Journal of Cardiovascular Electrophysiology最新文献

{"title":"Right Ventricular Septal Pacing-Derived V₆ R-Wave Peak Time Predicts Successful Left Bundle Branch Area Pacing in Patients With Heart Failure and Left Bundle Branch Block.","authors":"Mengxing Cai, Zhongli Chen, Yun Tang, Yuan Gao, Sijin Wu, Nan Xu, Xuan Ma, Jiandu Yang, Chongqiang Li, Xiahenazi Aiyasiding, Xiaojian Chi, Yan Dai, Shihua Zhao, Keping Chen","doi":"10.1111/jce.70110","DOIUrl":"https://doi.org/10.1111/jce.70110","url":null,"abstract":"<p><strong>Introduction: </strong>Left bundle branch area pacing (LBBAP) is an emerging strategy for cardiac resynchronization therapy (CRT), but its implementation in heart failure patients remains challenging. This study aimed to assess whether the initial V₆ R-wave peak time (V₆RWPT) during right ventricular septal pacing (RVSP) for lead localization can predict successful LBBAP implantation.</p><p><strong>Methods and results: </strong>Consecutive patients with left bundle branch block (LBBB) and left ventricular ejection fraction (LVEF) < 50% who met CRT indications were included. Clinical, echocardiographic, and electrocardiographic variables were collected. Among 99 patients enrolled in the study, the success rates for LBBAP and LBBP were 73.7% and 63.6%, respectively. Multivariate regression analysis revealed that baseline Strauss LBBB (OR:5.04, 95% CI:1.45-17.54, p = 0.011) and shorter RVSP V₆RWPT (per 10 ms, OR:0.42, 95% CI:0.29-0.59, p < 0.001) had a greater likelihood of successful LBBAP. RVSP V₆RWPT (cutoff: 145 ms) yielded the highest area under the curve (AUC:0.888), significantly outperforming LVEDD (AUC:0.721), LAD (AUC:0.709), baseline Strauss LBBB (AUC:0.694), and baseline QRSd (AUC:0.629) (all p < 0.01). Among 56 patients who underwent cardiac magnetic resonance imaging, RVSP V₆RWPT correlated significantly with both global (r = 0.592, p < 0.001) and septal scar percentages (r = 0.598, p < 0.001).</p><p><strong>Conclusion: </strong>V₆RWPT during RVSP is a novel predictor of successful LBBAP implantation in heart failure patients with LBBB. This marker demonstrates strong predictive value and correlates with cardiac scar burden. The RVSP V₆RWPT assessment dynamically guides CRT strategy optimization during implantation.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086083","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 Pulsed-Field Ablation on the Left Atrial Appendage Diameter-Insights From Intra-Procedural Echocardiography.","authors":"Nándor Szegedi, Piotr Gardziejczyk, Zoltán Salló, Gábor Orbán, Márton Boga, Paweł Szymkiewicz, Marta Skowrońska, Patrik Tóth, Ferenc Komlósi, Béla Merkely, Ewa Wlazłowska-Struzik, László Gellér, Jakub Baran, Dhiraj Gupta","doi":"10.1111/jce.70111","DOIUrl":"https://doi.org/10.1111/jce.70111","url":null,"abstract":"<p><strong>Introduction: </strong>Concomitant pulmonary vein isolation (PVI) and left atrial appendage (LAA) occlusion (LAAO) have become frequently used therapies. Pulsed-field ablation (PFA), will likely be used for combined PVI plus LAAO procedures. However, there may be concerns regarding the malposition of the LAAO device attributed to the potential tissue edema after PVI.</p><p><strong>Aim: </strong>We aimed to compare the LAA's size before and after PVI performed with the pentaspline catheter, measured intraprocedural by intracardiac echocardiography or transesophageal echocardiography.</p><p><strong>Methods: </strong>We conducted a multicenter, prospective, observational study investigating PVI using the Farapulse system. The anteroposterior diameter of the left-sided pulmonary vein (LPV), left atrial ridge, and LAA were measured before and after the PFA.</p><p><strong>Results: </strong>We enrolled 91 patients aged 63 ± 10 years, 36% were women, and 47% had paroxysmal AF. The most common comorbidities was hypertension (59%). Procedure time and left atrial dwell time were 65 (52-80) min, and 27 (24-32) min, respectively. The diameter of the LAA was not different before and after the PVI (15 [13-18] and 16 [13-19], respectively; p = 0.756). On the other hand, the diameter of the left atrial ridge (7 [6-8] and 8 [6-8]) and the LPV (13 [10-15] and 13 [11-15]) was smaller before ablation compared to the diameter after PVI (p < 0.0001 for both). No major complications occurred.</p><p><strong>Conclusion: </strong>LAA anteroposterior diameter does not change after PVI with PFA. Although there is a significant change in the anteroposterior diameters of the LPV and the left atrial ridge, it does not seem clinically relevant. If significant edema formation is detected in a single case after PVI, postponing the LAAO procedure should be considered.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086085","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":"Letter to the Editor Response.","authors":"John Rickard","doi":"10.1111/jce.70062","DOIUrl":"https://doi.org/10.1111/jce.70062","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086116","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":"Comparison of Two Different Pulsed Field Ablation Systems: The Dual Pulse System Study.","authors":"Behnam Subin, Corinne Isenegger, David Spreen, Philipp Krisai, Sven Knecht, Gian Völlmin, Nicolas Schaerli, Felix Mahfoud, Michael Kühne, Christian Sticherling, Patrick Badertscher","doi":"10.1111/jce.70078","DOIUrl":"https://doi.org/10.1111/jce.70078","url":null,"abstract":"<p><strong>Background: </strong>Recently, multiple pulsed field ablation (PFA)-system were introduced for catheter ablation (CA) of atrial fibrillation (AF). However, data comparing procedural performance, the extent of low-voltage areas (LVA), and myocardial injury between different PFA-systems in a real-world setting remain scarce.</p><p><strong>Methods: </strong>Consecutive patients undergoing CA for AF were enrolled. PFA was performed using either a Pentaspline catheter-system (PCS) or a loop catheter-system (LCS). The extent of acute antral LVA was assessed using a 3D-electroanatomical mapping system. High-sensitivity cardiac troponin T (hs-cTnT) was measured the day after the procedure to assess myocardial injury.</p><p><strong>Results: </strong>A total of 120 patients (median age 67 [59-73] years, 29% female) underwent de novo pulmonary vein isolation (PVI). The PCS-group included 90 patients, while the LCS-group included 30 patients. Acute PVI was achieved in all patients (100%). Procedural times were significantly shorter in the PCS compared to the LCS-group, including total procedure duration (57 [48-67] vs 66 [52-83] min, p = 0.016), left atrial dwell time (38 [32-48] vs 54 [38-65] min, p < 0.001), and ablation duration (17 [12-23] vs 24 [20-33] min, p < 0.001). Acute antral LVA and myocardial injury were significantly lower in the PCS compared to the LCS-group (6.6 [5.0-8.9] vs. 19.2 [16.8-25.4] cm², p < 0.001 and hs-cTnT of 1282 [892-1894] vs 1588 [1281-2110] ng/L, p = 0.029.</p><p><strong>Conclusion: </strong>Significant differences were observed between two commercially available PFA-systems. While PCS was associated with significantly shorter procedural time, LCS resulted in a greater extent of acute antral LVA and myocardial injury levels.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086149","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":"Adverse Effect of Ventricular Rate Regularization Pacing in Biventricular Cardiac Resynchronization Therapy.","authors":"Chu-Pak Lau, Kathy Lai-Fun Lee, Hung-Fat Tse","doi":"10.1111/jce.70106","DOIUrl":"https://doi.org/10.1111/jce.70106","url":null,"abstract":"<p><strong>Introduction: </strong>Ventricular pacing at a shorter cycle length to premature ventricular contractions (PVCs), termed either as ventricular rate regularisation (VRR) or rate smoothing can be used to increase the percentage of biventircualr pacing and to avoid the long-short-long sequence caused by PVCs causing ventricular tachycardias (VTs). However, the risk of inappropriate rate increase by VRR during frequent PVCs in worsening heart failure in patients with CRT-D has not been reported.</p><p><strong>Methods and results: </strong>A 72-year-old man with dilated cardiomyopathy and atrial fibrillation received a CRT-D after atrioventricular nodal ablation. He presented with heart failure and a persistent biventricular (BV) pacing rate of over 100 bpm. Frequent PVCs and non-sustained VT increased and sustained the pacing rate through VRR. Rate amelioration was partially achieved with antiarrhythmic medications and normalised by inactivation of VRR.</p><p><strong>Conclusion: </strong>In patients with CRT-D and frequent PVCs, VRR should be considered as a cause for inappropriate pacing rate that could worsen heart failure.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080348","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":"Are All Pulsed Field Ablation Systems Equal?","authors":"Andrea Di Cori, Giulio Zucchelli","doi":"10.1111/jce.70112","DOIUrl":"https://doi.org/10.1111/jce.70112","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080502","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":"Catheter Ablation for Ventricular Tachycardia in Ischemic Cardiomyopathy: A Meta-Analysis With Reconstructed Time-to-Event and Trial Sequential Analysis.","authors":"Hossam Elbenawi, Youmna Ayman, Ahmed Hashim, Siddharth Agarwal, Mohamed Wagdy, Belal Mohamed Hamed, Priyesh Thakurathi, Ali Saad Al-Shammari, Kareem A Mohamed, Abdul Mukhtadir Kalaiger, Ahmed Ibrahim, Mahmoud Eisa, Ramzi Ibrahim, Morad Zaaya, Min Choon Tan, Omar Almaadawy, Karol Quelal, Zain Ul Abideen Asad, Justin Z Lee, Konstantinos Siontis, Ángel Arenal, Freddy Del-Carpio Munoz, Christopher V DeSimone, Abhishek J Deshmukh","doi":"10.1111/jce.70075","DOIUrl":"https://doi.org/10.1111/jce.70075","url":null,"abstract":"<p><strong>Background: </strong>Ventricular tachycardia (VT) is a major contributor to sudden cardiac death among patients with ischemic heart disease (IHD). While catheter ablation reduces the arrhythmic burden, the impact on long-term outcomes remains uncertain. We assess the efficacy of catheter ablation in patients with IHD.</p><p><strong>Methods: </strong>We performed a meta-analysis by systematically searching electronic databases from inception to April 2025. Pairwise, reconstructed time-to-event data meta-analyses and Trial Sequential analyses were conducted.</p><p><strong>Results: </strong>A total of seven studies (1192 participants) were included. Among patients with IHD with ICD, VT ablation was associated with a significant reduction in ICD shocks (RR = 0.50, 95% CI = [0.34-0.74]), a trend toward reduced VT storm (RR = 0.64, 95% CI = [0.40-1.04], p = 0.07), and lower rates of cardiovascular hospitalization (RR = 0.73, 95% CI = [0.53-1.01], p = 0.06) compared to ICD alone. However, no significant differences were observed when compared to patients receiving ICD plus antiarrhythmic drugs (AADs). VT ablation showed no significant impact on mortality or VT/VF recurrence compared to either ICD alone or ICD with AADs. Reconstructed Kaplan-Meier analysis for all-cause mortality showed no significant difference between VT ablation and AAD  +  ICD. Trial Sequential Analysis provided conclusive evidence for VT/VF recurrence, while further data is required for other outcomes.</p><p><strong>Conclusion: </strong>Among patients with IHD with ICD, VT ablation reduces ICD shocks, VT storm, and cardiovascular hospitalizations compared to ICD-only therapy, but offers no significant advantage over ICD combined with AADs. VT ablation does not impact overall mortality or the recurrence of VT/VF. Trial sequential analysis confirmed conclusive evidence for VT/VF recurrence, while additional data is needed for other outcomes.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075053","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":"Bipolar Catheter Ablation as a Key for Successful Treatment of Intramural VentricuLar Arrhythmias: Results From the Bipolar-Kiel Study.","authors":"Fabian Moser, Vera Maslova, Adrian Zaman, Thomas Demming, Martina Spehlmann, Mohammed Saad, Derk Frank, Evgeny Lian","doi":"10.1111/jce.70018","DOIUrl":"https://doi.org/10.1111/jce.70018","url":null,"abstract":"<p><strong>Background: </strong>Unipolar catheter ablation (CA) is effective in the treatment of ventricular arrhythmias but its efficacy can be limited in eliminating intramural arrhythmic origins. Bipolar ablation has emerged as a bail-out strategy. However, currently, it is being primarily utilized after a failed ablation attempt.</p><p><strong>Objective: </strong>The aim of this study is to assess the safety and efficacy of endocardial and/or epicardial bipolar catheter ablation in patients with ventricular arrhythmias within their first procedure or after a previously failed ablation attempt.</p><p><strong>Methods and results: </strong>Patients who underwent bipolar CA between September 2022 and February 2025 were included. A total of 21 bipolar ablation procedures were performed in 19 patients (median age 66 ± 11, 11% female, median ejection fraction 42% ± 16%). In total, 16 procedures were performed due to ventricular tachycardia (VT) or VT storm, five procedures were performed due to symptomatic premature ventricular contractions (PVC). In 48% of all cases, ablation was performed within the patient's first procedure. The interventricular septum was the most common site of bipolar ablation (11/21), followed by epi-endocardial bipolar ablation procedures (9/21) and the papillary muscle (1/21). Bipolar ablation was successful in 17/21 patients. In one patient, AV block occurred after bipolar ablation. During a median follow-up time of 12 ± 6 months, four patients with initially acute procedural success experienced recurrence of a ventricular arrhythmia.</p><p><strong>Conclusion: </strong>Bipolar catheter ablation is an effective tool for arrhythmias with an intramural origin. It is shown to be safe with a high acute success rate in patients undergoing their first or redo procedure for VT or PVC.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064521","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":"Reassessing Safety Outcomes of Left Atrial Appendage Closure in Immunosuppressed Patients.","authors":"Muhammet Cihat Çelik, Mehmet Murat Şahin, Macit Kalçik","doi":"10.1111/jce.70108","DOIUrl":"https://doi.org/10.1111/jce.70108","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064482","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":"Response to the Letter to the Editor.","authors":"Riya Sam, Jeremiah Wasserlauf","doi":"10.1111/jce.70109","DOIUrl":"https://doi.org/10.1111/jce.70109","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064517","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}