Journal of Cardiovascular Electrophysiology最新文献

{"title":"Consensus-Recommended Follow-Up Mediates Cardiovascular Outcomes Disparities Between Implantable Cardioverter Defibrillator and Pacemaker Recipients.","authors":"Jingwen Huang, Rahul Patel, Chang Liu, Michael S Lloyd","doi":"10.1111/jce.70521","DOIUrl":"https://doi.org/10.1111/jce.70521","url":null,"abstract":"<p><strong>Background: </strong>Consensus-recommended follow-up after cardiac implantable electronic device (CIED) implantation improves outcomes, yet whether it mediates cardiovascular disparities between device types remains unknown.</p><p><strong>Methods: </strong>We prospectively studied 6806 patients undergoing CIED implantation across a multi-hospital system (2019-2023; median follow-up 3.5 years), categorized as implantable cardioverter defibrillator (ICD) (n = 2757) or permanent pacemaker (PPM) (n = 4049). Causal mediation analysis decomposed the effect of device type on major adverse cardiovascular events (MACE) and device extraction into direct and follow-up mediated components, adjusting for demographics and comorbidities.</p><p><strong>Results: </strong>ICD recipients had significantly lower consensus-recommended follow-up rates than PPM recipients (65.3% vs. 79.2%; adjusted OR 0.46, 95% CI 0.40-0.52, p < 0.001) and substantially higher MACE risk (HR 1.89, 95% CI 1.66-2.25, p < 0.001), of which 53.5% was mediated by follow-up adherence. Device extraction rates were lower in ICD recipients (HR 0.30, 95% CI 0.24-0.38), with only 7.9% mediated by follow-up adherence.</p><p><strong>Conclusions: </strong>More than half of the excess cardiovascular risk in ICD recipients was statistically mediated by suboptimal follow-up adherence-a potentially modifiable pathway. These findings identify follow-up adherence as a potentially important pathway and support further prospective investigation of strategies to improve monitoring and clinical outcomes in high-risk CIED populations.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110123","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 Vein Isolation Alone Versus Adjunctive Ablation for Paroxysmal Atrial Fibrillation.","authors":"Michel Abou Khalil, Christian M Massad, Eli Tsakiris, William Herbst, Maximilian Moersdorf, Mohammad Montaser Atasi, Yara Menassa, Alex El Darzi, Carlo El Khoury, Ghassan Bidaoui, Hadi Younes, Yishi Jia, Rodolfo Montiel, Amitabh Pandey, Han Feng, Qussay Marashly, Nassir F Marrouche, Omar Kreidieh","doi":"10.1111/jce.70519","DOIUrl":"https://doi.org/10.1111/jce.70519","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary vein isolation (PVI) is the standard ablation strategy for paroxysmal atrial fibrillation (PAF). Despite guideline recommendations favoring PVI alone in PAF, some operators routinely perform extra pulmonary vein ablation (PVI+) during initial procedures.</p><p><strong>Objective: </strong>To determine frequency of PVI+ strategy for treatment of PAF in the real world and examine its impact on arrhythmic recurrence and progression compared to PVI alone.</p><p><strong>Methods: </strong>Using the TriNetX research network, we identified adults with PAF who underwent catheter ablation between January 2020 and January 2024. Recurrence was defined as repeat ablation, cardioversion, or antiarrhythmic drug (AAD) use beyond a 3-month blanking period. Progression to persistent AF and atypical atrial flutter were also assessed. Kaplan-Meier analysis was performed with 3-year follow-up.</p><p><strong>Results: </strong>Before matching, 5134 of 18,891 patients (27.2%) underwent PVI+. In the propensity matched analysis (n = 5020 per group), recurrence was significantly higher in the PVI+ group (HR 1.28, 95% CI 1.16-1.42; p < 0.001). Repeat ablation, cardioversion and AAD use were more common with PVI+ (HR 1.99, 95% CI 1.60-2.46; p < 0.0001, HR 1.37, 95% CI 1.13-1.66; p = 0.001, and HR 1.41, 95% CI 1.05-1.87; p = 0.020, respectively). Progression to persistent AF was higher with PVI+ (HR 1.37, 95% CI 1.23-1.53, p < 0.001), as was atypical atrial flutter (HR 2.63, 95% CI 1.97-3.50; p < 0.0001).</p><p><strong>Conclusion: </strong>Extra-pulmonary vein ablation during first-time PAF ablation remains common in real-world practice but is associated with worse outcomes including repeat ablation, cardioversion, AAD use, atrial flutter, and progression to persistent AF.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110205","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":"Enhancing Persistent Atrial Fibrillation Ablation: The Added Value of Vein of Marshall Ethanol Infusion in a Tailored Strategy.","authors":"Mariana Rodrigues Simões, Carolina Saleiro, João Ferreira, Patrícia Alves, Nuno Pontes, José Nascimento, Natália António, Luís Elvas, Lino Gonçalves, Pedro A Sousa","doi":"10.1111/jce.70522","DOIUrl":"https://doi.org/10.1111/jce.70522","url":null,"abstract":"<p><strong>Background: </strong>Outcomes following catheter ablation for persistent atrial fibrillation (AF) remain suboptimal. Low-voltage areas (LVA), as a surrogate for atrial fibrosis, have been targeted due to their association with arrhythmia recurrence. Ethanol infusion in the vein of Marshall (VoM) has emerged as an adjunctive strategy that may enhance ablation efficacy. We evaluated the effectiveness of a tailored ablation strategy guided by the presence of LVA and incorporating VoM ethanol infusion in patients with persistent AF.</p><p><strong>Methods: </strong>This prospective, single-center study included patients referred for catheter ablation for persistent AF ablation between August 2022 and August 2024. Patients underwent a tailored ablation strategy guided by the presence of LVA. Procedural endpoints and 1-year outcomes were assessed and compared with those of a propensity score-matched cohort undergoing pulmonary vein isolation (PVI) alone.</p><p><strong>Results: </strong>A total of 118 patients (71% male, mean age of 62 ± 10years) were included in our study: 59 in the tailored approach group and 59 propensity score-matched controls. In the tailored group, VoM ethanol infusion was performed in 60% of patients, while ablation beyond pulmonary veins was not performed in 14% of patients due to LVA absence. Bidirectional block was achieved in all ablation lines except in two patients. At 1-year follow-up, 22% of patients had atrial arrhythmia recurrence. The risk of recurrence was significantly lower in the tailored approach group (13.5% vs. 30.5%, p = 0.02). A tailored approach was independently associated with freedom from atrial arrhythmia recurrence (HR 0.41 [0.17-0.94], p = 0.04). No significant differences in adverse events were observed between groups.</p><p><strong>Conclusions: </strong>In patients with persistent AF, a tailored ablation guided by LVAs was associated with significantly lower arrhythmia recurrence at 1-year compared with PVI alone.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110158","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":"Atrial Septal Defect Management Status and Long-Term Outcomes After Atrial Fibrillation Ablation: A Real-World Cohort Study.","authors":"Fengyuan Lu, Xiaodong Peng, Fanchao Meng, Shuqi Jin, Yuxin Bi, Feixiang Li, Changsheng Ma, Caihua Sang, Ronghui Yu, Ning Zhou, Songnan Li, Xiaoxia Liu, Yanfei Ruan, Nian Liu","doi":"10.1111/jce.70525","DOIUrl":"https://doi.org/10.1111/jce.70525","url":null,"abstract":"<p><strong>Background: </strong>As more adults with atrial septal defect (ASD) survive into older age and undergo atrial fibrillation (AF) ablation, evidence to guide post-ablation risk stratification remains limited.</p><p><strong>Objective: </strong>To evaluate long-term outcomes after the first AF ablation across ASD management states compared with an intact interatrial septum.</p><p><strong>Methods: </strong>This real-world cohort study included 27 675 patients undergoing their first AF ablation, classified by interatrial septal status as intact septum (n = 27 134), unrepaired ASD (n = 232), percutaneous closure (n = 119), or surgical repair (n = 190). Three pairwise comparisons with an intact septum were constructed. Propensity score overlap weighting was used to balance baseline characteristics, and Cox proportional hazards models were used to assess outcomes. The primary outcome was atrial arrhythmia recurrence after the 3-month blanking period; the secondary outcome was a composite cardiovascular outcome.</p><p><strong>Results: </strong>Compared with an intact septum, unrepaired ASD was associated with a higher recurrence risk (hazard ratio [HR], 1.27; 95% CI, 1.07-1.51; p = 0.006), with excess risk mainly observed between 3 months and 1 year after ablation. Surgical repair was also associated with higher recurrence risk (HR, 1.21; 95% CI, 1.01-1.46; p = 0.038), with differences emerging beyond 1 year. Percutaneous closure was not associated with increased recurrence risk (HR, 1.07; 95% CI, 0.83-1.38; p = 0.589). Composite cardiovascular outcomes did not differ significantly across groups.</p><p><strong>Conclusions: </strong>ASD management status identified distinct temporal patterns of atrial arrhythmia recurrence after AF ablation, suggesting that ASD should not be treated as a single binary condition in post-ablation risk assessment.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110174","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":"Temporal Association Between Intrathoracic Impedance and Tachyarrhythmia Occurrence.","authors":"Monika Butkuvienė, Andrius Petrėnas, Andrius Sološenko, Anneli Olsson, Rasmus Borgquist, Pyotr G Platonov","doi":"10.1111/jce.70526","DOIUrl":"https://doi.org/10.1111/jce.70526","url":null,"abstract":"<p><strong>Background: </strong>This study examined whether daily intrathoracic impedance is temporally associated with the occurrence of atrial fibrillation (AF) and ventricular tachycardia (VT).</p><p><strong>Methods: </strong>This retrospective cohort study included 117 patients with cardiac implantable devices, followed for a median of 668 days, corresponding to 89 637 person-days. Recurrent AF occurred in 28% of patients (mean AF burden 0.27), while 773 VT episodes occurred in 15% of patients. Daily intrathoracic impedance, expressed relative to a reference impedance, was analyzed to identify events of impedance decrease and increase. The temporal association between impedance events and tachyarrhythmia burden was quantified using a patient-specific relational strength measure (γ), which compares post-event and pre-event tachyarrhythmia burden.</p><p><strong>Results: </strong>For impedance decreases, event-related γ for AF was higher than control γ computed for randomly placed events (median 0.68 vs. 0.48, p = 0.04). For VT, event-related γ did not differ significantly from control γ (six patients; median 0.52 vs. 0.21, p = 0.82). No significant differences were observed for impedance increases in either the AF or VT analysis. In the pooled episode-level analysis, an impedance decrease was associated with a shorter time to VT occurrence than an impedance increase (median 4 vs. 7 days, p < 0.001), with 48% of VT episodes occurring within 3 days after an impedance decrease.</p><p><strong>Conclusion: </strong>A decrease in intrathoracic impedance is temporally associated with subsequent AF occurrence and, at the episode level, with a shorter time to VT. These findings suggest that daily intrathoracic impedance may provide information on short-term changes preceding tachyarrhythmia occurrence.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110115","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":"Electrogram Determinants of Acute Electrogram Attenuation During Pulmonary Vein Pulsed Field Ablation.","authors":"Ryuichi Usui, Akihiko Nogami, Yuka Oda, Kikuya Uno","doi":"10.1111/jce.70513","DOIUrl":"https://doi.org/10.1111/jce.70513","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) is a nonthermal modality for pulmonary vein isolation in atrial fibrillation. Whether baseline intracardiac electrogram characteristics are associated with acute electrogram attenuation during PFA remains unclear.</p><p><strong>Objectives: </strong>To evaluate the individual and combined associations of baseline bipolar amplitude and peak frequency (PF) with acute electrogram attenuation during pulmonary vein PFA.</p><p><strong>Methods: </strong>Thirty-four consecutive patients undergoing pulmonary vein PFA were retrospectively analyzed. Paired bipolar electrograms were recorded immediately before and after the first PFA application from the same electrode pair and catheter position. Logistic regression, receiver operating characteristic (ROC) analysis, and nonlinear Hill modeling were performed. Additional analyses accounted for within-patient clustering and evaluated alternative attenuation thresholds, pulmonary vein regional heterogeneity, and dynamic-range constraints.</p><p><strong>Results: </strong>Among 687 electrograms analyzed, marked attenuation (≥ 80%) occurred in 59.1%. Both baseline amplitude and PF were significantly associated with marked attenuation. ROC analysis demonstrated strong discrimination for amplitude (AUC 0.894) and moderate discrimination for PF (AUC 0.722), with ROC-derived cutoffs of 0.58 mV and 206 Hz, respectively. Both parameters remained independently associated with attenuation in multivariable analysis. Nonlinear modeling demonstrated distinct response patterns, with amplitude showing a gradual, broad dynamic-range relationship and PF exhibiting a steeper, threshold-like transition. Integration of amplitude and PF enabled graded stratification of attenuation across combined electrogram domains. These associations were preserved after accounting for within-patient clustering and were directionally consistent across alternative attenuation thresholds.</p><p><strong>Conclusions: </strong>Baseline bipolar amplitude and PF were independently associated with acute electrogram attenuation during pulmonary vein PFA. Their integration provides complementary, non-redundant information and supports a structured electrogram-based framework for interpreting acute electrogram response. These findings are hypothesis-generating and require validation against durable pulmonary vein isolation, late reconnection, and clinical outcomes.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110116","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":"Predictors of Recurrence and Quality of Life After Cryoballoon Ablation in Atrial Fibrillation: Data From a Multicenter Taiwanese Registry With 24-Month Follow-Up.","authors":"Lo-Chieh Ling, Ting-Yung Chang, Cheng-Hung Lee, Shih-Lin Chang, Ying-Hsiang Lee, Sheng-Hsiung Chang, Jen-Yuan Kuo, An-Ning Feng, Chin-Yu Lin, Fa-Po Chung, Yenn-Jiang Lin, Yu-Feng Hu, Li-Wei Lo, Ta-Chuan Tuan, Tze-Fan Chao, Jo-Nan Liao, Ling Kuo, Chih-Min Liu, Shin-Huei Liu, Cheng-I Wu, Cheng-Han Chan, Shih-Ann Chen","doi":"10.1111/jce.70518","DOIUrl":"https://doi.org/10.1111/jce.70518","url":null,"abstract":"<p><strong>Background: </strong>Contemporary Asian data on 24-month outcomes after cryoballoon ablation (CBA) in predominantly paroxysmal atrial fibrillation (AF) are limited.</p><p><strong>Methods: </strong>We conducted a multicenter registry across four Taiwanese tertiary centers (2018-2023). Consecutive patients undergoing CBA were analyzed for documented atrial-arrhythmia recurrence (≥ 30-s episodes after a 90-day blanking period) and 12-month quality of life (QoL; EQ-5D-3L index and visual analogue scale [VAS]). Rhythm follow-up relied mainly on intermittent ECG, Holter, event-recorder, or clinically indicated rhythm assessment. Cox models identified recurrence predictors; QoL analyses used paired complete-case data.</p><p><strong>Results: </strong>Among 298 patients (age 63.7 ± 11.8 years, 60% men), 282 (94.6%) had paroxysmal AF. Procedure-related adverse events were rare (2.0%), with no tamponade or atrioesophageal fistula. Fifty-eight patients (19%) had post-blanking documented recurrence (late 90-365 days: n = 37; very late > 365 days: n = 21). Kaplan-Meier recurrence-free survival under intermittent monitoring was approximately 90% at 12 months and 62% at 24 months, with wider confidence bands beyond 18 months. In multivariable analysis, longer time from AF diagnosis to ablation independently predicted recurrence (adjusted HR 1.050 per year, 95% CI 1.007-1.096; p = 0.023); left-ventricular ejection fraction showed a borderline inverse association (adjusted HR 0.970 per 1%, 95% CI 0.942-1.000; p = 0.052). QoL analyses in 205/298 patients with paired data showed no significant change in EQ-5D-3L index (p = 0.672), but VAS categories shifted toward lower symptom burden (moderate/high 21.5% to 10.2%). A clinically meaningful VAS improvement (≥ 10 points) occurred in 34% (70/205). Because paired QoL data were incomplete and the logistic model was unstable owing to sparse events and quasi-complete separation, no robust independent predictor of VAS improvement could be confirmed.</p><p><strong>Conclusion: </strong>In this multicenter Taiwanese registry of predominantly paroxysmal AF, CBA had a low complication rate and high 12-month freedom from documented arrhythmia under intermittent monitoring. Longer time from AF diagnosis to ablation was associated with recurrence. Among patients with paired QoL data, one-third achieved clinically meaningful VAS improvement despite an unchanged EQ-5D-3L index.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110172","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 Ganglionated Plexus Ablation on Early Recurrence After Thoracoscopic Atrial Fibrillation Ablation: A Post Hoc Analysis of the AFACT Study.","authors":"Zhenyu Dong, Marc M Terpstra, Jolien Neefs, Nicoline W E van den Berg, Femke R Piersma, Sebastien P J Krul, Wouter R Berger, Wim-Jan P van Boven, Jonas S S G de Jong, Ruben Coronel, Joris R de Groot, Antoine H G Driessen","doi":"10.1111/jce.70517","DOIUrl":"https://doi.org/10.1111/jce.70517","url":null,"abstract":"<p><strong>Background: </strong>Early recurrences of atrial fibrillation (AF) after ablation are often considered transient. However, they may be caused by a combination of temporary and permanent proarrhythmogenic factors.</p><p><strong>Objective: </strong>We evaluated whether adjunctive GP ablation was associated with the timing and clinical implications of early AF recurrence, and explored the hypothesis that autonomic mechanisms contribute to early recurrence.</p><p><strong>Methods: </strong>Using data from the randomized AFACT study, we compared patients with advanced AF who underwent stand-alone thoracoscopic ablation with or without GP ablation. Early recurrence was defined as AF or atrial tachycardia recurrence within 90 days postoperative. Cox models were used to assess time-dependent effects and identify clinical predictors.</p><p><strong>Results: </strong>A total of 235 patients were included in the current analysis. Seventy-one patients had early recurrence: 36 in the GP ablation group and 35 in the non-GP ablation group (p = 0.730). Of these, 45 (63%) occurred within the first 30 days. Patients in the GP ablation group had their first recurrence later than those in the non-GP group (24 [14-34] vs. 14 [11-24] days, p = 0.046). In the GP ablation group, markers of arrhythmogenic substrate (i.e., age, left atrial volume index, diabetes, CHA₂DS₂-VASc score, and persistent AF) were associated with early recurrence. Additionally, early recurrence was associated with late recurrence in the GP ablation group, but not in the non-GP ablation group.</p><p><strong>Conclusion: </strong>Adjunctive GP ablation was associated with later onset of first early recurrence, while the overall early recurrence rate was not reduced. In the GP ablation group, early recurrence was associated with subsequent late recurrence. These exploratory findings are compatible with a model in which early recurrence reflects both transient autonomic triggers and pre-existing substrate, but this mechanism remains hypothesis-generating.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov Identifier: NCT01091389.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110148","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 Editorial Letter.","authors":"Mohamad Mdaihly, Thomas Callahan","doi":"10.1111/jce.70441","DOIUrl":"https://doi.org/10.1111/jce.70441","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110177","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":"Real-World Experience With the Balloon-in-Basket Pulsed Field Ablation System for Pulmonary Vein Isolation and Ablation of Extra-Pulmonary Vein Sites.","authors":"Henri Xhakupi, Tommaso Sattin, Domenico G Della Rocca, Ludovica Carmagnola, Domenico Laviola, Paul-Adrian Calburean, Luca Canovi, Francesca Salghetti, Giampaolo Vetta, Alvise Del Monte, Charles Audiat, Antonio Sorgente, Gezim Bala, Luigi Pannone, Ingrid Overeinder, Ivan Eltsov, Juan Sieira, Erwin Stroker, Andrea Sarkozy, Carlo de Asmundis, Gian-Battista Chierchia","doi":"10.1111/jce.70509","DOIUrl":"10.1111/jce.70509","url":null,"abstract":"<p><strong>Background: </strong>A novel balloon-in-basket pulsed field ablation (PFA) system integrated with electroanatomical mapping has recently been introduced. However, real-world data on this technology, particularly for adjunctive posterior wall isolation (PWI) and extra-pulmonary vein sites, remain limited.</p><p><strong>Objective: </strong>To evaluate the acute performance, safety, and feasibility of pulmonary vein isolation (PVI) and adjunctive lesions using a balloon-in-basket PFA system.</p><p><strong>Methods: </strong>Consecutive patients with symptomatic paroxysmal or persistent AF undergoing ablation with the balloon-in-basket PFA system between February 2024 and February 2026 were included. Acute efficacy, procedural parameters, complications, exploratory haemolysis and renal biomarkers, and follow-up outcomes were assessed.</p><p><strong>Results: </strong>A total of 133 patients were included; 94 (70.7%) had paroxysmal AF and 39 (29.3%) persistent AF. Acute PVI was achieved in 96.2% of cases. Adjunctive PWI was performed in 25.6% of patients, and additional extra-PV lesion sets were performed in 12 patients. Mean procedure, left atrial dwelling, and fluoroscopy times were 65.6 ± 16.4, 45.4 ± 15.4, and 12.7 ± 7.3 min, respectively, with no significant differences between PVI-only and PVI + PWI procedures. Two periprocedural complications occurred (1.5%; femoral arterial pseudoaneurysm, pericarditis). Exploratory biomarker analyses showed no evident haemolysis-related renal safety signal. Among 82 patients with ≥ 6 months of follow-up, late clinically documented atrial arrhythmia recurrence occurred in 14.6%.</p><p><strong>Conclusion: </strong>In this real-world experience, the balloon-in-basket PFA system showed high acute efficacy, low complication rates, and efficient workflow. Adjunctive PWI appeared feasible in selected patients, with exploratory comparisons showing no evident increase in procedural burden or additional biomarker safety signal.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"2356-2364"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069598","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}