Heart Rhythm O2最新文献

{"title":"Correlation between mobile and 12-lead ECG among patients loading with intravenous sotalol: A PEAKS substudy","authors":"Benjamin A. Steinberg MD, MHS ,&nbsp;Suneet Mittal MD ,&nbsp;Richard Holubkov PhD, MBA ,&nbsp;Christopher A. Groh MD ,&nbsp;Robert Kennedy MD ,&nbsp;Parash Pokharel MD ,&nbsp;Marco Perez MD ,&nbsp;Salvatore J. Savona MD ,&nbsp;Nishant Verma MD, MPH ,&nbsp;Kevin Watt MD, PhD ,&nbsp;Jonathan P. Piccini MD, MHS ,&nbsp;T. Jared Bunch MD ,&nbsp;Thomas F. Deering MD","doi":"10.1016/j.hroo.2025.01.018","DOIUrl":"10.1016/j.hroo.2025.01.018","url":null,"abstract":"<div><h3>Background</h3><div>Electrocardiographic monitoring is performed during sotalol loading, primarily to assess QTc. Continuous telemetry increases resource utilization, generating interest in streamlining QTc monitoring through mobile technologies.</div></div><div><h3>Objective</h3><div>Assess feasibility and outcomes of mobile electrocardiogram (ECG) monitoring during intravenous sotalol loading.</div></div><div><h3>Methods</h3><div>In a substudy of the PEAKS (Prospective Evaluation Analysis and Kinetics of IV Sotalol) registry, AliveCor 6L mobile ECGs were recorded during intravenous sotalol loading, concomitantly with standard 12-lead ECGs. We calculated the correlation of heart rate and QTc between them.</div></div><div><h3>Results</h3><div>Overall, 77 patients were included: the median age was 68 years (interquartile range 63–73 years) and 20% were female. A total of 227 mobile recordings were performed within 30 minutes of 12-lead ECG, including baseline (8%), during infusion (54%), during oral dosing (35%), and during follow-up (0.4%). Half (51%) of 12-lead tracings were in atrial tachycardia (AT)/atrial fibrillation (AF), with a 93% correlation with automated mobile diagnostics. No mobile QTc values were available for recordings in AT/AF. The overall correlation between 12-lead ECG and mobile ECG was good for continuous heart rate (R &gt; 0.8) but was poor for continuous QTc (R = 0.24). Most physiologic QTc values from the mobile ECGs were within 10% of the adjudicated 12-lead values (83%), with 53% within 5%. There were few false negative values for QTc &gt;500 ms by mobile ECG (n = 2 of 58 [3.4%]).</div></div><div><h3>Conclusion</h3><div>Mobile ECGs can be performed during sotalol loading but are limited by the absence of QTc in AT/AF. While QTc values from automated mobile 6-lead ECGs appeared to detect cases of QTc prolongation in sinus rhythm, additional data are needed prior to use for routine clinical monitoring.</div></div><div><h3>ClinicalTrials.gov ID</h3><div><span><span>NCT05247320</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 4","pages":"Pages 499-508"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post–pulmonary vein isolation voltage remapping–guided incremental lesions: A feasible strategy to improve long-term outcomes","authors":"Juan F. Rodriguez-Riascos MD ,&nbsp;Hema Srikanth Vemulapalli MBBS ,&nbsp;Padmapriya Muthu MBBS ,&nbsp;Aria Raman BS ,&nbsp;Poojan Prajapati MBBS ,&nbsp;Shruti Iyengar MBBS, MSc ,&nbsp;Sumedh Iyengar MD ,&nbsp;Hicham El Masry MD ,&nbsp;Arturo M. Valverde MD ,&nbsp;Komandoor Srivathsan MD","doi":"10.1016/j.hroo.2024.12.015","DOIUrl":"10.1016/j.hroo.2024.12.015","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary vein isolation (PVI) has demonstrated acceptable success rates; however, there is still potential for improvement. Pulmonary reconnection remains the main problem and the role of adjunctive strategies, such as repeat mapping to guide additional lesions to enhance durability of pulmonary vein isolation, remains uncertain.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the impact of post-PVI high-density remapping with guided incremental lesions on long-term recurrence-free survival.</div></div><div><h3>Methods</h3><div>This study included consecutive patients who underwent PVI between 2015 and 2023. Patients were divided into 2 groups based on whether they received post-PVI high-density remapping. Those in the remapping group with documented areas of incomplete ablation received incremental lesions to achieve complete ablation. The primary endpoint was recurrence-free survival.</div></div><div><h3>Results</h3><div>A total of 588 patients, with a mean follow-up of 25.8 months, were included. Post-PVI remapping was performed in 243 patients, while 345 patients underwent conventional PVI. Post-PVI remapping with guided incremental lesions improved recurrence-free survival compared with conventional PVI (adjusted hazard ratio 0.75, 95% confidence interval [CI] 0.57-0.99, <em>P =</em> .04). This benefit was especially notable in patients with paroxysmal atrial fibrillation (hazard ratio 0.69, 95% CI 0.49-0.96, <em>P =</em> .027). Complication rates and procedure times were comparable between the 2 groups. For patients undergoing their first radiofrequency ablation, 1-year success was higher in those who underwent PVI remapping (adjusted odds ratio 1.70, 95% CI 1.04–2.77, <em>P =</em> .03). However, long-term outcomes were comparable between the 2 groups.</div></div><div><h3>Conclusion</h3><div>Postablation mapping effectively identifies and addresses proarrhythmic foci, potentially reducing atrial fibrillation recurrence and improving patient outcomes.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 4","pages":"Pages 424-433"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iatrogenic complete heart block due to His bundle transection in His lead placement","authors":"Bradley J. Reinoehl BS ,&nbsp;Destino Roman BS ,&nbsp;Joel Reinoehl MD","doi":"10.1016/j.hroo.2024.12.013","DOIUrl":"10.1016/j.hroo.2024.12.013","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 4","pages":"Pages 542-545"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra- and interpersonal variation in body surface potentials of healthy subjects","authors":"Iris van der Schaaf MD ,&nbsp;Manon Kloosterman MSc ,&nbsp;Deepthi Priya Chandrasekaran MSc ,&nbsp;Peter Loh MD, PhD ,&nbsp;Johan de Bie PhD ,&nbsp;Peter M. van Dam PhD","doi":"10.1016/j.hroo.2025.01.016","DOIUrl":"10.1016/j.hroo.2025.01.016","url":null,"abstract":"<div><h3>Background</h3><div>Body surface potential mapping (BSPM) can provide a detailed assessment of cardiac electrical activity and might be of potential added benefit in multiple cardiac diseases. Normal intra- and interpersonal variation in BSPM is not clearly described and could be of use in the distinction between normal variation and cardiac disease development.</div></div><div><h3>Objective</h3><div>The purpose of this study was to describe the effects of normal respiration, changes in body position, repeated electrode placement, and heart rate differences on BSPM signals in a healthy population.</div></div><div><h3>Methods</h3><div>Sixty-seven–lead BSPM was performed in healthy individuals during the resting supine position, a reclined position of 45°, an exercise-increased heart rate, and a follow-up measurement in the resting supine position after 1 week to determine the effect of repeated electrode placement. R-, S- and T-wave amplitudes in all leads were compared between the baseline supine position and the aforementioned conditions.</div></div><div><h3>Results</h3><div>Ten subjects were included {5 (50%) male; median age 28 years (interquartile range [IQR] 26–30 years)}. The R-wave showed the greatest amplitude variation across all conditions, with the largest changes caused by repeated electrode placement (maximum decrease –0.63 mV [IQR −0.69 to −0.22 mV]) and normal respiration (maximum increase 0.32 mV [IQR 0.08–0.55 mV]) and the smallest changes due to reclined position (maximum decrease −0.23 mV [IQR −0.28 to −0.15 mV]). Electrodes near standard precordial positions were most affected. The exercise-increased heart rate reduced the R-wave amplitude in left-sided electrodes and increased the S-wave amplitude in middle superior electrodes. T-wave amplitude generally increased after exercise.</div></div><div><h3>Conclusion</h3><div>Normal intrapersonal variation in BSPM signals was analyzed. Repeated electrode placement and normal respiration caused the largest amplitude changes. These findings may help differentiate normal variation from pathological changes in BSPM.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 4","pages":"Pages 450-462"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peak frequency can be effectively used to characterize scar in atrial fibrillation","authors":"Sayed Al-Aidarous MRCP, BSc ,&nbsp;Caterina Vidal Horrach BSc ,&nbsp;Caroline Roney MA PhD ,&nbsp;Charles Butcher MRCP, BSc, PhD ,&nbsp;Ross J. Hunter FESC, PhD ,&nbsp;Shohreh Honarbakhsh MRCP, BSc, PhD","doi":"10.1016/j.hroo.2024.12.011","DOIUrl":"10.1016/j.hroo.2024.12.011","url":null,"abstract":"<div><h3>Background</h3><div>Characterizing atrial fibrillation (AF) substrate can guide ablation strategies.</div></div><div><h3>Objective</h3><div>A novel parameter, peak frequency (PF), was evaluated in its ability to characterize the substrate in AF.</div></div><div><h3>Methods</h3><div>Patients undergoing persistent AF ablation were included. Patients had omnipolar voltage (OV) and PF maps in AF and bipolar voltage (BV) maps in sinus rhythm (SR) at pacing intervals of 600 and 250 ms. PF was evaluated at sites of fixed remodeling (low voltage zones [LVZs] across all maps), functional remodeling (LVZs in AF OV and SR BV 250 ms maps) and non-LVZs. <em>PF</em> was defined as the highest frequency detected in the electrogram.</div></div><div><h3>Results</h3><div>In 40 patients, the average voltage in AF OV maps differed significantly from that in SR BV 600 ms maps (0.49±0.76 mV in AF OV vs 1.12±0.97 mV SR BV 600 ms; <em>P</em>&lt;.001) but not SR BV 250 ms maps (0.49±0.76 mV in AF OV vs 0.52±0.84 mV SR BV 250 ms; <em>P</em>=.10). PFs of ≥244 and ≤214 Hz were predictive of non-LVZs (odds ratio [OR] 3.91; <em>P</em>&lt;.001) with an area under the curve (AUC) of 0.71 and of fixed remodeling (OR 17.67; <em>P</em>&lt;.001) with an AUC of 0.90, respectively. A PF between 215 and 236 Hz was predictive of functional remodeling (OR 2.83; 95% confidence interval 2.71–2.95; <em>P</em>&lt;.001) with an AUC of 0.76. A majority of LVZs identified only in AF OV maps exhibited PF compatible with that seen in non-LVZs, suggesting that PF analysis can pinpoint potential overestimations of LVZs.</div></div><div><h3>Conclusion</h3><div>PF can effectively discern between sites of fixed remodeling, functional remodeling, and potential overestimations of LVZs. PF may thereby aid in better characterization of the substrate in AF.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 4","pages":"Pages 434-443"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective evaluation of antral lesion size of the 31-mm size of a novel size-adjustable cryoballoon: Results of the BETTER-FIT study","authors":"Nick van Boven MD, PhD ,&nbsp;Rohit Bhagwandien MD ,&nbsp;Sip A. Wijchers MD ,&nbsp;Mark Hoogendijk MD, PhD ,&nbsp;Bakhtawar Khan Mahmoodi MD, PhD ,&nbsp;Sing-Chien Yap MD, PhD","doi":"10.1016/j.hroo.2025.01.013","DOIUrl":"10.1016/j.hroo.2025.01.013","url":null,"abstract":"<div><h3>Background</h3><div>A novel size-adjustable cryoballoon can deliver cryotherapy with a 28- or 31-mm balloon size. However, data on antral lesion size with the 31-mm balloon size are scarce.</div></div><div><h3>Objective</h3><div>The purpose of this study was to evaluate the antral lesion size of cryoablation with the 31-mm balloon size.</div></div><div><h3>Methods</h3><div>This prospective single-center study included patients with paroxysmal atrial fibrillation undergoing first-time pulmonary vein isolation (PVI). All pulmonary veins (PVs) were first ablated with the 31-mm balloon size. The 28-mm balloon size was only used as bailout. Pre- and postablation left atrial ultrahigh-definition mapping was performed to assess the antral lesion area. Secondary outcome measures were procedural efficacy including balloon occlusion grade.</div></div><div><h3>Results</h3><div>Complete PVI was achieved in all 80 PVs in 20 patients (mean age 59.7 ± 10.7 years, 75% male). More than one-third of the posterior wall was ablated (35.4% ± 13.8%), and the isolated surface area was 68.7% ± 8.5%. Lateral and septal circumferential antral lesion areas were 12.1 ± 2.0 cm² and 19.1 ± 4.7 cm², respectively. One patient demonstrated inadvertent overlap of the antral lesions on the roof. There was a trend toward lower complete balloon occlusion in the right superior PV with the 31-mm balloon size in comparison to the 28-mm size (75% and 90%, <em>P</em> = .08).</div></div><div><h3>Conclusion</h3><div>Cryoablation with the 31-mm size of a novel size-adjustable cryoballoon results in a large antral lesion. In small atria there is the potential for leaving a small nonablated corridor on the roof when using the 31-mm balloon in both superior PVs, which may be proarrhythmogenic.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 4","pages":"Pages 393-401"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Premature ventricular contraction detection and estimation of daily burden by an insertable cardiac monitor","authors":"Kris Z. Siejko MSEE ,&nbsp;Molly Kupfer PhD ,&nbsp;Abhijit Rajan PhD ,&nbsp;Keith Herrmann PhD ,&nbsp;Devi Nair MD, FHRS","doi":"10.1016/j.hroo.2025.01.004","DOIUrl":"10.1016/j.hroo.2025.01.004","url":null,"abstract":"<div><h3>Background</h3><div>Premature ventricular contraction (PVC) burden is a clinically important metric in the context of PVC-induced cardiomyopathy and is commonly obtained via ambulatory electrocardiogram (ECG) monitoring.</div></div><div><h3>Objective</h3><div>The purpose of this analysis is to characterize the performance of a novel PVC detection algorithm capable of identifying single PVCs and PVC sequences (couplets and triplets) for estimation of 24-hour PVC burden in an insertable cardiac monitor (ICM).</div></div><div><h3>Methods</h3><div>Performance of the ICM algorithm for detecting PVCs was validated by replaying 748 patient-triggered ICM-recorded ECG episodes from 184 patients through the ICM device. To assess performance over longer ambulatory periods, a validated software model equivalent of the implemented ICM algorithm was evaluated against a 24-hour Holter dataset of 89 patients. The model also was used to evaluate performance on an established reference library from the Massachusetts Institute of Technology and Beth Israel Hospital (MIT-BIH Arrhythmia Database) as a basis of comparison with other published algorithms.</div></div><div><h3>Results</h3><div>Beat-level validation on the ICM-stored episode dataset yielded a gross PVC sensitivity of 80.1% with a specificity of 99.7%. The correlation between 24-hour Holter burden and ICM algorithm PVC burden was <em>r</em> = 0.95. The sensitivity for identifying patients with PVC burdens ≥10% was 84%, with a patient-level positive predictive value (PPV) of 100%. Beat-level sensitivity of the PVC algorithm evaluated against the MIT-BIH dataset was 87.9% with a PPV of 96.4%.</div></div><div><h3>Conclusion</h3><div>The ICM algorithm reliably detects PVCs with high sensitivity and specificity. Twenty-four-hour PVC burden measurements demonstrated a strong correlation with a gold standard 12-lead Holter and may provide utility for identifying patients at risk for worsening left ventricular function.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 4","pages":"Pages 528-536"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of congestive heart failure from RR intervals during long-term electrocardiographic recordings","authors":"Teemu Pukkila MSc ,&nbsp;Matti Molkkari MSc ,&nbsp;Jussi Hernesniemi MD, PhD ,&nbsp;Matias Kanniainen MSc ,&nbsp;Esa Räsänen PhD","doi":"10.1016/j.hroo.2025.01.014","DOIUrl":"10.1016/j.hroo.2025.01.014","url":null,"abstract":"<div><h3>Background</h3><div>Timely detection is crucial for managing cardiovascular diseases. Recently developed computational tools to analyze RR interval (RRI) sequences offer cost-effective means for early cardiac screening and monitoring with consumer-grade heart rate devices.</div></div><div><h3>Objective</h3><div>The purpose of this study was to demonstrate detection of congestive heart failure (CHF) from RRIs by discriminating CHF from both healthy controls and patients with present atrial fibrillation (AF). We also examined the detection’s consistency regarding CHF severity and AF episode frequency.</div></div><div><h3>Methods</h3><div>We analyzed RRIs extracted from several datasets of long-term electrocardiographic (ECG) recordings. We use detrended fluctuation analysis (DFA) to evaluate the correlations of RRI, that is, how changes in the RRIs affect changes at another time. Furthermore, we utilized dynamical detrended fluctuation analysis (DDFA), which provides further insights into how the correlations change over time and different time scales. The resulting (D)DFA scaling exponents are used as features in classification, distinguishing CHF, AF, and healthy controls using the XGboost ensemble learning technique.</div></div><div><h3>Results</h3><div>Our (D)DFA computations revealed distinct RRI characteristics for CHF and AF patients during long-term ECG recordings, aiding disease detection. The DDFA-based classification pipeline detects CHF/AF from healthy controls with 90% sensitivity and 92% specificity. The 3-class classification algorithm correctly detects 78% of AF cases, 78% of CHF cases, and 91% of healthy cases. The DDFA results show consistency regarding CHF severity and AF episode frequency.</div></div><div><h3>Conclusion</h3><div>We achieved high confidence in detecting CHF, with DDFA showing excellent classification accuracy, especially in multiclass tasks. This approach highlights the potential of noninvasive, cost-efficient RRI analysis for early detection of CHF and AF.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 4","pages":"Pages 509-518"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Termination of perioperative atrial fibrillation with epicardial cooling in the oblique sinus: A first-in-human feasibility study","authors":"Alejandro Trainini MD ,&nbsp;Miragaya Nicolàs MD ,&nbsp;Crespo Fabián MD ,&nbsp;Delgado Elìas Lorena MD ,&nbsp;Heredia Florencia CCP ,&nbsp;Miranda Hernán CCP ,&nbsp;Brodaric María Magdalena MD ,&nbsp;Ciscato Julio MD ,&nbsp;Adetola Ladejobi MD ,&nbsp;Ammar Killu MBBS, FHRS ,&nbsp;Juan Crestanello MD ,&nbsp;Jason Tri ,&nbsp;Jeff Rynbrandt BS, MBA ,&nbsp;Samuel Asirvatham MD, FHRS ,&nbsp;Paul Friedman MD, FHRS ,&nbsp;Benjamin Elencwajg MD","doi":"10.1016/j.hroo.2025.01.017","DOIUrl":"10.1016/j.hroo.2025.01.017","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative atrial fibrillation (AF) is associated with prolonged hospitalization, stroke and expense. We have previously demonstrated the effectiveness of cooling the oblique sinus to terminate AF in animal models.</div></div><div><h3>Objective</h3><div>The study sought to determine whether cooling can terminate intraoperative AF in humans undergoing cardiac surgery.</div></div><div><h3>Methods</h3><div>Patients presenting for clinically indicated cardiac surgery with a history of atrial fibrillation were enrolled. During surgery, before bypass, AF was induced if not present, and a 1 × 1 inch cooling device was placed in the oblique sinus that cooled to 5 to 10 °C at the device-tissue interface. Due to the pandemic, remote, real-time monitoring was used.</div></div><div><h3>Results</h3><div>Four patients (all women, mean age 69.3 years) underwent 8 AF inductions. Five (63%) of 8 episodes were terminated with cooling, with average time to termination (after 30 seconds of sustained arrhythmia) of 21 seconds. Of the 3 failed episodes, 1 may have been a type II termination, 1 organized to flutter, and 1 failed to cool for technical reasons. There were no procedure-related complications.</div></div><div><h3>Conclusion</h3><div>Termination of perioperative atrial fibrillation with epicardial cooling in the oblique sinus is feasible and appears safe in this very early first-in-human study.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 4","pages":"Pages 444-449"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of cases requiring touch-up applications in pulmonary vein isolation with balloon ablation","authors":"Koshiro Kanaoka MD, PhD ,&nbsp;Koji Miyamoto MD, PhD ,&nbsp;Yoshitaka Iwanaga MD, PhD ,&nbsp;Michikazu Nakai PhD ,&nbsp;Reina Tonegawa-Kuji MD, PhD ,&nbsp;Yoko Sumita ,&nbsp;Koichi Inoue MD, PhD ,&nbsp;Teiichi Yamane MD, PhD ,&nbsp;Akihiko Nogami MD, PhD ,&nbsp;Yoshihiro Miyamoto MD, PhD ,&nbsp;Wataru Shimizu MD, PhD ,&nbsp;Kengo Kusano MD, PhD","doi":"10.1016/j.hroo.2025.01.009","DOIUrl":"10.1016/j.hroo.2025.01.009","url":null,"abstract":"<div><h3>Background</h3><div>Balloon ablation for pulmonary vein isolation (PVI) is a well-established treatment option for atrial fibrillation. Although some patients require touch-up ablation, generalizable evidence is limited.</div></div><div><h3>Objective</h3><div>This study aimed to investigate the current status and outcomes of touch-up applications using a nationwide registry in Japan.</div></div><div><h3>Methods</h3><div>Patients ≥18 years of age who underwent first-time PVI between January 2017 and December 2020 were included using the data from the Japanese Catheter Ablation registry. The annual trends in the proportion of cases requiring touch-up ablation with radiofrequency ablation were determined, and the associations of ablation strategies with acute success and periprocedural complications were analyzed using logistic regression analysis.</div></div><div><h3>Results</h3><div>Of the 51,402 patients included, 28,412 and 22,990 patients underwent PVI using radiofrequency ablation and balloon ablation, respectively. In the balloon ablation group, 1462 (6.4%) patients required touch-up applications, and the proportion of cases requiring touch-up applications decreased during the study period from 9.5% in 2017 to 5.5% in 2020 (<em>P</em> for trend &lt; .001). The proportion of acute success was &gt;99% across all ablation strategies. Although 2.5% of the patients in the touch-up ablation group had phrenic nerve palsy, the composite of complications, except for phrenic nerve palsy, was not significantly increased in the balloon + touch-up ablation group compared with that in the balloon ablation–only group and radiofrequency ablation group.</div></div><div><h3>Conclusion</h3><div>Touch-up applications following balloon ablation are required in some cases. Touch-up ablation with radiofrequency ablation may be a treatment option when achieving successful PVI using balloon ablation is difficult.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 4","pages":"Pages 410-416"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}