Journal of Interventional Cardiac Electrophysiology最新文献

{"title":"A novel, minimally invasive technology for intrapericardial injections via direct visualization.","authors":"Ryan P O'Hara, Justin D Opfermann, Bryan Gonzalez, Bradley C Clark, Charles I Berul, Rohan N Kumthekar","doi":"10.1007/s10840-024-01951-3","DOIUrl":"10.1007/s10840-024-01951-3","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"805-807"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687142","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":"Complexity analysis of electrical activity during endocardial and epicardial biventricular mapping of ventricular fibrillation.","authors":"Vasanth Ravikumar, Xiangzhen Kong, Nick Y Tan, George Christopolous, Thomas P Ladas, Zhi Jiang, Jason A Tri, Alan M Sugrue, Samuel J Asirvatham, Christopher V DeSimone, Elena G Tolkacheva","doi":"10.1007/s10840-023-01606-9","DOIUrl":"10.1007/s10840-023-01606-9","url":null,"abstract":"<p><strong>Background: </strong>Ventricular fibrillation (VF) is a lethal cardiac arrhythmia that is a significant cause of sudden cardiac death. Comprehensive studies of spatiotemporal characteristics of VF in situ are difficult to perform with current mapping systems and catheter technology.</p><p><strong>Objective: </strong>The goal of this study was to develop a computational approach to characterize VF using a commercially available technology in a large animal model. Prior data suggests that characterization of spatiotemporal organization of electrical activity during VF can be used to provide better mechanistic understanding and potential ablation targets to modify VF and its substrate. We therefore evaluated intracardiac electrograms during biventricular mapping of the endocardium (ENDO) and epicardium (EPI) in acute canine studies.</p><p><strong>Methods: </strong>To develop thresholds for organized and disorganized activity, a linear discriminant analysis (LDA)-based approach was performed to the known organized and disorganized activities recorded in ex vivo Langendorff-perfused rat and rabbit hearts using optical mapping experiments. Several frequency- and time-domain approaches were used as individual and paired features to identify the optimal thresholds for the LDA approach. Subsequently, VF was sequentially mapped in 4 canine hearts, using the CARTO mapping system with a multipolar mapping catheter in the ENDO left and right ventricles and EPI to capture the progression of VF at 3 discrete post-induction time intervals: VF period 1 (just after induction of VF to 15 min), VF period 2 (15 to 30 min), and VF period 3 (30 to 45 min). The developed LDA model, cycle lengths (CL), and regularity indices (RI) were applied to all recorded intracardiac electrograms to quantify the spatiotemporal organization of VF in canine hearts.</p><p><strong>Results: </strong>We demonstrated the presence of organized activity in the EPI as VF progresses, in contrary to the ENDO, where the activity stays disorganized. The shortest CL always occurred in the ENDO, especially the RV, indicating a faster VF activity. The highest RI was found in the EPI in all hearts for all VF stages, indicating spatiotemporal consistency of RR intervals.</p><p><strong>Conclusion: </strong>We identified electrical organization and spatiotemporal differences throughout VF in canine hearts from induction to asystole. Notably, the RV ENDO is characterized by a high level of disorganization and faster VF frequency. In contrast, EPI has a high spatiotemporal organization of VF and consistently long RR intervals.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"837-847"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9770946","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":"Evaluation of the safety and efficacy of bipolar radiofrequency catheter ablation for the treatment of refractory ventricular arrhythmias.","authors":"Gala Caixal, Michael Waight, Rahul Mukherjee, Adriana Pinto, Alexander Grimster, Anthony Li, Magdi Saba","doi":"10.1007/s10840-024-01964-y","DOIUrl":"10.1007/s10840-024-01964-y","url":null,"abstract":"<p><strong>Background: </strong>Bipolar radiofrequency catheter ablation (B-RFA) has shown promising results in refractory ventricular arrhythmias (VAs) of septal origin and underlying non-ischemic cardiomyopathy. However, its efficacy and safety in other locations, such as papillary muscles (PM) or with different underlying substrates has yet to be fully determined.</p><p><strong>Objective: </strong>To describe the procedure data, safety, and efficacy of B-RFA in a cohort of patients with VAs of different locations and underlying substrates and to generate new hypotheses.</p><p><strong>Methods: </strong>We prospectively enrolled 26 patients with VAs, of whom 21 ultimately underwent B-RFA during the ablation procedure. Of these, 17 were redo procedures. Thirteen patients presented ventricular tachycardia (VT), and eight patients had ventricular ectopy (VE). Procedure data, related complications and acute and long-term outcomes during follow-up were assessed.</p><p><strong>Results: </strong>Of the 21 patients, 76.2% were male, and the mean age was 60.8 ± 15.4 years. Fourteen patients had underlying substrate, and 7 had no structural heart disease. The VA originated from the septum (n = 9), lateral wall (n = 7), and PM (n = 5). Acute success, defined as the absence of the clinical VE or non-inducibility of VT at the end of the procedure, was achieved in 20 patients (95.2%). At 12-month follow-up, 8 (61.5%) patients with VT did not present any sustained arrhythmia or ICD therapy, and 6 (75%) patients with VE had a > 90% reduction in their burden on the 24-h Holter. Papillary muscle VAs seemed to present lower acute and long-term success after B-RFA. The use of B-RFA in PM, compared to other cardiac locations, required a greater number of radiofrequency applications (p = 0.010) with lower mean contact force (p = 0.001) and impedance drop (p = 0.010). No major peri-procedural complications were observed.</p><p><strong>Conclusions: </strong>Bipolar RF delivery can be used safely and successfully for VAs of septal and free wall origin but may have more limited use for PM arrhythmias. In this location, B-RFA exhibits reduced energy transfer, as does conventional ablation. No differences in procedural data or outcomes of B-RFA are observed based on the underlying substrate.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"857-868"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390994","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":"Mapping and ablation of ventricular fibrillation substrate.","authors":"Fatima M Ezzeddine, Robert Charles Ward, Samuel J Asirvatham, Christopher V DeSimone","doi":"10.1007/s10840-022-01454-z","DOIUrl":"10.1007/s10840-022-01454-z","url":null,"abstract":"<p><p>Ventricular fibrillation (VF) is a life-threatening arrhythmia and a common cause of sudden cardiac death (SCD). A basic understanding of its mechanistic underpinning is crucial for enhancing our knowledge to develop innovative mapping and ablation techniques for this lethal rhythm. Significant advances in our understanding of VF have been made especially in the basic science and pre-clinical experimental realms. However, these studies have not yet translated into a robust clinical approach to identify and successfully ablate both the structural and functional substrate of VF. In this review, we aim to (1) provide a conceptual framework of VF and an overview of the data supporting the spatiotemporal dynamics of VF, (2) review experimental approaches to mapping VF to elucidate drivers and substrate for maintenance with a focus on the His-Purkinje system, (3) discuss current approaches using catheter ablation to treat VF, and (4) highlight current unknowns and gaps in the field where future work is necessary to transform the clinical landscape.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"1031-1044"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10826792","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":"Ex vivo efficacy assessment of ultralow temperature cryoablation versus standard RF ablation applied to surgical ventricular patches: implications for ventricular ablation in patients with repaired congenital heart disease.","authors":"Tom J R De Potter, Dimitri Buytaert, Chiara Valeriano, Lucio Addeo, Alex Babkin, Joris Ector","doi":"10.1007/s10840-024-01952-2","DOIUrl":"10.1007/s10840-024-01952-2","url":null,"abstract":"<p><strong>Background: </strong>Clinical experience during trans-patch ventricular ablations shows difficult lesion formation when using standard RF ablation technology. The aim of this exploratory study is to test if ultralow temperature cryoblation (ULTC) technology could be suitable for trans-patch ventricular ablations.</p><p><strong>Materials and methods: </strong>Ex vivo ablations were performed on 16 porcine tenderloin specimens of 5 × 7 × 3 cm, eight with and eight without pericardial patch (Supple Peri-Guard Repair Patch, Baxter, USA). RF energy was applied for 1 min, with a power of 40W. ULTC was applied as a 2 × 2 min freeze. Temperature was measured using an array of thermocouples ranging between 0.5 and 13.1 mm below the tissue surface.</p><p><strong>Results: </strong>For RF, the maximum temperatures without and with patch respectively reached 58.9 °C and 48.5 °C. The thermocouple closest to the tissue surface displayed a 41% temperature range drop when RF energy was applied trans-patch, whereas the same thermocouple showed a 16% and 13% drop for the first and second ULTC freeze cycle when ULTC was applied trans-patch. The 45 °C isotherm depth was reduced by 55% for RF ablations, whereas the - 25 °C isotherm depth was reduced by 23% and 19% for the first and second freeze cycles, respectively.</p><p><strong>Conclusion: </strong>Both energy modalities show reduced efficacy for trans-patch ablations when considering absolute temperature differences and estimated lesion depths. However, when considering relative differences, ULTC is more effective than RF for trans-patch lesions. Additionally, ULTC did not show visible damage to either the patch or the ex vivo specimen, while RF resulted in visible damage to both the tissue and patch.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"849-856"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769580","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":"Volumetric lesion analysis and validation of various bipolar configurations in radiofrequency ablation of ventricular myocardium in a bovine model.","authors":"Saikiran Kakarla, UmaShankar Pr, Sabari Saravanan, Narayanan Namboodiri","doi":"10.1007/s10840-024-01927-3","DOIUrl":"10.1007/s10840-024-01927-3","url":null,"abstract":"<p><strong>Background: </strong>The bipolar radiofrequency ablation(B-RFA) strategy was increasingly used to target deep intramural re-entrant foci responsible for the arrhythmia not ablated by conventional unipolar RFA / sequential unipolar RFA. Lesional characteristics of various bipolar configurations were largely unknown.</p><p><strong>Objective: </strong>To investigate the lesional geometry in relation to various factors to determine the most effective ablation strategy that minimises steam pops and achieves transmurality. To assess the temperatures at the return electrode.</p><p><strong>Methods: </strong>A custom-made validated ex-vivo bipolar ablation model was used to assess lesion formation. The myocardial sample was placed between two ablation catheters in four different orientations. Lesions were created using different power (30 W, 40 W, 50 W) and time settings(30, 40 and 50 s) with different catheter orientations. Data was analysed using binary logistic regression and multiple linear regression.</p><p><strong>Results: </strong>Among 107 lesions, The volume of the active catheter lesion (266 +/- 137 mm^3) significantly differed from their return electrode counterparts (130 +/- 91.8 mm^3) (p < 0.001), and the temperatures at the return electrode end were lower than at the active electrode (p = 0.004). Higher power and longer duration application led to more frequent steam pops (p < 0.001), while true parallel configuration resulted in fewer steam pops (p < 0.001).</p><p><strong>Conclusion: </strong>A custom model without ground electrode temperature monitoring is safe and cost-effective. The safest strategy is a true parallel configuration with an inter-electrode distance of at least 15 mm and a power of 30 W to 40 W, which generates lower steam pops and better transmurality.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"811-820"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467639","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":"First-in-man clinical implantation and acute pacing performance of a novel subxiphoidal pacemaker system.","authors":"Imad Libbus, Venkatakrishna Tholakanahalli, Henri Roukoz, Varun Verma, Divya Isac, Yatheendhar Manicka","doi":"10.1007/s10840-024-01815-w","DOIUrl":"10.1007/s10840-024-01815-w","url":null,"abstract":"<p><strong>Background: </strong>Intravascular cardiac pacemakers are an established therapy for bradycardic indications. Recently, a new class of leadless pacemakers have mitigated some of the complications related to pacemaker leads. In this study, we evaluate the implantation and performance of a novel extravascular technology that delivers epicardial pacing through a subxiphoidal approach.</p><p><strong>Methods: </strong>Fifteen patients undergoing non-emergent open-heart surgery were enrolled. A midline incision was made just below the xiphoid process, and substernal tunneling was used to create a pocket for the device and to access the anterior pericardium over the right ventricle. The test device (Calyan Technologies, Oakdale, MN) was temporarily inserted underneath the ribcage and clipped to the xiphoid process. The sensing and pacing electrode (FlexArm) was positioned on the anterior pericardium. Ventricular sensing and pacing capture thresholds were measured.</p><p><strong>Results: </strong>The test device was successfully implanted in all 15 patients. There were no device or procedure-related adverse events. The first five implanted patients had no pacing capture at maximum stimulation intensity. Design changes were made to the device, including different electrode size and shape, and successful ventricular capture was achieved in 9 of the subsequent 10 patients. In these patients, pacing threshold was 3.8 ± 1.6 mA with a pulse width of 0.5 ms. All devices were successfully explanted at the end of the procedure.</p><p><strong>Conclusions: </strong>In a first-in-human experience with a novel extravascular pacemaker, this study demonstrated the feasibility of pericardial ventricular pacing via a subxiphoidal approach. Further chronic studies are required to evaluate the safety and performance of this novel pacing technology.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"823-827"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140957803","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":"Impedance drop during focal monopolar pulsed field ablation in the atrium.","authors":"Florent I P Farnir, Justin G L M Luermans, Frédéric P F J D J Farnir, Sevasti-Maria Chaldoupi, Dominik Linz","doi":"10.1007/s10840-024-01793-z","DOIUrl":"10.1007/s10840-024-01793-z","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"801-803"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140158342","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 single-center trial of electrographic flow mapping and concomitant voltage mapping in sinus rhythm and atrial fibrillation (FLOW EVAL-AF).","authors":"Philipp Sommer, Steven Castellano, Kostiantyn Ahapov, Marloes M Jansen, Nishaki K Mehta, Melissa H Kong","doi":"10.1007/s10840-024-01946-0","DOIUrl":"10.1007/s10840-024-01946-0","url":null,"abstract":"<p><strong>Background: </strong>Electrographic flow (EGF) mapping reconstructs atrial electrical wavefront propagation, potentially revealing sources of atrial fibrillation (AF). Electrographic flow consistency (EGFC) measures the concurrence of wavefront patterns and may provide insights into atrial substrate health. This study aimed to compare EGF patterns during atrial fibrillation (AF) with sinus rhythm (SR) and explore the correlation between EGFC and regional bipolar voltage.</p><p><strong>Methods: </strong>In this single-center, prospective study, AF patients underwent mapping of the atria using bipolar voltage and EGF mapping. Mapping was performed during both AF and SR using a 16-electrode grid catheter (bipolar mapping) and a 64-pole basket catheter (EGF mapping). EGFC was computed as the average modulus of individual EGF vectors, reflecting flow pattern consistency.</p><p><strong>Results: </strong>Ten patients were enrolled. EGF identified 11 sources with a mean source activity of 32 ± 9% during AF. Eight out of eleven sources in AF converted to passive \"sinks\" when mapped in SR. EGFC was significantly lower during AF compared to SR (0.74 ± 0.14 vs 1.0 ± 0.11 AUs, P < 0.01), consistent with EGFC quantifying the more chaotic wavefront propagation during arrhythmia. No spatial correlation between areas of high EGFC during AF and SR was observed. EGFC correlated with bipolar voltage across rhythms and atria (r = 0.647, P < 0.0001).</p><p><strong>Conclusion: </strong>EGF patterns varied by rhythm with AF showing lower EGFC values. EGFC correlated with bipolar voltage across rhythms and atria, suggesting its potential as an atrial myopathy marker akin to high-density voltage mapping and offering insights into atrial substrate health. Trial registration ClinicalTrials.gov Identifier: NCT06260670.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"189-199"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12876081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739725","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":"Pulsed field ablation for atrial fibrillation: now available without fluoroscopy.","authors":"Matthew J Singleton, Jose Osorio","doi":"10.1007/s10840-024-01933-5","DOIUrl":"10.1007/s10840-024-01933-5","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"185-186"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769690","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}