleeding: 3.8% vs. 0.37%), while procedural success remained similarly high.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SPA/SPM for AVNRT in octogenarians is highly effective with excellent acute success rates comparable to younger populations. However, complication rates are increased compared with a large institutional cohort and previously reported data. These findings highlight the need for careful patient selection, thorough risk-benefit assessment, and tailored procedural strategies when considering catheter ablation in this growing and vulnerable patient population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 10","pages":"2326-2331"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963223","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}