Journal of Cardiovascular Electrophysiology最新文献

{"title":"Subclinical Venous Injury in Transvenous Lead Extraction: Histological Correlation With Clinical Risk Factors","authors":"Azalfa U. Lateef,&nbsp;Ufuk Vardar,&nbsp;Alex Hochwald,&nbsp;Aziza Nassar,&nbsp;Thomas Ladas,&nbsp;Anca Chiriac,&nbsp;Christoffel Van Niekerk,&nbsp;Fred Kusumoto,&nbsp;Danesh K. Kella","doi":"10.1111/jce.70402","DOIUrl":"10.1111/jce.70402","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Transvenous lead extraction (TLE) is a commonly performed and generally safe procedure, though procedural complexity and risk can vary based on clinical and procedural factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aims to identify clinical and procedural factors associated with histologic evidence of subclinical vascular injury, defined by elastin positivity on extracted leads and its clinical significance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients undergoing TLE with a lead dwell time of ≥ 1 year were included. Extracted leads with tissue were analyzed histologically using Verhoeff–Van Gieson staining to assess the presence of elastin. Demographic data, procedural and lead characteristics, and indication for extraction were obtained. Established extraction risk scores were calculated to determine efficacy in predicting subclinical vascular injury.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort included 49 patients with 92 leads extracted. A total of 25 patients (51%) had elastin-positive leads. Complete procedural success occurred in 95.9% of cases. The multivariate regression model did not identify any independent predictors of elastin presence, including age (OR = 1.00; 95% CI 0.95–1.05; <i>p</i> = 0.89), female gender (OR = 3.04; 95% CI 0.67–13.65; <i>p</i> = 0.14), lead dwell time (OR = 1.13; 95% CI 0.98–1.29; <i>p</i> = 0.07). Additionally, no scoring system, such as the CCF, EROS, MB, SAFeTY, and LECOM, predicted the presence of elastin.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Subclinical venous injury was common following TLE, yet did not predict adverse clinical outcomes, reinforcing that TLE performed in experienced centers carries a favorable safety profile. Future studies in larger cohorts are needed to further characterize the clinical utility of subclinical vascular injury.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 9","pages":"1964-1971"},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411844","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 Outcomes of Minimalist Left Atrial Appendage Occlusion Guided Only by Periprocedural Imaging","authors":"Siu-Fung Wong,&nbsp;Christopher Broyd,&nbsp;Cara Hanley,&nbsp;Timothy Bagnall,&nbsp;Mohamed Abouelasaad,&nbsp;James Cockburn,&nbsp;James W. McCready,&nbsp;Sandeep Arunothayaraj,&nbsp;Arionilson Gomes,&nbsp;Andrew Hill,&nbsp;David Hildick-Smith","doi":"10.1111/jce.70433","DOIUrl":"10.1111/jce.70433","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pre- and post-procedural imaging in left atrial appendage occlusion (LAAO) adds to patient inconvenience and risks and may not materially influence outcomes. A more focused approach involving only peri-procedural imaging may suffice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>Data from patients who had LAAO at our centre between 2009 and 2024 were examined. Those with pre- and post-procedure imaging studies were excluded. Efficacy outcomes including procedural success and periprocedural complication were recorded. Long-term outcomes comprising cerebrovascular events, major bleeding, cardiovascular and all-cause death were retrieved through review of regional and national digital health records. 247 patients met the analysis criteria. The median CHA₂DS₂-VASc and HAS-BLED scores were 4 [interquartile range (IQR) 3–5)] and 3 (IQR 3–4) respectively. Successful closure of the left atrial appendage was achieved in 245 (99.2%) patients. Periprocedural death and complications occurred in 0.4% and 2.4% of patients respectively. Follow-up was obtained for 1155 patient-years (median follow-up time 6.8 years). Clinical stroke occurred in 6.9% of patients (1.55 per 100 patient-years)—a 67% reduction compared to that expected from the CHA₂DS₂-VASc score. 11.4% of patients suffered from major bleeding (2.56 per 100 patient-years)—a 55% reduction compared to that expected from the HAS-BLED score. 40.8% (8.65 per 100 patient-years) of patients died during follow-up. Patients suffering from cerebrovascular events had higher CHA₂DS₂-VASc (<i>p</i> = 0.048) and HAS-BLED scores (<i>p</i> = 0.045).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A minimalistic approach in LAAO using only periprocedural imaging guidance is feasible and safe, with an excellent success rate and a resultant reduction in cerebrovascular events in long-term.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 9","pages":"1972-1980"},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411862","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":"Spatial Clustering and High-Frequency Characteristics of Residual Conduction in the Left Atrial Posterior Wall","authors":"Takashi Kaneshiro,&nbsp;Sadahiro Murota,&nbsp;Minoru Nodera,&nbsp;Shinya Yamada,&nbsp;Yasuchika Takeishi","doi":"10.1111/jce.70479","DOIUrl":"10.1111/jce.70479","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Left atrial posterior wall (LAPW) isolation is frequently limited by residual conduction (RC) despite apparently complete endocardial linear lesions. Such conduction may involve interbundle connections between the septo-atrial and septo-pulmonary bundles or deeper conduction pathways. However, the spatial distribution and electrophysiological characteristics of these functionally defined RCs remain incompletely understood in clinical settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty-two patients undergoing LAPW isolation were prospectively studied. Among 22 patients, 11 required additional ablation after a confirmed roof and bottom line block, in whom residual electrograms were mapped using peak frequency (PF) analysis with the EnSite system. The LAPW was divided into nine predefined anatomical segments, and segments requiring ablation to achieve complete isolation were defined as RC-positive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>RC-positive segments predominantly clustered in the mid-central region (82%), whereas other regions were less frequently involved. PF was significantly higher in RC-positive than in RC-negative segments (460 [380–520] vs. 300 [250–400] Hz; <i>p</i> &lt; 0.001), and a PF cutoff of 365 Hz demonstrated moderate discriminatory performance (area under the curve, 0.796). RC-positive segments exhibited greater electrogram fractionation during both atrial fibrillation and atrial pacing, consistent with increased local conduction complexity. Targeted ablation at these sites resulted in complete LAPW isolation in all cases without complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Functionally defined RC within the LAPW exhibits a nonuniform spatial distribution with mid-central clustering and distinct electrophysiological characteristics. PF-based mapping may facilitate targeted identification of these regions and provide functional insights into potential non-endocardial conduction pathways in incomplete LAPW isolation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 9","pages":"2055-2062"},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793718","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":"Dynamic Behavior of Left Atrial Low-Voltage Areas in Persistent Atrial Fibrillation: Implications for Substrate-Guided Ablation","authors":"Yunus Emre Özbebek,&nbsp;Özcan Özdemir,&nbsp;Sinan Boz,&nbsp;Haluk Furkan Şahan,&nbsp;Engin Algül,&nbsp;Sinan İşcen,&nbsp;Hamza Sunman,&nbsp;Tolga Han Efe","doi":"10.1111/jce.70445","DOIUrl":"10.1111/jce.70445","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Low-voltage areas (LVAs) identified by electroanatomical mapping are commonly used to characterize the atrial substrate in persistent atrial fibrillation (PeAF). However, voltage measurements may vary according to rhythm and physiological state, and LVAs should not be considered synonymous with histological scar or fibrosis.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To evaluate rhythm- and physiological state-dependent changes in left atrial LVAs during atrial fibrillation (AF), early sinus rhythm after cardioversion (SR1), and sinus rhythm under isoproterenol infusion (SR2).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This retrospective observational study included 49 patients with persistent AF undergoing first-time catheter ablation. High-density left atrial voltage maps were acquired during AF, early sinus rhythm after electrical cardioversion (SR1), and sinus rhythm during isoproterenol infusion (SR2). Bipolar LVAs were defined as voltage amplitudes &lt; 0.3 mV during AF and &lt; 0.5 mV during sinus rhythm. Unipolar LVAs were defined using corresponding rhythm-specific thresholds of &lt; 0.71 mV during AF and &lt; 0.83 mV during sinus rhythm, whereas dense bipolar LVAs were defined as bipolar voltage amplitudes &lt; 0.2 mV. Global and regional LVA burden was quantified, and complete paired global analyses included 48 patients.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Global LVA burden decreased stepwise across mapping conditions. Bipolar LVA ratio decreased from 17.25% (IQR, 11.40–31.76) during AF to 8.70% (IQR, 6.98–16.17) during SR1 and 5.20% (IQR, 2.60–10.93) during SR2 (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Similar reductions were observed for unipolar and dense bipolar LVA ratios (both &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Regional analysis showed significant heterogeneity in bipolar LVA reduction, whereas unipolar and dense bipolar changes were more homogeneous. Larger left atrial volume was associated with less pronounced bipolar and unipolar LVA reduction. AF duration category was not significantly associated with LVA reduction.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Voltage-defined LVAs in PeAF vary substantially according to rhythm and physiological state. These findings suggest that single-condition voltage mapping may incompletely characterize the atrial substrate and should be interpreted as dynamic electroanatomical changes rather than evidence of fibrosis or scar regression.&lt;/p&gt;\u0000 &lt;/se","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 9","pages":"2005-2013"},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jce.70445","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411805","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":"Ventricular Tachycardia Ablation in Structural Heart Disease With LVEF > 35%: Clinical Outcomes and Recurrence Patterns","authors":"Said-Elias Waezsada,&nbsp;Moneeb Khalaph,&nbsp;Martin Braun,&nbsp;Thomas Fink,&nbsp;Vanessa Sciacca,&nbsp;Nadica Trajkovska,&nbsp;Philipp Lucas,&nbsp;Ersan Akkaya,&nbsp;Maxim Didenko,&nbsp;Mustapha El Hamriti,&nbsp;Guram Imnadze,&nbsp;Denise Guckel,&nbsp;Christian Sohns,&nbsp;Philipp Sommer,&nbsp;Angeliki Darma","doi":"10.1111/jce.70455","DOIUrl":"10.1111/jce.70455","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In patients with structural heart disease (SHD) and moderately impaired left ventricular ejection fraction (LVEF &gt; 35%), data on outcomes after ventricular tachycardia (VT) ablation remain limited. This analysis focuses on VT recurrence after ablation in patients presenting with sustained VT and LVEF &gt; 35% within a secondary-prevention population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate procedural outcomes and long-term VT recurrence after catheter ablation in SHD patients with LVEF &gt; 35%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed 219 consecutive patients with SHD and LVEF &gt; 35% undergoing VT ablation, including 89 with ischemic cardiomyopathy (ICM) and 130 with non-ischemic cardiomyopathy (NICM). Procedural characteristics, complications, and VT recurrence during follow-up were compared between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ICM patients were older, more frequently hypertensive, and had slightly lower LVEF than NICM patients. Ablation was predominantly endocardial in ICM, whereas combined endocardial–epicardial ablation was required in 28% of NICM patients (<i>p</i> &lt; 0.001). Acute VT non-inducibility was achieved more frequently in ICM than in NICM (93% vs 67%; <i>p</i> &lt; 0.001). Procedural complications were infrequent and comparable between groups (6% overall; <i>p</i> = 0.342). During follow-up, VT recurred in 35% of patients, more frequently in NICM than ICM (42% vs 25%; <i>p</i> = 0.004). Cardiomyopathy type emerged as the only independent predictor of VT recurrence (HR 2.312, CI 1.3–4.0, <i>p</i> = 0.004), while acute non-inducibility was associated with a lower recurrence risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>VT ablation in SHD patients with LVEF &gt; 35% was associated with acceptable safety and moderate arrhythmia control. Outcomes were more favorable in ICM than in NICM, reflecting the heterogeneity of arrhythmic risk in this secondary prevention population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 9","pages":"2031-2038"},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jce.70455","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497623","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":"Anatomical Determinants of the Left Atrial Electrograms: Wall Thickness and Myocardial Fat Infiltration.","authors":"Cecilia Granata, Nicola Pierucci, Lorenzo Mazzocchi, Raimondo Pittorru, Roger Borras, Jean-Baptiste Guichard, Mariona Regany-Closa, Jana Reventos-Presmanes, Laia Llorca, Rosa Maria Figueras I Ventura, Jose Maria Tolosana, Adelina Doltra, Susana Prat, Blanca Domenech-Ximenos, Rosario Jesus Perea-Palazon, Till Althoff, Lluís Mont, Eduard Guasch, Marta Sitges, Ana Garcia-Alvarez, Ivo Roca-Luque, Andreu Porta-Sanchez","doi":"10.1111/jce.70491","DOIUrl":"https://doi.org/10.1111/jce.70491","url":null,"abstract":"<p><strong>Introduction: </strong>Electrogram peak-to-peak voltage depends on atrial wall structure and mapping configuration. We evaluated the relationship between computed tomography-derived atrial wall thickness, intramyocardial fat, myocardial muscle thickness, and electrogram voltage obtained with omnipolar, bipolar, and unipolar mapping.</p><p><strong>Methods: </strong>Consecutive patients undergoing left atrial mapping during atrial fibrillation or atypical atrial flutter ablation were retrospectively included. Pre-procedural contrast-enhanced CT was processed with ADAS 3D to quantify left atrial wall thickness and intramyocardial fat infiltration, from which myocardial muscle thickness was derived. High-density electroanatomical maps were spatially co-registered with CT. Associations between anatomical parameters and peak-to-peak voltage were assessed, stratifying by rhythm stability.</p><p><strong>Results: </strong>Twenty patients were included. In stable rhythms, left atrial wall thickness correlated positively with voltage for all configurations, strongest for unipolar (β = 0.38) and omnipolar (β = 0.23) vs. bipolar mapping (β = 0.13) (BP-UP p < 0.0001; BP-OT p < 0.01). Intramyocardial fat showed the strongest inverse association with omnipolar (β = -0.39), compared with bipolar (β = -0.14) and unipolar (β = -0.01; p ≤ 0.02). After excluding fat, muscle thickness correlated positively with OT (β = 0.30) and UP (β = 0.30), exceeding BP (β = 0.14; p < 0.0001). In unstable rhythms, associations were attenuated but OT remained most responsive to fat (β = -0.20) and muscle thickness (β = 0.11) (both p < 0.01).</p><p><strong>Conclusions: </strong>Myocardial muscle thickness is the main determinant of local atrial voltage, while intramyocardial fat contributes to voltage attenuation. OT provides the most consistent assessment of atrial wall composition, particularly under rhythm instability.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955994","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":"Large Language Models for PVC Localization: Proof of Concept or Clinical Tool?","authors":"Alexander Siotis, Gurukripa N Kowlgi, Abhishek J Deshmukh","doi":"10.1111/jce.70499","DOIUrl":"https://doi.org/10.1111/jce.70499","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912157","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":"Time-Dependent Diagnostic Yield and Therapeutic Impact of Implantable Loop Recorders, Brugada Syndrome as the Exception.","authors":"Luigi Cocchiara, Benedetta Brescia, Procolo Marchese, Stefano Nardi, Luigi Argenziano, Gianmarco Arabia, Marco Micillo, Francesca Gennaro, Giovanni Mazzotta, Lucio Addeo, Alessandro Landolfi, Emiliano Calvi, Manuel Cerini, Alessio Nicolai, Teresa Strisciuglio, Pasquale Vergara, Giovanni Esposito, Antonio Rapacciuolo","doi":"10.1111/jce.70469","DOIUrl":"https://doi.org/10.1111/jce.70469","url":null,"abstract":"<p><strong>Introduction: </strong>The optimal duration of implantable loop recorder (ILR) monitoring remains uncertain and may differ according to the indication for implantation. We evaluated whether the time-dependent diagnostic yield and clinical relevance of ILR-detected arrhythmias differ among patients implanted for syncope, palpitations, cryptogenic stroke, or Brugada syndrome.</p><p><strong>Objective: </strong>This study sought to define the time-dependent diagnostic yield of ILRs across clinical indications and to assess whether early and late diagnoses differed in their impact on clinical management.</p><p><strong>Methods and results: </strong>We retrospectively analyzed 1734 consecutive patients undergoing ILR implantation at 5 Italian centers for unexplained syncope, palpitations, cryptogenic stroke, or Brugada syndrome. Diagnosis of interest was defined according to the implant indication: pauses for syncope, supraventricular tachycardia or atrial fibrillation for palpitations, atrial fibrillation for cryptogenic stroke, and ventricular tachycardia or pauses for Brugada syndrome. Median follow-up was 34 months. Maximally selected rank statistics identified 26 months as the global threshold separating early from late diagnoses, while indication-specific optimal diagnostic windows were 14 months for syncope, 13 months for palpitations, 16 months for cryptogenic stroke, and 55 months for Brugada syndrome. In syncope and palpitations, most actionable diagnoses occurred early, and diagnostic efficiency declined markedly after 26 months, with late findings often less clearly related to the index presentation. In cryptogenic stroke, atrial fibrillation detection was most frequent early but could still lead to changes in antithrombotic management later, supporting an individualized \"gray-zone\" approach to prolonged monitoring. By contrast, Brugada syndrome showed sustained diagnostic yield over extended follow-up, with late ventricular arrhythmias or pauses retaining major prognostic and therapeutic implications, including implantable cardioverter-defibrillator implantation and device-type selection.</p><p><strong>Conclusions: </strong>The value of ILR monitoring is strongly time- and indication-dependent. Prolonged routine monitoring or reimplantation appears to have limited incremental value in syncope and palpitations when early follow-up is unrevealing, whereas extended surveillance may remain justified in Brugada syndrome and should be individualized after cryptogenic stroke. These observations support indication-driven ILR follow-up strategies rather than a uniform approach based on device longevity alone.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900684","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 On-Site Cardiothoracic Surgery Availability on Outcomes of Catheter Ablation for Atrial Fibrillation in the United States.","authors":"Siddharth Agarwal, Harsh Patel, Zain Ul Abideen Asad, Muhammad Bilal Munir, Freddy Del-Carpio Munoz, Christopher V DeSimone, Abhishek Deshmukh","doi":"10.1111/jce.70495","DOIUrl":"10.1111/jce.70495","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation is an established rhythm control strategy for atrial fibrillation (AF) but carries a small risk of serious complications that may require emergent surgical intervention. Historically, the availability of on-site cardiothoracic surgery (CTS) has been considered an important safety requirement. However, contemporary advances in ablation techniques and peri-procedural care have improved procedural safety, and real-world data evaluating the impact of on-site CTS availability in current practice remain limited.</p><p><strong>Methods: </strong>We analyzed the National Readmissions Database (NRD) from 2016 to 2021 to identify adults undergoing catheter ablation for AF. Hospitals were classified based on the presence of on-site CTS, defined by the performance of coronary artery bypass graft surgery. Baseline characteristics were compared between groups. Multivariable logistic regression was used to assess the association between on-site CTS availability and in-hospital complications, mortality, discharge disposition, and 30-day all-cause readmissions, adjusting for demographic and clinical covariates.</p><p><strong>Results: </strong>Among 81 471 patients undergoing AF ablation, 3.3% were treated at centers without on-site CTS and 96.7% at centers with CTS. Patients treated at centers without CTS were older, more frequently female, and had a higher comorbidity burden, including greater thromboembolic risk. After multivariable adjustment, on-site CTS availability was not independently associated with in-hospital mortality, cardiac perforation, pericardiocentesis, need for open heart surgery, vascular, pulmonary, or neurological complications, discharge to home, or 30-day readmissions.</p><p><strong>Conclusion: </strong>In this large, contemporary national cohort, the availability of on-site cardiothoracic surgery was not independently associated with improved peri-procedural or short-term outcomes following AF ablation.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"2124-2128"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13576616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887495","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":"Pooled Efficacy and Safety of Left Atrial Appendage Occlusion Versus Direct Oral Anticoagulants or Antiplatelets: A Meta-Analysis of the Landmark Randomized Trials.","authors":"Leonardo M Knijnik, Birju Rao, David B DeLurgio","doi":"10.1111/jce.70493","DOIUrl":"10.1111/jce.70493","url":null,"abstract":"<p><strong>Background: </strong>Landmark randomized controlled trials (RCTs) comparing left atrial appendage occlusion (LAAO) against direct oral anticoagulants (DOACs) are individually underpowered for small but clinically meaningful differences. We performed a pooled meta-analysis to provide more precise efficacy and safety data.</p><p><strong>Methods: </strong>Utilizing random-effects models, we pooled data from 5890 patients across four landmark RCTs (PRAGUE-17, CLOSURE-AF, OPTION, and CHAMPION-AF) at their longest follow-up.</p><p><strong>Results: </strong>There were no significant differences between LAAO and antithrombotics in cardiovascular mortality (5.3% vs. 4.8%, p = 0.33), all-cause stroke (3.3% vs. 2.8%, p = 0.31), systemic embolism (0.2% vs. 0.1%, p = 0.68), or major bleeding (6.6% vs. 6.8%, p = 0.85). Non-procedural bleeding was significantly lower with LAAO (9.2% vs. 16.7%; RR 0.55; 95% CI 0.47-0.64; p < 0.0001), though there was a numerical trend toward more ischemic stroke events (2.7% vs. 2.0%; RR 1.35; 95% CI 0.97-1.88; p = 0.08).</p><p><strong>Conclusion: </strong>LAAO offers similar overall efficacy and safety to modern antithrombotics. It represents a clinical trade-off: accepting a known upfront procedural risk for a robust, long-term reduction in non-procedural bleeding, potentially at the cost of a slight numerical increase in ischemic stroke.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":"2122-2123"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13576593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887567","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}