Journal of Cardiovascular Electrophysiology最新文献

{"title":"Commercial Implant Experience of a Helix-Fixation Dual-Chamber Leadless Pacemaker.","authors":"Cyrus A Hadadi, Ken W Lee, Monica Lo, Mayer Rashtian, Athanasios Thomaides, Nebu Alexander, Zayd Eldadah, Nima Badie, Kyungmoo Ryu, Devi G Nair, Derek V Exner, Blandine Mondésert","doi":"10.1111/jce.16688","DOIUrl":"https://doi.org/10.1111/jce.16688","url":null,"abstract":"<p><strong>Introduction: </strong>The AVEIR DR pacemaker (Abbott) is a dual-chamber leadless pacemaker (LP) system that includes right atrial and right ventricular helix-fixation LPs (ALP, VLP), with atrioventricular synchrony maintained via wireless communication between the two devices. The initial, multi-center commercial implant experience of the AVEIR DR dual-chamber LP system has yet to be evaluated.</p><p><strong>Methods: </strong>Patients indicated for dual-chamber pacing after US commercial release were consecutively included. Implant procedural characteristics were evaluated, and electrical parameters were measured during pre-fixation mapping, post-fixation tether mode, after LP release, and before patient discharge. Any acute procedure- or device-related complications within 30 days were noted.</p><p><strong>Results: </strong>Patients were implanted with AVEIR DR per standard practice (N = 175 at 8 centers; 72 ± 11 years; 60% male; 62% sinus node dysfunction, 37% AV block; 83% de novo implants). ALPs were implanted predominantly in the base of the right atrial appendage (82%), VLPs in the mid-to-apical right ventricular septum (94%). Pre-fixation mapping allowed repositioning to be avoided in 95% of ALPs and VLPs. The total procedure duration was 64 ± 33 min, from initial incision to final suture, with a cumulative fluoroscopy duration of 13 ± 8 min. In both LPs, capture thresholds and sensed amplitudes improved significantly before patient discharge (ALP 1.2 ± 1.0 V, 2.1 ± 1.1 mV; VLP 0.8 ± 0.6 V, 9.5 ± 3.8 mV). At 30 days post-implant, 99% of patients were complication-free.</p><p><strong>Conclusion: </strong>The initial commercial experience of the helix-fixation, dual-chamber LP system demonstrated safe and efficient implantation with clinically acceptable electrical metrics and minimal acute complications.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005355","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":"Char Formation During Very High-Power Short-Duration Ablation for Atrial Fibrillation.","authors":"Kazumasa Suga, Hiroyuki Kato, Koudai Yamazaki, Taku Sakurai, Ryusuke Ota, Tomoyuki Ota, Hisashi Murakami, Kenji Kada, Naoya Tsuboi, Satoshi Yanagisawa, Yasuya Inden, Toyoaki Murohara","doi":"10.1111/jce.16707","DOIUrl":"https://doi.org/10.1111/jce.16707","url":null,"abstract":"<p><strong>Introduction: </strong>Pulmonary vein (PV) isolation using very high-power short-duration (vHPSD) radiofrequency catheter ablation is an effective treatment strategy for atrial fibrillation. However, PV isolation using vHPSD ablation (vHPSD-PVI) carries a potential risk of char formation. We aimed to assess the incidence, patient characteristics, and procedural factors of char formation during vHPSD-PVI.</p><p><strong>Methods and results: </strong>Fifty consecutive patients scheduled to undergo initial PV isolation (PVI) were prospectively included. PVI was performed using a QDOT MICRO^TM catheter in the vHPSD setting (90 W/4 s). PVs were divided into eight segments, and char formation around the ablation catheter was evaluated after the ablation of each segment. Patient characteristics and procedural parameters were analyzed to determine the risk factors for char formation. During vHPSD-PVI, char formation was observed in 24 (48.0%) patients, primarily at the groove between the tip and ring electrodes. Among the segments, the incidence of char formation was the highest (26.0%) in the anterior and posterior right inferior PV (RIPV) segments (p < 0.001). One patient with char formation developed symptomatic thromboembolism after the procedure. The left atrial volume index (LAVI) (odds ratio [OR], 1.089; 95% confidence interval [CI], 1.011-1.173; p = 0.024) and parallel catheter orientation (OR, 1.592; 95% CI, 1.416-1.791; p < 0.001) were independent predictors of char formation.</p><p><strong>Conclusion: </strong>Char formation occurred in 48.0% of the patients during vHPSD-PVI. Application to the RIPV segment, a higher LAVI, and parallel catheter orientation were associated with an increased risk of char formation, indicating that vHPSD applications should be avoided under these conditions.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965658","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":"Early Left Ventricular Reverse Remodeling After Catheter Ablation of Atrial Fibrillation is Associated With Lower Recurrence Rates and Improved Prognosis in Patients With Left Ventricular Systolic Dysfunction.","authors":"Hiroyuki Miyazawa, Itsuro Morishima, Yasunori Kanzaki, Yasuhiro Morita, Naoki Watanabe, Koichi Furui, Naoki Yoshioka, Naoki Shibata, Yoshihito Arao, Ryota Yamauchi, Tomoya Iwawaki, Takuma Ohi, Hoshito Karasawa, Satoshi Yanagisawa, Yasuya Inden, Toyoaki Murohara","doi":"10.1111/jce.16706","DOIUrl":"https://doi.org/10.1111/jce.16706","url":null,"abstract":"<p><strong>Introduction: </strong>Left ventricular (LV) reverse remodeling (LVRR) following catheter ablation (CA) of atrial fibrillation (AFCA) has not been fully elucidated. This study investigated the clinical impact of early LVRR after AFCA on prognosis in patients with LV systolic dysfunction (LVSD).</p><p><strong>Methods: </strong>Of 1,989 consecutive patients undergoing first-time AFCA, 302 patients with a baseline LV ejection fraction < 50% were included. LVRR was defined as a decrease in the LV end-systolic volume of ≥ 15% on an echocardiography at 3 months after AFCA. The clinical outcomes and prognoses were compared between patients with and without LVRR.</p><p><strong>Results: </strong>LVRR was observed in 191 (63%) patients at 3 months after AFCA. A multiple logistic regression analysis demonstrated that non-paroxysmal AF, non-cardiomyopathy, absence of early recurrence, QRS duration ≤ 120 ms were significantly associated with the LVRR after 3 months. During a median follow-up period of 30 (16-50) months, patients with LVRR showed a lower incidence of AF recurrence (24.1% vs. 39.6%; p = 0.004), heart failure hospitalizations (5.8% vs. 13.5%; p = 0.022), all-cause mortality (4.2% vs. 11.7%; p = 0.017), and composite events including recurrence, heart failure hospitalization, and mortality (26.7% vs. 48.7%; p < 0.001) compared to those without. A multivariate Cox regression analysis revealed that the LVRR at 3 months was independently associated with AF recurrence-free survival (hazard ratio, 0.624, p = 0.029) and composite endpoint (hazard ratio, 0.573, p = 0.006) after AFCA.</p><p><strong>Conclusions: </strong>The LVRR emerged in two-third of the patients with LVSD after 3 months of AFCA. Early LVRR was associated with favorable clinical outcomes and prognoses after AFCA.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025398","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":"Tricuspid Regurgitation as a Marker or Therapeutic Target of Atrial Fibrillation Recurrence Following Pulmonary Vein Isolation.","authors":"Bunnshichi Miichi, Naoya Kataoka, Teruhiko Imamura","doi":"10.1111/jce.16712","DOIUrl":"https://doi.org/10.1111/jce.16712","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972583","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":"Early Recurrence of Atrial Tachyarrhythmias After Pulsed Field Ablation: New Technologies, Same (Blanking) Problems.","authors":"Michael Ghannam","doi":"10.1111/jce.16709","DOIUrl":"https://doi.org/10.1111/jce.16709","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997582","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":"Antiarrhythmic Drug Initiation for Atrial Fibrillation in the USA: Is There More to Say?","authors":"James A Reiffel","doi":"10.1111/jce.16691","DOIUrl":"https://doi.org/10.1111/jce.16691","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019659","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":"Antiarrhythmic Drug Initiation for Atrial Fibrillation in the USA: How and Where.","authors":"Joshua Newman, Adam Strickberger, Jenna Spears, Peter Kowey","doi":"10.1111/jce.16681","DOIUrl":"https://doi.org/10.1111/jce.16681","url":null,"abstract":"<p><p>Atrial fibrillation (AF) is common and occurs in approximately 8% of adults over 65 years of age in the United States. Prevention of AF, with maintenance of healthy weight, treatment of sleep apnea, and regular exercise are key strategies. As prevention is often inadequate, the role of antiarrhythmic drugs (AADs) is paramount. Adverse events are often uncovered in the first 24 h of initiation, and occur approximately 10%-15% of the time, but AADs can still be used safely [2]. Herein, we describe the various categories in a practical guide to initiation to make clinicians more comfortable with starting and maintaining antiarrhythmic therapy in both the inpatient and outpatient setting. The central illustration summarizes the article.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998739","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":"Leadless Versus Single Chamber Pacemakers: An Analysis From the National Readmissions Database of Adverse Outcomes.","authors":"Anshul Parulkar, Wasiq Sheikh, Phinnara Has, Tamara P Lhungay, Esseim Sharma, Braden Vogt, Fabio V Lima, Malik Bilal Ahmed, Estelle Torbey, Daniel Philbin, Antony F Chu","doi":"10.1111/jce.16704","DOIUrl":"https://doi.org/10.1111/jce.16704","url":null,"abstract":"<p><strong>Background: </strong>Leadless pacemakers are considered a low-risk alternative to single-lead pacemakers (SL-PPMs). In 2021, the FDA issued a warning regarding leadless pacemakers because of increased morbidity and mortality from perforation. Clinical outcome data is limited. The National Readmissions Database (NRD) is a nationally representative annualized sample of US hospitalizations that may shed insight on patient selection and procedural risks from leadless pacemaker implantation.</p><p><strong>Objective: </strong>Determine patient selection, adverse events and mortality rates related to leadless pacemakers versus SL-PPM using the NRD.</p><p><strong>Methods: </strong>NRD data was analyzed from January 2016 to December 2019. ICD-10 and ICD-CM 10 coding was used to identify patients and adverse outcomes. Predictors of mortality and cardiac perforation were determined by multivariable regression.</p><p><strong>Results: </strong>Distribution of age and gender were similar between both groups. Patients receiving single-chamber leadless pacemakers were more likely to be dialysis dependent, have diabetes and obstructive sleep apnea. Mortality was higher in leadless pacemakers (5.3% vs. 1.9%, p < 0.001) with a higher incidence of adverse outcomes. A multivariable regression model found that dialysis dependence and pulmonary hypertension increased the risk for mortality in leadless pacemakers while obstructive sleep apnea and diabetes were associated with lower risk. Leadless pacemakers had an adjusted odds ratio of 2.74 and 2.92 for death and perforation respectively.</p><p><strong>Conclusions: </strong>Mortality rates were higher in patients receiving leadless pacemakers with a higher incidence of adverse outcomes in patients with dialysis dependence and pulmonary hypertension. Clinical benefits may be offset by increased risk of procedural mortality and adverse outcomes.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016282","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":"Cardioneuroablation as a Therapeutic Approach for Functional AV Block Presenting Late After AVNRT Ablation.","authors":"Rodolfo San Antonio, Andrea Di Marco, Jordi Mercé, Julián Rodríguez-García, Marcos Rodríguez, Valentina Faga, Paolo D Dallaglio, Ignasi Anguera","doi":"10.1111/jce.16710","DOIUrl":"https://doi.org/10.1111/jce.16710","url":null,"abstract":"<p><strong>Introduction: </strong>Atrioventricular block (AVB) is a rare but serious acute complication of atrioventricular nodal reentrant tachycardia (AVNRT) ablation. Additionally, compared to the general population, patients who undergo AVNRT ablation have an increased risk of requiring pacemaker implantation due to late-onset AVB. Cardioneuroablation (CNA) has emerged as a promising alternative to pacemaker implant in patients with recurrent cardioinhibitory reflex syncope and functional cardiac conduction disorders. However, its role in managing late AVB post-AVNRT ablation has not been established.</p><p><strong>Methods: </strong>This prospective study included three patients who experienced syncope due to paroxysmal AVB 97-127 months after successful AVNRT ablation. All patients exhibited normal infrahisian conduction and preserved functional reserve of suprahisian conduction, as assessed by an atropine test. CNA was performed using a biatrial approach with the Ensite X EP System, guided by both anatomical mapping and local fragmented atrial electrograms. Radiofrequency (RF) energy was delivered to the inferior paraseptal ganglionated plexus (IPSGP) and the left superior ganglionated plexus (LSGP). Acute procedural success was defined as complete abolition of atropine response at the atrioventricular node. Clinical success was defined as no recurrence of syncope, no cardioinhibitory response during tilt testing, and normal conduction on Holter monitoring.</p><p><strong>Results: </strong>Acute procedural success was achieved in all cases, with significant reductions in the antegrade Wenckebach point (AWP) following RF ablation at the IPSGP and LSGP. Post-CNA atropine tests showed no changes in AH interval or AWP response in any patient. Post-CNA tilt testing revealed vasodepressor responses in all patients, and Holter monitoring showed no conduction abnormalities. During follow-up (6-13 months), all patients remained free of syncope.</p><p><strong>Conclusions: </strong>CNA appears to be a promising alternative to pacemaker implantation for patients with late-onset paroxysmal AVB following AVNRT ablation. Targeting the IPSGP, in particular, may be crucial for optimizing outcomes. Larger studies are needed to confirm these findings and evaluate the long-term efficacy of CNA in this patient population.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965563","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":"Cerebral Safety Comparison: High-Power vs. Low-Power Ablation in AF Pulmonary Vein Isolation.","authors":"Dandan Chen, Qian Tang, Yifan Mao, Yuenan Ning, Huimin Lu, Wei Li, Wei Zhou","doi":"10.1111/jce.16683","DOIUrl":"https://doi.org/10.1111/jce.16683","url":null,"abstract":"<p><strong>Background: </strong>The use of high-power short-duration radiofrequency ablation techniques for atrial fibrillation (AF) treatment has gained popularity; however, the implications for cerebral safety, particularly regarding the risk of silent cerebral embolism (SCE), remain unclear. This study aims to assess procedural complications, focusing on cerebral safety, between HPSD and LPLD ablation techniques in patients who are receiving pulmonary vein isolation for AF.</p><p><strong>Methods: </strong>This study comprised 74 patients who were randomly allocated into two equal groups at a 1:1 ratio. The HPSD group utilized a 70 W, whereas the LPLD group employed a 40 W. The study evaluated safety (asymptomatic cerebral embolism, bleeding, and steam pop incidence) and efficacy (ablation time and success rates) between the groups.</p><p><strong>Results: </strong>In the HPSD group, 9 (26%) patients experienced SCE, compared to 12 (33%) patients in the LPLD group. The two groups did not differ significantly (p = 0.482). There were no clinically evident cerebrovascular events (stroke or TIA) in any patients. The incidence of steam pops was comparable (5% vs. 3%, p = 0.556). Significant differences were observed in ablation times for the left (218.70 ± 96.48 vs. 600.27 ± 249.83 s, p < 0.001) and right pulmonary veins (224.05 ± 77.89 vs. 658.38 ± 168.84 s, p < 0.001). A single case of hematoma was reported in the LPLD group.</p><p><strong>Conclusions: </strong>The incidence of SCE during PVI ablation is similar between HPSD and LPLD techniques. HPSD ablation is a safe and effective technique that significantly reduces ablation time without elevating perioperative complications.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026169","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}