Journal of Cardiovascular Electrophysiology最新文献

{"title":"One-Year Clinical Outcomes of Novel Dual-Sized Cryoballoon Ablation for Atrial Fibrillation.","authors":"Yosuke Hayashi, Shinsuke Miyazaki, Junichi Nitta, Takeshi Sasaki, Yasuteru Yamauchi, Osamu Inaba, Yukio Sekiguchi, Shu Yamashita, Yuichiro Sagawa, Yukihiro Inamura, Kentaro Goto, Takuro Nishimura, Tetsuo Sasano","doi":"10.1111/jce.70066","DOIUrl":"https://doi.org/10.1111/jce.70066","url":null,"abstract":"<p><strong>Background: </strong>Clinical outcomes after atrial fibrillation (AF) ablation using the novel dual-sized cryoballoon (DS-CB) are limited. This study aimed to analyze real-world data on the DS-CB.</p><p><strong>Methods: </strong>This multicenter observational study included consecutive AF patients who underwent pulmonary vein (PV) isolation (PVI) using a DS-CB catheter (28-mm/31-mm).</p><p><strong>Results: </strong>In 407 patients (68 ± 11 years, 279 men, 251 paroxysmal AF[PAF]), 1528 (95.9%) out of 1594 targeted PVs were successfully isolated with DS-CBs. The total application number and application time were 5 [4-6] and 812 ± 207 s, respectively. Cryoballoon-related phrenic nerve injury (PNI) occurred in 23 (5.6%) patients, with 4.7% in the right superior PV (RSPV) and 1.0% in the right inferior PV. All but one patient recovered within 12 months. Additional ablation beyond CB-PVI was performed in 251 (62%) patients. The 1-year arrhythmia freedom was 91.7% (93.3% for PAF and 89.5% for non-PAF, p = 0.08), with antiarrhythmic drug use in 23 (9.2%) and 32 (20.6%) PAF and non-PAF patients, respectively. Forty-three patients experienced early recurrence of AF (ERAF) within 2 months of follow-up. In a multivariate Cox regression analysis, including baseline and procedural parameters, a higher nadir balloon temperature in the RSPV (hazard ratio[HR] = 1.076, 95% confidence interval[CI] = 1.024-1.130, p < 0.01) and all 4 PVI with 31-mm balloons (HR = 3.085, 95% CI = 1.701-5.595, p < 0.01) were significantly associated with arrhythmia recurrence. In the multivariate analysis including all parameters, ERAF (HR = 5.066, 95% CI = 2.928-8.767, p < 0.01) was the strongest predictor of arrhythmia recurrence.</p><p><strong>Conclusions: </strong>The 1-year arrhythmia freedom post-DS-CB ablation was 91.7% in real-world clinical practice; however, right PNI remained a common complication, even with the balloon size adjustability.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873318","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 and Hemolysis: Critical Insights Into a Novel Technology.","authors":"Masateru Takigawa","doi":"10.1111/jce.70064","DOIUrl":"https://doi.org/10.1111/jce.70064","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873319","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":"Reducing Unnecessary Implantable Cardioverter-Defibrillator Therapy With ENHANCED Programming: Long-Term Outcomes of the ENHANCED-ICD Study.","authors":"Cheyenne S L Chiu, Akke van Dijkhuizen, Willem Gerrits, Maarten J Cramer, Anton E Tuinenburg, Pim van der Harst, Mathias Meine","doi":"10.1111/jce.70060","DOIUrl":"https://doi.org/10.1111/jce.70060","url":null,"abstract":"<p><strong>Background: </strong>Advances in implantable cardioverter-defibrillator (ICD) programming strategies have achieved significant reductions in inappropriate shocks. However, further refinement is needed to minimize appropriate but unnecessary therapies. The ENHANCED-ICD study initially demonstrated the short-term safety and efficacy of programming a number of intervals to detect (NID) of 60/80 over a median follow-up of 1.3 years. A decade later, this study presents the long-term impacts of this programming strategy.</p><p><strong>Objective: </strong>To assess the long-term impact of programming NID 60/80 for ventricular tachycardia (VT)/ventricular fibrillation (VF) detection on adverse events related to shocks and arrhythmias, as well as on ICD therapies-both delivered and avoided.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 60 patients from the ENHANCED-ICD study, a prospective, single-center trial. The median age was 60 years, 78% were men, and 53% had a primary prevention ICD indication. A prolonged detection interval of NID 60/80 was programmed for VT/VF detection. The cycle lengths for VT/fast VT/VF were set at 360/330/240 ms, respectively.</p><p><strong>Results: </strong>After a median follow-up of 9.4 years, Enhanced programming prevented unnecessary ICD therapies in 16.7% of patients and reduced the overall therapy rate by 25.9%. A total of 26.7% of patients received ICD therapy, with appropriate therapy delivered in 23.3% and inappropriate therapy occurring in 3.3% of patients. No arrhythmic deaths were observed, while syncope was reported in 10.0% of patients (1.63 per 100 patient-years).</p><p><strong>Conclusion: </strong>Prolonging the ICD detection interval to an NID of 60/80 successfully prevented appropriate but unnecessary therapy, while maintaining safety during long-term follow-up.</p><p><strong>Trial registration: </strong>The ENHANCED-ICD study registered on http://ClinicalTrials.gov under study ID NCT01715116.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873320","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":"Unravelling Sex Disparities in the Pathophysiology of Atrial Fibrillation: Review of the Current Evidence.","authors":"Ibrahim Antoun, Georgia R Layton, Ahmed Abdelrazik, Mahmoud Eldesouky, Hayley Davies, Osama Barakat, Amal Mahfoud, Abdulmalik Koya, Edward Y M Lau, Mustafa Zakkar, G André Ng, Riyaz Somani","doi":"10.1111/jce.70063","DOIUrl":"https://doi.org/10.1111/jce.70063","url":null,"abstract":"<p><p>Atrial fibrillation (AF) is the most common sustained arrhythmia associated with increased risks of stroke, heart failure, and mortality. Men experience AF more frequently than women, but women are more likely to suffer greater symptoms and reduced quality of life as a consequence of AF onset. Its pathophysiology is complex, influenced by hormonal, structural, electrophysiological, and genetic factors. Sex hormones, including oestrogen, progesterone, and testosterone, play critical roles in modulating cardiac electrophysiology, autonomic function, and atrial remodelling, contributing to sex-specific differences in AF prevalence and outcomes. Women experience increased AF risk post-menopause due to declining oestrogen levels, while testosterone fluctuations in men are associated with arrhythmogenesis. Thyroid hormones further complicate the hormonal landscape by influencing cardiac excitability and autonomic regulation. Electrophysiological and structural differences between sexes, such as longer P-wave durations and greater fibrosis in women, result in increased AF recurrence and complications, particularly after catheter ablation. Men, however, have a higher overall AF incidence, likely due to larger atrial sizes and different conduction properties. Lifestyle and psychological factors, including obesity, physical activity, and mental health, intersect with these sex-specific risks, further influencing AF susceptibility. Artificial intelligence (AI) offers transformative opportunities to integrate these factors into personalised prevention and treatment strategies, enhancing early detection and tailored interventions. This review highlights the critical role of hormonal and sex-specific factors in AF pathophysiology, emphasising the need for sex-specific approaches to optimise management. Understanding these mechanisms is essential for developing targeted, personalised strategies to improve outcomes for men and women with AF.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873323","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":"Reply to Letter to the Editor: The Single-Delayed-Phase Contrast Computed Tomography Before Ablation to Reduce Radiation Exposure Without Compromising Diagnostic Pulmonary Vein Accuracy.","authors":"Keishiro Yagyu, Yasushi Oginosawa","doi":"10.1111/jce.70068","DOIUrl":"10.1111/jce.70068","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873321","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":"Methodological Limitations in the Assessment of Intermittent Ventricular Pre-Excitation in WPW Syndrome.","authors":"Ayesha Abbas, Muhammad Riyyan, Sawaira Sajid, Muhammad Saeed Qazi, Mohammad Mujtaba Khokhar","doi":"10.1111/jce.70070","DOIUrl":"https://doi.org/10.1111/jce.70070","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873317","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":"Can Artificial Intelligence Identify the Ideal Ablation Area for the Patients With Atypical Atrial Flutter? A Proof of Concept Study Using Developed Software.","authors":"Motoki Amagasaki, Tadashi Hoshiyama, Takuma Meitoma, Masato Kiyama, Kenji Morihisa, Yuji Ogura, Kenichi Tsujita","doi":"10.1111/jce.70058","DOIUrl":"https://doi.org/10.1111/jce.70058","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation for atypical atrial flutter (AFL) is challenging owing to its complex circuit. Consequently, the success rate varies depending on the circuit complexity and the operator's level of experience.</p><p><strong>Objective: </strong>This study aimed to create software using artificial intelligence to identify the critical isthmus of atypical AFL on 3D mapping.</p><p><strong>Methods: </strong>Raw data from 19 episodes of atypical AFL were extracted from the 3D mapping system. Local data, including location, activation timing, and voltage amplitude, were used to design software to identify areas where wavefronts converge and conduction slowing (which are characteristics of the optimal treatment area), that is, the critical isthmus, in patients with atypical AFL. Subsequently, the newly developed software was validated by evaluating the concordance between the software-estimated critical isthmus location and the actual AFL termination area.</p><p><strong>Results: </strong>This newly developed software identified the estimated critical isthmus in all cases in 24.9 (6.7-46.2) seconds. The concordance rate between Top 1 prediction area and actual AFL termination area was high of 79% (95% confidence interval: 56.7%-91.5%). Although 4 of the 19 episodes did not show concordance, it is assumed that ablation at the estimated critical isthmus may have resulted in arrhythmia termination in two cases.</p><p><strong>Conclusion: </strong>This newly developed software identified the optimal treatment area for the atypical AFL with high accuracy. Use of this software may enable faster and more precise treatments. Furthermore, it may allow less experienced operators to achieve results that are comparable to those of experienced operators.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144846627","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":"Conduction System Pacing With Stylet Driven Leads: A Step-By-Step Guide to Implant.","authors":"Ryan Burris, Amulya Gampa, Gaurav A Upadhyay","doi":"10.1111/jce.16794","DOIUrl":"https://doi.org/10.1111/jce.16794","url":null,"abstract":"<p><strong>Background: </strong>In recent years, there has been a surge of interest in strategies to perform conduction system pacing (CSP). Of these, left bundle branch area pacing (LBBAP) has rapidly gained popularity as the preferred approach to perform CSP due to favorable pacing thresholds and greater perceived ease of implant.</p><p><strong>Aim: </strong>The majority of initial descriptions of LBBAP has focused on use of lumenless pacing leads. More recently, stylet-driven leads have increasingly been utilized during CSP, and may have shorter procedure and fluoroscopy times. The purpose of this article is to provide a practical description of LBBAP with stylet-driven leads, with specific attention to tips and procedural nuances to achieve a successful implant.</p><p><strong>Results: </strong>We focus here on a \"step-by-step\" approach to CSP utilizing stylet-driven leads. For consistency, we have focused on the Boston Scientific Ingevity+ lead and Site Selective Pacing Catheter (SSPC) family of sheaths. Similar techniques can be also used with other stylet-driven including Abbott UltiPace and CPS Locator 3D family of catheters or the Biotronik Solia S and Selectra 3D family of catheters. The steps cover preprocedural planning and vascular access, sheath selection and placement, use of ventriculography, lead delivery and recording, sheath removal, and trouble-shooting.</p><p><strong>Conclusions: </strong>Stylet-driven leads are now a feasible option for patients undergoing implantation of a left bundle branch area pacemaker with overall technique which is similar to lumenless leads with a few key differences that can be learned relatively quickly and improve overall success rate.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144846628","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":"From Failure to Success: Lithotripsy Transforms Lead Extraction in a Same-Patient Case.","authors":"Ghazaleh Goldar, Edward M Powers","doi":"10.1111/jce.70052","DOIUrl":"https://doi.org/10.1111/jce.70052","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiac implantable electronic device infections often necessitate extraction, which can be complicated by calcified adhesions, leading to increased procedural risk and reduced efficacy. Given these challenges, intravascular lithotripsy (IVL) has been proposed as a tool for lead extraction to aid in overcoming calcification. This report presents the first reported case where shockwave IVL was successfully employed to extract a severely calcified lead system after an initial extraction attempt failed due to extensive calcification.</p><p><strong>Clinical background: </strong>A 58-year-old woman with a dual-chamber pacemaker and recurrent MSSA bacteremia was found to have extensive calcification around her leads. An initial TLE attempt failed due to extensive calcifications.</p><p><strong>Intervention: </strong>Three months later, given ongoing bacteremia, IVL was used during a repeat percutaneous extraction attempt. Lithotripsy pulses were applied via balloon catheter to disrupt calcified adhesions, enabling sheath advancement and lead mobilization.</p><p><strong>Results: </strong>Both atrial and ventricular leads were successfully extracted without major complications. The use of IVL directly enabled success where prior methods had failed.</p><p><strong>Conclusion: </strong>This is the first reported case of successful CIED lead extraction using IVL following a failed initial attempt due to severe calcification. This case illustrates IVL's potential in overcoming specific high-risk anatomic challenges.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835198","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 Arrhythmia Recurrence After First Direct-Current Cardioversion in People With Atrial Flutter.","authors":"Chang Yoon Doh, Francis Phan, Khidir Dalouk, Merritt Raitt, Ignatius G Zarraga, Peter M Jessel","doi":"10.1111/jce.70057","DOIUrl":"https://doi.org/10.1111/jce.70057","url":null,"abstract":"<p><strong>Introduction: </strong>Risk factors for recurrence of atrial arrhythmia following first direct-current cardioversion (DCCV) is not well understood. Therefore, we created a clinical predictive risk score for recurrence after the first DCCV in AFL.</p><p><strong>Methods: </strong>Individuals with atrial arrhythmia who underwent DCCV were prospectively enrolled in our Veterans Affairs EP database (2002-2016). Time to recurrence in AF versus AFL was compared using Kaplan-Meier analysis and log-rank test. The AFL cohort was divided into derivation (60%) and validation (40%) cohorts. Multivariable Cox proportional hazards (CPH) model was used to identify covariates associated with increased hazards of recurrence (HR, 95% CI). The REAL-PDX risk score was created and tested in the AFL validation cohort.</p><p><strong>Results: </strong>There were 860 individuals with atrial arrhythmias who underwent their first-time DCCV. The median time to recurrence was 3.4 months (95% CI 2.6-4.7) in the AF cohort (n = 572), and 1.7 years (1.4-2.2) in the AFL cohort (n = 288). The CPH analysis of the AFL derivation cohort (n = 176) revealed that CKD (HR 2.42; 95% CI 1.41-4.14), every 1 year of older age (1.03; 1.01-1.06), LA dilation (1.60; 1.00-2.55; p < 0.05), and > 1 year since diagnosis (2.10; 1.22-3.61) were independently associated with increased risk of recurrence. BMI, OSA, hypertension, cerebrovascular disease, COPD, and heart failure did not affect the hazards of recurrence. REAL-PDX risk score (REnal disease, Age ≥ 65, LA dilation, Prior DX) incorporated one point for each factor. REAL-PDX stratified by ≥ 3 versus < 3 in the AFL validation cohort (n = 112) showed significantly shorter median time to recurrence (125 vs. 800 days; p < 0.001) and higher risk of recurrence of atrial arrhythmia (3.74; 1.93-7.24).</p><p><strong>Conclusions: </strong>This simple REAL-PDX risk score allows prediction of higher risk of recurrence, which can help guide continued anticoagulation, early cavotricuspid isthmus ablation, or perhaps pulmonary vein isolation.</p>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835197","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}