Journal of Interventional Cardiac Electrophysiology最新文献

{"title":"Omnipolar mapping for increased precision in atrial fibrillation ablation.","authors":"Shivaraj Patil, Abhishek Deshmukh, Christopher V DeSimone","doi":"10.1007/s10840-024-01917-5","DOIUrl":"10.1007/s10840-024-01917-5","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"29-30"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132969","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":"Incidence and risk factors for first and recurrent ICD shock therapy in patients with an implantable cardioverter defibrillator.","authors":"Diana My Frodi, Søren Zöga Diederichsen, Lucas Yixi Xing, Daniel Camillo Spona, Peter Karl Jacobsen, Niels Risum, Jesper Hastrup Svendsen","doi":"10.1007/s10840-024-01873-0","DOIUrl":"10.1007/s10840-024-01873-0","url":null,"abstract":"<p><strong>Background: </strong>Advances in medical treatment and outcomes in implantable cardioverter-defibrillator (ICD) recipients incentivize a need for improved candidate selection and identification of risk factors for ICD therapy. We examined contemporary rates of and risk factors for ICD therapy.</p><p><strong>Methods: </strong>Patients with ICD for primary (PP) or secondary prevention (SP), implanted between January 2010 and December 2020, were followed for appropriate and inappropriate incident and recurrent shock.</p><p><strong>Results: </strong>Overall, 2998 patients (mean age 61.8 ± 12.7 years, 20% female, 73% ICD carriers, and 47.1% SP) were analyzed with a median follow-up of 4.3 (interquartile range (IQR) 2.1-7.4) years. A total of 426/2998 (14.2%) patients had shock; 364/2998 (12.1%) had appropriate and 82/2998 (2.7%) inappropriate shock, with annualized event rates of 2.34 (2.11-2.59) and 0.49 (0.39-0.61) per 100 person-years, respectively. Of those with shock, 133/364 (36.5%) experienced recurrent appropriate shock and 8/364 (2.2%) received recurrent inappropriate shock, with event rates of 10.57 (8.85-12.53) and 0.46 (0.20-0.92), respectively. In multivariable analyses, female sex was associated with a reduced risk of incident appropriate shock (hazard ratio 0.69 [95% confidence interval 0.52; 0.91]). Of other variables, only revascularization status was associated with recurrent appropriate shock in PP, and CRT-D with recurrent appropriate shock in the overall cohort.</p><p><strong>Conclusion: </strong>One in eight ICD recipients received appropriate shock 2-7 years after guideline-directed implantation. More than one-third of patients with a first shock experienced recurrent shock. Few clinical variables showed potential in predicting shocks, illustrating a need for more advanced tools to select candidates for implantation.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"125-139"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017777","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":"Comparing pulsed field ablation with very high-power and high-power short-duration radiofrequency ablation for atrial fibrillation: a systematic review and meta-analysis.","authors":"Elísio Bulhões, Roberto A S V Mazetto, Antunes L Vanio, Maria L R Defante, Luanna Feitoza, Camila Guida, Henry Huang","doi":"10.1007/s10840-024-01970-0","DOIUrl":"https://doi.org/10.1007/s10840-024-01970-0","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation is a key treatment for atrial fibrillation (AF), with high-power, very high-power short-duration and pulsed field ablation (PFA) being efficient options. However, direct comparisons between these techniques are lacking.</p><p><strong>Objective: </strong>We performed a systematic review and meta-analysis, which included predominantly observational studies (four retrospective and one prospective study), to compare PFA and High-power short-duration (HPSD) and very high-power short-duration (vHPSD) radiofrequency (RF) ablation in patients with AF.</p><p><strong>Methods: </strong>We searched PubMed, Embase and Cochrane Central. Outcomes of interest included: Arrhythmia-free survival (AF, atrial flutter, and atrial tachycardia recurrences 30 s during follow-up after a 1-month blanking period), procedure time, fluoroscopy time, fluoroscopy dose, complications overall. Statistical analysis was performed using the R program (version 4.3.2). Heterogeneity was assessed with I² statistics.</p><p><strong>Results: </strong>Our meta-analysis included 1,255 patients from 5 studies, with a mean age ranging from 63 to 68 years. Among them, 554 (45.2%) underwent pulsed field ablation (PFA) and 701 (55.8%) received high/very high potential short-duration ablation. PFA improved arrhythmia-free survival (RR 1.05; 95% CI 1.002-1.120; P = 0.004; I² = 0%) and reduced procedure time (MD -29.95 min; 95% CI -30.90 to -29.00; P < 0.01; I² = 0%). However, PFA increased fluoroscopy time (MD 6.33 min; 95% CI 1.65 to 11.01; P < 0.01; I² = 98%) and showed no significant difference in overall complications (RR 0.88; 95% CI 0.38-2.02; P = 0.756; I² = 47%), cardiac tamponade (RR 1.62; 95% CI 0.27-9.85; P = 0.599; I² = 40%), or stroke/transient ischemic attack (TIA) incidence (RR 0.64; 95% CI 0.15-2.80; P = 0.555; I² = 0%). PFA was associated with a reduced need for redo procedures (RR 0.66; 95% CI 0.45-0.97; P = 0.036; I² = 0%) and did not significantly affect the fluoroscopy dose (MD 896.86 mGy·cm²; 95% CI -1269.44 to 3063.15; P = 0.42; I² = 39%).</p><p><strong>Conclusion: </strong>In this meta-analysis, PFA was associated with improved arrhythmia-free survival and reduced procedure time, although it resulted in increased fluoroscopy time. PFA and high/very high power short-duration ablation yielded similar outcomes regarding overall complications, cardiac tamponade, and stroke/TIA incidence. Both techniques demonstrated comparable efficacy in treating atrial fibrillation.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909734","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":"Long-term impact of atrial fibrillation catheter ablation on heart failure with preserved ejection fraction.","authors":"Harsh Patel, Rezwan Munshi, Aakash Sheth, Siddharth Agarwal, Freddy Del-Carpio Munoz, Guru Kowlgi, Christopher V DeSimone, Mohamed Rafa Labedi, Sourbha Dani, Abhishek Deshmukh","doi":"10.1007/s10840-024-01939-z","DOIUrl":"https://doi.org/10.1007/s10840-024-01939-z","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of catheter ablation as a treatment approach for patients with concurrent atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) has been inadequately investigated.</p><p><strong>Objective: </strong>This study's objective was to assess the effectiveness of atrial fibrillation ablation (AFA) in patients with heart failure with preserved ejection fraction.</p><p><strong>Methods: </strong>Utilizing the TriNetX research network, we identified individuals aged 18 and older with atrial fibrillation (AF) and concurrent heart failure with preserved ejection fraction (HFpEF) from January 1, 2010, to June 1, 2021. Patients were further classified based on their catheter ablation procedure, using Current Procedural Terminology codes. Following propensity-score matching, each cohort consisted of 9440 patients. The primary endpoint was all-cause mortality at two years and secondary outcomes during the 2-year follow-up encompassing readmissions for heart failure, AF, and stroke.</p><p><strong>Results: </strong>In propensity-matched cohort, patients with AF and HFpEF who underwent AFA plus medical therapy had significantly lower all-cause mortality at two years than those who did not undergo AFA (hazard ratio (HR): 0.37, 95% CI: 0.34-0.40; P < 0.001) even after matching antiarrhythmic medications. At two years, secondary outcomes including HF readmissions (HR: 0.86 95% CI: 0.84-0.89; P < 0.001) and stroke readmissions (HR: 0.66 95% CI: 0.59-0.73; P < 0.001) were lower in the AFA group.</p><p><strong>Conclusion: </strong>AFA amongst AF patients with concomitant HFpEF showed a significant reduction in all-cause mortality. It also leads to significant reductions in readmissions due to HF and ischemic stroke at two years.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877149","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":"Image quality assessment and automation in late gadolinium-enhanced MRI of the left atrium in atrial fibrillation patients.","authors":"Benjamin Orkild, K M Arefeen Sultan, Eugene Kholmovski, Eugene Kwan, Erik Bieging, Alan Morris, Greg Stoddard, Rob S MacLeod, Shireen Elhabian, Ravi Ranjan, Ed DiBella","doi":"10.1007/s10840-024-01971-z","DOIUrl":"10.1007/s10840-024-01971-z","url":null,"abstract":"<p><strong>Background: </strong>Late gadolinium-enhanced (LGE) MRI has become a widely used technique to non-invasively image the left atrium prior to catheter ablation. However, LGE-MRI images are prone to variable image quality, with quality metrics that do not necessarily correlate to the image's diagnostic quality. In this study, we aimed to define consistent clinically relevant metrics for image and diagnostic quality in 3D LGE-MRI images of the left atrium, have multiple observers assess LGE-MRI image quality to identify key features that measure quality and intra/inter-observer variabilities, and train and test a CNN to assess image quality automatically.</p><p><strong>Methods: </strong>We identified four image quality categories that impact fibrosis assessment in LGE-MRI images and trained individuals to score 50 consecutive pre-ablation atrial fibrillation LGE-MRI scans from the University of Utah hospital image database. The trained individuals then scored 146 additional scans, which were used to train a convolutional neural network (CNN) to assess diagnostic quality.</p><p><strong>Results: </strong>There was excellent agreement among trained observers when scoring LGE-MRI scans, with inter-rater reliability scores ranging from 0.65 to 0.76 for each category. When the quality scores were converted to a binary diagnostic/non-diagnostic, the CNN achieved a sensitivity of <math><mrow><mn>0.80</mn> <mo>±</mo> <mn>0.06</mn></mrow> </math> and a specificity of <math><mrow><mn>0.56</mn> <mo>±</mo> <mn>0.10</mn></mrow> </math> .</p><p><strong>Conclusion: </strong>The use of a training document with reference examples helped raters achieve excellent agreement in their quality scores. The CNN gave a reasonably accurate classification of diagnostic or non-diagnostic 3D LGE-MRI images of the left atrium, despite the use of a relatively small training set.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872226","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":"Very high-power short-duration radiofrequency ablation in patients with typical atrial flutter: rationale and design of the FASD-HP randomized trial.","authors":"Laura Valverde Soria, Jorge Toquero, Thomas Brouzet, Laura García Cano, Ana García Barrios, Melodie Segura Domínguez, Gloria A Hermón Ramírez, Raquel Ajo Ferrer, María Ajo Ferrer, Celia María Andreu Concha, Vicente Arrarte Esteban, Angel Sánchez Barbié, Juan Gabriel Martínez-Martínez, Alicia Ibáñez Criado, José Luis Ibáñez Criado","doi":"10.1007/s10840-024-01969-7","DOIUrl":"https://doi.org/10.1007/s10840-024-01969-7","url":null,"abstract":"<p><strong>Background: </strong>The aim of cavotricuspid isthmus (CTI)-dependent flutter ablation is the bidirectional conduction block of the CTI. Very-high-power short-duration (vHPSD) radiofrequency ablation aims to minimize conductive heating and increase resistive heating to create shallower but wider lesions in a very short time, while reducing the risk of collateral tissue damage. Experimental studies have shown that it produces effective transmural lesions with an equal or better safety profile compared to conventional parameters. There are published and ongoing trials studying long-term outcomes of this technique for pulmonary vein isolation, but there is a lack of evidence regarding its use in flutter ablation.</p><p><strong>Methods and results: </strong>Multicenter 1:1 randomized, single-blind study. Two CTI ablation strategies are compared: (1) conventional treatment arm consisting of 25-40-W applications of unlimited duration until reaching the minimum value of one of the currently accepted lesion markers (Ablation Index > 500 at the anterior half of the CTI and > 400 at the posterior half with CARTO3 system); (2) experimental treatment arm consisting of CTI block using point-by-point applications of very-high-power (90 W) short duration (4 s). The primary objective is to evaluate the non-inferiority of the efficacy and safety of vHPSD ablation in patients undergoing typical flutter ablation. Secondary objectives include comparison of total radiofrequency time, number of applications, number of steam pops, percentage of reconnections, procedure duration, pain during the procedure, and time to flutter recurrence.</p><p><strong>Conclusions: </strong>The FASD-HP trial is the first clinical trial to investigate the non-inferiority of CTI ablation with vHPSD in patients with typical atrial flutter.</p><p><strong>Clinical trial registration number: </strong>The study was registered at http://www.</p><p><strong>Clinicaltrials: </strong>gov (NCT05777850) on March 21, 2023.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872235","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 new stepwise approach to minimize phrenic nerve injury during cryoballoon pulmonary vein isolation.","authors":"K Phkhaladze, H Omran, T Fink, V Sciacca, D Guckel, M Khalaph, M Braun, M El Hamriti, J Thale, G Nölker, J Vogt, C Sohns, P Sommer, G Imnadze","doi":"10.1007/s10840-024-01953-1","DOIUrl":"https://doi.org/10.1007/s10840-024-01953-1","url":null,"abstract":"<p><strong>Background: </strong>A phrenic nerve injury (PNI) during cryoballoon (CB) pulmonary vein isolation (PVI) continues to represent a limitation of this technique. The objective of this study was to develop a novel technique with the aim of reducing the incidence of PNI.</p><p><strong>Methods: </strong>We performed a retrospective analysis of data from two hospitals in patients with symptomatic, drug-resistant atrial fibrillation (AF) over 7 years to evaluate the incidence and clinical characteristics of PNI during cryoballoon PVI. Patients in the intervention group were treated with a new technique consisting of the following consecutive steps: (A) phrenic nerve stimulation near stimulation threshold instead of 10 V stimulation; (B) advanced ablation to the right superior pulmonary vein (PV) using a pre-freezing technique; (C) \"pulling away\" of the CB after vein isolation and/or after reaching - 40 °C for both right PVs. Two subtypes of PNI were studied: persistent (no recovery to discharge) and transient (recovery to discharge) PNI.</p><p><strong>Results: </strong>Nine hundred patients with a mean age of 62.3 (± 10.9) years (38% female) were analyzed. Transient PNI occurred in 8/250 patients (3.2%) in the intervention group compared to 39/750 patients (6%) in the control group (p = 0.09). Persistent PNI occurred in one patient (0.4%) in the intervention group compared to 18 (2.8%) in the control group (p = 0.03). Any PNI occurred in 9 patients in the intervention group (3.6%) compared to 57 patients (8.8%) in the control group (p = 0.008).</p><p><strong>Conclusion: </strong>In this retrospective analysis, a new cryo-PVI technique significantly reduces the incidence of PNI, particularly persistent PNI.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864535","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":"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":"https://doi.org/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":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-19","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":"Efficacy, safety, and somatosensory comparison of pulsed-field ablation and thermal ablation: outcomes from a 2-year follow-up.","authors":"Jiale Wang, Xinqi Wang, Wei Liu, Haoyuan Hu, Jiahui Zhao, Changhao Hu, Weiwen Zhao, Youran Qin, Kaiqing Yang, Songyun Wang, Hong Jiang","doi":"10.1007/s10840-024-01966-w","DOIUrl":"https://doi.org/10.1007/s10840-024-01966-w","url":null,"abstract":"<p><strong>Background: </strong>Pulsed-field ablation (PFA), as a nonthermal ablative approach for atrial fibrillation, has attracted much attention in recent years. And there are few comparative studies on PFA versus conventional thermal ablation, including radiofrequency ablation (RFA) and cryoballoon ablation (CBA). The efficacy, safety, and somatic sensation of PFA and thermal ablation need to be further compared.</p><p><strong>Methods: </strong>A total of 109 patients with paroxysmal atrial fibrillation were divided into three groups (27 in the PFA group, 41 in the CBA group, and 41 in the RFA group), and the operation characteristics, efficacy, safety, and somatic sensation were recorded and analyzed. All patients were followed for 2 years.</p><p><strong>Results: </strong>All pulmonary veins were successfully isolated except for 1 pulmonary vein that was not successfully isolated during the CBA process (PFA vs. CBA vs. RFA = 100% vs. 99% vs. 100%). The total operation time for PFA is considerably shorter than that for thermal ablation (PFA vs. CBA vs. RFA = 65.28 ± 22.78 min vs. 75.38 ± 18.53 min vs. 96.26 ± 23.23 min, P < 0.001), and the same applies to all the sub-phases. PFA was similarly more dominant in terms of somatosensory perception, mainly in headache (PFA vs. CBA = 1.17 ± 0.48 vs. 2.31 ± 1.06, P < 0.001) and chest pain (PFA vs. RFA = 1.45 ± 0.88 vs. 2.52 ± 1.06, P < 0.001). All these three groups demonstrated good maintenance rates (PFA vs. CBA vs. RFA = 85.00% vs. 80.49% vs. 78.05%, 2 years after operation).</p><p><strong>Conclusion: </strong>PFA demonstrates its excellent somatic sensation and favorable safety. And it also showed a great immediate success and maintenance rate, which is not inferior to thermal ablation.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824245","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":"Differential and synergistic effects of right and left atrial ganglionated plexi ablation in patients undergoing cardioneuroablation: results from the ELEGANCE multicenter study.","authors":"Pietro Francia, Daniel Viveros, Carlo Gigante, Giulio Falasconi, Diego Penela, David Soto-Iglesias, Federico Landra, Lucio Teresi, Julio Marti-Almor, José Alderete, Andrea Saglietto, Aldo Francisco Bellido, Dario Turturiello, Chiara Valeriano, Paula Franco-Ocaña, Fatima Zaraket, Maria Matiello, Juan Fernández-Armenta, Rodolfo San Antonio, Antonio Berruezo","doi":"10.1007/s10840-024-01968-8","DOIUrl":"https://doi.org/10.1007/s10840-024-01968-8","url":null,"abstract":"<p><strong>Background: </strong>Cardioneuroablation (CNA) treats reflex syncope by ablating ganglionated plexi (GPs) either confined to the right (RA) or left atrium (LA), or accessible from both. We assessed whether GP ablation in one atrium affects parasympathetic modulation in the other and how ablation sequence (RA then LA, or vice-versa) impacts efficacy.</p><p><strong>Methods: </strong>Two propensity-matched groups of patients with reflex syncope or functional bradycardia were analyzed. Group 1 received CNA in the RA first, followed by LA. Group 2 in the reverse order.</p><p><strong>Results: </strong>Thirty-four patients were enrolled. In group 1, RA ablation prompted a heart rate (HR) increase (49.8 ± 10.6 vs. 61.2 ± 13.8 bpm; p < 0.01) that was enhanced after LA ablation (60.3 ± 14.5 vs. 64.5 ± 14.4 bpm; p = 0.02). RA ablation did not reduce PR interval in any patient or modify the Wenckebach point (WP) (596 ± 269 vs. 609 ± 319 ms; p = 0.68), while additional LA ablation reduced PR interval in 3 patients and mean WP (611 ± 317 vs. 482 ± 191 ms; p = 0.03). In group 2, LA ablation increased HR (56.7 ± 6.6 vs. 76.4 ± 13.8 bpm; p < 0.01), with an additional effect of RA ablation (76.0 ± 16.5 vs. 85.4 ± 15.9 bpm; p < 0.01). LA ablation decreased PR interval in 3 patients and mean WP (512 ± 182 vs .399 ± 85 ms; p = 0.01). Further RA ablation did not decrease PR or WP. CNA success was 82% in group 1 and 100% in group 2 (p = 0.552). After 24.5 ± 6.1 months, 2 patients in group 1 vs. no patients in group 2 experienced symptom recurrence.</p><p><strong>Conclusions: </strong>Bi-atrial CNA provides incremental benefits after both RA and LA ablation. Starting ablation in the LA provides the most significant effect on vagal modulation.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818336","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}