Pacing and clinical electrophysiology : PACE最新文献

{"title":"Relationship Between Left Atrial Coupling Index and Atrial High-Rate Episodes.","authors":"Ayca Arslan, Dogan Ilis, Inanç Artac, Muammer Karakayali, Timor Omar, Yuksel Erata, Yavuz Karabag, Ibrahim Rencuzogullari","doi":"10.1111/pace.70004","DOIUrl":"https://doi.org/10.1111/pace.70004","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to explore the role and compare the accuracy of the left atrial coupling index (LACI) with other efficient traditional parameters for predicting atrial high-rate episodes (AHREs) in patients with cardiac implantable electronic devices (CIEDs).</p><p><strong>Methods: </strong>This retrospective study included 203 patients with CIEDs whose echocardiographic data were recorded at least 6 months ago. The study population was divided into two groups based on whether the patients had developed AHRE. Subsequently, patients in the two groups were compared in terms of echocardiographic measurements, including left atrial functions, LACI, left atrial volume index (LAVI), left ventricle end-diastolic diameter (LVEDD), and lower left ventricle ejection fraction (LVEF).</p><p><strong>Results: </strong>AHRE was observed in 42.8% (n = 87) of the 203 patients. Those with AHRE had a higher mean mitral E/Em, LAVI, LACI, LVEDD, and lower LVEF. LACI (OR: 1.752, 95% CI: 1.356-2.263; p < 0.001), LAVI, and age were found to be independent predictors of AHREs. A receiver operating characteristic (ROC) curve comparison demonstrated that the LACI was a better predictor of AHRE than the LAVI.</p><p><strong>Conclusion: </strong>AHRE often progresses to atrial fibrillation, which has unfavorable consequences; therefore, predicting AHRE becomes vital. LACI, an easily accessible echocardiographic parameter, is a more robust predictor of AHRE than traditional parameters such as LAVI.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144513072","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":"Depression and Anxiety in Patients Who Received a CRT Device and Did Not Have Shock Therapy During a 12-Month Follow-Up.","authors":"Elizabeth Florou, Dimitrios Sfairopoulos, Sofia Plakoutsi, Aris Bechlioulis, Konstantinos Zekios, Haralampos Milionis, Petros Skapinakis, Panagiotis Korantzopoulos","doi":"10.1111/pace.70002","DOIUrl":"https://doi.org/10.1111/pace.70002","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiac resynchronization therapy (CRT) may affect the patients' psychological status differently in various populations. There are limited data regarding depression and anxiety in this setting, while there are no data regarding Greek patients.</p><p><strong>Methods: </strong>We studied heart failure with reduced ejection fraction (HFrEF) patients, without conditions affecting psychological status, undergoing CRT. We used the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the 9-item Patient Health Questionnaire (PHQ-9), and the 7-item Generalized Anxiety Disorder Scale (GAD-7) at baseline and 6- and 12-month postimplantation.</p><p><strong>Results: </strong>After excluding seven patients who experienced defibrillator shocks, we analyzed 99 patients (median age: 72 years, 77% men). The baseline MLHFQ score was 37 (interquartile range [IQR]: 36); at 6 months, 1 (IQR: 8); and at 12 months, 0.5 (IQR: 10); p < 0.01. The baseline PHQ-9 score was 9 (IQR: 11); at 6 months, 0 (IQR: 2); and at 12 months, 0 (IQR: 2); p < 0.01. The baseline GAD-7 score was 8 (IQR: 16); at 6 months, 0 (IQR: 1.5); and at 12 months, 0 (IQR: 3); p <0.01. At baseline, 44% of patients had clinically significant depression (PHQ-9 score ≥10), and 45% clinically significant anxiety (GAD-7 score ≥10). The baseline PHQ-9 and GAD-7 scores correlated with the MLHFQ score. The logistic regression analysis revealed that clinically substantial depression at baseline (PHQ-9 ≥ 10) had a negative association with chronic kidney disease [OR: 0.55; p < 0.01].</p><p><strong>Conclusions: </strong>Depression and anxiety markedly improved during the 12-month follow-up period after CRT device implantation in HFrEF patients who did not receive shock therapy.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487748","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":"Hitting the Wall: The Hidden Challenge of 2:1 Block in Pacemaker Patients.","authors":"Marc Strik, Sylvain Ploux, Anand Thiyagarajah, Lars van Krimpen, Pierre Bordachar","doi":"10.1111/pace.70006","DOIUrl":"https://doi.org/10.1111/pace.70006","url":null,"abstract":"<p><strong>Introduction: </strong>Dual-chamber pacemakers incorporate proprietary algorithms to optimize atrioventricular (AV) synchronization and prevent pacemaker-mediated arrhythmias. Patients have recently presented to our center with severe exercise intolerance due to the early onset of 2:1 AV block caused by Biotronik's Auto-PVARP and 2:1 Lock-in protection algorithms. This study evaluates the relationship of these algorithms to low 2:1 block rates in a large cohort of remotely monitored pacemaker patients.</p><p><strong>Methods: </strong>We troubleshooted the patients with symptomatic exercise intolerance. We then performed an observational study using remote monitoring data from 895 patients implanted with Biotronik pacemakers, programmed in DDD(R) mode with the Auto-PVARP algorithm activated. We analyzed PVARP settings, 2:1 block rates, and their relationship with age-predicted maximal sinus rates.</p><p><strong>Results: </strong>Among the 895 remotely monitored patients, the majority had significantly prolonged PVARP settings, lowering their 2:1 block rate. At the most recent transmission, only 37% had a PVARP ≤225 ms, while 63% had longer values (275-375 ms), leading to lower 2:1 block thresholds. The 2:1 block rate was below the age-predicted maximal sinus rate in 48% of patients, suggesting a high risk of pacing-induced exercise limitations. The prolonged PVARP was largely driven by Auto-PVARP extensions, often without documented pacemaker-mediated tachycardia (PMT). These findings indicate that a significant proportion of pacemaker-dependent patients may unknowingly experience pacing-related exercise intolerance.</p><p><strong>Conclusion: </strong>The Biotronik Auto-PVARP algorithm frequently extends the refractory period, lowering the threshold for 2:1 block and potentially limiting exercise capacity in active patients. Disabling Auto-PVARP and setting a fixed, shorter PVARP may improve exercise tolerance.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487749","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":"Does Surgical Treatment With Uvulopalatopharyngoplasty for Obstructive Sleep Apnea Prevent Future Arrhythmic Events?","authors":"Lae-Young Jung, Sunhwa Kim, Yisik Kim, Sung-Won Kim, Donghyun Kim, Hoseob Kim, Yoonjong Bae","doi":"10.1111/pace.15202","DOIUrl":"https://doi.org/10.1111/pace.15202","url":null,"abstract":"<p><strong>Introduction: </strong>Obstructive sleep apnea (OSA) is a known risk factor for cardiac arrhythmia. The impact of surgical OSA treatment on the future occurrence of arrhythmic disease in young patients remains insufficiently studied.</p><p><strong>Purpose: </strong>This study aimed to determine if surgical OSA treatment reduces future arrhythmic events (atrial fibrillation [AF], premature beats, ventricular arrhythmias, and sudden cardiac arrest [SCA]) and if these effects persist over time.</p><p><strong>Methods: </strong>This study was a retrospective cohort data analysis of the dataset from the Korean National Health Insurance Service system (2009-2020) on 359,851 OSA patients. Propensity score matching (PSM) compared surgical treatment with uvulopalatopharyngoplasty (UPPP) and a control group, resulting in a cohort of 117,665 participants (85.4% men, average age 45.5 ±14.0). Over 5 years, occurrences of AF, premature beats, ventricular arrhythmias, and SCA were evaluated.</p><p><strong>Results: </strong>The control group showed a linear increase in arrhythmic disease. The surgical treatment group had a lower incidence of arrhythmias. PSM showed significant reductions in AF, premature beats, ventricular arrhythmias, and SCA in the surgical treatment group. AF incidence was 5 times higher in the control group (HR 5.384), premature beats were 4 times higher (HR 4.284), ventricular arrhythmias were 11 times higher (HR 11.758), and SCA was over 24 times higher (HR 24.089).</p><p><strong>Conclusion: </strong>Young patients with OSA exhibited a progressively increasing trend in arrhythmic events over time. Surgical treatment with UPPP in a similar patient population was associated with a reduction in the incidence of these conditions.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478558","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":"Long-Term Results of Atrioventricular Node Ablation After His Bundle Pacing in Uncontrolled Atrial Tachyarrhythmias.","authors":"María Teresa Moraleda-Salas, Ane Erkoreka-Gasituaga, Carlos Perea-Alfaro, Irene Esteve-Ruiz, Álvaro Arce-León, José Miguel Carreño-Lineros, Emilio Amigo-Otero, María Del Mar Moraleda-Salas, Santiago Camacho-Freire, Francisco Navarro-Roldan, Pablo Moriña-Vázquez","doi":"10.1111/pace.70000","DOIUrl":"https://doi.org/10.1111/pace.70000","url":null,"abstract":"<p><strong>Introduction: </strong>In the evolving treatment of atrial fibrillation (AF), atrioventricular (AV) node ablation is being reconsidered as an early option for patients with inadequate AF control and limited cure potential. Although interest in physiological pacing is growing, concerns about the long-term safety of permanent His bundle pacing (p-HBP) persist. Our current study aims to evaluate the long-term outcomes of patients who underwent AV node ablation and p-HBP, focusing on left ventricular ejection fraction (LVEF), NYHA class, readmissions, and pacing parameters.</p><p><strong>Methods: </strong>This descriptive observational study involved patients with uncontrolled permanent atrial arrhythmias who were eligible for heart rate (HR) control (between January 2019 and July 2020) and underwent p-HBP and AV node ablation, followed during a near 4-year period.</p><p><strong>Results: </strong>We conducted a long-term follow-up study with a median duration of 47 months on 32 patients who received p-HBP followed by AV node ablation. The average age was 77 years, predominantly female (65.6%), with a high prevalence of hypertension (90.6%). The main indications for ablation were uncontrolled AF (59.4%) and atypical atrial flutter (37.5%). At baseline, the median LVEF was 60%. Notably, LVEF improved significantly from 45% to 50% in those with reduced baseline function (p < 0.05). NYHA class improvements were also observed over time. The His thresholds remained similar during long-term follow-up, being 1.25 V at 0.4 ms (1.25-2.4 V at 0.4 ms) before AV node ablation and 1.30 V at 0.4 ms (0.75-2.25 V at 0.4 ms), p = 0.89, at long-term follow-up. The impedances remained stable. No complications related to the pacemaker occurred. Number of medications per patient for HR control significantly decreased from 1.6 to 0.37 (p < 0.05), while hospital admissions for tachyarrhythmias dropped markedly. There was one death during the follow-up due to cancer, but conclusions regarding mortality are limited by the small sample size.</p><p><strong>Conclusions: </strong>AV node ablation and p-HBP significantly improve functional class and LVEF, with benefits maintained over time. Patients experience fewer emergency visits and reduced HR medication. Pacing parameters remained stable during long-term follow-up.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328468","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":"Comparing Efficacy and Complications Between Stylet-Driven Leads and Lumenless Leads in Left Bundle Branch Area Pacing.","authors":"Adivitch Sripusanapan, Nicha Wareesawetsuwan, Natee Deepan, Thanaboon Yinadsawaphan, Dingxin Qin, Pattara Rattanawong, Chee Yuan Ng","doi":"10.1111/pace.15217","DOIUrl":"https://doi.org/10.1111/pace.15217","url":null,"abstract":"<p><strong>Background: </strong>Left bundle branch area pacing (LBBAP) is an emerging technique in conduction system pacing (CSP) that may offer improved outcomes over traditional methods. Typically, lumenless leads are used; however, stylet-driven leads have recently been considered. This study conducts a systematic review and meta-analysis evaluating the efficacy and complications of stylet-driven leads versus lumenless leads.</p><p><strong>Method: </strong>Databases including PubMed, Embase, and Scopus were searched from inception to June 2024 for relevant studies. We included published prospective or retrospective randomized controlled trials and cohort studies using stylet-driven leads or lumenless leads for LBBAP. Data were combined using a random-effects, generic inverse variance method of DerSimonian and Laird.</p><p><strong>Results: </strong>Sixty-eight studies involving 8996 patients from 2016 to 2023 were included. From eight head-to-head studies, the stylet-driven leads group had a comparable success rate (OR = 1.46, 95% CI: 0.89, 2.39) but showed shorter procedural time (weighted mean difference [WMD] = -16.82 min, 95% CI: -24.42, -9.21). Stylet-driven leads had a higher pacing threshold at implantation (WMD = 0.09 V, 95% CI: 0.00, 0.17) and lower lead impedance (WMD = -86.13 ohms, 95% CI: -129.46, -42.80). QRS duration and R wave amplitude were comparable initially, but at follow-up (1-12 months), stylet-driven leads had a lower R wave amplitude (WMD = -1.92 mV, 95% CI: -3.33, -0.51). Complication rates were higher with stylet-driven leads (OR = 1.80, 95% CI: 1.34, 2.41), particularly lead dislodgement (OR = 3.26, 95% CI: 1.75, 6.07) and helix damage (OR = 11.46, 95% CI: 3.58, 36.63).</p><p><strong>Conclusion: </strong>In this meta-analysis of 8996 patients, stylet-driven leads for LBBAP showed a comparable success rate to lumenless leads but was associated with a higher complication risk.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304392","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":"Psychometric Performance of Florida Patient Acceptance Survey in Danish Implantable Cardioverter Defibrillator Patients.","authors":"Ole Skov, Jens Brock Johansen, Jens Cosedis Nielsen, Charlotte E Larroudé, Sam Riahi, Thomas M Melchior, Michael Vinther, Sören Möller, Søren Jensen Skovbakke, Nina Rottmann, Samuel F Sears, Susanne S Pedersen","doi":"10.1111/pace.15224","DOIUrl":"https://doi.org/10.1111/pace.15224","url":null,"abstract":"<p><strong>Background: </strong>Patient device acceptance reflects the psychological adjustment to living with an implantable cardioverter defibrillator (ICD) and is an important outcome for ICD patients. The Florida Patient Acceptance Survey (FPAS) is the gold standard for assessing patient device acceptance; however, the most optimal factor structure of the FPAS is an open question.</p><p><strong>Objectives: </strong>This study aimed to evaluate the psychometric properties of FPAS by conducting head-to-head comparison tests between the proposed factor structures using prospective data from a national, Danish randomized controlled trial (ACQUIRE-ICD).</p><p><strong>Methods: </strong>The sample included 478 first-time ICD recipients (mean age 59.6 ± 11.6 years), predominantly male (83.1%), assessed at ICD implantation and at 1-year follow-up (n = 364; 76.2%), completing the FPAS and measures of anxiety, depression, and Type D personality.</p><p><strong>Results: </strong>Confirmatory factor analyses showed that the abbreviated 12-item, three-factor version had the best fit to the data (CFI = 0.929), shortly followed by the original 15-item, four-factor version (CFI = 0.917, Δχ² (33) = 125.05, p < 0.001). Both were superior to the two-factor versions (CFI = 0.707 and 0.843). The psychometric properties of the abbreviated 12-item version and original 15-item version were satisfactory with a moderate fit to the data at both ICD implantation and at 1-year follow-up, along with good internal reliability and divergent validity.</p><p><strong>Conclusions: </strong>In a large prospective cohort from a national Danish ICD study, the shortened, three-factor, 12-item version of the FPAS appears to be the most suitable version. The FPAS demonstrated satisfactory psychometric properties at both ICD implantation and 1-year follow-up.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304393","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":"Voltage-Gradient Mapping-Guided Slow Pathway Ablation in Typical Atrioventricular Nodal Re-Entrant Tachycardia.","authors":"Toshinori Komatsu, Ayako Okada, Kiu Tanaka, Hideki Kobayashi, Yasutaka Oguchi, Koichiro Kuwahara","doi":"10.1111/pace.15223","DOIUrl":"https://doi.org/10.1111/pace.15223","url":null,"abstract":"<p><strong>Introduction: </strong>High-density mapping is useful for common atrioventricular nodal re-entrant tachycardia (AVNRT) ablation. This study aimed to evaluate the effective targets for slow pathway (SP) ablation using voltage-gradient mapping.</p><p><strong>Methods: </strong>Fifty-two patients diagnosed with slow/fast AVNRT were enrolled. Patients underwent SP ablation using either a voltage-gradient map (n = 20) or a conventional approach based on anatomic and electrophysiological findings (n = 32). The Ensite X EP system was used as the 3-D mapping system in all patients. The target CA site was defined as the location at which the Jackman potential, with a voltage of <0.5 mV on the tricuspid annulus (TA) side of the pivot point, was confirmed by the creation of a voltage-gradient map with the Advisor HD Grid SE.</p><p><strong>Results: </strong>The distance from the successful ablation site to the His bundle was significantly greater in the voltage-gradient map group (15.0 (12.8-19.0) vs. 11.0 (8.0-13.0) mm, p < 0.001), the junctional rhythm heart rate was slower (92.5 (78.8-121.8) vs. 114.0 (96.8-131.0) bpm, p = 0.028), and the time to the appearance of junctional rhythm after radiofrequency application was shorter (4.0 (2.5-7.3) vs. 7.8 (6.6-8.6) s, p = 0.002). Furthermore, the procedure time was also significantly shorter (53.5 (47.0-67.0) vs. 99.5 (76.3-112.5) min, p < 0.001) in the voltage-gradient map group.</p><p><strong>Conclusion: </strong>The site at which the Jackman potential was confirmed, with a voltage of <0.5 mV on the TA side from the pivot point drawn using the voltage-gradient map, may be defined as the CA target of SP.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304394","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 Fibrillation Recurrence After Catheter Ablation: The Puzzle We Have and the Pieces We Need.","authors":"Panayotis K Vlachakis, Anastasios Apostolos, Panagiotis Theofilis, Paschalis Karakasis, Ioanna Koniari, Athanasios Kordalis, George Leventopoulos, Maria Drakopoulou, Ioannis Leontsinis, Dimitrios Tousoulis, Konstantinos Toutouzas, Konstantinos Gatzoulis, Skevos Sideris, Costas Tsioufis","doi":"10.1111/pace.15221","DOIUrl":"https://doi.org/10.1111/pace.15221","url":null,"abstract":"<p><p>Atrial fibrillation (Afib) recurrence following catheter ablation (CA) remains a significant challenge within the electrophysiology community, potentially driven by complex mechanisms and diverse patient characteristics. Although multiple predictors of recurrence have been investigated, only a limited number have been consistently validated across studies, suggesting uncertainty in their predictive reliability. Advances in ablation techniques, such as pulsed-field ablation, may offer improved outcomes compared to traditional methods, though their long-term efficacy awaits further confirmation. Aggressive management of modifiable risk factors, alongside selective pharmacotherapies, appears to enhance ablation success, yet optimal strategies remain under exploration. Post-recurrence interventions, such as timely cardioversion or early reablation, could improve rhythm control, but their benefits depend on refined patient selection and timing. Emerging technologies, including artificial intelligence and advanced mapping, hold potential to refine risk stratification and procedural precision, pending robust validation. Comprehensive approaches integrating lifestyle interventions, procedural innovations, and individualized care seem essential for optimizing Afib management. Addressing these gaps may provide the critical pieces needed to solve the puzzle of Afib recurrence after CA.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259932","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":"Multiple Arterial Embolisms After Radiofrequency Ablation of Focal Atrial Tachycardia in the Left Atrium: A Case Report.","authors":"Yan Zhang, Jun-Tao Wang, Ming-Jie Lin, Xin-Yan Yang, Jing-Quan Zhong","doi":"10.1111/pace.15219","DOIUrl":"https://doi.org/10.1111/pace.15219","url":null,"abstract":"<p><p>We report a relatively rare case of multiple arterial embolisms after radiofrequency ablation for focal atrial tachycardia in the left atrium. The source of the emboli was not detected by transthoracic echocardiography. Enhanced CT of the left atrium confirmed that the emboli originated from the left atrium. After 2 months of anticoagulant treatment, a reexamination with enhanced CT of the left atrium showed that no thrombus was found in the left atrium.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259934","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}