Pacing and clinical electrophysiology : PACE最新文献

{"title":"Atrial Arrhythmias in Cardiac Sarcoidosis-Case Presentation and Systematic Review.","authors":"Emily C Hodkinson, Luis Quininir, Edward Hsiao, Rajesh Puranik, Raymond W Sy","doi":"10.1111/pace.70062","DOIUrl":"https://doi.org/10.1111/pace.70062","url":null,"abstract":"<p><p>Sarcoidosis is a rare idiopathic, multiorgan disease with clinical cardiac involvement in approximately 5% of cases. Diagnosis and management of cardiac sarcoidosis (CS) have mainly focused on impaired LV function, ventricular arrhythmias, and atrio-ventricular conduction disease. Atrial arrhythmias (AA) may be an under-recognized manifestation of sarcoidosis, and the purpose of the study was to perform a systematic review of the current literature, with an emphasis on the prevalence and management of AA in CS. AA occur as a result of direct infiltration of granulomatous disease in the atria or secondary to atrial myopathic changes from pulmonary or ventricular disease. Positron emission tomography (PET) is the modality of choice for surveillance of disease activity in the atria. AA occur frequently, in up to 40% in patients with CS, and may be associated with frequent hospitalization and reduction in quality of life. Moreover, AA may be the predominant cardiac manifestation, and there should be some consideration to include AA as part of future iterations of the diagnostic criteria for CS. Contemporary treatment involves a combination of immunosuppression, anti-arrhythmic therapy, and catheter ablation, but recurrence occurs more frequently than in patients with non-CS AA. Further systematic studies, likely in the form of multi-center observational cohort studies, are required to inform guidelines on the specific management of AA in CS.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145153115","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":"Techniques for Transvenous Lead Extraction of Cardiac Implantable Electronic Devices: A Network Meta-Analysis.","authors":"Charles Karel Martins Santos, Maria Clara Ramos Miranda, Gabriel Alves Barbosa, Antônio da Silva Menezes Júnior","doi":"10.1111/pace.70052","DOIUrl":"https://doi.org/10.1111/pace.70052","url":null,"abstract":"<p><strong>Background: </strong>Transvenous lead extraction (TLE) is procedurally complex and carries significant risk. Evidence on optimal TLE techniques is limited and lacks comparative studies.</p><p><strong>Methods: </strong>PubMed, Embase, Cochrane Library, and Web of Science were searched through November 27, 2024. We included randomized clinical trials (RCTs) or non-randomized controlled trials (non-RCTs) comparing two or more TLE methods in adults undergoing lead extraction. A network meta-analysis was conducted to estimate pooled outcomes with 95% CIs. P-scores ranked treatments.</p><p><strong>Results: </strong>Eleven non-RCTs and one RCT were included. No statistically significant differences were observed in patient-level clinical success or lead-level procedural success. The femoral approach was associated with a significantly lower risk of significant complications compared to the use of laser sheaths (odds ratio, 0.28; 95% CI, 0.09-0.89). Rotating mechanical sheaths (RMS) ranked highest for clinical (p = 0.7470) and procedural success (p = 0.7357), while the femoral approach ranked highest for safety (p = 0.8368). Laser sheaths ranked lowest across all outcomes.</p><p><strong>Conclusion: </strong>No single technique was superior in terms of success rates. RMS and the femoral approach had the highest rankings for efficacy and safety, respectively. Laser sheaths ranked lowest for both. Rigorous prospective studies with direct comparative analyses are required to establish evidence-based protocols and improve TLE patient outcomes.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145153143","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":"Vascular Closure Device Following Pulsed Field Ablation for Atrial Fibrillation: A Randomized Controlled Trial.","authors":"Alexander Dashwood, Francis J Ha, Stewart Healy, Robert Puchalski, Sing Huey Cheng, Brendan Tian, Emily Kotschet","doi":"10.1111/pace.70051","DOIUrl":"https://doi.org/10.1111/pace.70051","url":null,"abstract":"<p><strong>Introduction: </strong>Atrial fibrillation (AF) ablation often involves large-diameter catheters, posing challenges for post-procedure hemostasis and discharge. The impact of Perclose Prostyle vascular closure device (VCD) on time to ambulation and vascular access complications in patients undergoing pulsed field ablation (PFA) is uncertain.</p><p><strong>Methods: </strong>Patients undergoing PFA for AF with 16.8 French (F) sheaths were randomly assigned in a 1:1 ratio to Prostyle (Abbott Vascular, USA) or standard closure with a figure-of-eight suture (FO8) at a single center in an open-label design. A maximum of three VCDs were allowed. Pre-closure was achieved with deployment at 2 and 10 o'clock positions and a final Prostyle secured the second 6F short sheath. Ultrasound guidance was used in all patients. The primary end point was time to ambulation post-procedure. Secondary end points included major and minor periprocedural adverse events. Follow-up occurred up to 2 weeks post-procedure.</p><p><strong>Results: </strong>Sixty patients were randomized to undergo VCD (30 patients) or F08 suture (30 patients). There were no significant differences in baseline characteristics between groups. Time to ambulation was significantly reduced (215 ± 113 min) in the VCD group compared with the FO8 group (338 ± 71 min; p < 0.001). There were no major peri-procedural adverse events in either group. Rate of minor bleeding was significantly increased in the FO8 group (27%; 8/30) compared with none in the VCD group ((0%; 0/30; p = 0.005)). Rate of manual compression was numerically higher in the FO8 group (33%; 10/30) compared with the VCD group (10%; 3/30; p = 0.057). There were no differences in acute pain score, confidence in walking, overall patient satisfaction, or overall nurse satisfaction between groups.</p><p><strong>Conclusion: </strong>In this randomized controlled trial, VCD with Prostyle reduced time to ambulation and reduced minor bleeding in patients undergoing PFA for AF.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Triglyceride-Glucose Index Predicts Early Recurrence of Atrial Fibrillation After Ablation in Non-Diabetic Patients.","authors":"Chuanyi Sang, Renjie Gu, Tian Xia, Yameng Shao, Ye Zhu, Fukun Chen, Lei Sun, Chaoqun Zhang, Xiang Gu","doi":"10.1111/pace.70059","DOIUrl":"https://doi.org/10.1111/pace.70059","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to investigate the predictive value of the triglyceride-glucose (TyG) index for early recurrence (ER) of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA) in non-diabetic patients.</p><p><strong>Methods: </strong>This retrospective study included patients with AF who underwent RFCA for the first time from January 2020 to November 2022. According to whether they experienced the recurrence during follow-up, patients were divided into early and non-early recurrence groups. We performed the logistic regression analysis models and the receiver operating characteristic (ROC) curve to explore the value of the TyG index in predicting the ER of AF after RFCA.</p><p><strong>Results: </strong>A total of 417 non-diabetic patients with AF after RFCA were included in this study. Multivariate analysis identified the TyG index, left atrial diameter (LAD), and age as independent risk factors for ER of AF after RFCA in non-diabetic patients. ROC analysis demonstrated that the TyG index predicted ER with an area under the curve (AUC) of 0.687. Incorporating the TyG index into a clinical model (containing age and LAD) significantly improved its predictive value, with a net reclassification improvement (NRI) of 0.629 and an integrated discrimination improvement (IDI) of 0.068 CONCLUSIONS: The TyG index is an independent predictor of early AF recurrence after catheter ablation in non-diabetic patients.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126965","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 New Look for Micra: Epicardial Use of a Modified Micra-Based Pediatric IPG in a Neonate With Complete Heart Block.","authors":"Giacomo Mugnai, Luca Tomasi, Stiljan Hoxha, Alessandra Cristofaletti, Bruna Bolzan, Elena Franchi, Matteo Ciuffreda, Flavio Luciano Ribichini, Giovanni Battista Luciani","doi":"10.1111/pace.70058","DOIUrl":"https://doi.org/10.1111/pace.70058","url":null,"abstract":"<p><p>Severe bradycardia due to advanced atrioventricular (AV) block in neonates is rare but can be life-threatening, requiring urgent pacing. In the smallest infants, transvenous pacing is not feasible, and epicardial systems remain the standard. However, the pacemaker size still remains a significant issue in these small patients. Herein, we report the case of a premature neonate with complete intrauterine atrioventricular block successfully treated with an epicardial system using a custom-designed Micra-based Pediatric implantable pulse generator (IPG) connected to a standard epicardial lead.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083245","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":"Successful Catheter Ablation Under ECMO for Fatal Ventricular Tachycardia from RV Papillary Muscle in an Infant.","authors":"Shigehito Baba, Aya Miyazaki, Sou Otsuki, Shuichi Shiraishi, Kei Nishiyama, Akihiko Saitoh","doi":"10.1111/pace.70057","DOIUrl":"https://doi.org/10.1111/pace.70057","url":null,"abstract":"<p><p>Right ventricular papillary muscle (RVPM)-originating ventricular tachycardia (VT) is a potentially life-threatening arrhythmia that can rapidly lead to hemodynamic collapse. To the best of our knowledge, no cases have been reported in infants. We present the case of a 2-month-old male who developed RVPM-VT and subsequently underwent successful catheter ablation while on extracorporeal membrane oxygenation (ECMO). Due to the risk of air entry through the sheath from ECMO suction, catheter exchange was performed in a water-filled tray. Pace mapping was utilized to accurately localize the VT origin, followed by ablation using an irrigated catheter, which effectively delivered the necessary power to ablate the RVPM. The VT was successfully terminated post-ablation, with no recurrence observed.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083238","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":"When Legacy Triumphs: Resolving Leadless Pacemaker Programming Failure Caused by Loop Recorder Interference.","authors":"Gabriele Pavani, Antonino Previti, Paolo Garrone, Gianpaolo Varalda, Emma Fratini, Alfonso Franzè, Alessandra Chinaglia","doi":"10.1111/pace.70055","DOIUrl":"https://doi.org/10.1111/pace.70055","url":null,"abstract":"<p><p>The growing prevalence of co-implanted cardiac electronic devices increases the potential for clinically significant interactions. We describe the case of an 81-year-old man with a Biotronik BIOMONITOR IV implantable loop recorder (ILR) who required a Medtronic MICRA VR leadless pacemaker. Post-implantation, interrogation with the modern Medtronic SmartSync programmer failed due to suspected electromagnetic interference from the ILR. Communication was successfully established using the older Medtronic CareLink 2090 programmer. This report highlights a unique instance of inter-device interference, underscoring the importance of understanding programmer technology and device compatibility in complex clinical scenarios.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083242","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":"Expected Benefits From Antibacterial Envelope in Different CIED Patient Populations.","authors":"David Duncker, Christine Alonso, Mauro Biffi, Francisco Costa, Rim El Bouazzaoui, Panagiota Flevari, Maria Hee Jung Park Frausing, Andreas Goette, Didier Klug, Edward Maclean, Tobias Tönnis, Emilce Trucco, Andrew J Turley, Jay Wright, Bruno Valente, Matteo Ziacchi","doi":"10.1111/pace.70038","DOIUrl":"https://doi.org/10.1111/pace.70038","url":null,"abstract":"<p><p>Antibacterial envelope has proven to be safe and effective in reducing cardiac implantable electronic device (CIED) infection. Recently, its role in pocket healing process has also started to be studied, showing additional potential benefits for the patients. Risk scores such as the PADIT and the BLISTER ones have been developed to stratify patients at higher risk of developing CIED infections, but their use is still limited. There is a need for clear and concise practical guidance and scores for the correct stratification of patients at risk to develop CIED infections, to apply an effective preventive strategy. This article examines the most recent findings on the effectiveness of antibacterial envelopes in preventing CIED infections and introduces the latest concept of pocket stabilization. Additionally, patient populations that could potentially benefit from antibacterial envelope for both indications are provided based on the agreement of an expert panel made up of 16 European electrophysiologists from high-volume centers. Future studies will have to evaluate the strength of those proposals and the benefits of pocket stabilization in the long-term.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071588","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":"Minimizing Atrioesophageal Fistula Risk After AF Ablation: Risk Factors, Prevention, and Emerging Mini-Thermal Technology.","authors":"Muhammed Ibrahim Erbay, Esedullah Yağlı, Tasha Phillips-Wilson, Arda Çeviker, Henry D Huang, Joseph E Marine, Kıvanç Yalın","doi":"10.1111/pace.70037","DOIUrl":"https://doi.org/10.1111/pace.70037","url":null,"abstract":"<p><p>Atrial esophageal fistula (AEF) is a rare but life-threatening complication of atrial fibrillation (AF) ablation, linked to thermal injuries by conventional radiofrequency (RF) and cryo-balloon (CB) ablation techniques. AEF risk can be mitigated by considering several measures such as tailored power settings of ablation technique, mechanical displacement of esophagus, esophageal cooling, and alternative ablative techniques and energy sources. We review the current knowledge regarding AEF and esophageal thermal injuries as well as discussing the current research regarding a novel none-to-minimally thermal, myocardial tissue-selective modality known as pulsed-field ablation (PFA) which may mitigate such risks. By inducing irreversible electroporation, PFA reduces thermal injury and demonstrates improved safety profiles, as evidenced by recent meta-analyses reporting zero esophageal injury and AEF cases. Additionally, the integration of 3D mapping systems with PFA has enhanced its procedural precision and accuracy while lowering the radiation exposure. Despite these advances, challenges such as standardizing anesthesia protocols and tailoring energy settings remain. Our review suggests that PFA may reduce the risk of AEF from catheter ablation of AF. While early outcomes of PFA are encouraging, it is important to recognize that preliminary data may not always be predictive of long-term AEF formation risk, as demonstrated by earlier experiences with CB ablation. Although PFA may reduce the risk of any aberrant thermal injuries, recent studies report significant increase in collateral damage including hemolysis, exaggerated troponin leak and coronary vasospasms. PFA should be used with caution in patients with hemolytic anemia or renal dysfunction, as they may experience more pronounced effects. Future long-term outcome studies should provide more information on possible adverse outcomes with PFA as well as tailoring the power settings of PFA.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986744","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":"Cardiac Rehabilitation in Patients With Implantable Cardioverter-Defibrillator: A Scoping Review.","authors":"Carolina Castro Gómez, Maria Juliana Devia Quiñonez, Daniela López Gómez, Helen Johana Ortiz Rojas, Andrés Fernando Vallejo Andrade, Leonardo Arzayus-Patiño","doi":"10.1111/pace.70032","DOIUrl":"10.1111/pace.70032","url":null,"abstract":"<p><strong>Introduction: </strong>Sudden cardiac death (SCD) represents a serious global health problem. Therefore, an implantable cardioverter-defibrillator (ICD) is indicated in various clinical conditions as a strategy for the primary and secondary prevention of SCD. These patients benefit from a cardiac rehabilitation (CR) program aimed at improving cardiorespiratory fitness, increasing exercise tolerance, and reducing the fear of physical activity. This review aims to describe the outcomes of exercise-based CR in patients with an ICD.</p><p><strong>Methods: </strong>A scoping review was performed following the methodology described in the Joanna Briggs Institute Manual, the protocol presented by Arksey and O'Malley, and the improvements suggested by Levac, Colquhoun, and O'Brien. This review included defining the research question, identifying relevant studies, and systematic searches of databases: PubMed, Google Scholar, Science Direct, Lilacs, SCOPUS, Embase, Epistemonikos, and PEDro (Physiotherapy Evidence Database).</p><p><strong>Results: </strong>Four articles were included. The authors implemented a combined training program with aerobic exercise and strength training, almost all with 12 12-week duration. Most worked between 50% and 80% of maximum heart rate, and the suggested maximum target heart rate was 10-20 beats below the activation threshold of the implantable cardioverter defibrillator. CR generates an improvement in cardiopulmonary parameters without adverse cardiac events, with a low probability of presenting shocks due to episodes of tachycardia or ventricular fibrillation during exercise sessions.</p><p><strong>Conclusions: </strong>The literature analyzed suggests that exercise-based CR in patients with an ICD is a safe intervention, with a low complication rate, that generates significant improvement in VO2, MET, distance covered in the 6-min walk, impacting the quality of life and functionality of patients.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"999-1009"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986773","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}