Journal of Innovations in Cardiac Rhythm Management最新文献

{"title":"Transient Ischemic Attack Due to Delamination of a Steerable Guiding Sheath: A Potential Complication During Atrial Fibrillation Ablation.","authors":"Hafez Golzarian, Mohammad Khalil Kanjwal, Fayaz Hakim","doi":"10.19102/icrm.2026.17093","DOIUrl":"10.19102/icrm.2026.17093","url":null,"abstract":"<p><p>We report a case of transient ischemic attack due to a thromboembolic event secondary to delamination of the steerable guiding sheath, CARTO VIZIGO™ (J&J MedTech, New Brunswick, NJ, USA), indicating a device deficiency in structural integrity. This case illustrates an unforeseen device-related complication, emphasizing the importance of heightened vigilance for this potential complication during catheter ablations incorporating this sheath.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 9","pages":"6854-6856"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Atrial Appendage Closure: Past, Present, and Future.","authors":"Elio Zito, Pamela Horton Embrey, Vincenzo Mirco La Fazia, Carola Gianni, Sanghamitra Mohanty, Claudio Tondo, Andrea Natale, Rodney Horton","doi":"10.19102/icrm.2026.17095","DOIUrl":"10.19102/icrm.2026.17095","url":null,"abstract":"<p><p>Left atrial appendage closure (LAAC) has emerged as an important alternative strategy for stroke prevention in patients with non-valvular atrial fibrillation (NVAF), particularly when long-term oral anticoagulation (OAC) is contraindicated or poorly tolerated. Initially developed as a surgical technique based on ligation or excision of the left atrial appendage, LAAC has progressively shifted toward refined, minimally invasive transcatheter approaches. Randomized and observational data have established non-inferiority to warfarin, and non-inferiority compared with direct oral anticoagulants has also been suggested in selected high-risk cohorts and is currently under prospective evaluation in pivotal trials. At the same time, indications for LAAC are expanding beyond the classical high-bleeding-risk population, now encompassing patients undergoing atrial fibrillation (AF) ablation and those with only moderate thromboembolic risk but intolerance to OAC. Parallel advances in device design aimed at improving anatomical conformability, sealing performance, and surface biocompatibility seek to reduce peri-device leak (PDL), device-related thrombus (DRT), and bleeding and may allow for simplified or shortened post-procedural antithrombotic regimens. This narrative review summarizes the historical evolution of LAAC from surgical to contemporary transcatheter solutions, outlines key clinical evidence versus medical therapy, and discusses emerging implant-based and implant-free technologies. As evidence accumulates from ongoing randomized controlled trials, LAAC may transition from a niche intervention to a more widely adopted, guideline-supported component of AF management. However, broader implementation will depend on robust demonstration of long-term safety and efficacy, including clarification of PDL-, DRT-, and bleeding-related trade-offs, to define when LAAC can serve not only as an alternative to OAC but also as a tailored option for selected NVAF patients.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 9","pages":"6874-6895"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Advances in Ventricular Tachycardia Ablation.","authors":"Fahd Mohamed, Amar Ghaleb, Abimbola Kolawole, Arfaat M Khan","doi":"10.19102/icrm.2026.17092","DOIUrl":"10.19102/icrm.2026.17092","url":null,"abstract":"<p><p>Ventricular tachycardia (VT) is a potentially life-threatening arrhythmia associated with substantial morbidity and mortality, particularly in patients with structural heart disease. Over the past several decades, the management of VT has evolved significantly with the development of catheter-based and noninvasive ablation strategies aimed at eliminating arrhythmogenic myocardial substrates. This review provides a comprehensive overview of global advances in VT ablation, highlighting historical foundations, current therapeutic modalities, and emerging technologies shaping the future of ventricular arrhythmia (VA) management. Radiofrequency ablation remains the cornerstone of VT ablation and has undergone substantial technological refinement through innovations such as irrigated-tip catheters, high-density electroanatomic mapping, contact force sensing, and strategies for achieving deeper myocardial lesions. Alternative catheter-based energy modalities, including cryoablation and the emerging nonthermal technique of pulsed field ablation, provide additional therapeutic options with distinct mechanisms of action and safety profiles. In parallel, procedural advancements such as remote magnetic navigation have improved catheter stability and access to complex ventricular substrates. Beyond traditional catheter ablation, the therapeutic landscape has expanded to include neuromodulatory approaches targeting the cardiac autonomic nervous system, including thoracic epidural anesthesia, stellate ganglion blockade, cardiac sympathetic denervation, and renal denervation. These strategies play an important role in the management of refractory VAs and electrical storm. Furthermore, stereotactic body radiation therapy has emerged as a promising noninvasive treatment for patients with VT who are not candidates for or have failed catheter-based interventions. Additional investigational technologies including laser ablation, microwave ablation, and high-intensity focused ultrasound have been explored in preclinical and limited clinical settings but remain experimental in the context of VT management. Collectively, these evolving technologies underscore the increasingly multimodal approach required to treat complex VAs. In conclusion, VT ablation has progressed from early surgical and direct-current approaches to a sophisticated field incorporating advanced catheter techniques, neuromodulation, robotic navigation, and noninvasive therapies. Continued technological innovation, improved substrate characterization, and integration of emerging tools such as artificial intelligence are expected to further enhance procedural efficacy and patient outcomes. Individualized treatment strategies tailored to patient-specific arrhythmogenic substrates and clinical characteristics remain central to optimizing the management of VT.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 9","pages":"6865-6873"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluoroless Ablation of a Coronary Sinus-related Accessory Pathway Without Coronary Sinus Angiogram in a Patient with Multiple Prior Failed Ablations.","authors":"Anthony Costa, Fayaz Hakim, Jennifer Burchell, Megan Nettle, Khalil Kanjwal","doi":"10.19102/icrm.2026.17091","DOIUrl":"10.19102/icrm.2026.17091","url":null,"abstract":"<p><p>Accessory pathways (APs) associated with the coronary sinus (CS), often linked to diverticula, are rare and challenging to ablate, frequently requiring CS venography for anatomical guidance. We report the case of a 56-year-old woman with recurrent palpitations, manifest pre-excitation, and two prior failed ablations for a presumed posteroseptal pathway. The electrocardiogram showed an immediately negative QRS complex in the inferior leads, suggesting an epicardial CS-related pathway. Using solely three-dimensional (3D) electroanatomic mapping (CARTO™; J&J MedTech, New Brunswick, NJ, USA) without fluoroscopy or CS angiogram, we reconstructed the geometry of the right atrium, venae cavae, and CS. Mapping revealed early ventricular activation and fused atrioventricular signals in distal CS, enabling successful radiofrequency ablation at 30 W with immediate loss of antegrade conduction. No retrograde conduction persisted post-adenosine, and tachycardia was non-inducible. The patient remained symptom-free at 1-year follow-up. To the best of our knowledge, this is the first reported successful fluoroless ablation of a CS-related epicardial AP without venography, highlighting the role of advanced 3D mapping in reducing radiation and contrast risks in complex cases.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 9","pages":"6857-6864"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter from the Editor in Chief.","authors":"Devi Nair","doi":"10.19102/icrm.2026.17094","DOIUrl":"https://doi.org/10.19102/icrm.2026.17094","url":null,"abstract":"","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 9","pages":"A5-A6"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety, Efficacy, and Effectiveness of Pulsed Field Ablation with Farapulse™ to Treat Atrial Fibrillation: A Prospective Single-center Study.","authors":"Dean Sabayon, Deaa Abu Jazar, Khaled Alabdallah, Ritika Saxena, Ivana Garza, Arun Narayanan, Haidar Al Taii, Dustin Staloch, Hani Jneid","doi":"10.19102/icrm.2026.17096","DOIUrl":"10.19102/icrm.2026.17096","url":null,"abstract":"<p><p>Pulsed field ablation (PFA) using the Farapulse™ system (Boston Scientific, Marlborough, MA, USA) is a novel, non-thermal ablation technology developed to treat atrial fibrillation (AF) with improved safety and procedural efficiency. We present prospective single-center data on the safety, efficacy, and effectiveness of PFA in a real-world patient population. We enrolled 100 consecutive patients with symptomatic AF undergoing catheter ablation with the Farapulse™ system. Procedural characteristics, clinical outcomes, and acute safety events were evaluated. Freedom from AF recurrence was assessed at 6 months. The cohort had a mean age of 69.2 ± 10.9 years, and 47% were women. Pulmonary vein isolation was achieved in 96% of patients, with additional posterior wall ablation performed in 66%. The median procedure and fluoroscopy times were 42 and 12 min, respectively. No major adverse events occurred. At 6 months, 82% of patients were free from atrial arrhythmia recurrence off anti-arrhythmic drugs. PFA with the Farapulse™ system demonstrated high acute efficacy, excellent safety, and promising short-term effectiveness in a real-world population with AF. These findings support the broader adoption of PFA in routine clinical practice.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 9","pages":"6850-6853"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter from the Editor in Chief.","authors":"Devi Nair","doi":"10.19102/icrm.2026.17085","DOIUrl":"https://doi.org/10.19102/icrm.2026.17085","url":null,"abstract":"","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 8","pages":"A5-A7"},"PeriodicalIF":0.0,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electroanatomic Mapping Clues for Distinguishing a Breakthrough Site from the True Focal Source: Beware of a Big Focus.","authors":"Vatsal Singh, K Venkadesan, Bhagya Narayan Pandit, Ranjit Kumar Nath","doi":"10.19102/icrm.2026.17084","DOIUrl":"10.19102/icrm.2026.17084","url":null,"abstract":"<p><p>This case highlights an important electroanatomic mapping clue that electrophysiologists should be aware of when ablating focal atrial arrhythmias.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 8","pages":"6832-6836"},"PeriodicalIF":0.0,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Report of Right Phrenic Nerve Palsy Following Pulsed Field Ablation in a Patient with Persistent Atrial Fibrillation.","authors":"Hasan Munshi, Abdullah Ahmad, Abdel Dajani, Own Khraisat, Amer Hammad, Satish Tiyyagura","doi":"10.19102/icrm.2026.17082","DOIUrl":"10.19102/icrm.2026.17082","url":null,"abstract":"<p><p>Pulsed field ablation (PFA) is a nonthermal ablation modality that achieves myocardial ablation through irreversible electroporation and has been associated with a reduced risk of collateral tissue injury. Phrenic nerve injury is uncommon with PFA, and persistent injury has rarely been described. A 61-year-old woman with symptomatic persistent atrial fibrillation refractory to anti-arrhythmic drug therapy underwent catheter ablation using the PulseSelect™ PFA system (Medtronic, Minneapolis, MN, USA). Circumferential PFA applications were delivered to all four pulmonary veins, followed by additional applications to the posterior left atrial wall to achieve posterior wall isolation. A total of 61 pulsed field energy applications were delivered, and the entrance and exit blocks of the pulmonary veins and posterior wall were confirmed. The procedure was otherwise uncomplicated. Several hours post-procedure, the patient developed new-onset dyspnea. Chest radiography demonstrated elevation of the right hemidiaphragm consistent with right phrenic nerve palsy. Conservative management was initiated, with gradual symptomatic improvement. However, follow-up imaging at 3 months demonstrated persistent right hemidiaphragmatic elevation. This case demonstrates that phrenic nerve palsy may occur following pulmonary vein and posterior wall isolation using PFA. Continued awareness of this potential complication and careful post-procedural follow-up are warranted as clinical experience with PFA continues to expand.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 8","pages":"6822-6826"},"PeriodicalIF":0.0,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ablation of a Para-Hisian Accessory Pathway from the Non-coronary Cusp: A Case Report.","authors":"Marina Marins, Vidal Essebag, Martin Bernier","doi":"10.19102/icrm.2026.17087","DOIUrl":"10.19102/icrm.2026.17087","url":null,"abstract":"<p><p>Para-Hisian accessory pathways (PHAPs) remain among the most challenging substrates for catheter ablation because of their close anatomical relationship to the atrioventricular (AV) conduction system and the consequent risk of iatrogenic AV block. The non-coronary cusp (NCC) has emerged as a valuable alternative when right-sided ablation is ineffective or associated with an unacceptable risk of injury to the His bundle. We report the case of a 23-year-old man who presented with pre-excited atrial fibrillation. Electrophysiological study localized an anteroseptal/para-Hisian accessory pathway. Electroanatomical mapping identified the earliest ventricular activation at the para-Hisian region; however, multiple irrigated radiofrequency applications from the right atrial septum failed to eliminate pre-excitation because of the close proximity to the His bundle. A retrograde aortic approach to the NCC was subsequently undertaken using three-dimensional electroanatomical mapping integrated with intracardiac echocardiography. Mapping within the NCC demonstrated an accessory pathway potential with atrioventricular fusion and ventricular activation preceding delta-wave onset by 20 ms. Radiofrequency delivery at this site resulted in elimination of pre-excitation within 3 s while preserving normal AV conduction. No recurrence of pre-excitation or impairment of AV nodal conduction was observed during post-ablation assessment. This case supports the NCC as a safe and effective alternative target when conventional right-sided ablation is unsuccessful or poses a significant risk of AV conduction injury.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 8","pages":"6843-6849"},"PeriodicalIF":0.0,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}