Journal of Cardiovascular Electrophysiology最新文献

{"title":"Reconsidering the Antiarrhythmic Role of Sodium-Glucose Cotransporter-2 Inhibitors After Atrial Fibrillation Ablation.","authors":"Muhammet Cihat Çelik, Mehmet Murat Şahin, Macit Kalçik","doi":"10.1111/jce.70107","DOIUrl":"https://doi.org/10.1111/jce.70107","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":"145064519","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 Adjunctive Vein of Marshall Ethanol Infusion on Catheter Ablation Outcomes in Atrial Fibrillation: A Systematic Review and Meta-Analysis.","authors":"Eduardo Dan Itaya, Caique M P Ternes, André Rivera, Lara Melo Soares Pinho de Carvalho, Robert D'Angelo, Andre d'Avila","doi":"10.1111/jce.70100","DOIUrl":"https://doi.org/10.1111/jce.70100","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation (CA) for atrial fibrillation (AF) has limited efficacy. The vein of Marshall (VOM) is associated with autonomic innervation and has arrhythmogenic roles in AF, which can be ablated with ethanol infusion. However, the impact of VOM ethanol infusion (VOMEI) on the recurrence of atrial tachyarrhythmia (ATA) remains unclear.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) and observational studies comparing CA with versus without VOMEI in patients with AF. Outcomes were ATA recurrence and mitral isthmus (MI) block rate. ATA recurrence was defined as AF, atrial flutter, or atrial tachycardia following the index procedure. Sensitivity analyses were performed after restricting to patients with persistent AF, undergoing a re-do procedure, and RCTs.</p><p><strong>Results: </strong>This meta-analysis included 4 RCTs and 16 observational studies, comprising a total of 4732 patients, of whom 2105 (44%) underwent VOMEI. The mean follow-up ranged from 12 to 46.8 months. Compared with CA alone, VOMEI was associated with a significantly lower ATA recurrence (OR: 0.51; 95% CI: 0.40-0.65; p < 0.01) and significantly higher rates of MI block rate (OR: 4.41; 95% CI: 2.47-7.88; p < 0.01). Subgroup analysis also revealed significantly lower ATA recurrence with adjunctive VOMEI in patients with persistent AF at baseline (OR: 0.47; 95% CI: 0.35-0.64; p < 0.01), those undergoing a re-do procedure (OR: 0.44; 95% CI: 0.33-0.61; p < 0.01), and after restricting to RCTs (OR: 0.58; 95% CI: 0.44-0.76; p < 0.01).</p><p><strong>Conclusion: </strong>In patients with AF, adjunctive VOMEI combined with CA was associated with reduced ATA recurrence compared to CA alone, particularly in those with non-paroxysmal AF at baseline or undergoing a repeat ablation. Additionally, VOMEI was linked to significantly higher rates of mitral isthmus block, which may have contributed to the observed outcomes.</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":"145064503","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":"Silent Cerebral Embolism Following Left Ventricular Endocardial Ablation: The Silver Study.","authors":"Cemalettin Akman, Mustafa Yıldız, Özgür Sürgit, Sinem Aydın, Ender Öner, Ahmet Güner, Hüseyin Karakurt, Nail Güven Serbest, Mehmet Ertürk, Fatih Uzun","doi":"10.1111/jce.70099","DOIUrl":"https://doi.org/10.1111/jce.70099","url":null,"abstract":"<p><strong>Background: </strong>Endocardial ventricular ablation is frequently used to manage premature ventricular complexes (PVCs) and idiopathic ventricular tachycardias (VTs); however, data regarding new silent cerebral embolism (SCE) during this procedure are quite limited. This prospective study sought to determine the incidence and potential risk factors of SCE in patients who underwent left ventricular (LV) ablation for PVCs or idiopathic VTs.</p><p><strong>Methods: </strong>A total of 37 [male:15 (40.5%), mean age:52.27 ± 14.31years] patients who underwent treatment of endocardial ventricular ablation at our institution between August 2022 and January 2024 were included. Baseline data, arrhythmia characteristics (PVC/VT), and procedural details were prospectively evaluated. The primary endpoint was defined as a new SCE after the procedure. All patients were evaluated with diffusion-weighted magnetic resonance imaging (DW-MRI) before and after the procedure within 24 h.</p><p><strong>Results: </strong>Right ventricular (RV) and LV endocardial ablation was performed in 10 (VT, n = 1, PVC, N = 9) and 27 patients (VT, n = 3, PVC, n = 24), respectively. At least 1 new SCE detected by DW-MRI was observed in 6 patients (22.2%) in the LV ablation group, while no SCE was detected in the RV ablation group (p = 0.162). Patients with high CHA₂DS₂-VASc scores [relative risk (RR): 1.720, p = 0.047] and elevated N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels (RR: 1.002, p = 0.013) had a higher risk of SCE among LV ablation patients.</p><p><strong>Conclusion: </strong>Patients who underwent LV ablation for PVC/VT with high CHA₂DS₂-VASc scores and elevated NT-proBNP levels may be at increased risk of SCE.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040295","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":"Etripamil Nasal Spray for Recurrent Paroxysmal Supraventricular Tachycardia Conversion: Results From the NODE-303 Open-Label Study.","authors":"James E Ip, Benoit Coutu, John H Ip, Peter A Noseworthy, Maria L Parody, Farhad Rafii, Samuel F Sears, Narendra Singh, Bruce S Stambler, Naeem K Tahirkheli, Juan Agudelo-Uribe, Derek Hu, Silvia Shardonofsky, Muhammad B Sheikh, Anita Holz, David B Bharucha, A John Camm","doi":"10.1111/jce.70086","DOIUrl":"https://doi.org/10.1111/jce.70086","url":null,"abstract":"<p><strong>Introduction: </strong>Etripamil is a fast-acting intranasally self-administered calcium-channel blocker developed for termination of paroxysmal supraventricular tachycardia (PSVT). Prior studies have demonstrated safety and efficacy of etripamil for PSVT termination following an initial medically supervised test dose during sinus rhythm. NODE-303 is an open-label, single-arm study that evaluated etripamil for multiple, at-home PSVT episodes, without test dose before first use.</p><p><strong>Methods: </strong>Patients applied an ECG monitor at symptom onset and self-administered etripamil (70 mg) if a vagal maneuver was unsuccessful. ECG monitoring occurred for ≥ 1 h following study drug administration. A repeat 70-mg dose was introduced during the study for symptoms persisting 10 min after the first dose. Safety measures included treatment-emergent adverse events (TEAEs) and ECG arrhythmia-surveillance. Efficacy measures were captured for PSVT termination during treatment of each of the multiple episodes.</p><p><strong>Results: </strong>1054 perceived PSVT episodes were etripamil-treated in 503 of 1116 patients enrolled. TEAEs within 24 h were mostly mild or moderate and localized: 30.2% of patients experienced nasal discomfort, nasal congestion (13.9%), rhinorrhea (13.1%), epistaxis (7.4%). TEAE frequencies decreased across multiple PSVT episodes and were similar for single versus repeat doses. For first PSVT episodes, 70.5% of patients converted to sinus rhythm by 60 min post etripamil (median time to conversion = 18.3 min [14.2-25.6]). Conversion in earlier episodes was consistently predictive of conversion in subsequent episodes.</p><p><strong>Conclusions: </strong>Etripamil nasal spray self-administered in a real-world setting was well tolerated, effective, and had a consistent safety profile as a single- or repeat-dose regimen across multiple PSVT episodes.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT04072835.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033310","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":"Microembolic Signals During Atrial Fibrillation Ablation: Is the Thing That Catches the Eye the Real Villain? or Is It Innocent and Insignificant?","authors":"Koichiro Ejima","doi":"10.1111/jce.70104","DOIUrl":"https://doi.org/10.1111/jce.70104","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033242","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":"Reply To: Bayesian Evaluation of Pentaspline Pulsed Field Ablation Compared to High-Power Radiofrequency Ablation in Atrial Fibrillation.","authors":"Marco Valerio Mariani, Andrea Matteucci, Nicola Pierucci, Marta Palombi, Paolo Compagnucci, Raffaele Bruti, Pietro Cipollone, Sara Vinciullo, Sara Trivigno, Agostino Piro, Vincenzo Mirco La Fazia, Wael Saade, Cristina Chimenti, Giovanni Battista Forleo, Antonio Dello Russo, Claudio Pandozi, Andrea Natale, Carmine Dario Vizza, Carlo Lavalle","doi":"10.1111/jce.70103","DOIUrl":"https://doi.org/10.1111/jce.70103","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029920","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":"Trends in Atrial Fibrillation Ablation Utilization Following 2022 CMS Reimbursement Reduction: A Nationwide Analysis.","authors":"Pranav Puri, Daniel Moe, Ashraf Alzahrani, Ghazaleh Goldar, Brian Olshansky, Peter Farjo, Paari Dominic","doi":"10.1111/jce.70102","DOIUrl":"https://doi.org/10.1111/jce.70102","url":null,"abstract":"<p><strong>Background: </strong>In 2022, the Centers for Medicare & Medicaid Services (CMS) implemented a bundled payment policy that substantially reduced reimbursement for atrial fibrillation (AF) ablation procedures, raising concerns about potential effects on utilization and procedural complexity.</p><p><strong>Objective: </strong>To evaluate national trends in AF ablation volumes, reimbursement, and procedural complexity following the 2022 CMS reimbursement change.</p><p><strong>Methods: </strong>Using the Medicare Physician and Other Practitioners by Geography and Service Dataset from 2016 to 2023, we identified pulmonary vein isolation (PVI) procedures using CPT 93656 and additional ablations beyond PVI using CPT 93657. Reimbursement rates were inflation-adjusted to 2023 dollars. Joinpoint regression was used to assess trends before and after the 2022 policy change.</p><p><strong>Results: </strong>From 2016 to 2023, national AF ablation volume increased with an average annual percent change (AAPC) of 11.7% (95% CI, 8.2%-14.0%; p < 0.01). Following the 2022 CMS bundled payment policy, inflation-adjusted reimbursement declined by 27.7% in 2022 and by a further 20% in 2023 (slope change p = 0.01). Despite this, total AF ablation volume rose by 24.3% between 2021 and 2023, and procedures involving additional ablation beyond PVI increased by 42.4% over the same period. Joinpoint regression showed no significant inflection in PVI or additional ablation volume trends following the policy change (p = 0.87 and p = 0.97, respectively).</p><p><strong>Conclusions: </strong>Despite significant reimbursement reductions following Medicare's 2022 policy change, electrophysiologists continued to perform increasing numbers of AF ablations, including procedures with additional ablations beyond PVI.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029981","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":"Balancing Efficiency and Outcomes in the Evolution of Catheter Ablation.","authors":"Ibrahim Hasan, Marwan M Refaat","doi":"10.1111/jce.70098","DOIUrl":"https://doi.org/10.1111/jce.70098","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029934","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":"Cover Image, Volume 36, Issue 9","authors":"Guiwen Xu,&nbsp;Qiaobing Sun,&nbsp;Lin Wang,&nbsp;Han Gong,&nbsp;Ruopeng Tan,&nbsp;Yun-Long Xia,&nbsp;Yang Liu,&nbsp;Xiaomeng Yin","doi":"10.1111/jce.70105","DOIUrl":"https://doi.org/10.1111/jce.70105","url":null,"abstract":"<p>The cover image is based on the article <i>Radiofrequency ablation with a retractable needle-tipped catheter in the interventricular septum of healthy dogs</i> by Xiaomeng Yin et al., https://doi.org/10.1111/jce.70015\u0000 \u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"36 9","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jce.70105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145021860","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":"Fluoroless Mapping and Ablation With Integration of a Pentaspline Pulsed Field Catheter.","authors":"Ayesha Shaik, Tri Nguyen, Kichang Lee, Gregory Michaud, Alan Hanley","doi":"10.1111/jce.70097","DOIUrl":"https://doi.org/10.1111/jce.70097","url":null,"abstract":"<p><strong>Introduction: </strong>Fluoroless mapping and ablation using a Pentaspline pulsed field ablation catheter has many advantages. This can be achieved using a \"tripolar configuration,\" which enables high-quality electroanatomical maps, improves the ability to localize electrograms (EGMs), and minimizes the use of additional mapping catheters compared to the standard bipolar configuration. We aimed to evaluate the benefits of using a tripolar configuration in fluoroless atrial fibrillation ablation compared to the standard bipolar configuration.</p><p><strong>Methods: </strong>In the tripolar pinning configuration, visualization includes not only the 3rd electrode but also the interpolation of electrodes 1, 2, & 4 on each spline. Procedures were performed under general anesthesia, and the EnsiteX system (Abbott, Abbott Park, IL) was used for mapping. Intracardiac echocardiography and electro-anatomical mapping were used to identify catheter location and record local EGMs. Tripolar and standard bipolar signals were displayed on the same page to evaluate the signals before and after each PFA application. We compared the peak-to-peak signal voltage between the tripolar and standard configurations.</p><p><strong>Results: </strong>Ablation was performed in 59 cases (42 males, average age 65 (30-85); 17 females, average age 74 (59-83)) in which we configured the catheter in a tripolar setup for comparison with the standard bipolar setup. Geometry and post-voltage maps were created using the tripolar signals in 40 of the 59 patients. The average case duration was 85 min (53-198); for pulmonary vein isolation (PVI) alone, the average was 70 min (53-97). The average number of PFA applications was 48 (31-72). Standard bipolar EGMs demonstrated a large far-field component, as evidenced by significantly higher mean (84%) and root mean square (RMS, 51%) values compared to the tripolar configuration (p < 0.001). Ectopic atrial foci and atrial flutters were successfully mapped and ablated in four and five patients, respectively. We were able to demonstrate lines of block across the mitral isthmus and the cavotricuspid isthmus ablation. In cases where mapping was performed, geometry creation with the tripoles allowed for field scaling on Ensite X.</p><p><strong>Conclusion: </strong>Integration of the Pentaspline pulsed field ablation catheter with the tripolar configuration is feasible and facilitates fluoroless PVI.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029969","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}