Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing最新文献

{"title":"Pulsed field ablation of ventricular arrhythmias arising from intracavitary structures: insights from a clinical case series.","authors":"Kasun De Silva, Tai Chung So, Samual Turnbull, Max Bickley, Kenji Hashimoto, Ashwin Bhaskaran, Saurabh Kumar","doi":"10.1007/s10840-025-02072-1","DOIUrl":"10.1007/s10840-025-02072-1","url":null,"abstract":"<p><strong>Introduction: </strong>Premature ventricular complexes (PVCs) from intracavitary structures, such as papillary muscles and the moderator band, can be challenging to treat. Pulsed field ablation (PFA) offers a novel strategy for treating these arrhythmias.</p><p><strong>Methods: </strong>Between 2023 and 2024, three patients with intracavitary PVCs (two with PVC-mediated ventricular fibrillation) underwent PFA at a tertiary referral centre. Electroanatomic mapping was performed and, with intracardiac echocardiography (ICE) guidance, PFA was delivered using a pentaspline Farapulse catheter, with adjuvant radiofrequency (RF) ablation as needed.</p><p><strong>Results: </strong>All patients had successful abolition of PVCs. PFA delivery was feasible and safe, with excellent success despite prior RF ablation failures though one patient required adjuvant RF ablation. The only complication was a persistent right bundle branch block (RBBB) after PFA delivery to the moderator band. Follow-up showed significant reductions in PVC burden and no further ventricular fibrillation (VF) episodes. The mean procedural duration was 153.67 ± 31.71 min, and the mean fluoroscopy time was 14.38 ± 6.74 min.</p><p><strong>Conclusion: </strong>This is a preliminary proof of concept report for ablation of PVCs from intracavitary structures, warranting further validation studies.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":"1661-1670"},"PeriodicalIF":2.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201318","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":"One-year outcomes of focal pulsed-field ablation for redo procedures in atrial fibrillation and atypical flutter.","authors":"Sebastian Weyand, Viola Adam, Paloma Biehler, Patricia Hägele, Simon Hanger, Stephanie Löbig, Andrei Pinchuk, Felix Ausbuettel, Christian Waechter, Peter Seizer","doi":"10.1007/s10840-025-02079-8","DOIUrl":"10.1007/s10840-025-02079-8","url":null,"abstract":"<p><strong>Background: </strong>Redo ablation procedures are frequently required in patients with recurrent atrial fibrillation (AF) and atypical atrial flutter following initial pulmonary vein isolation (PVI). While focal pulsed-field ablation (PFA) has emerged as a promising nonthermal alternative, data on its long-term efficacy and safety in redo procedures remain limited. This study evaluates the 1-year outcomes of focal PFA in redo ablations for AF and atypical flutter, focusing on arrhythmia recurrence, procedural success, and safety.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 54 patients undergoing redo ablation with focal PFA at a single center. Procedural endpoints included acute and chronic procedural success, additional ablation line integrity, and complication rates. Arrhythmia recurrence was assessed via ECG and 24-h Holter monitoring at 6 and 12 months.</p><p><strong>Results: </strong>Complete PVI and bidirectional block of all additional ablation lines were confirmed in all cases at the end of the procedure. During the 1-year follow-up, 29.63% of patients experienced arrhythmia recurrence. Among patients undergoing a further redo ablation, reconnections were most frequently observed in the anterior mitral line, suggesting challenges in lesion durability in this region. The overall complication rate was low (1.85%), with one case of coronary vasospasm during cavotricuspid isthmus ablation.</p><p><strong>Conclusion: </strong>Focal PFA appears to be a feasible and safe option for redo ablations in AF and atypical flutter, with high acute success rates and acceptable arrhythmia control at 1 year. However, lesion durability, especially for complex lines, remains a limitation, underscoring the need for optimization and further prospective evaluation against thermal ablation.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":"1625-1636"},"PeriodicalIF":2.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164046","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":"The relationship between systemic immune-inflammation index and recurrence after cryoballoon ablation for paroxysmal atrial fibrillation.","authors":"Abdulcebbar Sipal, Sukriye Ebru Onder, Serdar Bozyel, Sadiye Nur Dalgıc, Metin Cağdas, Mujdat Aktas, Osman Muhsin Celik, Tumer Erdem Guler, Dhiraj Gupta, Tolga Aksu","doi":"10.1007/s10840-025-02071-2","DOIUrl":"10.1007/s10840-025-02071-2","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness of lesion formation during cryoballoon ablation (CBA) may be influenced by the extent of acute local inflammation induced during the ablation process. This study aims to evaluate the predictive value of inflammatory markers following CBA.</p><p><strong>Methods: </strong>A total of 102 consecutive patients with paroxysmal atrial fibrillation (AF) who underwent CBA (51.9% male; mean age 56.7 ± 11.5 years) were prospectively included in the study. Blood samples for Systemic Immune-Inflammation Index (SII), C-reactive protein (CRP), lymphocyte counts (LC) were collected from all participants prior to, and within 24 h post-procedure. SII was calculated as platelet count × neutrophil count / lymphocyte count. 12-lead electrocardiograms, clinical evaluations, medical history reviews, and 24-hour Holter monitoring were performed at one, three-, and six-months post-ablation. Recurrences of AF occurring beyond the initial 30-day blanking period were documented and analyzed.</p><p><strong>Results: </strong>Over a mean follow-up period of 12.3 ± 5.1 months, AF recurrence was observed in 30 (29.4%) patients. SII, CRP, LC, and left atrial end-systolic diameter (LAD), were associated with AF recurrence. Multivariable Cox regression analysis identified post-ablation SII levels as the sole independent predictor of AF recurrence (hazard ratio [HR]: 0.139; 95% confidence interval [CI]: 0.052-0.369; p < 0.001). Receiver operating characteristic (ROC) curve analysis determined an SII cut-off value of 900 for predicting AF recurrence, yielding a sensitivity of 80.0% and specificity of 63.9%. The area under the curve (AUC) was 0.72 (p < 0.001).</p><p><strong>Conclusion: </strong>Lower post-ablation levels of SII predict AF recurrence following CBA.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":"1613-1624"},"PeriodicalIF":2.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121974","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":"Prophylactic cardiac denervation to prevent post-operative atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis.","authors":"Junaid Ali, Muhammad Haris Khan, Zuhair Majeed, Ahmed Bostamy Elsnhory, Allan Edgardo Santos Argueta, Leenah Afiridi, Anum Nawaz, Mohamed Abuelazm, Ubaid Khan, Muhammad Aamir, Sourbha Dani","doi":"10.1007/s10840-025-02076-x","DOIUrl":"10.1007/s10840-025-02076-x","url":null,"abstract":"<p><strong>Background: </strong>Despite revolutionary advances in the field of percutaneous coronary intervention (PCI), a significant number of patients with coronary artery disease (CAD) require coronary artery bypass grafting (CABG), which is associated with postoperative atrial fibrillation (POAF) risk. This meta-analysis evaluates the efficacy and safety of prophylactic cardiac denervation (PCD) during CABG to prevent POAF.</p><p><strong>Methods: </strong>A systematic search was conducted across PubMed, CENTRAL, Web of Science, Scopus, and Embase until December 2024. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with a 95% confidence interval (CI). This systematic review and meta-analysis is registered with PROSPERO ID: CRD42025631310.</p><p><strong>Results: </strong>Five studies with 1266 patients were included in the final analysis. Compared to CABG alone, CABG plus PCD did not show any significant difference in the incidence of POAF (RR 0.77, [95% CI 0.38, 1.56], p = 0.47, I² = 83%) and all-cause mortality (RR 0.70, [95% CI 0.19, 2.51], p = 0.58, I² = 0). Additionally, there was no significant difference between both groups in cross-clamp time (MD: 0.68, [95% CI - 1.22, 2.57], p = 0.48, I² = 26%), cardiopulmonary bypass time (MD - 0.04 [95% CI - 5.29, 5.21], p = 0.99, I² = 82%), length of hospital stay (MD - 0.13 [95% CI - 0.55, 0.29], p = 0.54, I² = 59%), blood loss (MD 2.22, [95% CI - 23.60, 28.03], p = 0.87, I² = 0%), and number of grafts (MD 0.21, [95% CI - 0.07, 0.49], p = 0.13, I² = 91%).</p><p><strong>Conclusion: </strong>CABG with adjuvant PCD did not show significant efficacy in preventing the incidence of POAF compared to CABG alone. This calls for further research focusing on investigating combined preventive strategies, rather than relying solely on PCD, and developing risk stratification tools to identify patients most likely to benefit from autonomic modulation.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":"1671-1682"},"PeriodicalIF":2.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144218512","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":"AI-guided spatiotemporal dispersion mapping for individualized ablation in an all-comer cohort with atrial fibrillation.","authors":"Emanuel Heil, Nikolaos Dagres, Leif-Hendrick Boldt, Abdul Parwani, Florian Blaschke, Doreen Schoeppenthau, Philipp Attanasio, Robert Hättasch, Verena Tscholl, Gerhard Hindricks, Jin-Hong Gerds-Li, Felix Hohendanner","doi":"10.1007/s10840-025-02083-y","DOIUrl":"10.1007/s10840-025-02083-y","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI)-guided spatiotemporal dispersion (stD) mapping has been shown to improve outcomes in patients with persistent atrial fibrillation (AF). However, the relationship between stD mapping and markers of atrial cardiomyopathy, dispersion patterns in paroxysmal versus persistent AF, stability of dispersion regions, and stD-guided ablation-related outcomes in all-comer cohorts remain elusive.</p><p><strong>Methods: </strong>In this retrospective single-center analysis, AF patients underwent high-density electroanatomical mapping alongside multiple instances of stD mapping using VOLTA AF Explorer software. Pulmonary vein isolation (PVI) and targeted ablation of left atrial dispersion regions were performed. Clinical, echocardiographic, biomarker, and low-voltage area (LVA) data were collected as markers of left atrial remodeling.</p><p><strong>Results: </strong>stD mapping identified dispersion in 92% of patients. Mean time since AF diagnosis was 7 ± 1 years. Overall, 58% of patients showed dispersion exclusively co-localizing with low-voltage areas, while 42% had dispersion extending into intermediate or normal voltage regions. Dispersion burden correlated strongly with LVA extent and other remodeling markers such as NT-proBNP and LAVI. Persistent AF patients exhibited a significantly higher number of dispersion sites compared to paroxysmal AF. Dispersion patterns remained largely consistent before and after cardioversion in persistent AF, with the posterior left atrial wall emerging as a common hotspot. At follow-up, AF recurred in 33% of paroxysmal and 60% of persistent AF patients who had dispersion ablation limited to the left atrium. Despite these recurrences, most patients reported an improvement in symptomatic burden.</p><p><strong>Conclusion: </strong>AI-guided stD mapping effectively identifies atrial remodeling beyond classical voltage-derived substrate, supporting its potential as a useful adjunctive tool in AF characterization.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":"1683-1693"},"PeriodicalIF":2.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236743","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":"Pulmonary artery perforation after percutaneous left atrial appendage closure: two case reports and review of literature.","authors":"Ahmet Kivrak, Ahmet Hakan Ates, Mert Dogan, Cem Coteli, Ugur Canpolat, Ugur Nadir Karakulak, Mehmet Levent Sahiner, Ergun Barıs Kaya, Kudret Aytemir","doi":"10.1007/s10840-025-02090-z","DOIUrl":"10.1007/s10840-025-02090-z","url":null,"abstract":"<p><p>Management of anticoagulant therapy in certain patient populations with atrial fibrillation remains a clinical challenge. In addition to an increased thromboembolic risk, the concomitant bleeding risk significantly contributes to morbidity and mortality in some patients. In recent years, the global use of percutaneous left atrial appendage closure (LAAC) has expanded due to the growing variety of available devices and increasing operator experience. As procedural volumes rise, our understanding of the types and frequencies of related complications continues to evolve. In addition to well-recognized complications such as air embolism, pericardial effusion, and device embolization, rare but catastrophic events like pulmonary artery rupture have also been reported. Our knowledge regarding both the underlying mechanisms and preventive strategies for pulmonary artery rupture is also progressively increasing. In this review, we present two cases of pulmonary artery rupture following percutaneous LAAC performed at our center and provide a comprehensive discussion of risk factors, prevention strategies, and management approaches, incorporating insights from the existing literature.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":"1761-1769"},"PeriodicalIF":2.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693095","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":"Trends in atrial fibrillation-related mortality among adults under 65 years in the USA.","authors":"Siddharth Agarwal, Usama Qamar, Waleed Qamar, Gurukripa N Kowlgi, Muhammad Bilal Munir, Zain Ul Abideen Asad, Abhishek Deshmukh, Christopher V DeSimone","doi":"10.1007/s10840-025-02108-6","DOIUrl":"10.1007/s10840-025-02108-6","url":null,"abstract":"<p><strong>Introduction: </strong>Atrial fibrillation (AF) is the most common arrhythmia in the USA, contributing to increased risks of mortality and adverse cardiovascular events. While AF is predominantly seen in older adults, over 20% of cases occur in individuals younger than 65 years.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis using de-identified data from the CDC WONDER database, covering all US deaths from 1999 to 2020. AF-related deaths were identified using ICD-10 codes. Age-adjusted mortality rates (AAMR) were calculated per 1 million population, standardized to the 2000 US census. Temporal trends were analyzed using Joinpoint regression models with statistical significance set at p < 0.05.</p><p><strong>Results: </strong>From 1999 to 2020, 137,808 AF-related deaths were recorded among adults aged 15-64 years. The AAMR rose from 14.0 in 1999 to 50.5 by 2020, reflecting a 6.3% annual increase. Adults aged 45-54 years showed the highest annual increase (6.7%), followed by adults aged 35-44 years (6.6%), and adults aged 55-64 years (6.2%). Males had a higher AAMR than females (35.4 vs 16.2). Non-Hispanic Blacks had the highest AAMR among racial groups (37.4). Rural areas showed higher AAMRs than urban areas (30.3 vs 24.6). AAMR varied widely across states, with Oklahoma having the highest rate (46.7).</p><p><strong>Conclusion: </strong>AF-related mortality among younger US adults has significantly increased in the last 2 decades. The findings highlight the shifting epidemiology of AF, with middle-aged adults showing the highest annual increases.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":"1707-1709"},"PeriodicalIF":2.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144819030","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":"Procedural tricuspid valve damage associated with leadless pacemakers.","authors":"Ali Bahbah, Kerollos Abdelsayed, Mariam Desouki, Dawn Witt, Melanie Kapphahn-Bergs, Emily Halvorson, Joellyn Moore, Edwin Zishiri, Jay Sengupta, Robert Hauser","doi":"10.1007/s10840-025-02099-4","DOIUrl":"10.1007/s10840-025-02099-4","url":null,"abstract":"","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":"1703-1705"},"PeriodicalIF":2.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763007","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":"Beyond the type 1 pattern: comprehensive risk stratification in Brugada syndrome.","authors":"Kwan Yau Kan, Aléchia Van Wyk, Toby Paterson, Naveen Ninan, Pawel Lysyganicz, Ishika Tyagi, Ravisankar Bhasi Lizi, Fayza Boukrid, Maha Alfaifi, Alka Mishra, Sai Vamshi Krishna Katraj, Vivetha Pooranachandran","doi":"10.1007/s10840-025-02101-z","DOIUrl":"10.1007/s10840-025-02101-z","url":null,"abstract":"<p><p>Brugada Syndrome (BrS) is an inherited cardiac ion channelopathy associated with an elevated risk of sudden cardiac death, particularly due to ventricular arrhythmias in structurally normal hearts. Affecting approximately 1 in 2,000 individuals, BrS is most prevalent among middle-aged males of Asian descent. Although diagnosis is based on the presence of a Type 1 electrocardiographic (ECG) pattern, either spontaneous or induced, accurately stratifying risk in asymptomatic and borderline patients remains a major clinical challenge. This review explores current and emerging approaches to BrS risk stratification, focusing on electrocardiographic, electrophysiological, imaging, and computational markers. Non-invasive ECG indicators such as the β-angle, fragmented QRS, S wave in lead I, early repolarisation, aVR sign, and transmural dispersion of repolarisation have demonstrated predictive value for arrhythmic events. Adjunctive tools like signal-averaged ECG, Holter monitoring, and exercise stress testing enhance diagnostic yield by capturing dynamic electrophysiological changes. In parallel, imaging modalities, particularly speckle-tracking echocardiography and cardiac magnetic resonance have revealed subclinical structural abnormalities in the right ventricular outflow tract and atria, challenging the paradigm of BrS as a purely electrical disorder. Invasive electrophysiological studies and substrate mapping have further clarified the anatomical basis of arrhythmogenesis, while risk scoring systems (e.g., Sieira, BRUGADA-RISK, PAT) and machine learning models offer new avenues for personalised risk assessment. Together, these advances underscore the importance of an integrated, multimodal approach to BrS risk stratification. Optimising these strategies is essential to guide implantable cardioverter-defibrillator decisions and improve outcomes in patients vulnerable to life-threatening arrhythmias.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":"1771-1790"},"PeriodicalIF":2.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144791779","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":"Acute mitral isthmus block in patients undergoing catheter ablation for atrial fibrillation: efficacy and safety of a systematic stepwise approach.","authors":"Bo He, Wenxi Yu, Yi Li, Yingying Hu, Xiaoyan Wu, Fang Zhao, Fabrice Yves Ndjana Lessomo, Shuyuan Yao, Zhibing Lu","doi":"10.1007/s10840-025-02074-z","DOIUrl":"10.1007/s10840-025-02074-z","url":null,"abstract":"<p><strong>Background: </strong>Mitral isthmus (MI) line ablation is associated with a higher success rate of ablation for atrial fibrillation (AF), but completely blocking the MI is often challenging. The purpose of this study was to assess the effectiveness and safety of a systematic, step-by-step approach for completely blocking the MI in patients with AF undergoing MI line ablation for the first time.</p><p><strong>Methods: </strong>A total of 338 consecutive AF patients who underwent MI ablation for the first time were included in the study. MI line ablation was performed in the following sequence: Step 1 involved endocardial linear ablation from the mitral annulus to the left inferior pulmonary vein; Step 2 involved epicardial ablation in the coronary sinus (CS), next to the endocardial ablation line; Step 3 involved epicardial-endocardial insertion site mapping and ablation; Step 4 involved ethanol infusion of the vein of Marshall (EIVOM); and Step 5 involved ablation of the ostium of the VOM, followed by Step 3 if needed. The complete MI block was evaluated using differential pacing maneuvres.</p><p><strong>Results: </strong>After endocardial linear ablation, 111 patients (32.8%) experienced MI block. Further epicardial ablation in the CS induced MI block in another 89 patients (26.3%). In 42 patients (12.4%), epicardial-endocardial insertion sites were ablated to block the MI. EIVOM was performed in 64 patients (18.9%) to achieve MI block. Ablation at the ostium of the VOM induced MI block in 3 patients, and repeating step 3 induced MI block in 17 patients. The total success rate of MI block was 96.4%. No cardiac tamponade occurred during MI ablation.</p><p><strong>Conclusions: </strong>With a systematic stepwise approach, acute bidirectional MI block can be achieved with a high success rate and without severe complications.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":"1647-1659"},"PeriodicalIF":2.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192657","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}