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

{"title":"Dynamic anterior forces in a patient with fontan circulation.","authors":"Gustavo Goldenberg, Andrés Arteaga-Arellano, Adrian Baranchuk","doi":"10.1007/s10840-026-02439-y","DOIUrl":"https://doi.org/10.1007/s10840-026-02439-y","url":null,"abstract":"","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983826","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":"Persistent iatrogenic atrial septal defect after single-puncture, double transseptal access for 4D ICE-guided left atrial appendage occlusion: Incidence and clinical outcomes.","authors":"Kasen L Culler, Aamir Ahmed, Supreet Singh, Graham Peigh, Korosh Sharain, Aishwarya Pastapur, Aravind Kalluri, Anirudh Nandan, Chad Gier, Erik Simon, Alexandru B Chicos, Kaustubha Patil, Anna Pfenniger, Albert C Lin, Rod S Passman, Bradley P Knight, Susan Kim, Nishant Verma","doi":"10.1007/s10840-026-02440-5","DOIUrl":"https://doi.org/10.1007/s10840-026-02440-5","url":null,"abstract":"<p><strong>Background: </strong>Persistent iatrogenic atrial septal defect (iASD) is a known consequence of transseptal puncture (TSP). Large-bore double transseptal access through a single TSP is commonly used for intracardiac echocardiography (ICE)-guided left atrial appendage occlusion (LAAO). This study evaluated the incidence and clinical outcomes of persistent iASD following this approach.</p><p><strong>Methods: </strong>We retrospectively reviewed LAAO procedures at a single academic center from January 2020 to December 2024. Cases were grouped as: (1) 4D ICE with double transseptal access (n = 58), (2) 2D ICE with double transseptal access (n = 64), or (3) no left atrial (LA) ICE (n = 81). Patients were included if they had follow-up imaging (TEE or cardiac CT). Multivariable logistic regression identified predictors of persistent iASD.</p><p><strong>Results: </strong>Among 203 patients (age 77.1 ± 6.6 years; 59% male), follow-up occurred at 58.0 ± 25.2 days. Persistent iASD was detected in 88 patients (43%). ICE-guided cases had a higher incidence of iASD compared with no LA ICE (54.1% vs. 27.2%; p < 0.001), with no difference between 2D and 4D ICE (p = 0.340). On multivariable analysis, both 2D and 4D ICE were independently associated with increased odds of persistent iASD (2D ICE: OR 3.45, 95% CI 1.46-8.17; 4D ICE: OR 3.57, 95% CI 1.52-8.38). Coronary artery disease was associated with increased odds (OR 2.44, 95% CI 1.12-5.28), while hypertension was associated with decreased odds (OR 0.41, 95% CI 0.18-0.96). Persistent iASD was not associated with adverse clinical outcomes.</p><p><strong>Conclusions: </strong>Persistent iASD is common following LAAO, occurring in 43% of patients at early follow-up. Left atrial ICE use is independently associated with increased odds of persistent iASD, with similar rates between 2D and 4D ICE techniques.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983847","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":"A protocol for potentially averting takotsubo syndrome following electrophysiology procedures.","authors":"John E Madias","doi":"10.1007/s10840-026-02446-z","DOIUrl":"https://doi.org/10.1007/s10840-026-02446-z","url":null,"abstract":"","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983030","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":"Left atrial anatomy and atrial arrhythmia recurrence after pulsed-field ablation.","authors":"Mikko Mutti, David Spreen, Jonas Brügger, Fabian Jordan, Nicolas Schaerli, Albin Bislimaj, Behnam Subin, Felix Mahfoud, Christian Sticherling, Michael Kühne, Patrick Badertscher, Sven Knecht, Philipp Krisai","doi":"10.1007/s10840-026-02435-2","DOIUrl":"https://doi.org/10.1007/s10840-026-02435-2","url":null,"abstract":"<p><strong>Background: </strong>The impact of left atrial (LA) anatomical features on atrial arrhythmia (AA) recurrence after pulsed-field (PF)-based pulmonary vein isolation (PVI) is unknown. This study aimed to assess LA anatomical features associated with long-term AA recurrence after PVI.</p><p><strong>Methods: </strong>We prospectively enrolled patients undergoing PVI with a pentaspline PF-catheter at a tertiary center from June 2023 to September 2024. AA recurrence was assessed at 3, 6 and 12 months with Holter-ECGs and symptom-driven monitoring. The following anatomical features were assessed in pre-interventional CT or MR imaging: pulmonary vein (PV) ostial diameters, circularity, cross-sectional area, and inter-carina distances. Regression models adjusted for established risk factors were used for their associations with AA recurrence.</p><p><strong>Results: </strong>Among 287 patients (median age 66 years; 34% female; 61% paroxysmal AF), 98 (34%) experienced recurrence at a median of 6 months after PVI. In adjusted regression analysis, a larger minimal diameter of the right superior PV (OR 1.11 per 1 mm increase, 95% CI (1.02-1.21); p = 0.021), and higher circularity indices of the left inferior PV (OR 1.04 per 0.01 increase, 95% CI (1.01-1.07); p = 0.005) and the right superior PV (OR 1.03 per 0.01 increase, 95% CI (1.00-1.06); p = 0.040) were associated with AA recurrence. There was no interaction for catheter size but some effect modification for the number of PF-applications.</p><p><strong>Conclusion: </strong>Specific anatomical features of the right superior and left inferior PV were associated with recurrence after PF-based PVI. Although PF-based PVI appears suitable across diverse LA anatomies, the prognostic value of these anatomical characteristics warrants further investigation.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983828","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":"Ablation with the circular pulsed field ablation catheter: Tips & techniques for using the PulseSelect catheter.","authors":"Gabriel Ballesteros, Sikder M Zubair Rahim, Faizel Osman","doi":"10.1007/s10840-026-02436-1","DOIUrl":"https://doi.org/10.1007/s10840-026-02436-1","url":null,"abstract":"<p><p>Pulsed field ablation (PFA) is a novel method of cardiac ablation in which electrical fields create microscopic pores in cardiomyocyte cell membranes, resulting in cell death through a process of electroporation. Unlike thermal technologies, PFA has preferential cardiomyocyte selectivity, thereby reducing the risk of collateral damage to surrounding structures. The PulseSelect PFA system (Medtronic Inc., Minneapolis, MN, USA) is a 9-electrode circular ablation catheter with a central guidewire used for atrial fibrillation ablation. Currently, there is no consensus on workflow or best practice for this catheter. Its distinctive over-the-wire design and forward-tilted flexible electrode array provide considerable procedural versatility and, in our opinion, may offer advantages in terms of selective lesion delivery, reduced haemolysis, and a lower propensity for coronary vasospasm. Realising these potential benefits, however, requires a thorough understanding of catheter geometry, tissue-contact principles, and manipulation techniques. We present our real-world experience from centres in the UK and Spain, highlighting practical concepts, fluoroscopic and electro-anatomic mapping (EAM) strategies, as well as procedural techniques that may help shorten the learning curve, optimise lesion delivery, and safely expand the use of the catheter beyond pulmonary vein isolation.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979320","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":"Remote monitoring for implantable loop recorders: re-evaluating diagnostic speed, costs, and methodological limitations. Re: Fitzgerald JL, May AN, Baker D, et al. A randomized controlled trial of remote monitoring for cardiac implantable loop recorders: stay-away trial. J Interv Card Electrophysiol. 2026 [1].","authors":"Muhammad Asghar Khan, Syeda Sarah Jamal","doi":"10.1007/s10840-026-02424-5","DOIUrl":"https://doi.org/10.1007/s10840-026-02424-5","url":null,"abstract":"","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148964209","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":"Participant-reported chest pain and gastric esophageal reflux disease following protective esophageal cooling during radiofrequency ablation for atrial fibrillation - the EVERCOOL-AF study.","authors":"Joshua R Silverstein, George Shaw, Huy M Phan, William A Belden, Emerson Liu, Alexandru I Costea, Parin J Patel, Tiffany Sharkoski, Qun Sha, Erik Kulstad, Susan M Bezenek, David Singh, Mark D Metzl, Amit Thosani","doi":"10.1007/s10840-026-02437-0","DOIUrl":"https://doi.org/10.1007/s10840-026-02437-0","url":null,"abstract":"<p><strong>Background: </strong>Gastroesophageal reflux disease (GERD) and chest pain are common complications following catheter ablation for atrial fibrillation (AF), often attributed to esophageal thermal injury. Active esophageal cooling reduces thermal injury risk but may not reduce GERD symptoms. Factors associated with these complications, despite esophageal cooling, remain unclear. Our objective was to identify participant and procedural characteristics associated with post-ablation GERD and (CP) in AF participants undergoing radiofrequency ablation (RFA) with esophageal cooling.</p><p><strong>Methods: </strong>Participants undergoing RFA with esophageal cooling for paroxysmal or persistent AF completed a standardized questionnaire. GERD symptoms were assessed with GERDQ (score  ≥ 8 high probability of GERD) at 7-14 days post-procedure. Chest pain was queried separately. Associations with demographic and procedural variables were evaluated.</p><p><strong>Results: </strong>There were 295 out of a maximum of 312 participants completing post-ablation questionnaires that underwent esophageal cooling, 44 (14.9%) met criteria for GERD  ≥ 8 and 71 (24.1%) reported CP. The anterior maximum power was significantly lower in participants with GERD compared to those without (50.0 vs. 54.0 ± 14.0 W, p = 0.020). Participants reporting CP were younger (64.5 ± 9.3 vs. 67.5 ± 10.2 years, p = 0.026) and had higher mean ejection fraction (57.1 ± 6.6% vs. 53.1 ± 10.2%, p = 0.001). Chest pain was less common if bilateral first-pass isolation was achieved (59.2% vs. 72.6%, p = 0.033).</p><p><strong>Conclusion: </strong>In participants undergoing AF ablation with active esophageal cooling, younger age, higher ejection fraction and lack of bilateral first-pass isolation were associated with post-ablation CP. These findings suggest that despite esophageal protection, both procedural and participant-specific factors may contribute to symptom development.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957754","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":"Efficacy and safety of pulsed-field ablation with the pentaspline catheter versus thermal ablation in paroxysmal atrial fibrillation: a meta-analysis of randomised controlled trials.","authors":"Andre Briosa E Gala, Valon Spahiu, Boldizsar Kovacs, Nikola Kozhuharov, Salik Ur Rehman Iqbal, Theresa Storz, Jens Maurhofer, Claudia Herrera-Siklódy, Helge Servatius, Hildegard Tanner, Laurent Roten, Thomas Kueffer, Tobias Reichlin","doi":"10.1007/s10840-026-02432-5","DOIUrl":"https://doi.org/10.1007/s10840-026-02432-5","url":null,"abstract":"","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946510","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":"Vein of Marshall ethanol infusion in persistent atrial fibrillation: Insight from VOMALC-PeAF registry.","authors":"Michele Iavarone, Andrea Rossi, Martina Nesti, Luca Panchetti, Silvia Garibaldi, Umberto Startari, Gianluca Mirizzi, Luigi Cocchiara, Alessandro Valleggi, Francesca Gennaro, Giovanni Mazzotta, Serena Galiberti, Simone Taddeucci, Antonio Agresti, Gianluca Cortis, Federico Landra, Francesco Gentile, Alberto Giannoni, Vincenzo Russo, Marcello Piacenti, Pierfrancesco Grossi, Procolo Marchese","doi":"10.1007/s10840-026-02433-4","DOIUrl":"https://doi.org/10.1007/s10840-026-02433-4","url":null,"abstract":"<p><strong>Purpose: </strong>Pulmonary vein isolation (PVI) ablation has limited efficacy in persistent atrial fibrillation (PeAF). Anatomical strategies combining PVI, vein of Marshall ethanol infusion (VOM-EI), and an anatomical ablation strategy (AS) targeting key atrial isthmuses have shown promising short-term outcomes in this setting.</p><p><strong>Methods: </strong>In this retrospective multicenter observational cohort study, consecutive patients with PeAF who underwent either VOM-EI + AS or PVI-only were included. The primary endpoint was freedom from atrial arrhythmias (AAs) lasting > 30 s off antiarrhythmic drugs (AADs). Procedural characteristics and safety outcomes were also evaluated.</p><p><strong>Results: </strong>After 2:1 propensity score matching, 151 patients treated with VOM-EI + AS were compared with 75 treated with PVI-only. After a median follow-up of 22-month (interquartile range (IQR): 9-35 months), 81% vs. 47% of patients remained free from AA without AADs in the VOM-EI + AS vs. PVI-only group (p < 0.001). Achievement of bidirectional mitral isthmus (MI) block was the strongest independent predictor of arrhythmia-free survival (HR = 0.114; 95% CI: 0.041-0.321; p < 0.001). On the contrary, long-standing PeAF was independently associated with a higher risk of atrial arrhythmic recurrence (HR = 2.68; 95% CI: 1.240-5.812; p = 0.012).</p><p><strong>Conclusions: </strong>In a real-world PeAF population, a first ablation strategy incorporating VOM-EI, PVI and anatomical linear lesions was significantly more effective than PVI alone in preventing arrhythmic recurrences in a long-term follow-up. Bidirectional block validation across the mitral line and AF duration are key determinants of long-term success. In patients with persistent atrial fibrillation, a first-procedure ablation including vein of Marshall ethanol infusion and an anatomical ablation strategy combining pulmonary vein isolation and linear lesions significantly improved long-term arrhythmia-free survival compared with pulmonary vein isolation alone.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148932435","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":"An optimal output and electrode configuration for evaluating tissue transmurality - a preclinical study.","authors":"Iwanari Kawamura, Aiko Fujimaki, Masateru Takigawa, Shoko Kurosawa, Junji Yamaguchi, Ryosuke Kato, Masaki Honda, Hidehiro Iwakawa, Ryo Tateishi, Miho Negishi, Kentaro Goto, Kensuke Ihara, Takuro Nishimura, Kazuya Yamao, Susumu Tao, Sayaka Suzuki, Takehiro Iwanaga, Shinsuke Miyazaki, Masaru Kubota, Tetsuo Sasano","doi":"10.1007/s10840-026-02422-7","DOIUrl":"https://doi.org/10.1007/s10840-026-02422-7","url":null,"abstract":"<p><strong>Introduction: </strong>Achieving transmural lesions is critical for durable outcomes in catheter ablation. While electrogram amplitude reduction and pacing threshold changes have been reported as useful parameters, the optimal electrode configuration and cutoff values remain unclear. This preclinical study evaluated the efficacy of conventional and microelectrode configurations in predicting transmurality using the QDOT MICRO catheter.</p><p><strong>Methods: </strong>Radiofrequency ablation was performed in 14 swine, creating 131 atrial lesions. Pacing thresholds and electrogram amplitudes were measured before and after ablation using three configurations: conventional bipolar, microelectrode bipolar, and unipolar. Lesion transmurality was determined histologically. Receiver operating characteristic analyses were conducted to assess predictive accuracy.</p><p><strong>Results: </strong>Among all configurations, the conventional bipolar (A1-A2) showed the highest predictive value. Post-ablation bipolar amplitudes were lower in transmural lesions (AUC 0.777, 0.86mV), with greater amplitude reduction (64.4% vs. 40.5%, AUC 0.682). Pacing thresholds increased significantly after ablation and were higher in transmural lesions; the A1-A2 configuration had the highest accuracy in predicting transmurality (AUC 0.880, cutoff 3.4 V). Microelectrodes demonstrated inconsistent patterns, and even when the best configurations were selected, they remained less accurate than conventional bipolar measurements. Furthermore, morphological changes, including disappearance of R-waves (bipolar) and S-waves (unipolar), showed limited predictive value (AUCs ≤ 0.77 and ≤ 0.56, respectively).</p><p><strong>Conclusion: </strong>Conventional bipolar electrodes outperformed microelectrode configurations in assessing transmurality via electrogram amplitude and pacing threshold. Tip-to-ring bipolar pacing with the QDOT-MICRO catheter most effectively assesses atrial lesion transmurality, with 3.4 V as the optimal threshold.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908598","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}