Pacing and clinical electrophysiology : PACE最新文献

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Incidence and Influencing Factors for Steam Pops in Cardiac Ablations: A Systematic Review. 心脏消融术中蒸汽爆裂的发生率及影响因素:系统综述。
IF 1.3
Pacing and clinical electrophysiology : PACE Pub Date : 2025-07-31 DOI: 10.1111/pace.70022
Khaled Elenizi, Rasha Alharthi
{"title":"Incidence and Influencing Factors for Steam Pops in Cardiac Ablations: A Systematic Review.","authors":"Khaled Elenizi, Rasha Alharthi","doi":"10.1111/pace.70022","DOIUrl":"https://doi.org/10.1111/pace.70022","url":null,"abstract":"<p><strong>Background: </strong>Steam pops (SPs) during cardiac ablations have emerged as a notable phenomenon with potential implications for procedural safety and efficacy. This is the first review of SPs, which aims to explore the current understanding of SPs. The review investigates their incidence, associations, predictors, clinical significance, and management strategies. Presently, the factors that give rise to SPs have not been completely understood, and the root cause of SPs remains elusive. To achieve this goal, the study conducted a comprehensive review of existing research on SPs in cardiac ablation procedures to ascertain the prevalence and predictors of SPs.</p><p><strong>Methods: </strong>The research involved an extensive search of databases from their inception until April 2024 to investigate the prevalence of SPs during cardiac ablation procedures in humans. The primary objective of this study was to gather patient demographics, incidence rates, and potential risk factors and predictors that could contribute to the occurrence of SPs and determine any significant correlations between them. The data collected were thoroughly reviewed to identify any significant associations between the various risk factors, predictors, and the incidence of SPs.</p><p><strong>Results: </strong>A comprehensive review of literature sourced from EMBASE and PubMed identified 25 relevant studies focused on the incidence and clinical significance of steam pops (SPs) during catheter ablation procedures. The studies reported varying rates of SPs, ranging from 0% to 26%, with the highest incidence observed in atrial fibrillation (AFib) and ventricular ablation cases. The association between SPs and factors such as catheter type, irrigation methods, and monitoring parameters was assessed. Notably, advanced catheter technologies, such as the QDOT MICRO and THERMOCOOL SMARTTOUCH, demonstrated a significant reduction in SP occurrences. Additionally, the analysis highlighted the role of temperature control and contact force in minimizing the risk of SPs, with temperature-controlled ablation (TCA) generally leading to fewer SPs compared to power-controlled ablation (PCA). Despite the low incidence of severe complications, the review underscores the importance of careful monitoring of impedance and real-time feedback during ablation to ensure patient safety.</p><p><strong>Conclusion: </strong>SPs are not uncommon during ablation procedures with irrigated catheters. Caution is required to avoid temperature feedback issues. Advanced catheters are associated with a reduced incidence of steam pops. The risks can be minimized by decreasing energy settings and monitoring impedance changes.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763051","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}
引用次数: 0
Use of Direct Oral Anticoagulants Following Cardiac Implantable Electronic Device Placement. 心脏植入式电子装置置入后直接口服抗凝剂的应用。
IF 1.3
Pacing and clinical electrophysiology : PACE Pub Date : 2025-07-31 DOI: 10.1111/pace.70016
Carmel Ashur, Li Qin, Karl E Minges, James V Freeman, Sana M Al-Khatib, Steven M Bradley, P Michael Ho, Wendy S Tzou, Paul D Varosy, Paul L Hess, Amneet Sandhu
{"title":"Use of Direct Oral Anticoagulants Following Cardiac Implantable Electronic Device Placement.","authors":"Carmel Ashur, Li Qin, Karl E Minges, James V Freeman, Sana M Al-Khatib, Steven M Bradley, P Michael Ho, Wendy S Tzou, Paul D Varosy, Paul L Hess, Amneet Sandhu","doi":"10.1111/pace.70016","DOIUrl":"https://doi.org/10.1111/pace.70016","url":null,"abstract":"<p><strong>Background: </strong>Small studies have described the safety of uninterrupted direct oral anticoagulant (DOAC) use in atrial fibrillation (AF) patients undergoing elective, cardiac implantable electronic device (CIED) placement. Real-world practice patterns and associated outcomes remain poorly defined.</p><p><strong>Objective: </strong>Describe DOAC usage trends following uncomplicated, outpatient CIED placement in AF patients and evaluate clinical outcomes based on DOAC status at discharge.</p><p><strong>Methods: </strong>Using data from the National Cardiovascular Data Registry, AF patients with CHA<sub>2</sub>DS<sub>2</sub>-VASc ≥ 2 undergoing uncomplicated, outpatient CIED placement from April 2016 to December 2019 were stratified by DOAC prescription at discharge. Short and longer-term temporal trends and post-discharge outcomes were assessed using Centers for Medicare and Medicaid (CMS) claims.</p><p><strong>Results: </strong>Among 59,169 AF patients with elevated thromboembolic eligible for DOAC therapy who underwent elective, new CIED implant or generator replacement, 32,025 (54.1%) were discharged on a DOAC. Annual rates of DOAC use at discharge increased from 47.0% in 2016 to 62.5% in 2019 (p < 0.0001). Overall, patients discharged on DOAC had higher adjusted rates of pocket hematoma (0.51% vs. 0.33%, p = 0.0007) and lower rates of stroke (2.9% vs. 3.2%, p = 0.05) at 30-days but no significant differences in device infection or need for revision at 30-days or 1-year. Those undergoing new CIED implant had higher rates of pocket hematoma at 30-days (0.53% vs. 0.36%, p = 0.02) and need for device revision at 1-year (1.6% vs. 1.3%, p = 0.04).</p><p><strong>Conclusion: </strong>In AF patients undergoing CIED implantation, about half were discharged on DOACs, with increasing rates of DOAC resumption immediately following post-CIED implantation over the study period. Those discharged on DOACs had modestly higher rates of pocket hematoma or need for device revision but similar risk of device infection.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763055","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}
引用次数: 0
Safety of Same-Day Discharge Following Pulsed-Field Ablation Versus Radiofrequency Ablation: A Comparative Analysis. 脉冲场消融与射频消融后当日放电的安全性:比较分析。
IF 1.3
Pacing and clinical electrophysiology : PACE Pub Date : 2025-07-31 DOI: 10.1111/pace.70005
Adele Watfa, Arwa Younis, Mohamad Mdaihly, Joe Demian, Chadi Tabaja, Pasquale Santangeli, Bryan Baranowski, Hiroshi Nakagawa, Tyler Louis Taigen, Koji Higuchi, Thomas D Callahan, Shady Nakhla, Mohamed Kanj, Mina K Chung, Jakub Sroubek, Justin Z Lee, Mandeep Bhargava, Walid I Saliba, Oussama M Wazni, Ayman A Hussein
{"title":"Safety of Same-Day Discharge Following Pulsed-Field Ablation Versus Radiofrequency Ablation: A Comparative Analysis.","authors":"Adele Watfa, Arwa Younis, Mohamad Mdaihly, Joe Demian, Chadi Tabaja, Pasquale Santangeli, Bryan Baranowski, Hiroshi Nakagawa, Tyler Louis Taigen, Koji Higuchi, Thomas D Callahan, Shady Nakhla, Mohamed Kanj, Mina K Chung, Jakub Sroubek, Justin Z Lee, Mandeep Bhargava, Walid I Saliba, Oussama M Wazni, Ayman A Hussein","doi":"10.1111/pace.70005","DOIUrl":"https://doi.org/10.1111/pace.70005","url":null,"abstract":"<p><strong>Background: </strong>Same-day discharge (SDD) after catheter ablation is increasingly adopted to improve patient convenience and reduce healthcare costs. While SDD following radiofrequency ablation (RFA) is well-documented, no data exist on SDD in patients undergoing pulsed-field ablation (PFA) for atrial fibrillation (AF).</p><p><strong>Objective: </strong>To evaluate the safety of SDD in patients undergoing PFA and RFA for AF, with an exploratory comparison of practice patterns and outcomes.</p><p><strong>Methods: </strong>From a prospectively maintained registry, we included all consecutive patients undergoing PFA for AF (FARAWAVE catheter) since its FDA approval and patients undergoing AF RFA between March and October 2023 (comparison group). Outcomes included rates of major complications (vascular complications, cerebrovascular accidents, transient ischemic attacks (TIA), phrenic nerve injury, and pericardial effusion requiring intervention), minor complications, readmissions within 30 days, and all-cause mortality.</p><p><strong>Results: </strong>The study included 955 PFA patients, of whom 207 (21.7%) were discharged the same day, and 1072 RFA patients, of whom 127 (11.8%) were discharged the same day. Vascular closure modalities differed significantly across groups (p < 0.001). Major complications, including stroke and TIA, occurred in 0.5% of PFA non-SDD and 1.1% of RFA non-SDD patients (p = 0.29, p = 0.24), with no major complications in SDD groups and no deaths across all groups. Minor complications were 0.5% for PFA SDD versus 1.1% for PFA non-SDD (p = 0.44) and 1.6% for both RFA SDD and RFA non-SDD (p = 0.99), and not significantly different between PFA SDD and RFA SDD (p = 0.31). Readmission rates (UTI, AF, aspiration pneumonia) were similar between SDD patients at 1.4% for PFA and 2.4% for RFA (p = 0.54). A lower CHA2DS2-VASc score predicted the practice pattern of SDD in the PFA cohort (OR = 0.754, 95% CI: 0.663-0.858, p < 0.001), while being octogenarian reduced the likelihood of SDD (OR = 0.265, 95% CI: 0.105-0.666, p = 0.005).</p><p><strong>Conclusion: </strong>In this cohort, SDD was found to be a safe and viable option for both PFA and RFA. In this practice, the rates of same-day discharge were higher in the PFA group versus the RFA group and is being increasingly adopted.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763053","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}
引用次数: 0
Joint Pacing and Vascular Intervention for the Management of Cardiac Device Associated Central Venous Obstruction. 联合起搏和血管介入治疗心脏装置相关中心静脉阻塞。
IF 1.3
Pacing and clinical electrophysiology : PACE Pub Date : 2025-07-31 DOI: 10.1111/pace.70019
Nadeev Wijesuriya, Helen Sinabulya, Helena Johann-Meyer, Keisha Kellman, Felicity de Vere, Sandra Howell, Alphonsus Liew, Paolo Bosco, Steven A Niederer, Stephen Black, Christopher A Rinaldi
{"title":"Joint Pacing and Vascular Intervention for the Management of Cardiac Device Associated Central Venous Obstruction.","authors":"Nadeev Wijesuriya, Helen Sinabulya, Helena Johann-Meyer, Keisha Kellman, Felicity de Vere, Sandra Howell, Alphonsus Liew, Paolo Bosco, Steven A Niederer, Stephen Black, Christopher A Rinaldi","doi":"10.1111/pace.70019","DOIUrl":"https://doi.org/10.1111/pace.70019","url":null,"abstract":"<p><strong>Background and aims: </strong>Central venous obstruction (CVO) increases the complexity of pacing interventions, whether it be with device-associated symptomatic superior vena cava syndrome (SVCS), or by impeding new implants. Endovascular treatment involves the joint expertise of both cardiac pacing and vascular specialists. We report the outcomes of such procedures at our institution.</p><p><strong>Methods: </strong>A single-center retrospective observational study, examining outcomes of joint pacing-vascular procedures for CVO. Cases were screened from an existing institutional database.</p><p><strong>Results: </strong>There were 19 total cases. Two were new device implants where the novel \"inside-out\" procedure was utilized to establish access in SVCS, both with no complications. The remainder (n = 17) were transvenous lead extractions plus attempted recanalization of CVO using venoplasty with or without stenting. Transvenous devices were re-implanted in eight patients. Complete procedure success rate was 84%. There were two cases of pericardial effusion requiring pericardiocentesis, resulting in procedure abandonment. There was no in-hospital mortality and no cases of emergency sternotomy. Over mean follow-up of 28 months, 2/6 patients receiving venoplasty (33%) and 2/8 patients receiving stenting (25%) required re-intervention for symptomatic restenosis. Of the patients who were not re-implanted with a transvenous device following initially successful endovascular intervention (6/14), none had recurrence over the follow-up period.</p><p><strong>Conclusion: </strong>Pacing interventions in SVCS carry a significant risk profile, requiring management by experienced operators in high-volume centers to maximize safety. Endovascular interventions have a significant recurrence rate, with up-front stenting potentially being superior. Our data suggests that those without re-implantation of transvenous leads may have better long term outcomes.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763052","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}
引用次数: 0
Cardiac Resynchronization Therapy Pacing Interruption: From Early Challenges to Cutting-Edge Solutions. 心脏再同步化治疗起搏中断:从早期挑战到前沿解决方案。
IF 1.3
Pacing and clinical electrophysiology : PACE Pub Date : 2025-07-31 DOI: 10.1111/pace.70015
Hermine Poghosyan
{"title":"Cardiac Resynchronization Therapy Pacing Interruption: From Early Challenges to Cutting-Edge Solutions.","authors":"Hermine Poghosyan","doi":"10.1111/pace.70015","DOIUrl":"https://doi.org/10.1111/pace.70015","url":null,"abstract":"<p><strong>Background/purpose: </strong>In the current era of pacing, the loss of cardiac resynchronization therapy (CRT) pacing remains a significant challenge, especially in patients with heart failure (HF). Some manufacturers, such as Biotronik (Berlin, Germany), offer left ventricular (LV) sensing options to avoid pacing during vulnerable periods. However, even in the absence of LV sensing (LVs), CRT interruptions can still occur, though they often go unnoticed without this additional feature. When LVs is used, interruptions in biventricular pacing can sometimes lead even to device-induced ventricular tachycardia (VT).</p><p><strong>Results: </strong>A careful review of all CRT pacing interruption episodes reveals the precise causes of these interruptions. Although interruptions may exist even in devices without LVs, grouping the causes allows for a clearer understanding of the phenomenon and its potential adverse effects. Furthermore, recent advancements in CRT algorithms could reduce these interruptions and improve device performance, ultimately leading to better clinical outcomes.</p><p><strong>Conclusion: </strong>LVs plays a crucial role in identifying pacing interruptions, though it has its limitations. Even in the absence of LVs, interruptions may still occur, and minor algorithm adjustments can enhance the device's overall effectiveness and predictability. Careful analysis of each interruption episode provides valuable clinical insights that will help inform future management strategies aimed at achieving uninterrupted CRT pacing. Additionally, we are preparing two more studies to explore the clinical implications of CRT interruptions in HF management and propose new algorithms designed to minimize these interruptions.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763050","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}
引用次数: 0
Ultrasound Guided Venous Access for Cardiac Devices: Defining Learning Curve for Safety, Efficacy, and Radiation Exposure. 超声引导心脏装置的静脉通路:定义安全性、有效性和辐射暴露的学习曲线。
IF 1.3
Pacing and clinical electrophysiology : PACE Pub Date : 2025-07-31 DOI: 10.1111/pace.70021
Anish N Bhuva, Hnin Zaw, Adam Graham, Amal Muthumala, Philip Moore, Mehul Dhinoja
{"title":"Ultrasound Guided Venous Access for Cardiac Devices: Defining Learning Curve for Safety, Efficacy, and Radiation Exposure.","authors":"Anish N Bhuva, Hnin Zaw, Adam Graham, Amal Muthumala, Philip Moore, Mehul Dhinoja","doi":"10.1111/pace.70021","DOIUrl":"https://doi.org/10.1111/pace.70021","url":null,"abstract":"<p><strong>Background: </strong>There is limited real-world experience of the learning curve for ultrasound (US) guided axillary venous access for cardiac device implantation, and it is usually performed before cutaneous incision. We investigated the learning curve, radiation exposure, safety, and efficacy of US-guided venous access in standard workflow.</p><p><strong>Methods: </strong>US-guided access was performed by an experienced electrophysiologist with no prior application of the technique by using a standard vascular US probe and minimal modification to workflow. The learning curve was evaluated using access time (needle-to-wire time). Complications were recorded until hospital discharge, and efficacy was defined by procedural success. Radiation dose savings were estimated based on fluoroscopy time for access, and a control group underwent conventional fluoroscopy landmark-guided access (n = 44 punctures).</p><p><strong>Results: </strong>147 US-guided punctures were performed in 74 patients for one (8%), two (71%), or three (17%) leads, or upgrades (4%). Access was successful in 97% (n = 72). There were no access-related peri-procedural complications. First US-guided access time was 30 seconds (interquartile range [IQR]: 17,60), and was similar to fluoroscopy-guided access time (43 seconds, IQR: 24,58; p = 0.45). Access time stabilized after 45 procedures, decreasing from 81 (IQR: 61,90) to 16 seconds (IQR: 10,20) from the first to the last 15 procedures (p < 0.001). 96% (n = 69) did not require fluoroscopy. 4% (n = 3) required 1 second fluoroscopy to confirm wire position after difficult passage. Estimated radiation exposure saving from controls was 30 seconds (IQR: 15,78) of fluoroscopy, resulting in 0.4 (IQR: 0.26,1.7) mGy cumulative skin dose, equivalent to 1.3 (95% confidence interval: 0.26,1.45) patient chest radiograph radiation exposure.</p><p><strong>Conclusion: </strong>US-guided axillary venous access for cardiac device implantation is feasible in a standard workflow and reduces radiation exposure. The learning curve time is acceptable, and the procedure is safe, even during training.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763054","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}
引用次数: 0
Cardioneuroablation for the Treatment of Vagal Mediated Ventricular Fibrillation in Short QT Syndrome, Case Report. 心神经消融术治疗短QT综合征迷走神经介导的心室颤动,病例报告。
IF 1.3
Pacing and clinical electrophysiology : PACE Pub Date : 2025-07-29 DOI: 10.1111/pace.70018
Hamza Hamayel, Fateh Awwad, Yunis Daralammouri, Sajed Majadla, Nidal Sharan, Mohammed Sameer Dwikat, Majed Othman, Ibrahim Marai
{"title":"Cardioneuroablation for the Treatment of Vagal Mediated Ventricular Fibrillation in Short QT Syndrome, Case Report.","authors":"Hamza Hamayel, Fateh Awwad, Yunis Daralammouri, Sajed Majadla, Nidal Sharan, Mohammed Sameer Dwikat, Majed Othman, Ibrahim Marai","doi":"10.1111/pace.70018","DOIUrl":"https://doi.org/10.1111/pace.70018","url":null,"abstract":"<p><p>Augmented vagal effect may be the trigger of ventricular arrhythmia in Short QT syndrome (SQTS). We offer a novel option for refractory cases. This is a 28-year-old male patient who experienced recurrent ICD shocks due to ventricular fibrillation (VF) episodes preceded by enhanced vagal tone. Conventional treatment failed to suppress ventricular arrhythmia. Cardioneuroablation was performed to attenuate vagal response, which ultimately suppressed ventricular arrhythmia. Cardioneuroablation may be an alternative option for vagal mediated ventricular arrhythmia in patients with SQTS refractory to conventional treatments.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144747050","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}
引用次数: 0
Thermal Profile of Contact Force Dependent Pulse Field Electroporation Beyond Calcium Electroporation at the Koch Triangle. 科赫三角接触力相关脉冲场电穿孔的热分布,超越钙电穿孔。
Pacing and clinical electrophysiology : PACE Pub Date : 2025-07-17 DOI: 10.1111/pace.70013
Yiqi Lu, Huimin Chu, Rong Bai, Feifan Ouyang, Zhenyu Jia, Mingjun Feng, Xianfeng Du, Si Chen, Lipu Yu, Jiating Dai, Tingsha Du, Weidong Zhuo, Yijun Sun, Xinzhi Yu, Chenxu Luo, Caijie Shen
{"title":"Thermal Profile of Contact Force Dependent Pulse Field Electroporation Beyond Calcium Electroporation at the Koch Triangle.","authors":"Yiqi Lu, Huimin Chu, Rong Bai, Feifan Ouyang, Zhenyu Jia, Mingjun Feng, Xianfeng Du, Si Chen, Lipu Yu, Jiating Dai, Tingsha Du, Weidong Zhuo, Yijun Sun, Xinzhi Yu, Chenxu Luo, Caijie Shen","doi":"10.1111/pace.70013","DOIUrl":"https://doi.org/10.1111/pace.70013","url":null,"abstract":"<p><strong>Background: </strong>Contact force (CF)-dependent pulse field electroporation (PFE) may generate tissue heating, affecting junctional rhythm at the triangle of Koch (ToK) in a clinical setting. PFE may also disrupt calcium homeostasis, causing calcium electroporation (CE) for some Joule heating. The impact of CF on PFE and CE for electrode temperature (ET) at the ToK has not been validated.</p><p><strong>Methods: </strong>A CF-sensing catheter with an ET probe was positioned perpendicularly on dissected ToK from 12 swine. PFE was applied in four groups: low CF-calcium chloride (CC, 5.0 mM; LCF-CC, 2-10 g), high CF-CC (HCF-CC, 11-50 g), LCF-saline solution (SS; CF-SS, 2-10 g), and HCF-SS (11-50 g). ET changes derived from (LCF-CC minus LCF-SS) and (HCF-SS minus LCF-SS) was operationally defined as dominant CE (DCE) and PEF (DPFE) components, respectively.</p><p><strong>Results: </strong>Fewer time-temperature curves with straight, abrupt surge (AS) followed by sudden descent (SD) were observed in LCF-CC versus other groups (p < 0.001). The delayed AS-maximal temperature (MT) curve is almost absent in the LCF-SS versus LCF-CC group (6.3% vs. 70.3%, p < 0.001). The highest △AS-MT was detected in HCF-CC and LCF-CC groups (4.3 ± 0.7°C vs. 4.3 ± 1.0°C, p = 0.37). △△AS-MT was larger from DCE than the DPFE effect (1.1 ± 1.0°C vs. 0.4 ± 0.4°C, p < 0.001). Although △SD-MT was similar in DCE and DPFE groups (p > 0.05), △△SD-MT (resistance to △SD-MT) was more prominent in DCE (0.2 ± 0.5 vs. -0.1 ± 0.5, p < 0.05). More extensive △SD-MT/duration was synchronously changed with short duration in LCF-CC or HCF-SS versus HCF-CC, and DCE group (p < 0.05).</p><p><strong>Conclusions: </strong>The in vitro model showed biphasic ET changes (initial rise followed by decline) correlated with CF-dependent CE and PFE. CF significantly modulated ET dynamics while maintaining safe thermal thresholds. Further studies should clarify how this biphasic pattern affects junctional rhythm generation in vivo conditions.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661752","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}
引用次数: 0
3D Electroanatomical Mapping for Complex Atrial Arrhythmias in Adult Congenital Heart Disease-A Single Center Experience. 成人先天性心脏病复杂心房心律失常的三维电解剖定位——单中心经验。
Pacing and clinical electrophysiology : PACE Pub Date : 2025-07-17 DOI: 10.1111/pace.70012
Nili Schamroth Pravda, Ofir Brem, Alon Barsheshet, Kirill Buturlin, Aharon Erez, Ehud Kadmon, Gustavo Goldenberg, Ran Kornowski, Rafael Hirsch, Gregory Golovchiner
{"title":"3D Electroanatomical Mapping for Complex Atrial Arrhythmias in Adult Congenital Heart Disease-A Single Center Experience.","authors":"Nili Schamroth Pravda, Ofir Brem, Alon Barsheshet, Kirill Buturlin, Aharon Erez, Ehud Kadmon, Gustavo Goldenberg, Ran Kornowski, Rafael Hirsch, Gregory Golovchiner","doi":"10.1111/pace.70012","DOIUrl":"https://doi.org/10.1111/pace.70012","url":null,"abstract":"<p><strong>Introduction: </strong>Adult Congenital Heart Disease (ACHD) patients suffer from multiple, and often atypical, atrial arrhythmias. 3D electro-anatomical mapping systems assist in the identification and ablation of arrhythmogenic substrates critical to the initiating of theses arrhythmias.</p><p><strong>Methods: </strong>We report on patients with ACHD and atrial arrhythmias treated at our center using the high density Rhythmia (Boston Scientific. Marlborough, MA) mapping system. Procedural success was defined as no sustained arrhythmia inducible at the end of the procedure. Partial success was defined as non-inducibility of the clinical arrhythmia.</p><p><strong>Results: </strong>Our cohort included 16 patients in whom 21 electro-anatomical mapping and ablations were performed. Most patients were female (13 patients, 87%) and the average age was 43.5 ± 10.3 years. The congenital heart disease diagnosis was varied, including Fontan circulation and atrial switch palliation for Transposition of the great arteries. The identified arrhythmias included 21 intra-atrial re-entrant tachycardias and nine focal atrial tachycardias. In 14 cases (66.6%) the procedure was successful, in five cases (23.8%) the procedure was partially successful, and two cases (9.5%) were unsuccessful. There were no procedure-related major adverse events reported. At mean follow up of 15.3 ± 12.6 months, there were four cases of recurrent arrhythmias (44% of patients), four re-do procedures, three patients (18.8%) were discontinued from their antiarrhythmic medications.</p><p><strong>Conclusion: </strong>Electro-anatomical mapping is useful in the identification and treatment of complex atrial arrhythmias in patients with ACHD. In this cohort, mapping-assisted ablation of complex atrial arrhythmias in patients with ACHD was safe, feasible, and demonstrated an acceptable success rate.</p><p><strong>Condensed abstract: </strong>Patients with ACHD have anomalous cardiac anatomy and atrial arrhythmias can often be atypical. Electro-anatomical mapping is useful in the identification and treatment of complex atrial arrhythmias among patients with ACHD. We found that the use of a high-resolution 3D electro-anatomic mapping is safe, feasible and effective for the treatment of complex atrial arrhythmias in ACHD.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661751","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}
引用次数: 0
Machine Learning-Based Prognostic Models for Mortality in Patients Receiving Implantable Cardioverter Defibrillators. 基于机器学习的接受植入式心律转复除颤器患者死亡率预测模型。
Pacing and clinical electrophysiology : PACE Pub Date : 2025-07-08 DOI: 10.1111/pace.70008
Lei Pan, Xi Liu, Li Zhu, Ziqing Yu, Jingfeng Wang, Xiao Li, Weiwei Zhang, Ruogu Li, Zhongkai Wang, Hongyang Lu, Shengwen Yang, Peizhao Li, Yangang Su, Wei Hua, Yixiu Liang
{"title":"Machine Learning-Based Prognostic Models for Mortality in Patients Receiving Implantable Cardioverter Defibrillators.","authors":"Lei Pan, Xi Liu, Li Zhu, Ziqing Yu, Jingfeng Wang, Xiao Li, Weiwei Zhang, Ruogu Li, Zhongkai Wang, Hongyang Lu, Shengwen Yang, Peizhao Li, Yangang Su, Wei Hua, Yixiu Liang","doi":"10.1111/pace.70008","DOIUrl":"https://doi.org/10.1111/pace.70008","url":null,"abstract":"<p><strong>Background: </strong>Accurately predicting the clinical trajectory of patients with implantable cardioverter-defibrillators (ICDs) is critical for guiding their care and management. Machine learning (ML) methods surpass traditional statistical approaches by addressing complex data patterns and variability, providing more precise and personalized risk estimates.</p><p><strong>Methods: </strong>This retrospective study included patients from four major hospitals in China. Data from three hospitals were used for training and internal tests, while data from the remaining hospital were used for external tests. Six ML models were developed and validated. Model discrimination was measured using the area under the receiver operating characteristic curve (AUROC). Kaplan-Meier survival curves were generated by stratifying patients into high-risk and low-risk groups based on the optimal model's predictions. Interpretation analysis was performed to rank the importance of predictive features.</p><p><strong>Results: </strong>A total of 3175 patients were studied. The multilayer perceptron (MLP) model demonstrated superior predictive accuracy, with the AUROC of 0.70 and 0.72 in internal and external test sets, respectively, outperforming other models. Kaplan-Meier curves show distinct survival trends over time between high-risk and low-risk groups, with stratification determined by the MLP model using a Youden's index cut-off value of 0.3443 (p < 0.001). Among the seven key predictors identified, glomerular filtration rate (GFR) was the most influential factor.</p><p><strong>Conclusions: </strong>The MLP model effectively predicted 3-year survival for ICD or cardiac resynchronization therapy defibrillator (CRT-D) patients and accurately stratified them into distinct risk groups. The integration of MLP and SHapley Additive exPlanations (SHAP) provided explicit explanations for individualized risk predictions, facilitated clinical decision-making, and supported the optimization of treatment strategies.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT05396313.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586214","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}
引用次数: 0
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