Journal of Cardiovascular Electrophysiology最新文献

{"title":"Hemolysis Biomarkers After Pulmonary Vein Isolation via a Balloon-In-Basket PFA Catheter.","authors":"Lorenzo Marcon, Domenico G Della Rocca, Giampaolo Vetta, Kazutaka Nakasone, Antonio Sorgente, Carlo de Asmundis, Gian-Battista Chierchia","doi":"10.1111/jce.16608","DOIUrl":"https://doi.org/10.1111/jce.16608","url":null,"abstract":"<p><strong>Introduction: </strong>The extensive use of pulsed field ablation (PFA) in clinical settings has unveiled new evidence suggesting potential involvement in red blood cell structural impairment resulting in hemolysis and potential acute kidney injury (AKI).</p><p><strong>Methods: </strong>In this study, blood samples were collected from 16 patients before and 24 h after pulmonary vein isolation (PVI) via a novel investigational PFA-based technology. Biochemical analyses were performed to assess hemolysis and AKI, including total and indirect bilirubin, lactate dehydrogenase (LDH), haptoglobin, plasma free hemoglobin, urea, creatinine, and estimated glomerular filtration rate (eGFR).</p><p><strong>Results: </strong>Based on the periprocedural changes in hemolysis biomarkers, none of the patients displayed evidence of clinically relevant hemolysis following PVI with the PFA catheter.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468269","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 Tricuspid Regurgitation on Atrial Fibrillation Recurrence After Pulmonary Vein Isolation.","authors":"Sebastian Weyand, Viola Adam, Paloma Biehler, Patricia Hägele, Simon Hanger, Stephanie Löbig, Andrei Pinchuk, Felix Ausbuettel, Christian Waechter, Peter Seizer","doi":"10.1111/jce.16615","DOIUrl":"https://doi.org/10.1111/jce.16615","url":null,"abstract":"<p><strong>Background: </strong>The impact of tricuspid regurgitation (TR) on the outcomes of pulmonary vein isolation (PVI) for atrial fibrillation (AF) remains unclear. While the effects of mitral regurgitation (MR) on PVI outcomes are well-documented, there are limited data on how moderate or greater TR influences PVI efficacy and recurrence rates.</p><p><strong>Objectives: </strong>The aim of this study was to assess the impact of moderate or greater TR on the outcomes of PVI, particularly focusing on AF recurrence rates within the first year post-PVI.</p><p><strong>Methods: </strong>We conducted an observational cohort study involving 421 patients undergoing their first PVI. 96 patients with moderate or greater TR were propensity score-matched with 96 controls based on age, sex, body mass index, and MR severity. Procedural parameters, complication rates, and AF recurrence within 1-year post-PVI were analyzed.</p><p><strong>Results: </strong>Despite comparable procedural parameters and low overall complication rates between the groups, patients with moderate or greater TR experienced significantly higher AF recurrence rates within the first year after PVI. Right atrium (RA) area was notably larger in these patients, suggesting a potential link between RA remodeling and increased AF recurrence.</p><p><strong>Conclusions: </strong>Our findings indicate that moderate or greater TR is associated with higher recurrence rates of AF after PVI, potentially due to RA enlargement and remodeling. This highlights the need for tailored ablation strategies that consider the RA substrate and/or TR treatment in patients with significant TR and AF. Further multicenter, prospective studies are required to validate these results and explore long-term outcomes.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467973","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":"Cardiac Neuromodulation and Neurocardiology.","authors":"Robert Lemery","doi":"10.1111/jce.16593","DOIUrl":"https://doi.org/10.1111/jce.16593","url":null,"abstract":"<p><p>Neurocardiology has mostly been a specialty of medicine led by anatomists and physiologists. The characterization of the cardiac autonomic nervous system has resulted in a new understanding and appreciation of neurocardiology, leading to potential novel neuromodulation therapies in clinical cardiology and cardiac electrophysiology. Sympathectomy or spinal cord stimulation for the treatment of angina pectoris, as well as cardiac sympathetic denervation for the treatment of long QT syndrome associated with malignant ventricular arrhythmias, have been available and performed for more than half a century. However, a new neuromodulation has emerged, based on contemporary research findings, assisted by state-of-the art imaging and ablation techniques. Patients with structural heart disease and malignant ventricular arrhythmias, as well as symptomatic ventricular ectopy, can potentially benefit from techniques to reduce autonomic tone, such as stellate ganglionic block, epidural anesthesia and cardiac sympathetic denervation. Renal sympathetic denervation not only has been shown to ameliorate the treatment of patients with hypertension, but may also reduce atrial and ventricular arrhythmias. Patients with heart failure may be improved clinically by potentiating parasympathetic tone. Cardiac mapping of ganglia and nerves can be performed to delineate regions of ablation that can suppress atrial fibrillation, and potentially treat symptomatic bradyarrhythmias and cardio-inhibitory syncope.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458125","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":"Style Over Substance? Stylet-Driven Pacing Leads for the Purposes of Left Bundle Branch Area Pacing.","authors":"Sami Ibrahim, Pamela K Mason","doi":"10.1111/jce.16610","DOIUrl":"https://doi.org/10.1111/jce.16610","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440803","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":"Factors Influencing Contact Force in Robotic Magnetic Navigation Ablation.","authors":"Michal Orczykowski, Maciej Bak, Krzysztof Kaczmarek, Piotr Urbanek, Bodalski Robert, Krzysztof Dubowski, Grzegorz Warminski, Pawel Derejko, Pawel Ptaszynski, Maciej Sterlinski, Maria Bilinska, Lukasz Szumowski","doi":"10.1111/jce.16597","DOIUrl":"https://doi.org/10.1111/jce.16597","url":null,"abstract":"<p><strong>Introduction: </strong>Stability of catheter-tissue contact in the robotic magnetic navigation (RMN) system is one of the key features that distinguishes this system from manually guided catheters. Numerous studies have shown that contact force (CF) in manually controlled catheters is as crucial for forming an optimal lesion as the duration of application or power. Catheters used in the RMN system lack a quantitative method for intraoperative monitoring of this parameter. Our study aims to partially address this gap in scientific knowledge.</p><p><strong>Methods: </strong>We conducted a total of 1200 CF measurements using the RMN system (Stereotaxis, St. Louis, MO, USA), a magnetic-guided 8 Fr RF ablation catheter (THERMOCOOL RMT Catheter, Biosense Webster, Irvine, CA, USA) inserted through a long sheath (SR0, Abbott Cardiovascular, Nathan Lane North, Plymouth, MN, USA), and a precision jewelry scale (IKEME, Guangdong, CN). We analyzed the impact on the obtained CF values of four different magnetic field vectors (transverse, sagittal, caudal, and cranial), two field strengths (0.1T and 0.08T), and three catheter extension configurations from the long sheath (with Position 1 being the least extended and Position 3 the most extended).</p><p><strong>Results: </strong>The contact force values varied significantly across the different magnetic field vectors, field strengths, and catheter extensions from the vascular sheath. The greatest differences in achieved values were observed across the different magnetic field vectors in the Position 1, ranging from 3.52 ± 0.1 g (caudal plane) to 15.15 ± 0.05 g (cranial plane) at 0.08 Tesla (T) field strength (p < 0.001), and from 4.10 ± 0.06 g (caudal) to 15.01 ± 0.07 g (cranial) at 0.1 T, p < 0.001. Differences in other vectors reached approximately 20%. The highest CF values were obtained in Position 1, intermediate values in Position 2, and the lowest in Position 3. An exception was the transverse vector, where, particularly with a magnetic field of 0.1 T, more similar values were observed across Positions 1-3, with respective values of 8.61 ± 0.14 g, 9.36 ± 0.06 g, and 8.31 ± 0.05 g. A stronger magnetic field (0.1 T compared to 0.08 T) resulted in higher CF values, especially during measurements in the transverse vector. This effect was most pronounced in the most extended catheter from the sheath - Position 3 (with respective values of 4.54 ± 0.09 g vs. 8.31 ± 0.05 g, p < 0.001). In the sagittal, cranial, and caudal vectors, the differences were less noticeable.</p><p><strong>Conclusion: </strong>Different magnetic field vectors, catheter extensions from the sheath, and magnetic field strengths result in varying contact force values. For effective radiofrequency ablation lesions, these factors should be considered alongside power, duration, and other established parameters.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440792","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":"Safety of Ablation Within the Coronary Venous Sinus in Pediatric Patients.","authors":"Shankar Baskar, Martin J LaPage, Nicholas J Ollberding, David S Spar, Brynn E Dechert, Audrey Dionne, Luis Ochoa, Ian Law, Peter P Karpawich, Diana Torpoco-Rivera, Christopher W Follansbee, Jason Garnreiter, Richard J Czosek","doi":"10.1111/jce.16607","DOIUrl":"https://doi.org/10.1111/jce.16607","url":null,"abstract":"<p><strong>Background: </strong>Catheter-based ablation in the coronary venous sinus (CS) can be associated with inadvertent coronary artery (CA) injury. However, a significant gap remains in the literature with regard to safety of such ablation in pediatrics.</p><p><strong>Objectives: </strong>The primary aim of this study was to describe the safety of catheter-based ablation within the CS. Secondary aim was to describe the practice pattern of ablation energy source within the CS among pediatric centers.</p><p><strong>Methods: </strong>This was a multi-center, retrospective study over a period of 20 years (1999-2019) involving seven centers. Pediatric patients (≤ 21 years of age) undergoing ablation within the CS were included.</p><p><strong>Results: </strong>A total of 211 patients were included (median age: 14 [IQR: 10.5, 16.0]). Accessory pathways were the target in almost 90% of the patients with cryoablation in 55%, nonirrigated RF in 40% and irrigated RF in 6%. Only 16% had coronary arteriogram done before RF. There was a single patient who had CA injury, in the form of a transient spasm of the left circumflex CA following RF in the proximal CS. There was transient high-grade AV block in six patients (2.8%) who either had RF or cryoablation. There was no permanent AV block.</p><p><strong>Conclusion: </strong>The use coronary arteriogram before RF in the CS is infrequent, although acute CA injury appears to be rare following such ablation. Transient heart block is not uncommon, and the operators need to be vigilant in monitoring AV nodal conduction.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414400","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":"Concerns Regarding \"Ablation of Premature Ventricular Contractions With Prepotentials Mapped Inside Coronary Cusps: When to Go Infra-Valvular?\"","authors":"Mirza M Hadeed Khawar, Muneeb Khawar, Javed Iqbal, M Maheer Mubashir","doi":"10.1111/jce.16609","DOIUrl":"https://doi.org/10.1111/jce.16609","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414398","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":"A Quality Improvement Initiative to Optimize Follow-Up in the New England Area for Pediatric Patients With Cardiovascular Implantable Electronic Devices.","authors":"Zoe Schefter, William P Knapp, Elsie Helou, Kathleen Jay, Michael R Epstein, Edward O'Leary, Felicia Tam, Shailendra Upadhyay, Bridget Boss, Niels Giddins, Audrey Dionne, Kerry Burke, Kathleen M Rotondo, Elizabeth S DeWitt, David Kane, Anna Tsirka, Douglas Y Mah","doi":"10.1111/jce.16594","DOIUrl":"https://doi.org/10.1111/jce.16594","url":null,"abstract":"<p><strong>Background: </strong>The use of cardiac implantable electronic devices (CIEDs) continues to grow. Despite the presence of implanted hardware, patient compliance with in-clinic visits and remote transmissions is poor. We performed a quality improvement (QI) initiative to assess and optimize CIED follow-up in the New England area.</p><p><strong>Methods: </strong>A regional network of eight pediatric institutions was created. All patients with CIEDs were identified starting in 2016. Noncompliance was defined as: no in-person evaluation within 1 year, or no remote transmission within 6 months. Interventions performed included automated texts/emails, certified letters, and personal phone calls.</p><p><strong>Results: </strong>A total of 612 patients were identified, with the total number of patients increasing over the 5-year QI period as patients had devices implanted and removed. Initial noncompliance with in-person annual follow-up was 29%. If patients were noncompliant, a personal phone call was made, reminding them to return to clinic. If the patient could not be reached for 3 months, a certified letter was sent. The noncompliance rate decreased to 5% over the first year and remained around this level over the QI period (3%-9%). For remote transmissions, 54% of patients were noncompliant. Interventions were performed on subgroups of patients. Automated texts/emails were trialed in 126; after 6 months, 41% of these patients remained noncompliant. Phone calls were then trialed on 87 patients. Over 6 months, noncompliance decreased to 11%.</p><p><strong>Conclusions: </strong>Patients with CIEDs have poor compliance with regular follow-up. Patients have a limited response to automated measures (texts/emails). Personal phone calls had the greatest impact in improving compliance.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391007","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 Right Ventricular Pacing in Patients Undergoing Implantable Defibrillator Placement.","authors":"James P Hummel, Zhou Lan, Paul W Jones, Rohan Khera, Kenneth Stein, Jeptha P Curtis, Joseph G Akar","doi":"10.1111/jce.16570","DOIUrl":"https://doi.org/10.1111/jce.16570","url":null,"abstract":"<p><strong>Introduction: </strong>Identifying patients who will develop a need for right ventricular (RV) pacing after defibrillator (ICD) placement would help inform appropriate device selection, specifically to identify patients who might be more suitable for dual chamber or biventricular transvenous defibrillators versus single-chamber or subcutaneous devices which do not provide pacing. We sought to determine predictors of RV pacing in patients who did not have a pacing indication at the time of initial ICD implant.</p><p><strong>Methods: </strong>This observational study assessed single-chamber ICD recipients implanted from 2006 to 2016 from Boston Scientific's ALTITUDE database and linked to the NCDR® ICD Registry. The study population (n = 11 044) of ICDs (programmed VVI mode at 40 bpm), and without a clinical indication for pacing. was randomly divided into training and validation cohorts (70/30) and characteristics associated with RV pacing were identified using logistic regression. The outcome was defined as the development of > 20% RV pacing averaged over any continuous 90-day period within 24 months after the ICD implant.</p><p><strong>Results: </strong>Patients who developed > 20% RV pacing (n = 148, 1.3%) had a higher likelihood of being older, male, and with a history of syncope, ventricular tachycardia or cardiac arrest, hypertension, previous or ongoing AF, and longer PR, QRS duration and BUN level (p < 0.01). After adjustment, PR > 230 ms, history of AF, ongoing AF at time of implant, history of VT or cardiac arrest, and age > 70 were independently associated with RV pacing.</p><p><strong>Conclusions: </strong>This study provides insight into predictors of RV pacing in ICD recipients without pacing needs at baseline.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390360","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":"Catheter Ablation for Atrial Fibrillation in Octogenarians-Outcome and Impact for Future Same Day Discharge Strategies.","authors":"Rahin Wahedi, Stephan Willems, Mario Jularic, Jens Hartmann, Omar Anwar, Jannis Dickow, Tim Harloff, Philipp Bengel, Peter Wohlmuth, Andreas Metzner, Nele Gessler, Melanie A Gunawardene","doi":"10.1111/jce.16600","DOIUrl":"https://doi.org/10.1111/jce.16600","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation (CA) for atrial fibrillation (AF) in the elderly poses a growing challenge. Outcome data regarding CA in these patients are scarce.</p><p><strong>Methods: </strong>Octogenarians with AF or consecutive atrial tachycardia undergoing index or re-ablation (pulmonary vein isolation [PVI] and ablation beyond PVI with different energy sources) in a single center, were analyzed. Study endpoints were efficacy as well as procedural safety. Secondary endpoints included periprocedural complications and predictors for prolonged hospital stay.</p><p><strong>Results: </strong>In total, 301 patients (82.1 ± 1.9 years, paroxysmal AF n = 94 [31.2%], CHA₂DS₂-VASc-Score 4.2 ± 1.2) undergoing index ablation (n = 172/301, 57.1% [PVI only n = 156/172, radiofrequency n = 92, cryoballoon n = 59, pulsed-field ablation n = 5]) and re-ablation (n = 129/301 [42.9%]) were included. Arrhythmia-free survival at 1 year was 72.6%. Complication rates were low (groin site n = 2/301 [0.7%], tamponade n = 2/301 [0.7%] and stroke n = 1/301 [0.3%]). However concomitant infections (pneumonia n = 5/301 [1.7%], urinary-tract-infections n = 4/301, [1.3%]) and pacemaker-implantation n = 6/301 (2%) occurred more commonly. Hospital stay after CA was 2.3 ± 2 nights. Predictors for prolonged hospitalization were complications (odds ratio: 3.1), infections (odds ratio: 2.1), female sex (odds ratio: 1.15) and frailty assessed by Barthel index (odds ratio: 1.02).</p><p><strong>Conclusions: </strong>CA for AF in octogenarians shows low procedural complications and reasonable efficacy. However, concomitant infections and pacemaker implantations occur in this cohort. Due to prolonged hospitalization after CA, especially in female and frail octogenarians, same-day discharge may not be suitable for this specific patient cohort.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389944","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}