Journal of Cardiovascular Electrophysiology最新文献

{"title":"Should Left Atrial Appendage Occlusion Devices Be Routinely Used Instead of Oral Anticoagulants to Prevent Thromboembolic Events, Stroke, and Bleeding for Patients With Non-Valvular Atrial Fibrillation?","authors":"Bharat K Kantharia, April Slee, Brian Olshansky","doi":"10.1111/jce.70494","DOIUrl":"10.1111/jce.70494","url":null,"abstract":"<p><strong>Introduction: </strong>Oral anticoagulants (OACs), preferably direct (D)/non-vitamin K (N) dependent OACs [DOACs/NOACs] are recommended for the management of patients with non-valvular atrial fibrillation (AF) at risk for thromboembolic events, including stroke. Left atrial appendage occlusion (LAAO) device implantation has been considered for patients who are unsuitable for OACs or prefer not to take them. Herein, we discuss the clinical evidence for routine use of LAAO instead of OACs for patients with AF at risk of thromboembolic events, stroke, and bleeding.</p><p><strong>Method: </strong>From pertinent, recent, randomized clinical trials, the CHAMPION-AF (Watchman Flx vs. NOAC for Embolic Protection in the Management of Patients with Non-Valvular Atrial Fibrillation), and CLOSURE-AF (Catheter-Based Left Atrial Appendage Closure in Patients with Atrial Fibrillation at High Risk of Stroke and Bleeding as Compared with Best Medical Therapy) were selected for review.</p><p><strong>Results: </strong>As interpreted by the authors of the CHAMPION-AF trial, LAAOs were considered non-inferior to NOACs at 3 years. In the CLOSURE-AF trial, non-inferiority criteria were not met. For safety, that is, bleeding, LAAO was considered superior in CHAMPION-AF. We found several points related to both trials that are critical to interpret the results and clinical implications of these trials. These points are particularly related to the interpretation of non-inferiority trial design, selection bias, combined primary endpoint, bleeding and peri-procedural bleeding complications, serious adverse events, cross-over rates, sub-group analyses, conflicts of interest, and mechanism of stroke.</p><p><strong>Conclusion: </strong>Data from the CHAMPION-AF and CLOSURE trials do not favor routine and widespread use of LAAO devices in non-valvular AF patients over use of OACs.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"2403-2408"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912138","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":"Deciphering an Unexpectedly Small Change in VA Interval With Parahisian Pacing.","authors":"Rajeshwari Lingala, Chandan Sharma, Raja Selvaraj","doi":"10.1111/jce.70504","DOIUrl":"10.1111/jce.70504","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"2421-2423"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963210","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 Voltage Attenuation Beyond Ablation Sites After Unipolar Pulsed-Field Ablation for Atrial Fibrillation.","authors":"Satoshi Osaki, Koichi Inoue, Tsuyoshi Mishima, Tatsuhisa Ozaki, Takuya Ohashi, Haruhiko Abe, Kuniyasu Ikeoka, Haruya Yamane, Masayuki Nakamura, Yasunori Ueda","doi":"10.1111/jce.70511","DOIUrl":"10.1111/jce.70511","url":null,"abstract":"<p><strong>Introduction: </strong>Unlike most pulsed-field ablation (PFA) systems, Affera (Medtronic) delivers unipolar energy between a lattice-tip catheter and a cutaneous return patch, potentially generating a broader electric field. We hypothesized that this may attenuate voltage beyond ablated regions and tested this using spatially matched pre- and post-ablation maps.</p><p><strong>Methods and results: </strong>We retrospectively studied five consecutive patients undergoing primary atrial fibrillation ablation with the Affera system. Pre- and immediate post-ablation voltage maps were generated using CARTO 3 and OCTARAY (Biosense Webster) with identical settings during right atrial pacing. Because Affera lacks point-level 3D coordinates for spatial matching, coordinates (x, y, z) and bipolar voltages were extracted from CARTO 3. Pre- and post-ablation points-outside energy delivery sites, excluding the annulus and left atrial appendage-were spatially matched using a 2 mm mutual nearest-neighbor criterion. This yielded 3772 pairs. Bipolar voltages were averaged by case. Mean bipolar voltage decreased in all cases from 1.01 ± 0.61 to 0.56 ± 0.29 mV, representing a 40.2% reduction (95% CI, 24.6%-55.8%; p = 0.044). In a distance-stratified analysis, residual bipolar voltage (post/pre × 100) was lowest just beyond the ablated zone and increased progressively with distance from the nearest application tag center (16.5% at 10-15 mm to 57.8% at 25-30 mm; all p < 0.001), becoming numerically comparable to baseline beyond approximately 30 mm.</p><p><strong>Conclusions: </strong>Affera-based unipolar ablation produced acute bipolar voltage attenuation that extended into non-ablated myocardium adjacent to the lesion set but diminished with distance and was largely confined within approximately 30 mm of the application sites.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"2413-2416"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069115","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":"Pulsed Field Ablation Is Associated With Favorable Outcomes After Atrial Fibrillation Ablation: Insights From the Polish National Ablation Registry (POL-AR).","authors":"Piotr Urbanek, Robert Bodalski, Michał Orczykowski, Ilona Kowalik, Andrzej Głowniak, Piotr Ponikowski, Oskar Kowalski, Paweł Derejko, Mariusz Pytkowski, Łukasz Szumowski","doi":"10.1111/jce.70514","DOIUrl":"10.1111/jce.70514","url":null,"abstract":"<p><strong>Background: </strong>The Polish National Ablation Registry (POL-AR), mandatory for all centers performing catheter ablation and integrated with National Health Fund data, enables prospective analysis of a nationwide cohort with complete inclusion of all consecutive patients.</p><p><strong>Objective: </strong>We aimed to assess real-world safety profiles and clinical outcomes of atrial fibrillation (AF) ablation modalities-radiofrequency (RF), cryoballoon (CRYO), and pulsed-field ablation (PFA)-and to report the first-year PFA experience in Poland.</p><p><strong>Methods: </strong>All AF ablations in 2023 were prospectively analyzed in POL-AR and cross-referenced with National Health Fund data. Only centers with complete reporting were included. Patients were grouped by modality. Major complications, unplanned hospitalizations, cardioversions, repeat ablations, and deaths were assessed at 1 year. Multivariate analysis identified independent predictors of outcomes.</p><p><strong>Results: </strong>Twenty-eight centers reported 3430 patients (CRYO: 2125; RF: 1098; PFA: 207). Procedure time was longest for RF (median 120 min) versus CRYO (75 min) and PFA (65 min); (p < 0.001). No major complications occurred with PFA. Phrenic nerve injury persisted in 1.51% of CRYO, 0.09% of RF, and 0% of PFA patients (p < 0.001). Pericardial effusion was more frequent after RF (0.91% vs. 0.34% for CRYO + PFA; p = 0.032). Overall complication rates were lowest with PFA (0% vs. RF: 2.19%, CRYO: 2.59%). PFA patients required fewer cardioversions during follow-up (p = 0.017). Predictors of poor outcome included age, female sex, left atrium (LA) size, hypertension, and hypertrophic cardiomyopathy (HCM). Favorable outcome was independently associated with higher left ventricular ejection fraction (LVEF), paroxysmal AF, and PFA use (HR 0.70, p = 0.04).</p><p><strong>Conclusion: </strong>In the POL-AR registry, PFA was independently associated with favorable outcomes after AF ablation.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"2385-2392"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069550","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":"Learning Curve of Pentaspline Pulsed-Field Ablation With Posterior Wall Isolation for Persistent Atrial Fibrillation.","authors":"Atsuhiko Yagishita, Kazuma Iimura, Aika Iijima, Mari Amino, Yuji Ikari, Koichiro Yoshioka","doi":"10.1111/jce.70515","DOIUrl":"https://doi.org/10.1111/jce.70515","url":null,"abstract":"<p><strong>Background: </strong>Pentaspline pulsed-field ablation (PFA) has emerged as a novel modality for pulmonary vein isolation (PVI) and posterior wall isolation (PWI) in persistent atrial fibrillation (AF). However, the learning curve associated with combined PVI + PWI and the contribution of anatomical factors to acute lesion completeness remain incompletely defined.</p><p><strong>Methods: </strong>We analyzed 182 consecutive patients with persistent AF undergoing fluoroscopy- and intracardiac echocardiography-guided PFA. Acute incomplete lesions were defined as residual conduction requiring additional PFA applications after systematic remapping. Learning phases were identified using segmented logistic regression and sequential block analysis. Multivariable models evaluated procedural phase, left atrial volume (LAV), and posterior wall geometry.</p><p><strong>Results: </strong>A learning curve was observed, with the greatest reduction in incomplete lesion formation occurring during the first 20 procedures. Incomplete lesions occurred in 55% of cases 1-20 (early phase), 32% of cases 21-160 (intermediate phase), and 4.8% of cases ≥ 161 (late phase). Procedural phase was the dominant determinant of incomplete lesions, with approximately 24-fold and 9-fold higher odds during the early and intermediate phases, respectively. Larger LAV showed a modest independent association (OR 1.009 per mL), whereas posterior wall geometry was not independently associated. Mid-term arrhythmia recurrence did not differ across phases, although follow-up duration was shorter in the late phase.</p><p><strong>Conclusions: </strong>Lesion completeness during pentaspline PFA with PVI + PWI improves progressively with increasing procedural experience. Although larger LAV may contribute modestly to incomplete lesion formation, procedural experience appears to play the predominant role. Systematic electroanatomical remapping remains important for identifying and correcting incomplete lesions even after substantial procedural experience has been accumulated.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069108","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 Carina Width on Re-Ablation Rate of Atrial Fibrillation After Primary Cryoballoon-Ablation","authors":"Miriam Müller,&nbsp;Marja Hedman,&nbsp;Marianne Heikkilä,&nbsp;Juhani Junttila","doi":"10.1111/jce.70430","DOIUrl":"10.1111/jce.70430","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Reconnection of the pulmonary veins (PVs) is the primary cause of atrial fibrillation (AF) episodes after pulmonary vein isolation (PVI). Cryoballoon ablation does not always include the isolation of the carina due to anatomic variants and carina width has been associated with increased re-ablation rate in previous radiofrequency ablation studies. Aim of our study was to assess the impact of carina width on the re-ablation rate after cryoballoon-PVI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 518 patients who underwent cryoballoon ablation for AF between 2015 and 2022. Each patient underwent contrast enhanced chest computed tomography (CT) scan prior to ablation. We measured the shortest distance between the superior and inferior PV (carina width) and the size of the left atrium in CT images. In patients referred to re-ablation due to recurring symptomatic and ECG documented AF we defined the reconnected veins. The minimum follow up after prior PVI was 1 year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In all patients the right carina was wider than the left (8.04 ± 4.49 mm vs. 5.25 ± 3.03 mm, <i>p</i> &lt; 0.059). One fifth (<i>n</i> = 102) of the patients underwent re-ablation for AF. Left carina width was significantly associated with re-ablation rate (in re-ablation group 6.4 ± 2.7 mm vs. in no re-ablation group 4.9 ± 3.0 mm, <i>p</i> &lt; 0.001) whereas right carina width was not (8.3 ± 3.0 mm vs. 7.9 ± 3.6 mm, <i>p</i> = 0.421, respectively). Left atrium (LA) was larger in the re-ablation group, but the size of the LA did not correlate with the left carina width (<i>r</i> = 0.075; <i>p</i> = 0.111). However, there was a significant correlation between the size of the LA and the width of the right carina (<i>r</i> = 0.251, <i>p</i> &lt; 0.001). Also, in the re-ablation group a significant correlation between right carina width and reconnection of the right PV's (RPV) was detected, which was not seen in the left PV's (LPV) (<i>p</i> = 0.015; <i>p</i> = 0.360, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The left carina width and LA size are associated with the success rate of primary cryoballoon-PVI. However, there was a correlation between the right carina width and the reconnection of the RPV's leading to re-ablation. It seems that recognition of anatomical variants could be useful in the decision of ablation technique, but further studies are needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 9","pages":"1947-1955"},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jce.70430","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148360944","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":"Pulsed Field Ablation Is Associated With Fewer Post-Procedural Pericardial Inflammatory Symptoms Compared With Radiofrequency Ablation","authors":"Dor Yadin,&nbsp;Michael Barkagan,&nbsp;Maxime Zabern,&nbsp;Sivan Hay,&nbsp;Anat Milman,&nbsp;Elad Anter","doi":"10.1111/jce.70424","DOIUrl":"10.1111/jce.70424","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Acute pericarditis is an uncommon complication of thermal atrial fibrillation (AF) ablation, whereas milder pericardial inflammatory symptoms, typically pleuritic or positional chest pain, are more common and negatively affect post-procedural recovery. Pulsed field ablation (PFA), a non-thermal modality with tissue-selective properties, may reduce collateral pericardial injury. We compared post-procedural pericardial inflammatory symptoms and recovery after AF ablation using PFA vs. radiofrequency ablation (RFA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center observational study with prospective data collection included 150 patients undergoing catheter ablation for paroxysmal or persistent AF using focal PFA (<i>n</i> = 75) or RFA (<i>n</i> = 75). Patients were identified from the procedural workflow during the study period. Post-procedural pericardial inflammatory symptoms, chest pain severity (5-point scale), anti-inflammatory therapy use, length of hospital stay, and biomarkers of inflammation (CRP) and myocardial injury (hs-TnT) were assessed during hospitalization and structured post-discharge follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Baseline characteristics were similar between groups. Post-procedural chest pain occurred more frequently after RFA than PFA (32% vs. 5.3%, <i>p</i> &lt; 0.001), despite a significantly greater proportion of patients in the PFA group receiving lesion sets beyond pulmonary vein isolation (94.7% vs. 73.3%, <i>p</i> &lt; 0.001). Anti-inflammatory therapy was prescribed more frequently after RFA (20% vs. 2.7%, <i>p</i> = 0.001), and hospital length of stay was longer [2 (1–2) vs. 1(1–1) days, <i>p</i> = 0.03). Procedure duration was shorter with PFA (86 ± 36 vs. 122 ± 55 min, <i>p</i> &lt; 0.001). Median hs-TnT levels were higher after PFA [1288 (865–2137) vs. 1001 (652–1368] ng/L, <i>p</i> = 0.01), whereas CRP levels were similar [10.4 (4.9–23.3) vs. 10.5 (6.9–27.3) mg/L; <i>p</i> = 0.38].</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PFA was associated with fewer post-procedural pericardial inflammatory symptoms, reduced need for anti-inflammatory therapy, and faster recovery compared with RFA. These findings suggest reduced pericardial irritation and improved patient-centered recovery after AF ablation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 9","pages":"1930-1938"},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148360761","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":"High-Risk ECG in Syncope: High Risk or Overstated?","authors":"Maria Giulia Bellicini,&nbsp;Matthew J. Reed","doi":"10.1111/jce.70476","DOIUrl":"10.1111/jce.70476","url":null,"abstract":"<p>Proposed emergency department approach to syncope. After confirming true syncope and excluding immediately apparent diagnoses, assessment focuses on identifying patients at high risk of clinically significant bradyarrhythmia or other specific cardiac conditions requiring hospital admission, while avoiding unnecessary admission for isolated non-specific ECG abnormalities.</p><p>The proposed recommendations and algorithm reflect the authors' interpretation of the available evidence and are intended to complement current ESC recommendations. Although informed by observational studies, they remain exploratory and have not yet been prospectively validated.\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":"37 9","pages":"1915-1917"},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793640","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 Fibrosis Imaging: Correlation of Late Gadolinium Enhancement Magnetic Resonance Imaging With High-Definition Voltage Electroanatomical Mapping Across Different Thresholds","authors":"Theodoros Efremidis,&nbsp;Eva Nyktari,&nbsp;Ourania Kariki,&nbsp;Konstantinos Pamporis,&nbsp;Athanasios Saplaouras,&nbsp;Panagiotis Mililis,&nbsp;Stavroula Koskina,&nbsp;Stylianos Dragasis,&nbsp;Ignatios Ikonomidis,&nbsp;Konstantinos P. Letsas,&nbsp;Michael Efremidis","doi":"10.1111/jce.70447","DOIUrl":"10.1111/jce.70447","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Atrial fibrosis is an adverse factor for arrhythmia recurrences and thromboembolic events in atrial fibrillation (AF). Cardiac magnetic resonance imaging (CMRi) has emerged as a noninvasive tool for its assessment, though evidence remains conflicting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>Sixty ablation-naïve patients with AF scheduled for first-time catheter ablation were enrolled (78% men, 67% paroxysmal AF, 73% heart failure reduced ejection fraction [HFrEF]). Prior to the procedure, CMRi was performed in sinus rhythm (SR) on a 1.5T system using a high-resolution (1.3 mm isotropic) free-breathing 3D LGE sequence with echo-navigator end-expiratory gating and whole-heart coverage. Left atrium (LA) fibrosis was quantified using the commercially available ADAS 3D software, with fibrosis defined at four image intensity ratios (IIR) thresholds (0.97, 1.2, 1.32, and 1.61 times mean blood-pool signal intensity). High-density electroanatomical mapping (EAM) was performed in SR, and low-voltage substrates (LVS) were quantified at three bipolar voltage thresholds (0.5, 0.25, and 0.1 mV). LVS-EAM were identified in 97%, 88%, and 45% of patients at 0.5, 0.25, and 0.1 mV, respectively. LGE-CMRi was detected in 100%, 97%, 63%, and 17% of patients at IIR thresholds of 0.97, 1.2, 1.32, and 1.61, respectively. Quantitative correlation between CMR- and EAM-derived fibrosis was negligible to weak across all threshold combinations. When fibrosis was analyzed dichotomously, agreement was highest between EAM 0.5 mV and CMR IIR 0.97 (0.97, 95% CI [0.92, 1.00]; <i>p</i> &lt; 0.001) and IIR 1.2 (1, 95% CI [1.00, 1.00]; <i>p</i> &lt; 0.001), and between EAM 0.25 mV and CMR IIR 0.97 (0.87 95% CI [0.76, 0.97]; <i>p</i> &lt; 0.001) and IIR 1.2 (0.9, 95% CI [0.81, 0.99]; <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In an ablation-naïve AF population with a predominance of HFrEF patients, CMR- and EAM-derived measures of atrial fibrosis showed poor quantitative correlation across multiple threshold combinations. Although agreement improved when fibrosis was analyzed dichotomously (presence vs. absence of fibrosis), the highest agreement was observed at the most sensitive threshold combinations. The findings of our study highlight the need for standardized, validated, and reproducible CMR protocols for native atrial fibrosis assessment in order to provide a noninvasive alternative to EAM.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 9","pages":"2014-2022"},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411802","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":"Mechanisms of Recurrent Arrhythmia in Patients With Prior Surgical Ablation of Atrial Fibrillation Who Undergo Catheter Ablation","authors":"Mark S. Brahier,&nbsp;Elizabeth A. Brahier,&nbsp;Hannah Schwennesen,&nbsp;Kelly Arps,&nbsp;Adam Williams,&nbsp;Brittany Zwischenberger,&nbsp;Zak Loring,&nbsp;Daniel Friedman,&nbsp;Jonathan P. Piccini","doi":"10.1111/jce.70477","DOIUrl":"10.1111/jce.70477","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial tachyarrhythmias frequently recur after surgical ablation and often require catheter ablation (CA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study of patients who underwent CA for symptomatic atrial fibrillation or flutter (AF hereafter) following surgical ablation. Clinical data, including patient and surgical characteristics and results of electrophysiology testing and mapping, were recorded. Recurrence was defined as 30 s of AF, atrial flutter, or atrial tachycardia following a 3-month blanking period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-seven patients were included in the study (mean age 67.0 ± 9.8 years, 43% female) who underwent isolated surgical ablation (<i>n</i> = 5), concomitant mitral valve surgery (<i>n</i> = 21), aortic valve (<i>n</i> = 5), tricuspid valve surgery (<i>n</i> = 6), and/or coronary artery bypass grafting (<i>n</i> = 6). The mean time from surgical ablation to CA was 5.9 ± 5.1 years. Among the 37 patients, 19 (51%) experienced one or more pulmonary vein reconnections (mean 3.0 ± 1.3 veins per patient), and 15 (41%) developed mitral annular flutter. Following ablation, 12 (32%) patients developed recurrent arrhythmia by 1-year post-ablation. Age, sex, body mass index, time from surgical ablation to CA left ventricular ejection fraction &lt; 50%, prior CA, left atrial diameter, and mitral annular flutter were not associated with recurrence. The number of pulmonary vein reconnections at the time of repeat CA was predictive of arrhythmia recurrence in subsequent follow-up (OR 2.148 [95% CI: 1.059−4.357]; <i>p</i> = 0.034).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Pulmonary vein reconnection and mitral annular flutter are common recurrence mechanisms in patients with symptomatic arrhythmia recurrence following surgical ablation. The number of pulmonary vein reconnections predicts recurrent arrhythmia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 9","pages":"2047-2054"},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793706","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}