Journal of Cardiovascular Electrophysiology最新文献

{"title":"Association of Diagnostic Code Priority With Identification of True Cardiac Arrest in Patients Presenting to the Emergency Department","authors":"Paulomi Gohel,&nbsp;Aditi Naniwadekar,&nbsp;Krishna Kancharla,&nbsp;Aditya Bhonsale,&nbsp;Suresh Mulukutla,&nbsp;Floyd Thoma,&nbsp;Andrew Voigt,&nbsp;Alaa Shalaby,&nbsp;N. A. Mark Estes,&nbsp;Sandeep K Jain,&nbsp;Samir Saba","doi":"10.1111/jce.70435","DOIUrl":"10.1111/jce.70435","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sudden cardiac arrest (SCA), a leading cause of mortality, is administratively coded as ventricular tachycardia (VT), ventricular fibrillation (VF), or unspecified SCA. Diagnostic codes are widely used in research, yet their accuracy in reflecting true SCA events is uncertain. The objective of this study is to evaluate the relationship between administrative diagnostic code rank (listing order) and the likelihood of true SCA in patients presenting to the emergency department (ED).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From a database of 22 369 patients with VT/VF/SCA, we randomly selected 380 patients for detailed chart review. Diagnostic accuracy was confirmed when patients (1) had sustained a true VT/VF/SCA event during the index hospitalization and (2) when the event was not precipitated by non-cardiac causes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Manual chart review for the 380 patients (age 71 ± 12 years, 53% women) confirmed that 65% experienced true VT/VF/SCA and 55% had an arrest unrelated to non-cardiac causes. Diagnostic accuracy was 100% at priority rank #1 and declined significantly at lower ranks. In the overall larger cohort of 22 369 patients, recurrence of VT/VF/SCA trended 3% lower (<i>p</i> = 0.086) and all-cause mortality was 5% higher (<i>p</i> &lt; 0.001) with each diagnostic priority rank decrease, over a mean follow-up of 1.5 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Diagnostic codes show variable predictive accuracy for true VT/VF/SCA events, with the highest accuracy at priority rank #1. Higher-priority codes identify patients most likely to have true SCA, while lower-priority codes capture sick patients with other in-hospital events. These results have important implications for the interpretation of administrative health datasets.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 9","pages":"1981-1987"},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411680","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":"Long-Term Serial Exercise Stress Testing in Catecholaminergic Polymorphic Ventricular Tachycardia on Beta-Blocker and Flecainide Therapy","authors":"Fernando Wangüemert-Perez,&nbsp;German Ostos-Cañero,&nbsp;Marta Wangüemert-Guerra,&nbsp;Carlos Acosta-Materan,&nbsp;Aridane Cárdenes-león,&nbsp;Eduardo Caballero-Dorta,&nbsp;Kevin Pérez-Rodríguez,&nbsp;Ramón Brugada,&nbsp;Josep Brugada,&nbsp;Efrén Martínez-Quintana","doi":"10.1111/jce.70429","DOIUrl":"10.1111/jce.70429","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a potentially life-threatening arrhythmic disorder typically treated with beta-blockers and, occasionally, with flecainide.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All patients underwent genetic testing, electrocardiogram, echocardiogram, and exercise testing. Ventricular arrhythmias were assessed using qualitative and quantitative scoring systems. Flecainide dosing was progressively titrated, and follow-up extended from 2007 to 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 235 genetically confirmed carriers of the RyR2 (ryanodine receptor 2) p.Gly357Ser mutation, 32 required combination therapy with beta-blockers and flecainide (age at diagnosis 18 [1–55] years; age at flecainide initiation 32 [15–66] years; 50% male). Forty-seven percent had an implantable cardioverter defibrillator (ICD). Flecainide was indicated for exercise-induced ventricular arrhythmias despite beta-blocker therapy, and the median treatment duration was 7.3 years. All patients received propranolol (median dose 65 mg/day). Flecainide (median dose 100 mg/day) was well tolerated, with no syncope or stress-induced symptoms. Before flecainide, five patients (16%) experienced ventricular arrhythmic events recorded by the ICD, including two requiring appropriate shocks; no events occurred after treatment initiation. Both qualitative (2.07 ± 0.77 vs. 1.22 ± 1.08, <i>p</i> &lt; 0.001) and quantitative (69.78 ± 83.17 vs. 15.29 ± 5.53, <i>p</i> &lt; 0.001) arrhythmic scores improved significantly. Additionally, maximum heart rate and the percentage of age-predicted maximum heart rate were significantly reduced, while metabolic equivalents increased significantly (12.3 ± 3.8 vs. 14.7 ± 7.5; <i>p</i> = 0.010).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In CPVT patients, the addition of flecainide to beta-blocker therapy was associated with a significant reduction in arrhythmic burden and improvement in exercise-related parameters during long-term follow-up.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 9","pages":"1939-1946"},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jce.70429","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148360514","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":"Impact of Pulse Field Ablation on Hemolysis Markers: A Single-Center Experience","authors":"Yong Hao Yeo,&nbsp;Nolan Shoukri,&nbsp;Chandramohan Meenakshisundaram,&nbsp;Ilana Kutinsky,&nbsp;Brian D. Williamson,&nbsp;Nishaki K. Mehta","doi":"10.1111/jce.70438","DOIUrl":"10.1111/jce.70438","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pulse field ablation (PFA) has gained attention as an alternative modality for ablation of atrial fibrillation (AF) due to its favorable safety profile compared with thermal ablation. However, hemolysis has emerged as a unique concern with PFA, yet the risk factors underlying its development and the extent to which it translates into renal complications remain poorly defined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective cohort study of patients with atrial fibrillation who underwent PFA at our health system between June 2024 and May 2025. Postprocedural hemolysis was assessed using plasma-free hemoglobin (Hb) levels, with patients stratified into high (&gt; 30 mg/dL) and normal/low (≤ 30 mg/dL) groups. Baseline characteristics, procedural details, and renal outcomes were compared between groups, and multivariable analyses were conducted to identify independent risk factors associated with hemolysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 232 patients (FARAPULSE [Manufacturer 1 PFA system] in 173 patients [74.6%]; PulseSelect [Manufacturer 2 system] in 59 patients [25.4%]) underwent PFA (mean age 67.5 ± 9.6, 34.1% female), of whom 109 (47.0%) developed high postprocedural plasma-free Hb (&gt; 30 mg/dL). Baseline demographics were similar between groups, but patients with high free Hb were more often treated with the Manufacturer 1 PFA system (91.7% vs. 59.3%, <i>p</i> &lt; 0.01), underwent PVI with additional ablation (73.4% vs. 45.5%, <i>p</i> &lt; 0.01), and received a greater number of applications (63.2 ± 14.9 vs. 51.1 ± 11.5, <i>p</i> &lt; 0.01). On multivariable analysis, independent risk factors associated with hemolysis included use of the Manufacturer 1 system (aOR 6.67, 95% CI 2.94–16.47), total applications &gt; 59 (aOR 4.25, 95% CI 2.04–9.19), and higher preprocedural hemoglobin level (aOR 1.52, 95% CI 1.19–1.97). The rate of AKI was low and similar between the two groups (0.9% vs. 0.8%, <i>p</i> = 1.00). None of the patients required renal replacement therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our real-world study, following the commercial approval of PFA systems, showed that 47% of patients developed subclinical hemolysis after PFA, with no actionable clinical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 9","pages":"1997-2004"},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411853","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":"The V6R/V4R Index: A Novel ECG Parameter for Identifying Idiopathic Ventricular Arrhythmias Originating From the Aortic Cusp","authors":"Yoshihisa Naruse,&nbsp;Kohki Nakamura,&nbsp;Kanae Hasegawa,&nbsp;Toshihiko Tsuji,&nbsp;Machiko Miyoshi,&nbsp;Tatsuhiro Kataoka,&nbsp;Hideyuki Aoki,&nbsp;Yoshinori Okazaki,&nbsp;Shigeto Naito,&nbsp;Hiroshi Tada,&nbsp;and other members of the V6R/V4R Study Group","doi":"10.1111/jce.70436","DOIUrl":"10.1111/jce.70436","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Radiofrequency catheter ablation within the aortic cusp can eliminate left ventricular outflow tract (LVOT) ventricular arrhythmias (VAs). However, in a significant proportion of cases, successful ablation requires targeting the aorto-mitral continuity, the endocardium just below the left ventricular summit, and/or the mitral annulus. This study aimed to identify electrocardiographic (ECG) indices useful for differentiating VAs originating from the aortic cusp from those arising outside the cusp among LVOT-VAs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included 159 idiopathic VAs (79 in the derivation cohort and 80 in the validation cohort) successfully ablated from the LVOT. Based on the site of VA origin, VAs were classified into cusp (<i>n</i> = 125) and non-cusp (<i>n</i> = 34) groups. Detailed PVC morphologies were compared between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the derivation cohort (mean age 60 ± 16 years, 43 men), the ratio of R-wave amplitude in lead V6 to that in lead V4 was significantly higher in the cusp group than in the non-cusp group (0.64 [0.56–1.00] vs. 0.32 [0.24–0.40], <i>p</i> &lt; 0.001). Receiver operating characteristic curve analysis showed that a V6R/V4R amplitude index &gt; 0.55 predicted cusp-origin VAs with 0.80 sensitivity and 0.88 specificity (area under the curve, 0.865; 95% confidence interval [CI], 0.762–0.967). In the validation cohort, the sensitivity and specificity of a V6R/V4R amplitude index &gt; 0.55 for predicting cusp origin were 84% and 82%, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The V6R/V4R index is a simple and practical ECG criterion for distinguishing VAs originating from the aortic cusp from those arising outside the cusp among LVOT-VAs, with high accuracy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 9","pages":"1988-1996"},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jce.70436","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411923","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":"Advantages of the QDOT MICRO Catheter in Finding Conduction Gaps in Pulmonary Vein Isolation Compared With the Conventional 3.5-mm Tip Electrode","authors":"Ken Masuda,&nbsp;Daigo Nagahara,&nbsp;Ryosuke Hatano,&nbsp;Kimitaka Nishizaki,&nbsp;Satoshi Yuda","doi":"10.1111/jce.70472","DOIUrl":"10.1111/jce.70472","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pulmonary vein isolation (PVI) remains a cornerstone treatment for atrial fibrillation; however, residual conduction gaps often hinder first-pass success and contribute to late reconnection, leading to arrhythmia recurrence. The QDOT MICRO catheter (Biosense Webster Inc., CA, USA) is equipped with three microelectrodes at its tip. Their small size and short inter-electrode spacing allow for a more detailed recording of intracardiac potentials. This study evaluated the utility of the QDOT MICRO catheter in detecting conduction gaps during PVI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Forty-four gaps in 40 patients undergoing initial PVI were analyzed by comparing electrograms recorded using microelectrodes and conventional 3.5-mm tip electrodes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At the gap sites, the local electrogram voltage recorded by microelectrodes was significantly higher than that by 3.5-mm tip electrodes (median, 0.449 vs. 0.195 mV, <i>p</i> &lt; 0.001), representing a 2.3-fold amplification. The prevalence of fragmented potentials at the gap sites was significantly higher with microelectrodes than with 3.5-mm tip electrodes (61% vs. 30%, <i>p</i> &lt; 0.001). In 36% of gaps, fragmented potentials were detected with microelectrodes, whereas the 3.5-mm electrodes recorded nonfragmented signals, contributing to accurate gap detection. In 11% of gaps, the amplitude was extremely low with 3.5-mm tip electrodes [median 0.107 (IQR 0.088–0.112) mV], rendering the interpretation of local electrogram challenging. However, microelectrodes amplified the signal [median 0.215 (IQR 0.176–0.283) mV], allowing for accurate identification and interpretation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Microelectrodes enhance the detection and characterization of conduction gaps, particularly under low-voltage or in scarred tissue, thereby improving ablation accuracy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 9","pages":"2039-2046"},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706518","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":"Influence of High-Frequency Low-Tidal Volume Versus Jet Ventilation on Acute and Long-Term Outcomes Following Pulmonary Vein Isolation","authors":"Daniel Villarreal,&nbsp;Juliana Perez-Pinzon,&nbsp;Andre d'Avila,&nbsp;Peter Zimetbaum,&nbsp;Andrew H. Locke,&nbsp;Shu Yang,&nbsp;Timothy Maher,&nbsp;Sankalp Sehgal,&nbsp;Maximilian S. Schaeffer,&nbsp;Sebastian D. Sahli,&nbsp;Jonathan W. Waks,&nbsp;Patricia Tung","doi":"10.1111/jce.70422","DOIUrl":"10.1111/jce.70422","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Use of high-frequency low-tidal volume (HFLTV) and high-frequency jet ventilation (HFJV) during pulmonary vein isolation (PVI) improves acute procedural success and long-term outcomes compared to conventional ventilation. However, the impact of HFLTV compared to HFJV on acute and long-term outcomes is unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We prospectively identified 1039 patients who underwent first-time PVI or PVI with posterior wall isolation (PWI) at our institution between 2022 and 2024 with HFLTV or HFJV. Acute procedural and safety outcomes were analyzed. Twelve-month arrhythmia-free survival was evaluated using the Kaplan-Meier and Cox proportional hazards method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After excluding 44 patients who required discontinuation of HFJV, 860 patients receiving HFJV were compared with 179 receiving HFLTV ventilation. Mean age was 65 years, 93% were White, 30% female and 53% had paroxysmal AF. First-pass isolation (FPI) rates were similar between ventilation strategies. HFLTV was associated with a higher rate of intraprocedural hypotension (31% vs 23%, <i>p</i> = 0.02). Complications were generally minor and comparable between groups. Arrhythmia recurrence rates at 12 months were similar (HR: 0.89, <i>p</i> = 0.55). There was a trend toward improved outcomes when FPI was achieved for both pulmonary veins in either group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this observational cohort, no significant differences in acute procedural outcomes, safety outcomes, or long-term arrhythmia recurrence were observed between HFLTV and HFJV. Given the specialized equipment and operator training required for HFJV and its non-negligible rate of discontinuation, HFLTV may offer a modest practical advantage in routine clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 9","pages":"1921-1929"},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148360977","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":"Comparison of Pentaspline Pulsed Field Ablation Catheter Mapping Modes to Assess Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation","authors":"John L. Fitzgerald,&nbsp;Geoffroy Ditac,&nbsp;Konstantinos Vlachos,&nbsp;Nicolas Johner,&nbsp;Xavier Paul Bouteiller,&nbsp;Kinan Kneizeh,&nbsp;Francesco Notaristefano,&nbsp;Karim Benali,&nbsp;Cinzia Monaco,&nbsp;Marianne T. Langlois,&nbsp;Benjamin Sacristan,&nbsp;Jan Charton,&nbsp;Romain Tixier,&nbsp;Nicolas Derval,&nbsp;Thomas Pambrun,&nbsp;Mélèze Hocini,&nbsp;Michel Haïssaguerre,&nbsp;Josselin Duchateau,&nbsp;Pierre Jaïs,&nbsp;Frédéric Sacher","doi":"10.1111/jce.70408","DOIUrl":"10.1111/jce.70408","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We assessed the electro-anatomic mapping (EAM) capabilities of a pulsed field ablation (PFA) system previously guided by fluoroscopy to assess acquisition modes, and effects of near and far-field signal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>After pulmonary vein isolation (PVI) proven by pacing to check entrance and exit block, EAM was performed in 2 modes with the Faraview system during CS pacing. Mode 1 utilized bipoles between electrode 3 of each adjacent catheter spline. Mode 2 utilized a pseudo-unipole between electrode 3 and a combination of electrodes 1, 2, and 4 on individual splines. Signals and voltage map demonstration of PVI were compared with pacing assessment. Two observers assessed the maps with a third observer to resolve discrepancies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifteen patients (87% male, aged 58 ± 9 years) had PVI then mapping with the Faraview system. Pacing confirmed isolation of all pulmonary veins. Bipolar mapping (mode 1) displayed multiple apparent PV signals: only 32/61 (52%) of veins appeared isolated. On pseudo-unipolar mapping 59/61 (97%) of veins appeared isolated. The majority of variance in assessment (70.4%) was explainable by the mapping method with minimal variance attributed to observer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Pseudo-unipolar EAM Faraview mode appears the most accurate for assessment post-PVI compared with bipolar mode.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 9","pages":"2023-2030"},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jce.70408","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497628","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":"Feasibility, Safety, and Efficacy of Pulsed Field Ablation for Ventricular Arrhythmias: Insights From a Large Health System Registry in the United States.","authors":"Narut Prasitlumkum, Juan F Rodriguez-Riascos, Hema Vemulapalli, Aakash Somappa, Camilo A Estrada-Vargas, Olubadewa A Fatunde, Carlos A Rojas, Poojan Prajapati, Keerthika Vijayakumar, Suraj Kapa, Duy Nguyen, Samuel Asirvatham, Malini Madhavan, Christopher McLeod, Hicham Z El Masry, Abhishek J Deshmukh, Danesh K Kella, Ammar M Killu, Siva K Mulpuru, Mayank Sardana, Luis R Scott, Alan M Sugrue, Komandoor Srivathsan","doi":"10.1111/jce.70503","DOIUrl":"https://doi.org/10.1111/jce.70503","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) is an emerging non-thermal ablation modality with proven safety in atrial arrhythmia ablation. However, data on its performance for ventricular arrhythmias (VA) remain limited.</p><p><strong>Objective: </strong>To evaluate the feasibility, safety, and efficacy of PFA for complex VA in a multicenter real-world US registry.</p><p><strong>Methods: </strong>This retrospective study included consecutive patients undergoing PFA for ventricular tachycardia (VT) or premature ventricular contractions (PVCs) at three Mayo Clinic centers (April 2024 to July 2025). The primary feasibility outcome was the successful delivery of PFA lesions to the intended target substrate. Primary efficacy outcomes included acute procedural success; sustained VT recurrence requiring implantable cardioverter-defibrillator (ICD) shocks or multiple antitachycardia pacing therapies; and ≥ 80% reduction in PVC burden. Safety outcomes included procedural complications, valvular function, thromboembolic events, renal function, and conduction disturbances.</p><p><strong>Results: </strong>Twenty-six patients were included (13 PVC, 13 VT). Acute success was achieved in all VT ablations (69.2% complete; 30.8% partial) and in 92.3% of PVC ablations. Complications occurred in 11.5% of patients (transient LBBB [n = 1] and vascular complications [n = 2]). No thromboembolic events, intracardiac thrombus, or acute kidney injury were observed. Lesions near the mitral valve apparatus did not worsen mitral regurgitation, including in patients with pre-existing valve disease. After a median follow-up of 365 days, one patient experienced VT recurrence requiring ICD shocks. Estimated recurrence-free survival after VT ablation was 61.5% at 12 months; 58.3% of PVC patients achieved ≥ 80% burden reduction.</p><p><strong>Conclusion: </strong>PFA for VA appears feasible and acutely effective, with a low rate of procedure-related complications. While acute success was high, long-term outcomes were acceptable for VT ablation and relatively modest for PVC ablation, highlighting the need for continued refinement of technology and energy-delivery strategies. Larger prospective studies are warranted.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976259","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 Trends in Post-LAAO Surveillance Imaging: Increasing Adoption of CT-Based Follow-Up in Contemporary Practice","authors":"Issam Motairek,&nbsp;Ali Dakik,&nbsp;Mohamad Mdaihly,&nbsp;Chadi Tabaja,&nbsp;Bryan Abadie,&nbsp;Mohamed Kanj,&nbsp;Walid Saliba,&nbsp;Oussama Wazni,&nbsp;Wael A. Jaber","doi":"10.1111/jce.70418","DOIUrl":"10.1111/jce.70418","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Surveillance imaging after left atrial appendage occlusion (LAAO) is recommended to evaluate for peri-device leak and device-related thrombus, with both transesophageal echocardiography (TEE) and cardiac computed tomography (CT) considered appropriate modalities. Longitudinal trends in surveillance imaging utilization and modality selection have not been well characterized in large, real-world populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective observational study using the TriNetX Research Network, a federated, de-identified electronic health record database. Adult patients (≥ 18 years) undergoing percutaneous transcatheter LAAO between January 2017 and December 2024 with available imaging data were included. Surveillance imaging was defined as TEE or cardiac CT performed between 45 and 365 days post-implantation. Annual rates of TEE-only, CT-only, and any surveillance imaging were calculated relative to total LAAO volume per year. Temporal trends were assessed using linear regression (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 33 267 patients, the proportion undergoing any surveillance imaging increased from 47.2% in 2017 to 66.6% in 2024 (slope +3.1%/year, <i>p</i> &lt; 0.001). TEE utilization remained stable (slope +0.11%/year, <i>p</i> = 0.68), while CT utilization increased from 2.6% to 22.1% (slope +2.7%/year, <i>p</i> &lt; 0.001). The overall increase in surveillance imaging was driven primarily by CT adoption. Approximately one-third of patients did not undergo any surveillance imaging within 1 year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Between 2017 and 2024, CT utilization following LAAO increased nearly eightfold while TEE rates remained stable; however, approximately one-third of patients did not undergo any surveillance imaging within 1 year, revealing a substantial gap in adherence to FDA-mandated surveillance protocols.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 9","pages":"1918-1920"},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jce.70418","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148360897","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":"Single-Cell Transcriptomics and Mendelian Randomization Analysis Reveal Key Genes in Atrial Fibrillation","authors":"Xiangpeng Chen,&nbsp;Hongquan Chen,&nbsp;Shiguang Xu,&nbsp;Shumin Wang,&nbsp;Huishan Wang,&nbsp;Hao Meng","doi":"10.1111/jce.70432","DOIUrl":"10.1111/jce.70432","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) is one of the most common cardiac arrhythmias. It reduces quality of life and increases the risk of complications such as stroke. Although progress has been made in understanding its pathogenesis, the key cellular subtypes and therapeutic targets remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We applied single-cell transcriptomics to identify critical cellular subtypes in AF. High-dimensional weighted gene co-expression network analysis (hdWGCNA) and machine learning were used to screen AF-related genes. Mendelian randomization (MR) and colocalization analyses were performed to assess causal relationships between these genes and AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Single-cell analysis showed a significant increase in macrophages in AF, especially SPP1-expressing macrophages, which may drive AF onset and progression. HdWGCNA identified AF-related gene modules. Three genes, LRCH1, RSRC2 and VAMP2, were found to be causally associated with AF. MR analysis confirmed their significant causal effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The accumulation of SPP1-expressing macrophages may drive the onset and progression of AF. Furthermore, LRCH1, RSRC2, and VAMP2 were identified as key causal genes for AF, providing novel insights into its molecular mechanisms and potential therapeutic targets.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 9","pages":"1956-1963"},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jce.70432","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148360759","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}