Pacing and clinical electrophysiology : PACE最新文献

{"title":"A Standardized Zero-Fluoroscopy, 3D-Guided Workflow for AVNRT Ablation With Same-Day Discharge: PICENO AVNRT Approach.","authors":"Procolo Marchese, Francesca Gennaro, Giovanni Mazzotta, Luigi Cocchiara, Giuseppe Crapisi, Chiara Pratolongo, Dalila Desiro, Francesco Luca Berardini, Karim Shebabeddine, Matteo Mirarchi, Pierfrancesco Grossi","doi":"10.1111/pace.70308","DOIUrl":"10.1111/pace.70308","url":null,"abstract":"<p><strong>Introduction: </strong>Slow-pathway ablation for atrioventricular nodal re-entrant tachycardia (AVNRT) is highly effective but carries a small risk of atrioventricular block. A fully standardized, safety-driven 3D-guided workflow tailored to AVNRT ablation has not been clearly defined.</p><p><strong>Methods and results: </strong>We retrospectively analyzed 150 consecutive day-hospital patients with invasive electrophysiological confirmation of AVNRT who underwent ablation using the standardized PICENO AVNRT approach between 2017 and 2025. The protocol integrates Koch's triangle pace mapping and voltage-bridge mapping to guide slow-pathway ablation. Acute success was achieved in 100% of patients. No transient or permanent AV block occurred. Fluoroscopy was not required in any case. Mean procedure time was 62 ± 14 min. At 30.5 ± 18.8 months of follow-up, one recurrence (0.7%) was observed.</p><p><strong>Conclusion: </strong>A standardized 3D-guided safety-driven workflow for AVNRT ablation is feasible and reproducible in a day-hospital setting, achieving excellent outcomes while eliminating fluoroscopy because of procedural reliability.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1478-1486"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote Monitoring of Implantable Loop Recorders in Syncope Patients: Management of High Volume of Transmissions.","authors":"Antti Oinonen, Eeva Torvinen, A Marjamaa, Toni Jäntti, Mikko Parry, Jarkko Karvonen, Pekka Raatikainen, Markus Sane","doi":"10.1111/pace.70289","DOIUrl":"10.1111/pace.70289","url":null,"abstract":"<p><strong>Background: </strong>Implantable loop recorder (ILR) is among the first line diagnostic tools in patients with unexplained syncope. When ILRs are followed with remote monitoring (RM) diagnosis can be established readily. However, the challenge in RM is the substantial workload related to false positive findings. The aim of this study was to evaluate the impact of symptom base scheduled monitoring (SBSM) on the efficacy and safety on follow-up of patients with unexplained syncope and large number of nonactionable RM transmissions.</p><p><strong>Methods: </strong>The data of all patients (n = 176) with ILR implantation due to unexplained syncope from first of January 2021 to 31st of December 2024 were collected. Symptom based scheduled monitoring (SBSM), where the alert transmissions were replaced by scheduled quarterly and symptom-triggered transmissions, was introduced after 3 months alert-based follow-up in patients with a high burden of nonactionable transmissions.</p><p><strong>Results: </strong>Mean age of the patients was 60 ± 17 years (56% female). ILR monitoring led to diagnosis in 34 % of the patients. Median time to diagnosis was 84 days (18-216 days) and the therapy included a pacemaker or an ICD implantation in 85% of them. SBSM was used in 18% of the patients. It was associated neither with an increased need for emergency room visits (p = 0.6) nor with hospitalization (p = 0.8). With SBMS the number of monthly RM transmissions decreased almost 80% from 1.5 to 0.3 transmission/device (p = 0.001).</p><p><strong>Conclusions: </strong>Our data indicates that the burden related to the non-actionable ILR alerts can be significantly reduced with SBMS without compromising patient safety.</p><p><strong>Capsule summary: </strong>Implantable loop recorders (ILRs) enable prompt diagnosis in patients with unexplained syncope. Unfortunately, they also generate a deluge of false-positive alerts. However, turning off alerts in patients with the highest burden of nonactionable transmissions can reduce the remote-monitoring workload without compromising patient safety.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1604-1611"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147960679","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":"Prior Stroke Increases Residual Shunt Risk After Combined Ablation and LAAO: A Device-Specific Interaction.","authors":"Haoqing Ren, Hengli Lai","doi":"10.1111/pace.70254","DOIUrl":"10.1111/pace.70254","url":null,"abstract":"<p><strong>Background: </strong>The safety and efficacy profile of the combined \"one-stop\" catheter ablation (CA) and left atrial appendage occlusion (LAAO) procedure in atrial fibrillation (AF) patients with a prior history of cerebral infarction requires further validation.</p><p><strong>Methods: </strong>In this retrospective, single-center study, 242 consecutive AF patients undergoing the one-stop procedure were categorized into Stroke (n = 103) and Non-Stroke (n = 139) groups. A 1:1 propensity score matching (PSM) was performed, yielding 57 balanced pairs. The primary efficacy endpoint was procedural success. Key safety endpoints included post-procedural residual shunt assessed at 45 days, device-related thrombosis (DRT), and stroke recurrence.</p><p><strong>Results: </strong>After PSM, baseline characteristics were well-balanced. Procedural success (91.2% vs. 87.7%, p = 0.484) and freedom from AF recurrence (88.6% vs. 89.3%, p = 0.979) were comparable between Stroke and Non-Stroke groups. However, the incidence of residual shunt was significantly higher in the Stroke group (5.3% vs. 0%, p = 0.028). No significant differences were observed in DRT or stroke recurrence rates. Notably, a significant interaction was found between prior stroke and LAAO device type on residual shunt risk (p-for-interaction = 0.045), indicating the risk varied substantially depending on the occluder used.</p><p><strong>Conclusion: </strong>A history of prior stroke does not impair the procedural success or mid-term rhythm control of the one-stop CA+LAAO strategy. However, it is associated with an increased risk of residual shunt, a relationship significantly modified by the type of occluder device. These findings highlight the potential need for individualized device selection in stroke survivors.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1622-1629"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147966954","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":"Hybrid Technique for a Rare Complication of Cardiac Devices Implantation.","authors":"Maria Moutafi, Ioannis Chaveles, Dimitrios Tzalas, Georgios Papingiotis, Maximos Georgopoulos, Charis Armonis, Victor Panagiotakopoulos, Athanasios Trikas","doi":"10.1111/pace.70270","DOIUrl":"10.1111/pace.70270","url":null,"abstract":"<p><p>Cardiac perforation is a rare complication of cardiac devices implantation. In this case report, a case of a 90-year-old man with early cardiac lead perforation is presented. The combination of capture failure on the electrocardiogram with the malposition of ventricular lead on the chest radiogram raised the suspicion for this complication, while the chest computed tomography confirmed the diagnosis. A hybrid management approach was applied for the removal of the initial ventricular lead. Although cardiac perforation is considered a potentially lethal complication, the early diagnosis and the appropriate treatment strategy can be lifesaving and effective, even for older patients.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1584-1587"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147795612","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":"Taking Full Advantage of the \"Fifth Cardiac Chamber\" to Implant a VDD CRT-D Through a Persistent Left Superior Vena Cava.","authors":"Giovanni Coluccia, Giacomo Tarantino, Maurelio Domenico Lauretti, Antonio Parlavecchio, Elena Marino, Matteo Passiatore, Giuseppe Colonna","doi":"10.1111/pace.70426","DOIUrl":"10.1111/pace.70426","url":null,"abstract":"","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1500-1504"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893219","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":"Customized Sheath Modification for Bachmann Bundle Area Pacing With a Stylet-Driven Lead.","authors":"Yousaku Okubo, Shogo Miyamoto, Shunsuke Ishida, Junji Maeda, Naoki Ishibashi, Sho Okamura, Takehito Tokuyama, Noboru Oda, Yukiko Nakano","doi":"10.1111/pace.70263","DOIUrl":"10.1111/pace.70263","url":null,"abstract":"<p><p>Bachmann bundle area pacing (BBp) has primarily been performed using lumenless leads delivered through dedicated atrial sheaths. With stylet-driven leads, stable positioning at the superior interatrial septum can be technically challenging. We report two patients in whom the distal portion of a standard ventricular delivery catheter was shortened and reshaped using controlled heat molding with a heat gun. The customized sheath enabled stable placement of a stylet-driven lead at the high interatrial septum, resulting in successful BBp with favorable electrical parameters. Customized sheath modification may facilitate BBp using conventional pacing systems. Clinical Trial Registration: This study was not registered in a clinical trial registration, as it represents a retrospective case series and dose not meet the criteria for a prospective interventional clinical trial.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1580-1583"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147795616","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":"Nifekalant-Magnesium Cocktail for Chemical Cardioversion of Atrial Flutter: A Multicenter Pilot Study.","authors":"Akinori Sairaku, Michitaka Amioka, Yoshikazu Watanabe, Shunsuke Tomomori, Yukihiro Fukuda, Yukiko Nakano","doi":"10.1111/pace.70301","DOIUrl":"10.1111/pace.70301","url":null,"abstract":"<p><strong>Background: </strong>Pharmacologic cardioversion of atrial flutter (AFL) remains challenging, particularly in older or frail patients who are not candidates for catheter ablation. Nifekalant is effective for AFL but is limited by QT prolongation and the risk of torsades de pointes (TdP). Magnesium sulfate may mitigate this risk.</p><p><strong>Methods: </strong>In this multicenter, investigator-initiated pilot study, 86 patients with symptomatic persistent AFL received intravenous magnesium sulfate followed by nifekalant. The primary outcome was AFL termination within 60 min. Time to termination and safety outcomes, including TdP, were assessed. Multivariable logistic regression analyses were performed to identify factors associated with AFL termination.</p><p><strong>Results: </strong>AFL terminated in 42 patients (48.8%). Among patients with successful cardioversion, 80% achieved termination within 20 min. Larger left atrial diameter was associated with a lower likelihood of AFL termination. Adverse events occurred in 2 patients (2.3%), including sinus pauses requiring pacemaker implantation and transient hypotension requiring vasopressor support. No cases of TdP were observed.</p><p><strong>Conclusions: </strong>These findings suggest that the nifekalant-magnesium cocktail may be a feasible and potentially safe option for chemical cardioversion of AFL, warranting further investigation in larger studies.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1641-1646"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147985096","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":"Empiric and Trigger-Guided Superior Vena Cava Isolation in AF Ablation: Systematic Review and Meta-Analysis.","authors":"Ojasav Sehrawat, Vasudha Garg, Cher Ying Foo, Chao Xue, Ninad Khandekar, Pallavi Matai, Samuel Asirvatham, Konstantinos C Siontis, Peter A Noseworthy","doi":"10.1111/pace.70296","DOIUrl":"10.1111/pace.70296","url":null,"abstract":"<p><strong>Background: </strong>Superior vena cava isolation (SVCI) is performed as an adjunct to pulmonary vein isolation (PVI) for atrial fibrillation, yet whether an empiric or trigger-guided strategy is preferable remains uncertain. Prior meta-analyses have been largely restricted to index procedures in paroxysmal AF and have not explicitly stratified by ablation strategy. We sought to address these gaps through a systematic review of available randomized evidence.</p><p><strong>Methods: </strong>Major databases were searched through November 2025 for RCTs comparing PVI+SVCI versus PVI alone. Trials were stratified by strategy: empiric SVCI (performed irrespective of SVC ectopy) or trigger-guided SVCI (performed only upon demonstrated SVC triggers). The primary outcome was atrial tachyarrhythmia recurrence (≥30 s) beyond the blanking period. Random-effects models, pre-specified subgroup analyses, meta-regression, and GRADE certainty assessment were performed.</p><p><strong>Results: </strong>Eight RCTs (n = 1231) were included; most enrolled paroxysmal AF, while two incorporated non-paroxysmal AF subtypes and one evaluated repeat ablation procedures. Overall, SVCI+PVI significantly reduced recurrence versus PVI alone (97/604 vs. 135/627; RR 0.77, 95% CI 0.61-0.97; p = 0.03; I² = 0%). On stratified analysis, empiric SVCI demonstrated a significant recurrence reduction (RR 0.70, 95% CI 0.53-0.92; p = 0.01; I² = 0%), while trigger-guided SVCI did not reach statistical significance (RR 0.80, 95% CI 0.37-1.74; p = 0.57; I² = 52%). In paroxysmal AF (n = 1038), adjunctive SVCI significantly reduced recurrence compared with PVI alone (RR 0.68, 95% CI 0.52-0.90; p = 0.01; I² = 0%). Fluoroscopy time was longer with SVCI; total procedure duration was comparable. Major complications were infrequent but numerically higher with SVCI+PVI (15/604 vs. 7/627; RR 1.96, 95% CI 0.87-4.38; p = 0.10). Meta-regression identified no significant effect modifiers. GRADE certainty was high for overall and empiric analyses, and moderate for trigger-guided SVCI.</p><p><strong>Conclusions: </strong>Empiric SVCI significantly reduced AT/AF recurrence as an adjunct to PVI, while trigger-guided SVCI did not demonstrate a significant benefit. These findings suggest SVC isolation confers benefit independent of prior trigger documentation, supporting the role of empiric SVCI as an adjunct to AF ablation.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1630-1640"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978606","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":"Validation of Automated Low Voltage Area Measurement Using CARTONET in Atrial Fibrillation Patients.","authors":"Yuncong Mao, Tarif Bitar, Henning Horlitz, Syed Yusuf Ali, Don Yungher, Marc Horlitz, Natalia Trayanova, Florian Stöckigt, Yazan Mohsen","doi":"10.1111/pace.70313","DOIUrl":"10.1111/pace.70313","url":null,"abstract":"<p><strong>Background: </strong>Low-voltage areas (LVAs) detected via electroanatomic mapping (EAM) are key indicators of atrial remodeling and predictors of atrial fibrillation (AF) recurrence following pulmonary vein isolation (PVI). However, manual LVA quantification is time-intensive, operator-dependent, and prone to variability.</p><p><strong>Objective: </strong>To validate the accuracy, consistency, and efficiency of automatic LVA quantification function of CARTONET-a cloud-based automated platform for LVA quantification-by comparing it with conventional manual analysis in AF patients.</p><p><strong>Methods: </strong>This retrospective study included 100 patients who underwent PVI for AF at a single center between January 2022 and December 2023. Manual LVA measurements were performed by experts using CARTO3. LVA quantification and anatomical segmentation were performed using CARTONET. LVA was stratified into four categories: low (<5%), mild (5%-20%), moderate (20%-35%), and severe (>35%). Statistical analyses included Spearman's rank correlation (ρ), Bland-Altman agreement, and confusion matrices for categorical classification, with subgroup analysis based on segmentation errors and map point density. The number and the locations of segmentation errors were quantified.</p><p><strong>Results: </strong>CARTONET demonstrated strong correlation with manual measurements across all LA regions (ρ = 0.928-0.983, p < 0.01). Significant differences were observed in anterior and posterior walls (p < 0.01), especially in low-density maps. In high-density maps, no significant differences were observed (p ≥ 0.07). Bland-Altman analysis showed minimal bias (mean difference: -0.8%), and 96% of values fell within limits of agreement. The confusion matrix showed that categorical agreement for LVA stratification exceeded 90%. Segmentation errors were most common at the LSPV but did not significantly impact LVA quantification.</p><p><strong>Conclusion: </strong>CARTONET offers reliable, efficient LVA quantification with high concordance to manual methods. Its performance in high-quality maps supports its use in clinical and research settings, reducing operator workload and promoting standardized substrate evaluation.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1487-1495"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213798","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":"Coronary Artery Proximity to Potential Ablation Sites in Children: The Case for Careful Consideration.","authors":"Rachel A Magnan, Muhammad Yasir Qureshi, Ivor Asztalos, Nathaniel W Taggart, Philip L Wackel","doi":"10.1111/pace.70306","DOIUrl":"10.1111/pace.70306","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery (CA) injury from catheter ablation is an uncommon complication, but the risk is under-recognized. The risk for CA injury significantly increases when a CA is within 3 mm of the site of ablation, but CA imaging to assess for CA proximity to ablation sites is not commonly performed in children prior to ablation.</p><p><strong>Objective: </strong>The aim of the study was to assess CA proximity to potential ablation sites.</p><p><strong>Methods: </strong>A retrospective review of all coronary computed tomography angiograms (CTAs) in pediatric patients <18 years of age at Mayo Clinic from 2017 through 2023 was conducted. The proximity of CAs to potential ablation sites in the coronary sinus and the appendage bases were measured.</p><p><strong>Results: </strong>Seventy-two CTAs in 67 patients >15 kg and <18 years old were included. Median age was 12 years, and median weight was 41 kg. In right dominant CA circulation, 23/36 (64%) had a CA within 3 mm of the coronary sinus. In left and co-dominant CA circulation, 26/26 (100%) had a CA within 3 mm of the coronary sinus. The right CA was within 3 mm of the appendage base in 49/69 (71%). The circumflex CA was within 3 mm of the appendage base in 50/68 (74%).</p><p><strong>Conclusion: </strong>Most pediatric patients have a CA ≤ 3 mm from potential ablation sites in the coronary sinus and base of the appendages. Precautions should be taken to avoid CA damage before performing catheter ablation in these areas.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"1473-1477"},"PeriodicalIF":1.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044921","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}