Journal of Cardiovascular Electrophysiology最新文献

{"title":"Impact of Emergent Physician Notifications from Mobile Cardiac Outpatient Telemetry on Patient Outcomes (The EP-COT Trial).","authors":"David Lin, Sanchit Kumar, Khurram Butt, Jake Klewer, Mahesh Balakrishnan, Alvaro Altamirano, Aaron Vigdor, Andrea Schell, Purvee Parikh, C J Grigoriadis, Manish Wadhwa, Mathew D Hutchinson","doi":"10.1111/jce.70354","DOIUrl":"https://doi.org/10.1111/jce.70354","url":null,"abstract":"<p><strong>Introduction: </strong>Mobile ambulatory cardiac telemetry (MCOT) use has increased over time; however, data on the prevalence and the impact of emergent arrhythmia notifications with MCOT remains unclear. We sought to determine the prevalence and clinical impact of emergent arrhythmia events in patients undergoing MCOT monitoring. We also analyzed the efficiency of the emergent notification process.</p><p><strong>Methods: </strong>We analyzed 8404 consecutive patients from two centers who were prescribed Philips MCOT (K153473) over a 28-month period (September 2018-January 2021). Participants meeting emergent notification criteria were included. The primary outcome was any unscheduled provider intervention after the emergent notification. We also analyzed several time domains of the provider notification process.</p><p><strong>Results: </strong>A total of 122 patients (1.45%) satisfied emergent notification criteria during the study period. The median notification time from arrhythmia onset to provider notification was 42 min. Physician review of the arrhythmia notifications showed agreement with the monitoring technician diagnosis in 102/122 (83.6%). An emergent notification resulted in an unscheduled follow-up visit in 104/122 (85.2%) patients. Time from arrhythmia event to unscheduled follow up visit was < 24 h in 88/104 (84.6%), 24-72 h in 9/104 (8.7%) and > 72 h in 7/104 (6.7%). In 33 patients (27%), emergent notifications resulted in unscheduled interventions including: device implantation (24), ablation (8), and electrical cardioversion (4).</p><p><strong>Conclusions: </strong>Emergent arrhythmias events recorded during ambulatory telemetry monitoring resulted in unscheduled patient contact in 85% of cases and procedures in 27% of cases. The monitoring notification process was efficient, with median time from arrhythmia onset to provider notification of 42 min.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772335","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":"First Pediatric Application of Bachmann's Bundle Pacing and Left Bundle Branch Area Pacing for Bi-Physiologic Conduction System Pacing.","authors":"Hei-To Leung, Sabrina Tsao, Samuel Chung-Sum Ho, Kwok-Lap Chan, Yiu-Fai Cheung, Sit-Yee Kwok","doi":"10.1111/jce.70349","DOIUrl":"https://doi.org/10.1111/jce.70349","url":null,"abstract":"<p><strong>Background: </strong>Atrial pacing at right atrial appendage causes nonphysiologic delays. Bachmann's bundle (BB) pacing preserves synchrony but lacks pediatric data.</p><p><strong>Case summary: </strong>We report the first pediatric combined BB and left bundle branch area pacing in a 9-year-old boy (23.5 kg). With electrophysiologic and echocardiographic guidance, successful BB capture was achieved on a thin 2.1 mm atrial septum. Pacing significantly shortened P-wave duration (122-> 66 ms) and reduced interatrial mechanical delay (53-> 40 ms) on speckle-tracking echocardiography.</p><p><strong>Conclusion: </strong>This case demonstrates the acute success of BB pacing in a child. Bi-physiologic pacing is technically feasible and safe, though long-term outcomes warrant further evaluation.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771912","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":"VASCADE MVP-XL Versus VASCADE MVP for Large-Bore Venous Access-Site Closure in Electrophysiology Procedures: A Single-Center Experience on Efficacy and Complications.","authors":"Elio Zito, Sanghamitra Mohanty, Prem Geeta Torlapati, Vincenzo Mirco La Fazia, Marco Marino, Emanuele Chiarazzo, Giuseppe Stifano, Carola Gianni, Bryan MacDonald, Angel Mayedo, John Allison, G Joseph Gallinghouse, Weeranun Bode, John D Burkhardt, Rodney Horton, Amin Al-Ahmad, Andrea Natale","doi":"10.1111/jce.70348","DOIUrl":"https://doi.org/10.1111/jce.70348","url":null,"abstract":"<p><strong>Introduction: </strong>Vascular closure devices, used for the percutaneous closure of the femoral venous access-sites following electrophysiology (EP) procedures, are known to require shorter time to hemostasis compared to manual compression. The new VASCADE MVP_XL (Haemonetics Corp., USA) was designed for procedures utilizing large procedural sheaths, with a resorbable patch with 58% higher collagen content than the earlier VASCADE-MVP system, for better efficacy.</p><p><strong>Objective: </strong>We aimed to compare the safety and efficacy of VASCADE MVP-XL and VASCADE MVP in consecutive patients with atrial fibrillation (AF) undergoing procedures utilizing large sheaths (i.e. Farapulse pulsed-field ablation and left atrial appendage closure procedure).</p><p><strong>Methods: </strong>Based on the device used to achieve access-site hemostasis, AF patients undergoing EP procedures were classified into group 1: MVP-XL (n = 151) and group 2: MVP (n = 423). The closure device was deployed under ultrasound guidance and included 2-4 min of gentle compression followed by approximately 2 h of bedrest. Fluoroscopy was used for proper positioning and accurate deployment of the collagen patch. All procedures were conducted under uninterrupted anticoagulation. The access-sites were examined immediately after the procedure, after the 2 h bed-rest and before discharge.</p><p><strong>Results: </strong>Baseline characteristics were similar between the groups except the procedure type (Watchman) and rivaroxaban use. Time to final sheath pull, time to ambulation and time to discharge were similar between the groups. Access-site bleeding occurred in 13 patients (3.1%) in the MVP group versus none (0%) in the MVP-XL group (p = 0.029). Time to hemostasis was significantly shorter in the MVP-XL group.</p><p><strong>Conclusion: </strong>VASCADE MVP-XL has a better safety and efficacy profile compared to the VASCADE-MVP system, especially in procedures involving large sheaths.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729207","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":"Abstracts From the 31st Annual International Atrial Fibrillation Symposium, February 5-7, 2026.","authors":"","doi":"10.1111/jce.70300","DOIUrl":"10.1111/jce.70300","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147722963","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 Right Superior Pulmonary Vein Anatomy and 31-mm Cryoballoon Use on the Risk of Phrenic Nerve Injury During Cryoablation for Atrial Fibrillation.","authors":"Sadahiro Murota, Minoru Nodera, Shinya Yamada, Takashi Kaneshiro, Masayoshi Oikawa, Yasuchika Takeishi","doi":"10.1111/jce.70351","DOIUrl":"https://doi.org/10.1111/jce.70351","url":null,"abstract":"<p><strong>Background: </strong>Phrenic nerve injury (PNI) is a common complication of cryoballoon pulmonary vein isolation, especially during right superior pulmonary vein (RSPV) ablation. The impact of a newly introduced size-adjustable 31-mm cryoballoon on PNI and its anatomical predictors remain unclear.</p><p><strong>Methods and results: </strong>This retrospective study included 249 patients who underwent first-time cryoballoon ablation with successful RSPV isolation: 153 with a conventional 28-mm balloon and 96 with a size-adjustable balloon in the 31-mm configuration. Preprocedural computed tomography assessed RSPV anatomical features, including ostial diameters, cross-sectional area, and the RSPV-left atrium (LA) angle, defined as the angle between the RSPV and anterolateral LA wall on axial slices. The overall incidence of PNI did not differ between groups (28-mm: 10%; 31-mm: 15%; p = 0.330). However, persistent PNI, defined as dysfunction beyond the procedure, occurred only in the 28-mm group (5%). Multivariate analysis showed that the RSPV-LA angle independently predicted PNI in both groups (28-mm: odds ratio 3.819, 95% confidence interval 1.825-7.926, p < 0.001; 31-mm: odds ratio 3.633, 95% confidence interval 1.538-8.594, p = 0.003). No other anatomical parameters showed consistent associations.</p><p><strong>Conclusion: </strong>The RSPV-LA angle is a robust anatomical predictor of PNI during RSPV cryoballoon ablation, regardless of balloon size. Use of the 31-mm cryoballoon may help to reduce the risk of persistent PNI.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729197","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":"Sheath Withdrawal May Represent a Mechanically Vulnerable Phase for Septal Perforation During Left Bundle Branch Area Pacing.","authors":"Masayuki Ohta, Yuki Ishidoya, Ryosuke Ito, Daisuke Sunaga, Naohiro Funayama, Katsuhiko Ohori, Yusuke Kashiwagi, Shunsuke Ohori","doi":"10.1111/jce.70346","DOIUrl":"https://doi.org/10.1111/jce.70346","url":null,"abstract":"<p><strong>Introduction: </strong>Although interventricular septal perforation is a recognized complication of left bundle branch area pacing (LBBAP), its underlying mechanisms remain unclear. Previous studies have focused primarily on lead deployment-related factors, whereas mechanical events occurring after apparently successful lead fixation have received limited attention.</p><p><strong>Methods: </strong>In this exploratory mechanistic study, we investigated axial force transmission during delivery sheath withdrawal using a simplified benchtop model motivated by a representative clinical observation in which overt septal perforation became apparent immediately after sheath slitting. Axial force transmitted along the lead-sheath system was quantified under two geometric configurations simulating a constrained (5 cm) and less-constrained (10 cm) atrial space. Sheath withdrawal was performed in 1-cm increments under three initial orientations (neutral, clockwise, and counterclockwise). Peak axial force values were analyzed using two-way analysis of variance.</p><p><strong>Results: </strong>In the benchtop model, the constrained configuration generated significantly higher peak axial forces than the less-constrained configuration across all sheath orientations (p < 0.001). Initial sheath orientation significantly modified force transmission, with a counterclockwise orientation producing the highest peak axial force under constrained conditions (p < 0.001). Peak axial force consistently occurred during the early phase of sheath withdrawal, corresponding to a lead tip-to-sheath tip distance of approximately 3.5-4.5 cm. These mechanical findings were concordant with fluoroscopic observations from the index clinical case, in which distinct lead-tip excursion and overt septal perforation were recognized during early sheath withdrawal. However, subtle pre-existing protrusion of the lead helix before sheath withdrawal could not be excluded.</p><p><strong>Conclusions: </strong>Sheath withdrawal during LBBAP may represent a mechanically vulnerable phase during which geometric constraint and sheath orientation can synergistically amplify axial force transmission to the lead tip. Recognition of this vulnerable phase, together with attention to atrial geometry and sheath orientation during early withdrawal, may help reduce the risk of lead destabilization or overt interventricular septal perforation during LBBAP.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723006","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 Resynchronization Effect in Left Bundle Branch Pacing Can be Evaluated Non-Invasively With the Implementation of Lead V8.","authors":"Vadivelu Ramalingam, Johan van Koll, Peter Tai, Vidal Essebag, Atul Verma, Uyên C Nguyên, Joost Lumens, Justin G L M Luermans, Kevin Vernooy, Jacqueline Joza","doi":"10.1111/jce.70336","DOIUrl":"https://doi.org/10.1111/jce.70336","url":null,"abstract":"<p><strong>Background: </strong>Left bundle branch area pacing (LBBAP) is increasingly being used for cardiac resynchronization therapy (CRT); however an additional left ventricular (LV) lead is required when resynchronization remains incomplete. This study evaluates whether lead V8 can provide a simple, non-invasive marker of persistent posterolateral LV delay during LBBAP.</p><p><strong>Methods: </strong>Consecutive patients undergoing LOT-CRT implantation were included. Standard 12-lead ECGs were obtained with the V5 electrode repositioned to the V8 location. Local activation time was measured as the steepest negative downslope of the QRS (negative derivative activation time, NDAT) and compared with the LV electrical delay (LVED) determined from the LV lead during LBBAP.</p><p><strong>Results: </strong>Thirty consecutive patients undergoing LOT-CRT implantation were included with a total of 106 ECG recordings with corresponding LVED measurements. The NDAT-V8 demonstrated a strong correlation with the LVED during intrinsic conduction (r = 0.95) and during all LBB pacing subtypes: combined r = 0.922; mean difference 2.5 ± 8 ms; RV septal pacing, r = 0.89; LV septal pacing, r = 0.92; non-selective LBBP, r = 0.91; and selective LBBP, r = 0.81. The correlation of LVED during intrinsic conduction and all LBBAP pacing subtypes was significantly weaker for NDAT-V6 and the RWPT in V6 and V8 (r = 0.681, 0.626, and 0.726, respectively).</p><p><strong>Conclusion: </strong>The NDAT-V8 provides a reliable non-invasive surrogate for the LV posterolateral wall delay during LBBAP, outperforming NDAT-V6 and the RWPT in V6 and V8 and establishes the groundwork for future studies evaluating NDAT-V8 as a tool to guide adequate resynchronization during LBBAP.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698917","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":"Long-Term Outcomes After Catheter Ablation: A 42-Month Longitudinal Study From the ITHACA-Database.","authors":"Dimitrios Varrias, Kristie Coleman, Jonas Leavitt, Kuan Yu Chi, Haisam Ismail, Jason Chinitz, Raman Mitra, Marcin Kowalski, Nicholas Skipitaris, Laurence M Epstein, Stavros E Mountantonakis","doi":"10.1111/jce.70345","DOIUrl":"https://doi.org/10.1111/jce.70345","url":null,"abstract":"<p><strong>Background: </strong>There is a paucity of real-world data on the long-term clinical outcomes of patients undergoing catheter ablation (CA) for atrial fibrillation (AF).</p><p><strong>Objective: </strong>Assess long-term outcomes for patients undergoing CA for AF in a large multicenter health system.</p><p><strong>Methods: </strong>We analyzed consecutive patients undergoing de novo CA for AF at one of Northwell Health's five electrophysiology laboratories between 2015 and 2021 from the ITHACA-Database. The primary composite outcome (freedom from AF) was defined as the absence of electrocardiographically documented AF > 30 s, direct current cardioversion (DCCV), ongoing therapy with a Class I/III AAD 3 months after index CA, or repeat ablation any time post-index CA throughout extended longitudinal follow-up (97% patient retention). Regression was performed to identify predictors. The annual risk of recurrence was also calculated.</p><p><strong>Results: </strong>Three thousand four hundred forty patients (69.4 ± 10.2 years, 44% females, 64% paroxysmal AF) were observed for an average time of 42 ± 9.2 months. The primary composite outcome was achieved in 65% at 1 year, 59% at 2 years, and 52% at the last follow-up (42 months). While the 1-year composite outcome of freedom from AF post-ablation was higher for patients with paroxysmal AF compared to persistent AF (69% vs. 61%), the annual risk for recurrence for every year thereafter was similar (+6% vs. +7%). Patients who remained AF-free at 1-year post-index ablation had higher chances of freedom from AF at 42 months (80% vs. 48%, p = 0.001). The annual risk of recurrence for patients who were AF-free the first year was 5%, significantly less than those who experienced AF recurrence within the first year (12%, p = 0.002).</p><p><strong>Conclusion: </strong>Annual recurrence rates appear similar across AF types after the first year post-ablation. Maintaining sinus rhythm for 1 year after the initial ablation significantly increases the likelihood of long-term freedom from AF.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690306","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 Comprehensive Assessment of Renal Function During and After Pulsed Field Ablation.","authors":"Václav Melenovský, Marek Hozman, Sabri Hassouna, Ivana Fišerová, Barbora Bačová, Dalibor Heřman, Jakub Karch, Jana Veselá, Michal Zuzčák, Ivan Rychlík, Pavel Osmančík","doi":"10.1111/jce.70281","DOIUrl":"10.1111/jce.70281","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury is an uncommon complication of pulsed field ablation (PFA). There is, however, limited empirical data on the dynamics of renal biomarkers apart from creatinine. Furthermore, no study to date has assessed creatinine at more than 24 h after the procedure.</p><p><strong>Methods: </strong>Patients undergoing PFA for atrial fibrillation (AF) were enrolled in a prospective observational study. The ablation was performed using the Farawave pentaspline catheter along with the Farapulse system and consisted of pulmonary vein isolation along with additive lesions in patients with persistent AF and/or atrial flutter. Administration of 500-1000 mL of crystalloid was a mandatory part of the periprocedural management protocol. Before and 24 h after the procedure, serum renal biomarkers were measured (urea, creatinine, cystatin C, NGAL, and KIM-1), and urinalysis was performed. Hemolysis indices (haptoglobin, Lactate Dehydrogenase, and red blood cell microparticles) were measured after the procedure. Patients were instructed to undergo blood sampling for creatinine and urea 48 h after the procedure.</p><p><strong>Results: </strong>Samples from 88 patients were analyzed (mean age 67 ± 8.8 years, 33% female, 53% paroxysmal AF, average of 63 [IQR: 40-77] applied pulses). The creatinine concentration at 24 h decreased from 86 (IQR: 72-100) to 82 (IQR: 68-92) µmol/L (p < 0.001), the concentration at 48 h was similar to preprocedural values (83 [IQR: 69-100] µmol/L; (p = 1.00). However, 9 patients (10.2%) met AKI criteria; in six of them, AKI was only detectable at the 48-h measurement. Serum cystatin-C levels remained unchanged, and urea and urinary erythrocytes increase significantly from baseline to 24 h. NGAL levels increased significantly from 121 (IQR: 86-173) to 143 (IQR: 112-198) at 24 h while changes in KIM-1 were unsignificant. All changes in renal function were transient and did not require hospitalization. Logistic regression identified age and the total number of pulsed field pulses as the major risk factors for AKI.</p><p><strong>Conclusions: </strong>Routine PFA with periprocedural hydration and an average of 63 PF pulses appears safe in patients without significant preexisting renal disease, with a low risk of clinically relevant renal impairment. However, the incidence of AKI in our cohort was higher than previously reported, suggesting that transient kidney function changes may be more common than recognized. These findings highlight the need for kidney function monitoring beyond 24 h in higher-risk patients undergoing PFA.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690287","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":"Persistence of Low-Voltage Area in the Superior Vena Cava Following Pulsed-Field Ablation for Pulmonary Vein Isolation: Findings During Repeat Procedure.","authors":"Haruka Matsuura, Tsukasa Kamakura, Takashi Ikee, Daiki Shako, Toshihiro Nakamura, Satoshi Oka, Akinori Wakamiya, Nobuhiko Ueda, Kenzaburo Nakajima, Kosuke Nakasuka, Mitsuru Wada, Kohei Ishibashi, Yuko Inoue, Koji Miyamoto, Takeshi Aiba, Kengo Kusano","doi":"10.1111/jce.70344","DOIUrl":"https://doi.org/10.1111/jce.70344","url":null,"abstract":"<p><strong>Introduction: </strong>Superior vena cava (SVC) conduction delay or isolation can occur during right superior pulmonary vein (RSPV) ablation using pulsed-field ablation (PFA). However, the persistence of these abnormalities and their clinical associations with atrial tachyarrhythmias remain unclear. Herein, we assessed the persistence of low-voltage area (LVA) within SVCs, initially identified following the index procedure, and their associations with atrial tachyarrhythmias documented at repeat intervention across 25 patients with atrial fibrillation (AF) who underwent a repeat procedure after pulmonary vein isolation (PVI) using PFA.</p><p><strong>Methods and results: </strong>A de novo SVC LVA occurred in 20 of 25 patients (80%) after the index procedure. At the repeat procedures, performed after a median of 155 days, SVC LVA persisted in 13 of 20 patients (65%). Patients with persistent SVC LVA exhibited a shorter SVC-RSPV distance on preprocedural computed tomography than those without persistence (3.2 vs. 5.1 mm, p = 0.013). Residual LVA in the SVC was associated with colocalization with an atrial tachycardia isthmus in one patient and SVC-triggered AF in another.</p><p><strong>Conclusion: </strong>SVC LVA after PVI using PFA frequent occurred and persisted in approximately two-thirds of the patients, particularly when SVC and RSPV proximity was close. PFA-related collateral effects may facilitate atrial tachyarrhythmias.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147662600","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}