Journal of Interventional Cardiac Electrophysiology最新文献

{"title":"Non-invasive prediction of atrial cardiomyopathy characterized by multipolar high-density contact mapping.","authors":"Moritz T Huttelmaier, Alexander Gabel, Jonas Herting, Manuel Vogel, Stefan Störk, Stefan Frantz, Caroline Morbach, Thomas H Fischer","doi":"10.1007/s10840-025-02001-2","DOIUrl":"10.1007/s10840-025-02001-2","url":null,"abstract":"<p><strong>Introduction: </strong>Atrial cardiomyopathy (AC) establishes links between atrial fibrillation (AF), left atrial (LA) mechanical dysfunction, structural remodeling, and thromboembolic events. Early diagnosis of AC may impact AF treatment and stroke risk prevention. Modern endocardial contact-mapping provides high-resolution electro-anatomical (EA) maps of the LA, thus allowing to display the myocardial substrate based on impaired signal amplitude and to characterize AC. Correlation of invasively assessed AC using a novel, multipolar mapping catheter (OCTARAY™, Biosense Webster, limited market release) and LA echocardiographic parameters could form the basis for a set of echo parameters for non-invasive prediction of AC.</p><p><strong>Methods: </strong>We retrospectively identified 50 adult patients who underwent primary pulmonary vein isolation (PVI) for paroxysmal or persistent AF between 08/22 and 05/23 fulfilling the selection criteria: (i) EA mapping with a novel multipolar mapping catheter (Octaray®); (ii) acquisition of voltage maps in sinus rhythm (SR) with ≥ 5000 points/map; and (iii) transthoracic echocardiography acquired in SR ≤ 48 h before PVI. Exclusion criterion was previous LA ablation. We generated EA maps with two sets of upper voltage thresholds (0.2-0.5 mV and 0.2-1.0 mV) and assessed total LA low voltage area (LVA). As LVA thresholds for the classification of AC are not yet established, an unsupervised machine learning cluster analysis was performed using a Gaussian mixture model (GMM), and two groups of patients with mild and severe AC were identified. Based on these two groups, we selected echo parameters for further analysis by applying the Boruta algorithm. The predictive capacity of the selected parameters was evaluated using a support vector machine.</p><p><strong>Results: </strong>The mean age of the studied sample (n = 50) was 63 ± 11 years, 62% were men, 64% showed persistent AF, median CHA₂DS₂-VASc score was 2 (quartiles 1, 3), and NT-proBNP was 190 (71, 391) pg/ml. A median of 5771 (5217, 6988) points/map were acquired. GMM yielded clusters of mild AC (n = 28) and severe AC (n = 22). Median LVA was 0.6 cm² (< 0.5 mV) resp. 4.1 cm² (< 1.0 mV) in group mild AC and 6.9 cm² (< 0.5 mV) resp. 27.2 cm² (< 1.0 mV) in group severe AC. Several echocardiographic parameters differed between the groups of mild and severe AC: dynamic LA parameters (end diastolic LA reservoir strain: 24.5% (22, 29) vs 15% (12, 19), p < 0.001; LA reservoir strain at atrial contraction: 22% (19, 25) vs 15% (11, 18), p < 0.001, end diastolic LA contraction strain: 13% (8, 15) vs 7.5% (3, 13), p < 0.01) as well as LA end-systolic volume index to a´ ratio (LAVI/a': 297 (231,365) vs 510 (326,781), p < 0.01). Consistent distribution of NT-proBNP (mild AC: 125 (48,189) pg/ml, severe AC: 408 (254,557) pg/ml, p < 0.0001) and CHA₂DS₂-VASc score (mild AC: 1 (1-","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"865-876"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined subcutaneous implantable cardioverter defibrillator and pacemaker devices in complex congenital heart disease: a single-center experienced based study.","authors":"Berardo Sarubbi, Giovanni Domenico Ciriello, Giovanni Papaccioli, Anna Correra, Emanuele Romeo, Nicola Grimaldi, Diego Colonna, Michela Palma","doi":"10.1007/s10840-023-01670-1","DOIUrl":"10.1007/s10840-023-01670-1","url":null,"abstract":"<p><strong>Background: </strong>Subcutaneous implantable cardioverter defibrillators (S-ICD) are widely accepted therapy in congenital heart disease (CHD) patients at risk of life-threatening ventricular arrhythmias or sudden cardiac death (SCD) when pacing is not required. Occasionally, pacemaker (PM)-dependent CHD patients will subsequently develop an indication for a cardioverter defibrillator. The use of S-ICD in complex CHD patients who have had already PM devices implanted implies some specific considerations, as the safety for these patients in unknown and recommendations among physicians may vary widely.</p><p><strong>Methods: </strong>We review the data and studied the indications for S-ICD in complex CHD with previous PM and discuss its usefulness in clinical practice.</p><p><strong>Results: </strong>From a large cohort of 345 patients enrolled in the S-ICD Monaldi care registry, which encompass all the patients implanted in the Monaldi Hospital of Naples, we considered 11 consecutive complex CHD patients (10M/1F aged 40.4 ±18.4 years) who underwent S-ICD implant after a previous PM implant, from February 2015 to October 2022. Mean follow-up was 25.5 ± 22 months. All the patients showed a good compliance to the device system with no complications (infections or skin erosions).</p><p><strong>Conclusions: </strong>In complex CHD with already implanted PM devices, S-ICD implant appears to be a safe alternative to PM upgrading to transvenous ICD system, avoiding abandoned leads or life-threatening lead extraction. However, there are important issues with regard to testing and programming that need to be addressed at the time of implantation.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"737-747"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50158116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT-scan-guided-irrigated trans-catheter ablation of epicardial accessory pathways in the coronary sinus: safety and feasibility in pediatric patients.","authors":"Fabrizio Drago, Francesco Flore, Rita Blandino, Aurelio Secinaro, Ilaria Cazzoli, Cristina Raimondo, Corrado Di Mambro","doi":"10.1007/s10840-024-01921-9","DOIUrl":"10.1007/s10840-024-01921-9","url":null,"abstract":"<p><strong>Background: </strong>The most common site of epicardial APs is posterior-septal, and ablation from the coronary sinus (CS) or its main tributaries is needed. However, particularly in children, it can carry a considerable risk of complications, such as coronary artery (CA) injury, CS damage, and perforation. This study aims to assess the efficacy and safety of computed tomography (CT)-scan-guided-irrigated trans-catheter (TC) ablation of epicardial APs through the CS in children.</p><p><strong>Methods: </strong>Twenty-four children (19 males; mean age 13.8 ± 2.6) with posterior-septal and left posterior epicardial APs who underwent an endocavitary electrophysiological study (EPS) and TC ablation from the CS were enrolled in this study. All patients underwent a CT scan to visualize the CS and its branches and their proximity to the CAs before the ablation. Clinical, electrophysiological and follow-up data were collected.</p><p><strong>Results: </strong>Acute success rate was 87.5% (21 out of 24 procedures). No complications occurred. In 16 (66.7%) patients, the ablation site was detected at the proximal CS, in two (8.3%) patients in the mid-proximal CS and in six (25%) in the middle cardiac vein (MCV). Ablation was achieved using an irrigated radiofrequency (RF) catheter in all patients and without the use of fluoroscopy in 20 patients (83.3%). Over a median follow-up of 15.1 months (IQR 2.5-32.3), no recurrences or complications occurred.</p><p><strong>Conclusion: </strong>Epicardial posterior-septal and left posterior APs, in the area of CS or MCV, can be definitively eliminated in most children using CT-scan-guided electro-anatomical mapping and transvenous irrigated RF ablation.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"795-802"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surveillance of esophageal injury after atrial fibrillation catheter ablation.","authors":"Alberto Pereira Ferraz, Cristiano Faria Pisani, Esteban Wisnivesky Rocca Rivarola, Tan Chen Wu, Francisco Carlos da Costa Darrieux, Rafael Alvarenga Scanavacca, Carina Abigail Hardy, Muhieddine Omar Chokr, Denise Tessariol Hachul, Maurício Ibrahim Scanavacca","doi":"10.1007/s10840-024-01922-8","DOIUrl":"10.1007/s10840-024-01922-8","url":null,"abstract":"<p><strong>Aims: </strong>Atrial-esophageal fistula following ablation procedures for atrial fibrillation (AF) remains a major concern. There is no standardized approach to minimize the risk and morbidity of this serious complication. The objective of this study was to present the 7-year experience of systematic endoscopic surveillance of esophageal injury after AF catheter ablation.</p><p><strong>Methods: </strong>This was a retrospective single-center registry of systematic endoscopic evaluations after consecutive AF ablation procedures performed from 2016 to 2022.</p><p><strong>Results: </strong>A total of 677 AF ablation procedures with controlled esophagogastroduodenoscopy (EGD) were analyzed during that period. Most patients were male (71%) with paroxysmal AF (71%). Radiofrequency with electroanatomical mapping was the main ablation approach for 633 patients (93.5%). Esophageal temperature monitoring was performed using a single sensor in 220 patients (34.3%) and a multisensor probe in 296 patients (46%). Most of the patients presented no esophageal lesions (75,7%). Severe lesions (Kansas-city-classification KCC 2B) were found in 46 (6.8%) of them, requiring a new EGD in 7 days. KCC2B lesions were persistent in 3 patients, 2 of whom had ulcers during healing and 1 patient with a deep ulcer of 10 mm who was admitted to the hospital and underwent fasting and parenteral nutrition. The ulcer healed in the second week after the procedure. Both esophageal temperature monitoring strategies were equivalent at preventing thermal lesions. Additionally, a greater left atrium (LA) was associated with a lower incidence of esophageal ulcer (P = 0.028). Most of the lesions spontaneously healed.</p><p><strong>Conclusion: </strong>The incidence of esophageal injury after ablation was 24.3%. Most (72%) were mild lesions that required no therapeutic intervention. A larger left atrium (LA) was correlated with a lower incidence of thermal lesions. Early endoscopy can help diagnose severe esophageal lesions and may provide additional information for the surveillance of esophageal injury after AF ablation.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"825-833"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A simple technique for manipulating a pentaspline pulsed field ablation catheter to select right inferior pulmonary vein using vertebral body alignment.","authors":"Yoshiaki Mizutani, Daishi Nonokawa, Masaaki Kanashiro, Satoshi Yanagisawa, Yasuya Inden, Toyoaki Murohara","doi":"10.1007/s10840-025-01999-9","DOIUrl":"10.1007/s10840-025-01999-9","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"731-733"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An approach to electroanatomical mapping with a pentaspline pulsed field catheter to guide atrial fibrillation ablation.","authors":"Mark T Mills, Peter Calvert, Calum Phenton, Nicole Worthington, Derick Todd, Simon Modi, Reza Ashrafi, Richard Snowdon, Dhiraj Gupta, Vishal Luther","doi":"10.1007/s10840-025-01980-6","DOIUrl":"10.1007/s10840-025-01980-6","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) of atrial fibrillation (AF) using a pentaspline multi-electrode catheter is commonly performed under fluoroscopic guidance. No data exist on the integration of this catheter within a three-dimensional electroanatomical mapping (3D-EAM) system for left atrial voltage and activation mapping, posterior wall isolation (PWI), or redo ablation. This technical report reviews an approach whereby mapping is performed using the pentaspline PFA catheter itself within an open architectural impedance-based 3D-EAM system.</p><p><strong>Methods: </strong>Cases involved mapping with the PFA catheter itself, with real-time visualisation of the guidewire tip and catheter within the 3D-EAM system. In certain cases, additional 3D-EAM was performed with a grid-style high-density mapping catheter for comparison.</p><p><strong>Results: </strong>In a series of 22 patients (45% female, mean age 63 ± 13 years, 55% paroxysmal AF, 27% redo procedures), mapping increased procedural times (mean 108 min vs. 68 min in fluoroscopy-only controls), without reducing fluoroscopy times. Three potential advantages of mapping with the PFA catheter were identified: (1) The technique helped identify sleeves of incomplete pulmonary vein isolation after index applications. (2) In the four cases mapped with both the PFA and grid-style catheters, voltage maps appeared concordant. (3) The technique helped facilitate robust PWI and identify inadvertent partial PWI.</p><p><strong>Conclusions: </strong>3D-EAM with a pentaspline PFA catheter itself is feasible, without the need for high-density mapping catheters. This approach has potential advantages over fluoroscopic-only guidance, although its long-term efficacy and cost-effectiveness require formal assessment.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"921-931"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiofrequency balloon ablation: 1-year outcomes of the AURORA study.","authors":"Ilaria My, Boris Schmidt, Laura Rottner, Shota Tohoku, Marc Lemoine, David Schaack, Fabian Moser, Lukas Urbanek, Julius Obergassel, Djemail Ismaili, Jun Hirokami, Paulus Kirchhof, Karin Plank, Bruno Reissmann, Feifan Ouyang, Andreas Rillig, Julian Chun, Andreas Metzner, Stefano Bordignon","doi":"10.1007/s10840-024-01938-0","DOIUrl":"10.1007/s10840-024-01938-0","url":null,"abstract":"<p><strong>Background: </strong>A novel irrigated radiofrequency balloon (RFB) for pulmonary vein isolation (PVI) integrated into a 3D mapping platform was recently launched.</p><p><strong>Methods: </strong>Patients undergoing a first atrial fibrillation (AF) ablation at two German high-volume EP centers were included into the prospective AURORA registry. All patients underwent clinical follow-up (FU) at 90, 180, and 360 days following ablation including 48-h Holter ECGs.</p><p><strong>Results: </strong>A total of 99 patients were enrolled (43/99 (43.4%) women, median age 67 years (interquartile range [IQR] 59-74), 43/99 (43.4%) persistent AF (Pers-AF), median left ventricular ejection fraction (LVEF) 60% (IQR 62-55)). Eighty-eight patients completed the follow-up. Acute PVI was achieved in 383/383 (100%) PV. Single-shot PVI was achieved in 211/383 (55.1%) PVs. Primary adverse events occurred in 3% of patients (1 postprocedural pharyngeal bleeding, 1 myocardial infarction, 1 non-cardiovascular death); no pericardial effusion, stroke, or phrenic nerve paralysis was observed. Median ablation and procedure times were 23 (IQR 18-32) and 67 (IQR 57-85) min, respectively. Median dose area product was 761 (IQR 509-1534) mGycm². AF-free survival after a median FU of 361 (IQR 261-375) days was 78.4% for paroxysmal AF (PAF) and 75.4% for Pers-AF (p value = 0.828). Early recurrence of atrial tachyarrhythmia at the 90-day visit was the only independent predictor for AF recurrence at 1 year upon multiple regression analysis (hazard ratio [HR] 3.198; 95% confidence interval [95% CI] 1.036-10.32, p value = 0.0433).</p><p><strong>Conclusion: </strong>RFB-based PVI is acutely successful, appears safe, and has comparable rhythm outcomes to other single-shot AF ablation tools. A recurrence of AF at 90 days predicts later AF recurrence.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"835-844"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Near-zero fluoroscopy workflow for pulmonary vein isolation in atrial fibrillation using a variable loop, 3D-integrated circular PFA catheter (Varipulse™): initial single-center experience with the first 35 patients.","authors":"M Borlich, S Groschke, J Wietgrefe, F Witt, A Paulssen, S Fichtlscherer, A Elsässer, H Nef, L Iden","doi":"10.1007/s10840-025-01981-5","DOIUrl":"10.1007/s10840-025-01981-5","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation is a standard atrial fibrillation (AF) treatment, traditionally using radiofrequency (RF) or cryoablation, which carries the risk of damaging nearby structures. Pulsed field ablation (PFA) offers partly tissue-selective energy application with minimal collateral damage. This study evaluated a near-zero fluoroscopy workflow with the novel VARIPULSE™ catheter, combining advanced mapping for optimized PFA delivery and reduced radiation. Here, we investigate the safety, efficiency, and effectiveness of this approach in the first 35 patients treated.</p><p><strong>Objective: </strong>This study aimed to assess the procedural characteristics, safety, and acute efficacy of pulmonary vein isolation (PVI) using the VARIPULSE™ PFA catheter in patients with AF, while specifically evaluating a near-zero fluoroscopy workflow to minimize radiation exposure during the procedure.</p><p><strong>Methods: </strong>Thirty-five consecutive patients with paroxysmal or persistent AF underwent pulmonary vein isolation (PVI) using the VARIPULSE™ PFA catheter. Procedures were conducted under general anesthesia or deep sedation. Key procedural endpoints included acute pulmonary vein isolation, total procedure time, left atrial (LA) dwell time, fluoroscopy time and dose, and safety outcomes, with a focus on assessing the feasibility of a near-zero fluoroscopy workflow.</p><p><strong>Results: </strong>Thirty patients underwent near-zero fluoroscopy atrial fibrillation ablation using the novel VARIPULSE™ Pulsed Field Ablation catheter. Patients had a median age of 70 years and typical cardiovascular comorbidities, with 54% presenting with paroxysmal AF. Thirty-three of 35 patients (94%) had a normal left ventricular systolic function (> 60%). The median CHA₂DS₂-VA score was 2 (IQR 1-3.75). Sinus rhythm was observed in 66% of cases at procedure start. Median fluoroscopy time was 0.8 min, total median procedure time 53 min, median LA dwell time 38 min, and median fluoroscopy dose 20.4 µGym². Pulmonary vein isolation was achieved in 100% of cases without radiofrequency touch-up. No major complications occurred.</p><p><strong>Conclusion: </strong>The VARIPULSE™ Pulsed Field Ablation system enables an efficient, nearly fluoroscopy-free atrial fibrillation ablation with a simple, easily integrable workflow in the electrophysiology lab. Complete pulmonary vein isolation was achieved in all cases without radiofrequency touch-ups, and the procedure was safe with no major complications. This demonstrates the potential for widespread adoption of this technology and workflow.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"877-884"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catheter ablation in rate-controlled atrial fibrillation with severely reduced ejection fraction: intervention for irregularity-mediated cardiomyopathy.","authors":"Samuel D Maidman, Anthony Aizer, Lior Jankelson, Douglas Holmes, David S Park, Scott A Bernstein, Robert Knotts, Alex Kushnir, Larry A Chinitz, Chirag R Barbhaiya","doi":"10.1007/s10840-024-01965-x","DOIUrl":"10.1007/s10840-024-01965-x","url":null,"abstract":"<p><strong>Background: </strong>Recent evidence suggests atrial fibrillation (AF) causes cardiomyopathy due to remodeling driven by both irregular rate and rhythm. Atrial fibrillation (AF) ablation in patients with reduced ejection fraction (EF) ≤ 35% has been shown to improve EF and mortality. It is unknown whether the benefits of AF ablation among patients with reduced EF are affected by the degree of pre-ablation rate control.</p><p><strong>Objectives: </strong>To evaluate AF ablation echocardiographic outcomes for patients who have EF ≤ 35% with varying degrees of pre-ablation rate control.</p><p><strong>Methods: </strong>Single-center, retrospective study of patients with EF ≤ 35% undergoing first-time ablation of persistent AF. Primary analyses evaluated the degree to which pre-ablation rate control impacted echocardiographic outcomes. Rates of EF recovery to > 35% were compared at three different cutoffs: 110 bpm, 90 bpm, and 70 bpm. A linear regression analysis was then performed to evaluate whether baseline heart rate (HR) predicted change in EF.</p><p><strong>Results: </strong>Among 73 patients, the mean pre-ablation resting HR was 90 ± 25 bpm, and baseline EF was 27 ± 7%. Patients experienced significant improvements in EF by mean + 14% ± 11% (p < 0.001). Post-ablation EF recovery occurred in 60% of patients. No differences in EF improvement were detected at HR control targets of ≤ 110 bpm or ≤ 90 bpm, while patients achieving HR ≤ 70 bpm had less improvement in EF (+ 9% ± 9%) compared to those with HR above the cutoff (+ 16% ± 11%; p = 0.01). Linear regression analysis did not reveal baseline HR as a significant predictor of change in LVEF (slope = 0.09, r² = 0.05, p = 0.07).</p><p><strong>Conclusions: </strong>Catheter ablation of persistent AF in patients with reduced EF frequently resulted in recovery in EF > 35%, irrespective of pre-ablation achieved rate control. While patients with HR > 70 bpm experienced a greater improvement in EF compared to those ≤ 70 bpm, patients with baseline HR below this target still experienced significant EF improvements. Further investigation into irregularity-mediated cardiomyopathy is warranted.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"857-864"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative considerations for choosing between Amulet and Watchman FLX and management of device related complications.","authors":"Alexander Kushnir, Chirag R Barbhaiya, Lior Jankelson, Douglas Holmes, Anthony Aizer, David Park, Michael Spinelli, Scott Bernstein, Leonard Garber, Felix Yang, Richard Ro, Larry A Chinitz","doi":"10.1007/s10840-025-02011-0","DOIUrl":"10.1007/s10840-025-02011-0","url":null,"abstract":"<p><strong>Background: </strong>Left atrial appendage occlusion (LAA-O) with Amulet and Watchman FLX are approved for reducing stroke risk in patients with atrial fibrillation when oral anticoagulation is not tolerated. Real world clinical outcomes reported along with imaging data are needed to help clinicians choose between these two technologies and manage device-related complications.</p><p><strong>Methods: </strong>The study retrospectively analyzed clinical, transesophageal (TEE), and available computed tomography (CT) data from 364 FLX and 292 Amulet procedures performed at an academic medical center over a 4-year period.</p><p><strong>Results: </strong>LAA-O procedures were successful in 96.7% FLX and 97.3% Amulet cases. FLX implant success rate increased to 98.9% when only patients with LAA diameter to depth ratio < 1.8 and LAA area < 4.4 cm² were included. TTE LAA-orifice area correlated with CT-derived measurements. There were more late pericardial effusions for Amulet (3.1%) compared to FLX (0.3%), though the majority were conservatively managed. Mean procedure times were similar (FLX 64 ± 24, Amulet 65 ± 21 min) as were the rates of device related thrombus (FLX 1% and Amulet 1.4%). Clinically relevant peridevice leak (PDL) on follow-up TEE imaging was greater for FLX (16%) compared to Amulet (10%). Combined AF ablation-LAA-occlusion procedures exhibited lower rates of PDL and late pericardial effusions compared to solo procedures.</p><p><strong>Conclusions: </strong>Based on retrospective analysis, an initial strategy with Watchman FLX in patients with favorable LAA anatomy would reduce the risk of late pericardial effusions at the expense of a higher rate of clinically relevant PDL compared to Amulet. Combined AF ablation and LAA-O procedures exhibit less PDL.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"909-920"},"PeriodicalIF":2.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}