Avishag Laish-Farkash, Michael Rahkovich, Yonatan Kogan, Gergana Marincheva, Eyal Ben-Assa, Ariel Roguin, Eli I Lev
{"title":"Innovative radiation protection system enables reduction in the weight of lead aprons during electrophysiological procedures.","authors":"Avishag Laish-Farkash, Michael Rahkovich, Yonatan Kogan, Gergana Marincheva, Eyal Ben-Assa, Ariel Roguin, Eli I Lev","doi":"10.1007/s10840-025-02123-7","DOIUrl":"https://doi.org/10.1007/s10840-025-02123-7","url":null,"abstract":"<p><strong>Background: </strong>Fluoroscopy-guided medical procedures require medical personnel to wear lead aprons (typically 0.5-mm Pb), which weigh up to 7 kg and can cause significant occupational injuries. A novel robotic radiation-blocking system, Radiaction, reduces full-body scattered radiation by 92% for all Cath-lab staff.</p><p><strong>Objectives: </strong>This study aimed to determine if lighter lead aprons, when combined with Radiaction, can provide protection comparable to the standard 0.5-mm Pb aprons.</p><p><strong>Methods: </strong>Three setups were tested: (1) 0.5-mm Pb apron without Radiaction (control), (2) 0.25-mm Pb apron with Radiaction, and (3) 0.125-mm Pb apron with Radiaction. Radiation attenuation was measured through analytic calculations, bench tests, and clinical prospective controlled evaluations in an electrophysiology laboratory.</p><p><strong>Results: </strong>According to analytical calculations, radiation reduction was 98% for 0.5-mm Pb aprons, 98.5% for 0.25-mm Pb with Radiaction, and 97% for 0.125-mm Pb with Radiaction. Bench tests showed reductions of 97%, 98.9%, and 98%, respectively. Clinical evaluations showed reductions of 99.2% for ablation procedures (98.8% upper- and 99.6% lower body) and 97.1% reductions for cardiovascular implantable electronic devices (CIED) procedures (94.4% upper- and 99.7% lower body) with the 0.25-mm Pb apron and Radiaction. With the 0.125-mm Pb apron and Radiaction, reductions were 97.9% for ablations (97.4% upper- and 98.4% lower body) and 81.7% for CIED procedures (65% upper- and 98.5% lower body).</p><p><strong>Conclusions: </strong>The 0.25-mm Pb apron with Radiaction appears to surpass the standard 0.5-mm Pb apron in radiation protection, while the 0.125-mm Pb apron with Radiaction offers comparable protection. This suggests that Radiaction enables significant apron weight reduction during electrophysiologic procedures without compromising safety and potentially reducing orthopedic injuries.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240733","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}
David Hayes, Christian Ramharter, Stefan Paule, Daniele Giacopelli, Bobak Salehi, Volker Lang
{"title":"Worldwide data analysis of BIOTRONIK ICD and CRT-D battery longevity.","authors":"David Hayes, Christian Ramharter, Stefan Paule, Daniele Giacopelli, Bobak Salehi, Volker Lang","doi":"10.1007/s10840-025-02141-5","DOIUrl":"https://doi.org/10.1007/s10840-025-02141-5","url":null,"abstract":"<p><strong>Background: </strong>Battery longevity is a key consideration in the selection of implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-Ds), with implications for both clinical outcomes and healthcare costs. A recent study suggested shorter-than-expected battery life for BIOTRONIK devices, prompting a comprehensive internal analysis. This analysis aimed to evaluate the real-world battery longevity of BIOTRONIK high-voltage devices (ICDs and CRT-Ds) across three generations, using global remote monitoring data.</p><p><strong>Methods: </strong>A total of 215,471 BIOTRONIK devices implanted between 2006 and 2024 were analyzed using data from the BIOTRONIK Home Monitoring Service Center. Devices were grouped into three generations (BIO 2000, 2010, 2020) and stratified by type: single-chamber ICD (VR), dual-chamber ICD (DR), CRT-D, and single-lead ICD with an atrial floating dipole (DX). Kaplan-Meier survival analysis was used to estimate median service times, with extrapolation applied to censored data.</p><p><strong>Results: </strong>Median service times increased substantially across generations (p < 0.001): VR devices improved from 92 (interquartile range 72-106) to 175 (169-182) months (+89%), DR from 73 (63-93) to 155 (132-168) months (+108%), CRT-D from 72 (62-79) to 111 (95-126) months (+52%), and DX from 97 (92-101) to 170 (163-175) months (+74%). DX devices demonstrated superior longevity compared to DR devices.</p><p><strong>Conclusion: </strong>Battery longevity of BIOTRONIK ICDs and CRT-Ds has improved markedly with each generation. Newer devices demonstrate service times at or above industry standards, supporting their clinical and economic value.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234686","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}
Maciej Lis, Jorge L Reyes, Jakub Garbacz, Adam Priadka, Agata Krawczyk-Ożóg, Stanisław Bartuś, Jakub Batko, Marcin Kuniewicz, Tomasz Puto, Henri Roukoz, David G Benditt, Mateusz K Hołda
{"title":"Cardiac phase variability in pulmonary root geometry: implications for electrophysiological mapping and ablation.","authors":"Maciej Lis, Jorge L Reyes, Jakub Garbacz, Adam Priadka, Agata Krawczyk-Ożóg, Stanisław Bartuś, Jakub Batko, Marcin Kuniewicz, Tomasz Puto, Henri Roukoz, David G Benditt, Mateusz K Hołda","doi":"10.1007/s10840-025-02143-3","DOIUrl":"https://doi.org/10.1007/s10840-025-02143-3","url":null,"abstract":"<p><strong>Background: </strong>The pulmonary root has emerged as a critical target for catheter ablation of ventricular arrhythmias, accounting for approximately 11% of idiopathic outflow tract arrhythmias. Current electroanatomical mapping systems assume stable cardiac geometry throughout the cardiac cycle, yet the dynamic behavior of the pulmonary root during interventional procedures remains poorly characterized. The aim of this study was to quantify geometric, morphometric, and positional variability of the pulmonary root between systole and diastole using ECG-gated computed tomography angiography, establishing clinically relevant reference values for electrophysiological interventions.</p><p><strong>Methods: </strong>We analyzed ECG-gated contrast-enhanced CTA scans from 100 adult patients (51% female; mean age 59.5 ± 12.1 years) with normal cardiac function. Three-dimensional reconstructions were generated for both systolic and diastolic phases. Morphometric parameters were measured at four anatomical levels: basal ring, coaptation center plane, commissural plane, and tubular plane. Pulmonary root displacement and angulation changes were quantified.</p><p><strong>Results: </strong>The basal ring demonstrated remarkable dimensional variability with 32.3 ± 30.7% reduction in cross-sectional area during systole, while the coaptation center plane remained relatively stable (6.0% variation). The entire pulmonary root underwent significant three-dimensional displacement (median 8.0 mm) with predominant caudal, ventral, and leftward movement during systole, accompanied by 5.6° increase in sagittal angulation. Pulmonary root volume increased significantly during systole (4.1% median increase, p = 0.001).</p><p><strong>Conclusions: </strong>The pulmonary root undergoes substantial cardiac cycle-dependent anatomical changes that challenge current mapping system assumptions. These findings have immediate implications for catheter stability, procedural planning, and the development of motion-compensated electrophysiological technologies.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234672","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 randomized controlled trial of two pulsed field ablation systems for paroxysmal atrial fibrillation: the DUAL-PULSE trial rationale and design.","authors":"Kentaro Goto, Shinsuke Miyazaki, Kohki Nakamura, Junichi Nitta, Masato Murakami, Kanae Hasegawa, Osamu Inaba, Atsushi Kobori, Yasuteru Yamauchi, Shigeto Naito, Shingo Mizuno, Hiroshi Tada, Yasuhiro Sasaki, Hiroyuki Sato, Akihiro Hirakawa, Tetsuo Sasano","doi":"10.1007/s10840-025-02137-1","DOIUrl":"https://doi.org/10.1007/s10840-025-02137-1","url":null,"abstract":"<p><strong>Background: </strong>The energy source for atrial fibrillation (AF) catheter ablation is shifting from thermal energy to pulsed field ablation (PFA), introducing several systems with distinct pulse settings and catheter designs. This study aims to compare the efficacy and safety of two PFA systems: the PulseSelect™ and FARAPULSE™ PFA systems.</p><p><strong>Methods: </strong>The DUAL-PULSE trial is a multicenter, prospective, open-label, randomized controlled trial conducted at eight centers across Japan (UMIN000056534). A total of 180 patients undergoing an index ablation for paroxysmal AF will be enrolled. They will be randomly assigned in a 1:1 ratio to either the PulseSelect™ or FARAPULSE™ group using permuted block randomization. The study was approved by the Institutional Review Boards at all centers.</p><p><strong>Results: </strong>The primary endpoint is the one-year atrial arrhythmia recurrence-free rate, defined as the proportion of patients remaining free from any atrial arrhythmia lasting ≥ 30 s without antiarrhythmic drug use after a 90-day blanking period. Secondary endpoints include the one-year procedure-related adverse event rate, defined as the proportion of patients experiencing any procedure-related complications, biomarkers of myocardial injury, PFA-related hemolysis, and changes in the sinus rate during a one-year follow-up. The silent cerebral ischemic event rate in patients undergoing brain magnetic resonance imaging post-procedure will be evaluated as an exploratory endpoint.</p><p><strong>Conclusion: </strong>The DUAL-PULSE trial is a multicenter, prospective, open-label, randomized controlled trial that will directly compare the efficacy and safety of the two PFA systems. This study will provide a better understanding of the advantages and limitations of each system.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145215477","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}
Roberto Rordorf, Stefano Bianchi, Antonio Dello Russo, Francesco Solimene, Claudio Tondo, Maurizio Malacrida, Andrea Petretta, Antonio Rossillo, Sakis Themistoclakis, Maurizio Russo, Stefano Bandino, Matteo Bertini, Mario Volpicelli, Gianluca Zingarini, Gianfranco Tola, Ilaria Meynet, Gianfranco Mitacchione, Antonio De Simone, Beatrice Stegagno, Michele Magnocavallo, Michela Casella, Vincenzo Schillaci, Fabrizio Tundo, Antonio Sanzo, Giulio Zucchelli, Saverio Iacopino
{"title":"Conventional pulsed-field ablation versus pulsed-field ablation with non-integrated three-dimensional mapping for paroxysmal and persistent atrial fibrillation ablation.","authors":"Roberto Rordorf, Stefano Bianchi, Antonio Dello Russo, Francesco Solimene, Claudio Tondo, Maurizio Malacrida, Andrea Petretta, Antonio Rossillo, Sakis Themistoclakis, Maurizio Russo, Stefano Bandino, Matteo Bertini, Mario Volpicelli, Gianluca Zingarini, Gianfranco Tola, Ilaria Meynet, Gianfranco Mitacchione, Antonio De Simone, Beatrice Stegagno, Michele Magnocavallo, Michela Casella, Vincenzo Schillaci, Fabrizio Tundo, Antonio Sanzo, Giulio Zucchelli, Saverio Iacopino","doi":"10.1007/s10840-025-02129-1","DOIUrl":"https://doi.org/10.1007/s10840-025-02129-1","url":null,"abstract":"<p><strong>Background: </strong>There is limited evidence on efficiency, effectiveness, and safety outcomes in the context of pulsed-field ablation (PFA) of atrial fibrillation (AF) when a 3D mapping system is used.</p><p><strong>Purpose: </strong>To assess the impact of non-integrated 3D mapping systems in PFA for the treatment of AF.</p><p><strong>Methods: </strong>Consecutive patients undergoing PFA (FARAPULSE system) at 17 centers were included. Procedures were stratified according to the use of 3D mapping system (MAP vs standard; STD).</p><p><strong>Results: </strong>A total of 1804 patients were included, 484 (26.8%) with a 3D mapping system. MAP procedures had longer skin-to-skin (90 [75-120] min vs. 60 [50-70] min, p < 0.0001), cath lab utilization (120 [100-165] min vs. 70 [60-94] min, p < 0.0001), and fluoroscopy time (22 [17-28] min vs. 15 [11-21] min, p < 0.0001). The use of 3D mapping was not associated with a better long-term clinical outcome in the overall population (freedom from AF/atrial tachycardia (AT) of 82.5% in MAP procedures vs. 77.4% in STD procedures, HR = 0.737, 95% CI 0.53-1.03, p = 0.0746) as well as in PVI-only paroxysmal AF (86.5% vs. 80.3%, 0.67, 0.38-1.19, p = 0.172), in PVI plus additional lesion sets paroxysmal AF (72.7% vs. 77.8%, 1.08, 0.44-2.65, p = 0.869), or in PVI only persistent AF (76.0% vs. 68.0%, 0.86, 0.36-2.04, p = 0.727). A significantly higher arrhythmia recurrence-free rate was noticed in patients with persistent AF undergoing additional lesion set ablation (83.7% vs 70.3%, 0.45, 0.24 to 0.86, p = 0.016). Three major complications (0.2%) occurred, all in the STD group.</p><p><strong>Conclusion: </strong>The use of a non-integrated 3D mapping system for PFA of AF did not significantly affect long-term success rates in paroxysmal AF or in patients undergoing PVI-only procedures.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145215478","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}
Valter Bianchi, Giorgio Spiniello, Assunta Iuliano, Salvatore Leccisotti, Vito Sollazzo, Gregorio Covino, Giovanni Caroli, Antonio Medico, Angelo Simonetti, Raimondo Calvanese, Michelangelo Canciello
{"title":"Effectiveness of dynamic atrioventricular delay optimization in CRT patients across different physiological conditions.","authors":"Valter Bianchi, Giorgio Spiniello, Assunta Iuliano, Salvatore Leccisotti, Vito Sollazzo, Gregorio Covino, Giovanni Caroli, Antonio Medico, Angelo Simonetti, Raimondo Calvanese, Michelangelo Canciello","doi":"10.1007/s10840-025-02125-5","DOIUrl":"https://doi.org/10.1007/s10840-025-02125-5","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":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208951","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}
Amer Hammad, Abdullah Ahmad, Noman Khalid, Hasan Munshi, Own Khraisat, Vicky Kumar, Haris Muhammad, Aparna Iyer, Sacide Ozgur, Abdel Rahman Dajani, Adil Afzal, Shivam Patel, Satish Tiyyagura, Fayez E Shamoon, Rahul Vasudev
{"title":"Efficacy and safety of left atrial appendage occlusion for atrial fibrillation in patients with a history of prior intracranial hemorrhage: a systematic review and meta-analysis of observational studies.","authors":"Amer Hammad, Abdullah Ahmad, Noman Khalid, Hasan Munshi, Own Khraisat, Vicky Kumar, Haris Muhammad, Aparna Iyer, Sacide Ozgur, Abdel Rahman Dajani, Adil Afzal, Shivam Patel, Satish Tiyyagura, Fayez E Shamoon, Rahul Vasudev","doi":"10.1007/s10840-025-02136-2","DOIUrl":"https://doi.org/10.1007/s10840-025-02136-2","url":null,"abstract":"<p><strong>Background: </strong>Left atrial appendage occlusion (LAAO) is emerging as alternative to anticoagulation in patients with nonvalvular atrial fibrillation (AF) to reduce ischemic stroke risk, particularly in those at high bleeding risk.</p><p><strong>Objective: </strong>Assess LAAO efficacy and safety in patients with prior intracranial hemorrhage (ICH).</p><p><strong>Methods: </strong>Systematic review was performed using PubMed, Embase, and Cochrane Central Register of Controlled Trials. Observational studies reporting outcomes of percutaneous LAAO for AF thromboembolic stroke prophylaxis in patients with prior ICH were included. Classic meta-analysis with risk ratios (RR) for outcomes with control groups and proportions for outcomes without controls were conducted.</p><p><strong>Results: </strong>A total of 19 observational studies (13 retrospective and 6 prospective) involving 1671 patients met the inclusion criteria. The mean CHA₂DS₂-VASc score was 4.59 ± 0.46, and the mean HAS-BLED score was 3.66 ± 0.56. The mean follow-up duration was 19.1 ± 10.2 months, with follow-up ranging from 6 months to 3.7 years. LAAO was successfully implanted in 99.3% of patients. Periprocedural complications included ICH (0.4%), ischemic stroke (0.3%), pericardial effusion/cardiac tamponade (1.3%), device embolization (0.5%), and device-related thrombosis (0.1%). During follow-up, the incidence of ICH was 1.9%, ischemic stroke/TIA 2.9%, device-related thrombosis 1.4%, and all-cause mortality 3.3%. Using the CHA₂DS₂-VASc score, LAAO significantly reduced ischemic stroke risk (RR = 0.28, 95% CI 0.21-0.39). Similarly, using the HAS-BLED score, bleeding events were reduced (RR = 0.61, 95% CI 0.44-0.84).</p><p><strong>Conclusion: </strong>LAAO is effective and relatively safe treatment for reducing ischemic stroke risk in nonvalvular AF patients with history of ICH.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202834","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}
Serkan Cay, Selin Yondem, Meryem Kara, Sona Huseynova, Ozcan Ozeke, Hande Cetin, Ahmet Korkmaz, Firat Ozcan, Serkan Topaloglu
{"title":"Left bundle branch area pacing in a patient with persistent left superior vena cava.","authors":"Serkan Cay, Selin Yondem, Meryem Kara, Sona Huseynova, Ozcan Ozeke, Hande Cetin, Ahmet Korkmaz, Firat Ozcan, Serkan Topaloglu","doi":"10.1007/s10840-025-02147-z","DOIUrl":"https://doi.org/10.1007/s10840-025-02147-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":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188269","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":"Atrial bipolar voltage analysis to assess vein of Marshall ethanol infusion acute effectiveness and its implication in predicting mitral isthmus block.","authors":"Simone Taddeucci, Silvia Garibaldi, Martina Nesti, Umberto Startari, Luca Panchetti, Gianluca Mirizzi, Federico Landra, Vincenzo Lionetti, Marcello Piacenti, Procolo Marchese, Andrea Rossi","doi":"10.1007/s10840-025-02127-3","DOIUrl":"https://doi.org/10.1007/s10840-025-02127-3","url":null,"abstract":"<p><strong>Background: </strong>The vein of Marshall (VoM) is a promising therapeutic target for persistent atrial fibrillation (PeAF) treatment. Ethanol infusion into the VoM (VoM-EI) has demonstrated high effectiveness in facilitating mitral isthmus (MI) block, a fundamental part of the anatomical ablation setup for the treatment of PeAF. However, reliable indexes for optimal ethanol delivery are still lacking, and the role of voltage analysis after VoM-EI in predicting MI block has been poorly explored.</p><p><strong>Purpose: </strong>To evaluate the role of voltage analysis after VoM-EI in predicting acute bidirectional MI block and the need of coronary sinus (CS) radiofrequency (RF) applications.</p><p><strong>Methods: </strong>Fifty-three PeAF patients who underwent catheter ablation were retrospectively enrolled. Left atrial (LA) high-density bipolar voltage mapping was performed before and after VoM-EI. Low voltage areas (LVA) were assessed for all LA maps using the area measurement tool, and the difference in area width between pre- and post-VoM-EI was defined as ∆LVA. An anatomical lesion set including VoM-EI, pulmonary vein isolation (PVI) and linear lesion for dome, lateral MI, and cavo-tricuspid isthmus (CTI) was performed. In case of residual conduction across MI, additional endocardial and/or epicardial ablations approaching the CS musculature were performed. The time required to achieve bidirectional MI block (AblTime-MI) was collected and the VoM length was measured.</p><p><strong>Results: </strong>Forty-eight out of 53 patients enrolled (90.5%) achieved acute bidirectional MI block. After VoM-EI, mean bipolar ∆LVA was 6.6 ± 4.4 cm<sup>2</sup>, and mean AblTime-MI was 14.7 ± 10.4 min. RF applications targeting CS musculature were required in 22/53 patients (41.5%). Linear regression showed a strong inverse correlation between ∆LVA and AblTime-MI (r = -0.70, β = -128.2; 95% CI -165.3, -91.2; p < 0.001). Patients with higher ∆LVA were less likely to need CS applications [OR = 0.70 (95% CI 0.56-0.88); p = 0.002]. Patients requiring CS applications had significantly longer AblTime-MI (21.0 ± 9.0 min vs 8.8 ± 8.2 min; p < 0.001), and larger left atrial volume index (LAVI) (37.0 ± 10.0 ml/m<sup>2</sup> vs 31.8 ± 6.6 ml/m<sup>2</sup>; p = 0.03). ∆LVA showed the best performance in predicting the need for CS applications (AUC 0.79) with a threshold of < 5.30 cm<sup>2</sup> associated with a higher risk of requiring additional RF applications.</p><p><strong>Conclusions: </strong>VoM-EI-induced LA lesions align with VoM trajectory and anatomy. Larger ∆LVA correlates with shorter ablation time for bidirectional MI block and predicts fewer residual epicardial MI gaps requiring RF application in CS musculature. ∆LVA represents a reliable indicator of VoM-EI effectiveness, predicting MI block failure due to epicardial gaps.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180732","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}
Ceren Yağmur Doğru Yılmaz, Fırat Özcan, Özcan Özeke, Elif Hande Özcan Çetin, Meryem Kara, Ahmet Korkmaz, Duygu Koçyiğit, Serkan Çay, Henry D Huang, Tolga Aksu, Dursun Aras, Serkan Topaloğlu
{"title":"Impact of frailty on outcomes after ventricular tachycardia ablation: A prospective observational study.","authors":"Ceren Yağmur Doğru Yılmaz, Fırat Özcan, Özcan Özeke, Elif Hande Özcan Çetin, Meryem Kara, Ahmet Korkmaz, Duygu Koçyiğit, Serkan Çay, Henry D Huang, Tolga Aksu, Dursun Aras, Serkan Topaloğlu","doi":"10.1007/s10840-025-02118-4","DOIUrl":"https://doi.org/10.1007/s10840-025-02118-4","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":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139974","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}