Journal of Interventional Cardiac Electrophysiology最新文献

{"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":"https://doi.org/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":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardioneuroablation for the management of patients with recurrent vasovagal syncope and symptomatic bradyarrhythmias: the CNA-FWRD Registry.","authors":"Tolga Aksu, Roderick Tung, Tom De Potter, Timothy M Markman, Pasquale Santangeli, Jeanne du Fay de Lavallaz, Jeffrey R Winterfield, Tina Baykaner, Daniel Alyesh, Jacqueline E Joza, Rakesh Gopinathannair, Patrick Badertscher, Duc H Do, Ayman Hussein, Jose Osorio, Thomas Dewland, Alexander Perino, Albert J Rodgers, Christopher DeSimone, Alberto Alfie, Brett D Atwater, David Singh, Kapil Kumar, Jonathan Salcedo, Jason S Bradfield, Gaurav Upadhyay, Nitesh Sood, Parikshit S Sharma, Sandeep Gautam, Vineet Kumar, Alexander Romeno Janner Dal Forno, Christopher E Woods, Moshe Rav-Acha, Chiara Valeriano, Sunil Kapur, Andres Enriquez, Sri Sundaram, Michael Glikson, Edward Gerstenfeld, Jonathan Piccini, Wendy S Tzou, William Sauer, Andre d'Avila, Kalyanam Shivkumar, Henry D Huang","doi":"10.1007/s10840-024-01789-9","DOIUrl":"10.1007/s10840-024-01789-9","url":null,"abstract":"<p><strong>Background: </strong>Cardioneuroablation has been emerging as a potential treatment alternative in appropriately selected patients with cardioinhibitory vasovagal syncope (VVS) and functional AV block (AVB). However the majority of available evidence has been derived from retrospective cohort studies performed by experienced operators.</p><p><strong>Methods: </strong>The Cardioneuroablation for the Management of Patients with Recurrent Vasovagal Syncope and Symptomatic Bradyarrhythmias (CNA-FWRD) Registry is a multicenter prospective registry with cross-over design evaluating acute and long-term outcomes of VVS and AVB patients treated by conservative therapy and CNA.</p><p><strong>Results: </strong>The study is a prospective observational registry with cross-over design for analysis of outcomes between a control group (i.e., behavioral and medical therapy only) and intervention group (Cardioneuroablation). Primary and secondary outcomes will only be assessed after enrollment in the registry. The follow-up period will be 3 years after enrollment.</p><p><strong>Conclusions: </strong>There remains a lack of prospective multicentered data for long-term outcomes comparing conservative therapy to radiofrequency CNA procedures particularly for key outcomes including recurrence of syncope, AV block, durable impact of disruption of the autonomic nervous system, and long-term complications after CNA. The CNA-FWRD registry has the potential to help fill this information gap.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"183-191"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140158341","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":"Baroreceptor reflex after pulmonary vein isolation assessed by tilt table test: adding another piece to the puzzle.","authors":"Irina Mustafina, Stavros Stavrakis","doi":"10.1007/s10840-023-01722-6","DOIUrl":"10.1007/s10840-023-01722-6","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"325-326"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139074329","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":"Targeted ablation of epicardial ganglionated plexi during cardiac surgery with pulsed field electroporation (NEURAL AF).","authors":"Daniel R Musikantow, Vivek Y Reddy, Ivo Skalsky, Tamaz Shaburishvili, Martin van Zyl, Barry O'Brien, Ken Coffey, John Reilly, Petr Neuzil, Samuel Asirvatham, Joris R de Groot","doi":"10.1007/s10840-023-01615-8","DOIUrl":"10.1007/s10840-023-01615-8","url":null,"abstract":"<p><strong>Background: </strong>Modulation of the cardiac autonomic nervous system (ANS) is a promising adjuvant therapy in the treatment of atrial fibrillation (AF). In pre-clinical models, pulsed field (PF) energy has the advantage of selectively ablating the epicardial ganglionated plexi (GP) that govern the ANS. This study aims to demonstrate the feasibility and safety of epicardial ablation of the GPs with PF during cardiac surgery with a primary efficacy outcome of prolongation of the atrial effective refractory period (AERP).</p><p><strong>Methods: </strong>In a single-arm, prospective analysis, patients with or without a history of AF underwent epicardial GP ablation with PF during coronary artery bypass grafting (CABG). AERP was determined immediately pre- and post- GP ablation to assess cardiac ANS function. Holter monitors were performed to determine rhythm status and heart rate variability (HRV) at baseline and at 1-month post-procedure.</p><p><strong>Results: </strong>Of 24 patients, 23 (96%) received the full ablation protocol. No device-related adverse effects were noted. GP ablation resulted in a 20.7 ± 19.9% extension in AERP (P < 0.001). Post-operative AF was observed in 7 (29%) patients. Holter monitoring demonstrated an increase in mean heart rate (74.0 ± 8.7 vs. 80.6 ± 12.3, P = 0.01). There were no significant changes in HRV. There were no study-related complications.</p><p><strong>Conclusions: </strong>This study demonstrates the safety and feasibility of epicardial ablation of the GP using PF to modulate the ANS during cardiac surgery. Large, randomized analyses are necessary to determine whether epicardial PF ablation can offer a meaningful impact on the cardiac ANS and reduce AF.</p><p><strong>Trial registration: </strong>Clinical trial registration: NCT04775264.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"467-474"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9967410","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":"The Efficacy of Cardioneuroablation versus Midodrine in Patients with Vasovagal Syncope: Design and Rationale for the CAMPAIGN Trial.","authors":"Pakezhati Maimaitijiang, Bin Tu, Zihao Lai, Aiyue Chen, Zhuxin Zhang, Likun Zhou, Simin Cai, Lihui Zheng, Yan Yao","doi":"10.1007/s10840-025-02029-4","DOIUrl":"10.1007/s10840-025-02029-4","url":null,"abstract":"<p><strong>Background: </strong>Current treatment strategies for vasovagal syncope (VVS) patients recommended by the guidelines are diverse, but effects of these therapies are still unsatisfactory with respective limitations on the indications. Cardioneuroablation (CNA), an innovative and promising therapy, has shown potently effective against syncopal recurrences in numerous observational studies. Recently, a single-center randomized clinical trial has reported CNA was superior to non-pharmacologic therapy for VVS patients. Therefore, this study is designed to compare the efficacy of CNA with pharmacologic treatment in a multicenter and randomized fashion.</p><p><strong>Methods and results: </strong>The Cardioneuroablation versus Midodrine in Patients with Vasovagal Syncope (CAMPAIGN) study is an international multicenter, prospective, open-label, randomized controlled trial. The recurrent VVS patients with a positive response to tilt testing despite sufficient conventional treatment will be predominantly enrolled at different medical centers in China, Russia, and Turkey. All eligible participants will be randomized in a ratio of 1:1 to treatment with CNA versus midodrine, and followed up for 12 months after randomization. Approximately 184 subjects are projected to enroll from April 2023 to December 2024 with follow-up until 2025. The primary endpoint is the recurrence rate of syncope at 12 months of follow-up. The secondary endpoints are comprised of quality of life assessed with the Impact of Syncope on Quality of Life, tilt-induced syncope, blood pressure, cardiac deceleration capacity, and heart rate variability.</p><p><strong>Conclusion: </strong>A prospective and multicenter clinical trial to compare outcomes of CNA with drug therapy is still lacking. The CAMPAIGN study will provide outcome-based evidence for VVS treatment strategy.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov: NCT05803148 (Date: March 9, 2023).</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"257-265"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674173","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":"Refractory malignant cardioinhibitory vasovagal syncope: should we pace or should we ablate?","authors":"Juan Carlos Zerpa Acosta, Jose Carlos Pachon Mateos","doi":"10.1007/s10840-023-01576-y","DOIUrl":"10.1007/s10840-023-01576-y","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"211-213"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9572366","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":"Different time course effect of autonomic nervous modulation after cryoballoon and hotballoon catheter ablations for paroxysmal atrial fibrillation.","authors":"Noriyuki Suzuki, Yasuya Inden, Satoshi Yanagisawa, Yuuki Shimizu, Shingo Narita, Kei Hiramatsu, Ryota Yamauchi, Ryo Watanabe, Naoki Tsurumi, Masafumi Shimojo, Kazumasa Suga, Yukiomi Tsuji, Rei Shibata, Toyoaki Murohara","doi":"10.1007/s10840-023-01581-1","DOIUrl":"10.1007/s10840-023-01581-1","url":null,"abstract":"<p><strong>Background: </strong>Few studies have reported on the quantitative evaluation of autonomic nerve modification after balloon ablation. Therefore, this study aimed to evaluate the effects of cryoballoon and hotballoon ablations on the autonomic nervous system (ANS) and their relationship with prognosis.</p><p><strong>Methods: </strong>We included 234 patients who underwent cryoballoon ablation (n = 190) or hotballoon ablation (n = 44) for paroxysmal atrial fibrillation. Heart rate variability (HRV) analysis was performed on all patients using a 3-min electrocardiogram at baseline, 1, 3, 6, and 12 months after ablation. HRV parameters and prognoses were compared between the two balloon systems.</p><p><strong>Results: </strong>Ln low-frequency (LF), Ln high-frequency (HF), standard deviation of the R-R intervals (SDNN), and RR intervals significantly decreased after 1 month in both groups, but the changes were more pronounced in the cryoballoon group than in the hotballoon group. In contrast, HRV indices in the hotballoon ablation group decreased gradually and reached their lowest point 3-to-6 months after the procedure, which was later than in the cryoballoon ablation group. The recurrence rate did not differ between the two groups. HRV parameters changed similarly in the cryoballoon group, regardless of recurrence. However, patients with recurrence had significantly higher SDNN and Ln LF at 12 months than those without recurrence in the hotballoon group (41.2 ± 39.3 ms vs. 18.5 ± 12.6 ms, p = 0.006, and 2.2 ± 0.7 ms² vs. 1.5 ± 0.7 ms², p = 0.003, respectively).</p><p><strong>Conclusions: </strong>The time course of HRV changes differed between cryoballoon and hotballoon ablations. Hence, the two balloon systems may have distinct effects on the ANS and its role in prognosis.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"355-369"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10054529","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":"Foreword neuromodulation for antiarrhythmic therapy.","authors":"Tolga Aksu, Carlos A Morillo, Juan C Zerpa","doi":"10.1007/s10840-024-01901-z","DOIUrl":"10.1007/s10840-024-01901-z","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"181-182"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912973","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":"Vagal AF induction test (VAFIT): a new endpoint for optimizing atrial fibrillation ablation through cardioneuroablation.","authors":"Jose Carlos Pachon-M, Enrique I Pachon-M, Tomas G Santillana-P, Tasso J Lobo, Carlos Thiene C Pachon, Juan Carlos Pachon-M, Maria Zelia C Pachon, John Clark","doi":"10.1007/s10840-025-02007-w","DOIUrl":"10.1007/s10840-025-02007-w","url":null,"abstract":"<p><strong>Introduction: </strong>Currently, there is no reliable endpoint for the conclusion of atrial fibrillation (AF) ablation. Atrial burst pacing and/or isoproterenol challenge are poor diagnostic tools. A newly proposed vagal AF induction test (VAFIT) uses effective atrial refractory period measurement, simultaneously with extra-cardiac vagal stimulation (ECVS) to study AF inducibility pre- and post-ablation. This is a prospective study in patients submitted to radiofrequency catheter pulmonary vein isolation (PVI) plus cardioneuroablation (CNA) evaluating the VAFIT result before and at the end of the procedure with AF recurrence.</p><p><strong>Methods: </strong>Prospective study of 142 patients, 57.5 (48.9-70.2) years old, 71% males, with symptomatic AF (79.6% paroxysmal/20.4% persistent), left atrium diameter of 38.0 (35.0-41.2) mm, and left ventricular ejection fraction of 63.0 (62.0-68.2). VAFIT was considered positive or negative depending on whether AF induction occurred. It was performed at baseline and after PVI + CNA, with a single atrial extra stimulus during ECVS (5 s/50 Hz/1 V/kg up to 70 V/pulse width = 50 µs). Patients were followed for a median of 15.0 (7.0-20.0) months. The association of VAFIT-positive status at the end of the procedure with AF recurrence was investigated by univariate and multivariate Cox regression analysis.</p><p><strong>Results: </strong>Pre-ablation VAFIT was positive in all cases and became negative in 62.9% of patients. AF recurrence: 18.7% in VAFIT-positive and 5.6% in VAFIT-negative patients (p = 0.012). VAFIT-positivity was associated with AF recurrence (HR 4.56 (1.37-15.23, p = 0.014).</p><p><strong>Conclusion: </strong>A VAFIT-positive status following PVI + CNA was strongly and independently associated with AF recurrence. VAFIT negative status reduced 4.5 times the post-ablation AF recurrence. It remains to be investigated in randomized studies whether achieving VAFIT-negativity at the end of the procedure, as demonstrated in this study, would lead to better clinical outcomes.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"293-306"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414520","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":"Modified sympathicotomy in patients with refractory ventricular tachycardia and structural heart disease: a single-center experience.","authors":"Filippo Maria Cauti, Pietro Rossi, Stefano Bianchi, Michele Magnocavallo, Silvia Capone, Domenico Giovanni Della Rocca, Marco Polselli, Katia Bruno, Pierfrancesco Tozzi, Chiara Rossi, Jacopo Vannucci, Francesco Pugliese, Raffaele Quaglione, Federico Venuta, Marco Anile","doi":"10.1007/s10840-023-01706-6","DOIUrl":"10.1007/s10840-023-01706-6","url":null,"abstract":"<p><strong>Background: </strong>Modified cardiac sympathetic denervation (CSD) with stellate ganglion (SG) sparing is a novel technique for cardiac neuromodulation in patients with refractory ventricular tachycardia (VT).</p><p><strong>Objectives: </strong>Our aim is to describe the mid- to long-term clinical outcome of the modified CSD with SG sparing in a series of patients with structural heart disease (SHD) and refractory VT.</p><p><strong>Methods: </strong>All consecutive patients with SHD and refractory VT undergoing modified CSD were enrolled. Baseline clinical characteristics and periprocedural data were collected for all patients. The primary outcome was any recurrence of sustained VT.</p><p><strong>Results: </strong>We enrolled 15 patients (age: 69.2 ± 7.9 years; male 100%) undergoing modified CSD. Left ventricular ejection fraction was 37 ± 11% and all patients had an implantable cardiac defibrillator (ICD); the underlying cardiomyopathy was non-ischemic in 73.3% of them. At least one previous ablation had been attempted in 66.6% of cases. The 73.3% of patients underwent bilateral CSD and the mean effective surgical time was 10.8 ± 2.4 min per side; no major periprocedural complication occurred. After a median follow-up time of 15 months (IQR: 8.5-24.5 months), the primary outcome occurred in 47.6% of cases. All patients experienced a reduction of ICD shocks after CSD (3.1 ICD shocks/patient before vs. 0.3 ICD shocks/patient after CSD; p-value: 0.001). Bilateral CSD and a VT cycle length < 340 ms were associated with better outcomes.</p><p><strong>Conclusions: </strong>A modified CSD approach with stellate ganglion sparing appears to be safe, fast, and effective in the treatment of patients with SHD and refractory VTs.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"391-399"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138470369","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}