Journal of Cardiovascular Electrophysiology最新文献

{"title":"Catheter Ablation of Idiopathic Premature Ventricular Contractions Using Robotic Magnetic Navigation: Extensive Experience and Review","authors":"Qingzhi Luo,&nbsp;Xiang Li,&nbsp;Peng Zhang,&nbsp;Zhuhui Liu,&nbsp;Yun Xie,&nbsp;Yangyang Bao,&nbsp;Yue Wei,&nbsp;Changjian Lin,&nbsp;Tianyou Ling,&nbsp;Ning Zhang,&nbsp;Kang Chen,&nbsp;Wenqi Pan,&nbsp;Pete Weiss,&nbsp;Liqun Wu,&nbsp;Qi Jin","doi":"10.1111/jce.70446","DOIUrl":"10.1111/jce.70446","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This retrospective analysis of our extensive experience focuses on idiopathic premature ventricular contractions (PVC) ablation guided by robotic magnetic navigation (RMN). Critical evaluation is given to the causes and impact of acute procedural failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study enrolled 824 patients (mean PVC burden 21.0 ± 6.6%) undergoing first-time RMN-guided PVC ablation. Acute failure was defined as recurrent clinical PVC during the observation period after the last radiofrequency (RF) application. The Navigation Index was calculated as the ratio of RF delivery time to total ablation time. Multivariate logistic regression was used to detect the impact factors of acute failure from patient demographics, PVC characteristics, and procedural parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean procedure and fluoroscopic times were 73.8 ± 38.3 and 2.6 ± 2.9 min, respectively. The overall acute procedural failure rate was 11% (90/824). Acute procedure failure was strongly dependent on the PVC origin: lowest in the right ventricular outflow tract (2.7%) and highest in the left ventricular summit (44%). The primary mechanisms were determined to be intramural origins (50%, 45/90) and proximity to high-risk structures (24%, 22/90). Multivariate analysis identified PVC origin and Navigation Index (OR = 0.1, 95% CI 0.05–0.20; <i>p</i> &lt; 0.001) as independent predictors of failure. A higher Navigation Index, reflecting greater procedural efficiency, correlated with procedural success. No major complications occurred, and minor complications were observed in 0.6% of patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>RMN-guided idiopathic PVC ablation demonstrated excellent safety and a relatively low acute procedural failure rate. Procedural outcomes are critically determined by the anatomical origin of the PVC and the procedural efficiency measured by the Navigation Index.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 10","pages":"2222-2231"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470752","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":"Differential Air Entrainment of Mini-Basket and Circular Mapping Catheters Through the FARADRIVE Sheath: Mitigation With a Liquid-Sealed Insertion Method","authors":"Thai Duy Vo,&nbsp;Ting-Yung Chang,&nbsp;Chin-Yu Lin,&nbsp;Pei-Yi Wang,&nbsp;Kuo-Hsiang Lu,&nbsp;Hsin-Lei Huang","doi":"10.1111/jce.70492","DOIUrl":"10.1111/jce.70492","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Iatrogenic air entrainment is a preventable embolic hazard in pulsed field ablation (PFA). Mapping catheter insertion through large-bore PFA sheaths may be a vulnerable step, but the roles of catheter geometry and liquid-sealed insertion are unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>In an ex vivo saline tank model, ORION mini-basket and SPIRAL circular mapping catheters were inserted through the FARADRIVE steerable sheath using saline infusion only, continuous manual suction, or liquid-sealed insertion with a custom Adapter Sink. The primary endpoint was macroscopic air recovered distally after each trial of 10 insertions; the trial was the unit of analysis, and 0.2 mL was the smallest quantitatively reportable volume. In 60 trials (600 insertions), mitigation strategy significantly affected air entrainment (Kruskal–Wallis <i>p</i> &lt; 0.001). Under saline infusion alone, ORION generated more air than SPIRAL (23.86 ± 3.63 vs. 7.20 ± 2.09 mL per 10 insertions; 2.39 vs. 0.72 mL per insertion; adjusted <i>p</i> &lt; 0.001). Manual suction reduced entrainment to 3.96 ± 1.01 and 1.02 ± 0.45 mL per 10 insertions (0.40 and 0.10 mL per insertion), but residual air persisted. With liquid-sealed insertion, no visually detectable or quantitatively measurable macroscopic air was observed in any trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Air entrainment varied according to mapping-catheter geometry and mitigation strategy. Timed manual suction substantially reduced, but did not abolish, measurable air. Liquid-sealed insertion was associated with no measurable macroscopic air within this ex vivo model, warranting further evaluation under physiologic pressure conditions and in clinical PFA workflows.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 10","pages":"2317-2325"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912136","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 Utility of Tissue Proximity Indication With a Variable-Loop Circular Catheter for Pulmonary Vein Isolation","authors":"Masataka Narita,&nbsp;Daisuke Kawano,&nbsp;Naomichi Tanaka,&nbsp;Tsukasa Naganuma,&nbsp;Wataru Sasaki,&nbsp;Kazuhisa Matsumoto,&nbsp;Kei Matsumoto,&nbsp;Hitoshi Mori,&nbsp;Yoshifumi Ikeda,&nbsp;Ritsushi Kato","doi":"10.1111/jce.70376","DOIUrl":"10.1111/jce.70376","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The variable-loop circular catheter (VLCC, VARIPULSE) is a pulsed-field ablation (PFA) catheter equipped with a Tissue Proximity Indication (TPI) function, which monitors catheter-tissue contact. Although TPI-negative sites have been reported to contribute to gap formation, no studies have evaluated the utility of real-time function. This study assessed the success rate of pulmonary vein isolation (PVI) using the VLCC, incorporating the activated TPI function as the primary setting from the start of the procedure, representing an <i>activated TPI function-guided ablation</i> approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between February 1 and September 3, 2025, 60 consecutive patients underwent PFA using the VLCC. After creating the 3D geometry using CARTOSOUND FAM before ablation, PVI using the VLCC was performed with the activated TPI function. After an initial two-by-two PFA set, the catheter orientation was adjusted to target areas without visible TPI-positive tags. After applying an additional PFA application to ensure a circumferential TPI function-on tags, a voltage map was created using a multielectrode catheter, and the rate of residual potentials was compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Using an activated TPI function-guided PFA strategy, a first pass isolation was successfully achieved in 90% of patients (54/60) and in 97.1% of pulmonary veins (231/238). Multielectrode catheter mapping revealed residual antrum potentials in some cases, necessitating additional PFA applications in 3.8% of the pulmonary vein antrum (9/238).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Activated TPI function-guided PFA was associated with a low incidence of residual PV potentials, suggesting its potential utility to improve lesion continuity and procedural efficacy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 10","pages":"2173-2182"},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jce.70376","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148360997","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":"Procedural Outcomes of Leadless Pacemaker Extraction and Retrieval: A Systematic Review and Meta-Analysis With Descriptive Synthesis of Post-Implant Management.","authors":"Bahaa El Deen Wehbeh, Atef Akoum, Mohammed A Elbahloul, Joe Youssef, Mikhael F El Chami","doi":"10.1111/jce.70531","DOIUrl":"https://doi.org/10.1111/jce.70531","url":null,"abstract":"<p><strong>Introduction: </strong>Leadless pacemakers reduce lead- and pocket-related complications, but pooled evidence on the procedural outcomes of their extraction and retrieval remains limited.</p><p><strong>Methods and results: </strong>A systematic review and meta-analysis (PROSPERO CRD420261397097) evaluated leadless pacemaker extraction or retrieval. The primary analysis pooled independent full-text studies reporting at least three attempted removals using a random-effects binomial-normal generalized linear mixed model. Outcomes were procedural success and major retrieval-related procedural events. Eight studies contributed 303 removal attempts to the primary success analysis, and six studies contributed 293 subjects or procedures to the safety analysis. Pooled procedural success was 89.1% (95% CI, 85.1% to 92.2%), and major retrieval-related procedural events occurred in 3.8% (95% CI, 2.1% to 6.7%); between-study heterogeneity was not detected for either outcome. Sensitivity estimates for major events ranged from 3.3% to 4.1%. Reported dwell time before removal ranged from intraprocedural retrieval to 9 years. A secondary descriptive synthesis of 96 clinical publications and five cohorts with complete denominators characterized post-implant management without cross-study pooling.</p><p><strong>Conclusion: </strong>Leadless pacemaker removal was successful in approximately nine of 10 attempts, while qualifying major retrieval-related events occurred in approximately four of 100 safety denominators. The certainty of evidence was very low. Post-implant management patterns varied across cohorts and could not be pooled.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166165","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":"Development and Validation of a Novel Contact Force-Integrated Pulsed Field Quantization Index for Pulmonary Vein Isolation in a Porcine Model.","authors":"Jie Yang, Yi Zhang, Jie Zheng, Xiaoyue Tang, Bo Zhang, Yuanbin Song, Xia Wang, Changsong Liu, Qiucan Xiong, Wenzu Gu, Mengjia Sun, Huishan Liang, Yanbo Sheng, Tuo Zhou, Hu Tan","doi":"10.1111/jce.70527","DOIUrl":"https://doi.org/10.1111/jce.70527","url":null,"abstract":"<p><strong>Introduction: </strong>There is no bipolar-specific quantitative ablation index currently available to guide pulsed field ablation (PFA). We aimed to develop and validate a novel contact force (CF)-integrated pulsed field quantization index (PFQI) for real-time lesion depth prediction during bipolar PFA.</p><p><strong>Methods and results: </strong>In total, 27 healthy Yorkshire swine were included in a two-phase preclinical study. In Phase I, a nonlinear multivariable model was developed to derive a novel PFQI incorporating real-time CF, pulse train number, delivery voltage, and impedance variation. In Phase II, the PFQI was prospectively validated by comparing predicted with actual lesion depth, followed by PFQI-guided circumferential pulmonary vein isolation (PVI). Acute procedural success, 30-day PVI durability, and extracardiac safety were evaluated using serial electroanatomic mapping and blinded histopathological examination. Lesion depth was strongly associated with CF, pulse train number, voltage, and impedance change. The PFQI predicted actual depth with high accuracy (R = 0.94, R² = 0.88; validation R² = 0.82, slope = 1.014). In the validation cohort, 92% of predicted depths fell within ±0.75 mm of measured values. PFQI-guided PVI achieved 100% (6/6) acute isolation and 100% 30-day durable electrical isolation, with contiguous transmural fibrosis on histology. No collateral phrenic nerve, esophageal, or pulmonary vein injury occurred, and phrenic capture thresholds remained unchanged.</p><p><strong>Conclusion: </strong>The PFQI is the first bipolar-specific, CF-integrated quantitative metric for PFA, enabling accurate, real-time lesion depth prediction. PFQI-guided PVI achieved consistent, durable, and safe PVI in a porcine model, providing a promising operator-independent quantitative strategy to optimize clinical bipolar PFA for atrial fibrillation.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168128","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":"Changes in Lead Parameters of Cardiac Implantable Electronic Devices After VT/VF Ablation Using a Dual-Energy Lattice-Tip Catheter.","authors":"Kazuto Hayasaka, Petr Peichl, Nicoletta Ventrella, Ibrahim Fahmawi, Josef Marek, Peter Štiavnický, Jana Hašková, Predrag Stojadinović, Dan Wichterle, Josef Kautzner","doi":"10.1111/jce.70528","DOIUrl":"https://doi.org/10.1111/jce.70528","url":null,"abstract":"<p><strong>Background: </strong>Interactions between cardiac implantable electronic devices (CIEDs) and pulsed field ablation (PFA) have been studied mainly in the context of atrial ablation, whereas the effects of ventricular ablation using a dual-energy lattice-tip catheter on ventricular leads remain unclear.</p><p><strong>Methods: </strong>This retrospective study involved 79 patients (mean age 60.9 ± 13.6 years) with an implantable cardioverter-defibrillator or cardiac resynchronization therapy defibrillator who underwent ventricular ablation using a lattice-tip catheter between February 2024 and November 2025. Pacing thresholds were assessed before, immediately after, and 3 months after ablation and standardized to a pulse width of 0.4 ms using the Lapicque-Weiss model. Marked acute threshold elevation was defined as an increase in pacing threshold of ≥ 1.0 V immediately after ablation. The anatomical relationship between ablation sites and ventricular lead locations was assessed based on the American Heart Association 17-segment model of the left ventricle and classified as corresponding when ablation involved the same or opposing ventricular region as the lead location, adjacent when ablation involved a directly adjacent region, and remote otherwise.</p><p><strong>Results: </strong>Marked acute pacing-threshold elevation occurred in 5 of 79 right ventricular (RV) leads (6.3%) and 2 of 22 evaluable left ventricular (LV) leads (9.1%). For RV leads, marked threshold elevation occurred in 4 of 14 patients (28.6%) in the corresponding group, 1 of 19 (5.3%) in the adjacent group, and none of 46 (0%) in the remote group. When threshold change was analyzed as a continuous variable, the acute increase was significantly greater in the corresponding group (+ 0.74 V; 95%CI 0.465-1.018) than in the adjacent (+ 0.31 V; 95%CI 0.076-0.550) and remote (+ 0.007 V; 95%CI - 0.145-0.160) groups. For LV leads, the pacing threshold increased significantly after ablation involving the corresponding segment (+ 0.71 V; 95%CI 0.167-1.245), although the overall association between anatomical relationship and threshold change was not significant. At 3 months, pacing thresholds in the corresponding groups were not significantly different from baseline for either RV or LV leads.</p><p><strong>Conclusion: </strong>Marked acute pacing-threshold elevation was observed in both RV and LV leads after ventricular arrhythmia ablation using a dual-energy lattice-tip catheter. However, both RV and LV thresholds were no longer significantly different from baseline at 3 months. These findings suggest the importance of considering the anatomical relationship between ablation sites and CIED leads and of careful peri-procedural assessment of lead function during ventricular ablation.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169443","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":"Electrical Alternans With Alternating Left Ventricular Apical Ballooning Mimicking Takotsubo Cardiomyopathy in a Patient With Extreme QT Prolongation.","authors":"Ankavipar Saprungruang, Sarin Lekchuensakul, Supaluck Kanjanauthai, Apichai Khongphatthanayothin","doi":"10.1111/jce.70501","DOIUrl":"https://doi.org/10.1111/jce.70501","url":null,"abstract":"<p><strong>Introduction: </strong>We report unique and rare findings of coupled electrical and mechanical alternans in a patient with extreme QT prolongation.</p><p><strong>Methods: </strong>A 5-year-old girl with congenital long QT syndrome type 3 developed alternate left ventricular apical ballooning precipitated by mycoplasma pneumonia and azithromycin exposure.</p><p><strong>Results: </strong>During atrial pacing, electrocardiography showed beat-to-beat alternation not only in T-wave morphology but also in QRS configuration, ST segment, and QT interval. These electrical changes were tightly associated with mechanical alternans: beats with markedly prolonged QT intervals showed normal left ventricular (LV) contraction, whereas beats with shorter QT intervals and ST elevation exhibited LV apical ballooning. Treatment with mexiletine shortened the QT interval, abolished both electrical and mechanical alternans, and restored normal LV function.</p><p><strong>Conclusions: </strong>Alternate LV apical ballooning mimicking Takosubo cardiomyopathy can be seen in a patient with extreme QT prolongation. These findings probably reflected a functional intraventricular conduction block due to marked spatial heterogeneity of repolarization between the LV base and apex.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172222","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":"Pulmonary Artery Approach for Radiofrequency Catheter Ablation of Atrial Tachycardia Originating From Left Atrial Post Wall: A Case Report.","authors":"Ping Zhang, Sanbao Chen, Ming Liang, Mingyu Sun, Jian Ding, Jiaqi He, Zheng Cai, Zulu Wang, Yaling Han","doi":"10.1111/jce.70480","DOIUrl":"https://doi.org/10.1111/jce.70480","url":null,"abstract":"<p><strong>Introduction: </strong>Due to limitations in ablation energy delivery and myocardial wall thickness, endocardial ablation of atrial tachycardia can sometimes be challenging.</p><p><strong>Methods and results: </strong>In this case, ablation of the left atrial posterior wall shifted the earliest endocardial breakthrough site from the posterior wall to the roof, suggesting a potential epicardial origin near left atrial roof. The atrial arrhythmia was successfully eliminated via a right pulmonary artery approach.</p><p><strong>Conclusion: </strong>The right pulmonary artery approach may be an effective strategy for ablating epicardial atrial arrhythmias, particularly those originating from the left atrial posterior roof.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170134","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":"Left Atrial Appendage Closure Versus Oral Anticoagulation for Prevention of Stroke or Systemic Embolism in Patients With Atrial Fibrillation: An Updated Meta-Analysis of 7004 Patients Across Six Randomized Trials.","authors":"Aymen Ahmed, Neha Saleem Paryani, Muteia Shakoor, Vikash Jaiswal, Harsh Golwala, Jonathan R Rosenberg, Mark D Metzl, Mark J Ricciardi, Gregory Y H Lip, Arman Qamar","doi":"10.1111/jce.70523","DOIUrl":"https://doi.org/10.1111/jce.70523","url":null,"abstract":"<p><strong>Introduction: </strong>Left atrial appendage closure (LAAC) is an emerging alternative for stroke prevention in patients with atrial fibrillation (AF) who are unsuitable for long-term oral anticoagulants (OACs). However, its efficacy and safety relative to OACs remain uncertain.</p><p><strong>Methods: </strong>Three databases were searched up to April 7, 2026, for randomized controlled trials comparing LAAC with OAC in patients with AF. Risk ratios with 95% confidence intervals were pooled using a random-effects model.</p><p><strong>Results: </strong>Six RCTs (n = 7004 patients) were analyzed. The risk of stroke or systemic embolism (SSE) did not differ significantly between the LAAC and OAC groups (RR: 1.10 [0.87-1.39]; p = 0.42). The risk of ischemic SSE was significantly increased with LAAC (RR: 1.41 [1.07-1.85]; p = 0.02) compared with OAC. No significant differences were observed in all-cause mortality (RR: 0.94 [0.81-1.09]), cardiovascular mortality (RR: 0.91 [0.69-1.21]), non-cardiovascular mortality (RR: 0.91 [0.75-1.12]), or hemorrhagic stroke (RR: 0.58 [0.29-1.17]). LAAC was associated with a similar risk of overall major bleeding (RR: 0.92 [0.77-1.09]) and low risk of non-procedural bleeding (RR: 0.61 [0.52-0.73]; p < 0.001) compared with OAC. Upon sensitivity analysis comparing LAAC with DOACs, the findings remained consistent across most clinical outcomes.</p><p><strong>Conclusion: </strong>LAAC demonstrates comparable risks of SSE and major bleeding to OACs, but is associated with a higher risk of ischemic SSE and reduced non-procedural bleeding, supporting its use in selected patients at high risk for long-term bleeding while emphasizing individualized shared decision-making.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166034","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":"Evolving Mechanisms on Mortality in Atrial Fibrillation: A 25-Year National Death-Certificate Analysis.","authors":"Jacqueline S Dickey, Ashley Goodwin, Bobby Endo, Arthur Chen, Marc C Engels, Klitos Konstantinidis, Immo Lehmann, Jose Roberto Martinez-Parachini, Douglas L Packer, Ravi Ranjan, Benjamin A Steinberg, T Jared Bunch","doi":"10.1111/jce.70524","DOIUrl":"https://doi.org/10.1111/jce.70524","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) prevalence has risen alongside an aging US population and wider adoption of contemporary therapies, yet population-level changes in mechanisms of death among people with AF remain incompletely characterized. We used National Death Certificate Trends in AF Mortality data to assess 25-year trends in AF-related mortality and the contribution of heart failure (HF), stroke, myocardial infarction (MI), and dementia.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of CDC WONDER records for US decedents aged ≥ 35 years with AF listed as a contributing cause of death from 1999 to 2023, coinciding with the implementation of ICD-10 coding in the CDC database. We quantified all-cause and cause-specific mortality rates per 100 000 and stratified trends by age, sex, and race. The analytic cohort included decedents with AF and at least one of four cardiovascular conditions (stroke, dementia, HF, or MI) listed as a primary or contributing cause of death. Confidence intervals were obtained from CDC WONDER outputs or calculated per CDC guidance.</p><p><strong>Results: </strong>Among 3 273 015 decedents with AF noted on the death certificate, 461 321 had HF, dementia, stroke, or MI listed as a contributing cause. HF emerged as the leading cause/contributor with a steep rise beginning in approximately 2008. Stroke rates were stable or declining, MI-related mortality remained low and stable, while dementia, particularly stroke-free dementia, increased significantly in adults ≥ 85 (outpacing stroke among the oldest White decedents since early 2000s). Non-White groups exhibited higher stroke and HF mortality trends; women ≥ 85 had higher stroke-related mortality than men.</p><p><strong>Conclusions: </strong>Over 25 years, AF-associated mortality patterns shifted toward HF and stroke-free dementia while ischemic stroke and MI declined or stabilized. Findings highlight the need to expand AF care beyond stroke prevention to prioritize HF prevention/management, cognitive health, equitable AF-care pathways to ensure broad access to therapies, and additional studies of targeted interventions to mitigate disease risks.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127520","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}