Pacing and clinical electrophysiology : PACE最新文献

{"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":"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":"700-721"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","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":"Shortening of Stimulus-Atrial Interval Without Change in QRS Morphology During Parahisian Pacing. What Is the Mechanism?","authors":"Anish Bhargav, Ramanathan Velayutham, Raja J Selvaraj","doi":"10.1111/pace.15212","DOIUrl":"10.1111/pace.15212","url":null,"abstract":"","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"722-724"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228421","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":"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":"790-798"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12266631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mid-Term Cardiac Outcomes in Prosthetic Valve Surgery and HF Patients Across EF After CSP.","authors":"Peng Li, Xiao-Xiao Jiang, Yi-Heng Yang, Wan-Xuan Ding, Ying Chen, Tian-Zhu Li, Xiao-Lei Yang, Yun-Long Xia, Ying-Xue Dong","doi":"10.1111/pace.15213","DOIUrl":"10.1111/pace.15213","url":null,"abstract":"<p><strong>Objective: </strong>Clinical outcomes of conduction system pacing (CSP) in patients with prosthetic valve surgery (PVS) and heart failure (HF) remain unclear. This study evaluated the feasibility, safety, and clinical impact of CSP in this population.</p><p><strong>Methods: </strong>Consecutive patients with atrioventricular block post-PVS and HF history undergoing CSP from January 2018 to December 2022 were enrolled. Exclusions included prior pacemaker implantation, biventricular pacing, or ventricular pacing <40%. Outcomes were assessed by left ventricular ejection fraction (LVEF) categories: reduced (HFrEF, LVEF ≤40%), mildly reduced (HFmrEF, 41%-49%), and preserved (HFpEF, ≥50%).</p><p><strong>Results: </strong>CSP succeeded in 90/96 patients (93.75%): 34 HFrEF (37.78%), 11 HFmrEF (12.22%), and 45 HFpEF (50.00%). All cohorts showed improved left ventricular end-diastolic diameter (LVEDD) (HFrEF: 56.35 ± 10.01 vs. 60.76 ± 8.36 mm, p < 0.001; HFmrEF: 52.54 ± 5.01 vs. 56.73 ± 4.10 mm, p = 0.017; HFpEF: 48.07 ± 4.22 vs. 48.80 ± 3.99 mm, p = 0.035). The HFrEF cohort demonstrated significant improvements in LVEF (44.15 ± 12.23% vs. 31.26 ± 5.98%, p < 0.001), left atrial diameter (50.12 ± 13.91 vs. 54.00 ± 17.14 mm, p = 0.006), and New York Heart Association class (2.63 ± 0.85 vs. 3.13 ± 0.78, p = 0.002). No deterioration occurred in HFmrEF/HFpEF. Complete LVEF/LVEDD normalization was achieved in 26.47% of HFrEF patients (9/34), with absence of rheumatic heart disease (RHD) as an independent predictor (HR = 8.851, 95% CI 1.336-58.646, p = 0.024). Over 25.49 ± 9.4 months, no cardiac perforation, thrombosis, pacemaker-induced cardiomyopathy (PICM), or infections occurred.</p><p><strong>Conclusions: </strong>CSP is feasible and safe, promoting cardiac reverse remodeling and mitigating PICM risk in PVS patients with HF across LVEF categories. Over 25% of HFrEF patients achieved complete normalization, predicted by non-RHD etiology.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"691-699"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228419","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":"Should Ivabradine be First-Line Therapy for Inappropriate Sinus Tachycardia?","authors":"Asif Khan, Joanne Ling, Valay K Parikh, Soad Bekheit","doi":"10.1111/pace.15214","DOIUrl":"10.1111/pace.15214","url":null,"abstract":"<p><p>Inappropriate sinus tachycardia (IST) is a rare syndrome characterized by a persistent daytime resting heart rate (HR) >100 beats per minute, a mean 24-h HR of >90 beats per minute, with P wave morphology and axis characteristics similar to that of sinus rhythm. IST is associated with symptomatic palpitation described as an abrupt transient acceleration of HR at rest or minimal activity and is often associated with multiple psychosomatic symptoms. Self-sustained contractile activity, i.e., pace-making, is the basic physiological process characterizing the sinus node. The funny current (I_f) initially described in sinus node myocytes is a mixed Na/K cation channel that is slowly activated upon the hyperpolarization of the sinoatrial node's myocytes. This inward current generates repetitive activity responsible for the rhythmic pacemaker activity. The higher the activation of I_f current, the steeper will be phase 4 hence greater the frequency of action potential firing, i.e., HR. Dysfunctional funny channels have been identified as playing a critical role in the development of IST, alongside the external influences stemming from modulatory actions of the autonomic nervous and humoral systems. Beta-blockers and calcium channel blockers are current first-line therapies that often require high doses, but are usually inefficient and poorly tolerated. Ivabradine has been shown to have unique properties of blocking I_f current at low concentration with a use-dependent way, which manifests as a slowly progressing accumulation of the drug during repetitive channel activation/deactivation cycles. Thus, unlike beta-blockers, Ivabradine, in smaller doses, results in a more substantial blocking effect at higher tachycardic rates and, therefore, more successful in the treatment of IST. The current literature review, which includes a small number of patients, has shown that Ivabradine lowered basal, mean, and maximal HR and was associated with symptomatic improvement. We have described the unique and specific mechanism of action, along with its safety profile, which supports Ivabradine's role as the first-line therapy for the resolution of IST.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"725-732"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210718","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":"Characterization of Septal Scar After Left Bundle Branch Area Pacemaker Implantation.","authors":"Ilya Y Shadrin, David C Wendell, Fawaz Alenezi, Sara A Coles, Sana M Al-Khatib, Zak Loring, Jonathan P Piccini, Albert Y Sun, Donald D Hegland, Daniel J Friedman","doi":"10.1111/pace.15211","DOIUrl":"10.1111/pace.15211","url":null,"abstract":"<p><strong>Background: </strong>Left bundle branch area pacing (LBBAP) is increasingly used in patients with a ventricular pacing indication but necessitates precise septal localization. The resulting effects of intraoperative lead repositioning on septal fibrosis remain unknown.</p><p><strong>Objective: </strong>To assess the safety of cardiac magnetic resonance imaging (cMRI) in patients with LBBAP pacemakers and evaluate the septal myocardium via cMRI following LBBAP implantation compared with standard RV endocardial pacing (RVP).</p><p><strong>Methods: </strong>Patients aged > 18 y.o. with bradycardia, LBBAP or RVP implant from 2021 to 2023, and at least one cMRI after implant were identified. LBBAP versus RVP was verified per established criteria. Delayed-enhancement cMRI and native T1 relaxation times were used to characterize myocardial scar.</p><p><strong>Results: </strong>A total of 34 patients were identified-20 with LBBAP implants (9 with matched pre-implant cMRI) and 14 with RVP implants (3 with matched pre-implant cMRI)-with no evidence of ventricular septal defects post-implant. LBBAP lead parameters were stable pre-/post-cMRI and out to 9 months. Comparing pre- versus post-implant cMRIs (median 579 days apart), 1/9 patients following LBBAP showed a new scar on the RV inferoseptal side directly adjacent to the pacing lead on post-implant cMRI, suggestive of potential implant-related scarring with LBBAP.</p><p><strong>Conclusion: </strong>CMRI appears safe for patients with LBBAP pacemakers, with stable short- and long-term device parameters. In patients with matched pre/post-implant cMRIs, the new septal scar can be identified with LBBAP implantation, raising the possibility of lead-related fibrosis. Larger studies are required to substantiate whether the single case of lead-related fibrosis is an exception or occurs more frequently.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"765-775"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228417","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":"Role of Autonomic Dysfunction in Initiating Postoperative Atrial Fibrillation in a Canine Sterile Pericarditis Model.","authors":"Seungyup Lee, Don W Wallick, Celeen Khrestian, Dragan Juzbasich, Daniel Laurita","doi":"10.1111/pace.15220","DOIUrl":"10.1111/pace.15220","url":null,"abstract":"<p><strong>Background: </strong>Autonomic dysfunction plays a significant role in initiating postoperative atrial fibrillation (POAF) by causing atrial ectopic triggers, potentially through mechanisms such as increased sympathetic activity and altered vagal tone. These atrial ectopic triggers can easily induce POAF, especially in the presence of vulnerable substrates such as pericardial inflammation or structural remodeling.</p><p><strong>Objective: </strong>To test the hypothesis that autonomic dysfunction causes atrial ectopic triggers or POAF in the canine sterile pericarditis model.</p><p><strong>Methods: </strong>Ten sterile pericarditis dogs were studied on postoperative Days 2-3. Autonomic dysfunction was induced by stellate ganglion nerve stimulation (SNS, 5-15 mA; 4-10 Hz; pulse width 0.5-5 ms) with or without vagus nerve stimulation (VNS, 15 mA; 20 Hz; pulse width 0.5-2 ms) performed during sinus rhythm for up to 2 h. Atrial ectopic triggers and heart rate (HR) were assessed during autonomic dysfunction.</p><p><strong>Results: </strong>Sustained POAF by burst pacing was induced in 5 of 10 animals (50%). During sinus rhythm (HR 109 ± 14 bpm), autonomic dysfunction using SNS (±VNS) changed the HR from 151 ± 18 bpm (SNS alone) to 72 ± 10 bpm (SNS+VNS) (mean HR fluctuation 79 ± 16 bpm). Atrial ectopic triggers were observed in 1 of 10 animals (10%), originating from either right or left atrium, yet these triggers did not induce POAF.</p><p><strong>Conclusion: </strong>Atrial ectopic triggers associated with autonomic dysfunction were observed in only 10% of animals in the postoperative period and did not induce POAF. The low incidence of atrial ectopic triggers in this model may provide mechanistic insights into the lower observed incidence of POAF in patients undergoing coronary artery bypass grafting (CABG) compared to those undergoing valvular heart surgery.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"776-781"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12266625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","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":"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":"799-806"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","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":"Optimal Thromboembolism Prevention for Patients With Atrial Fibrillation on Long-Term Dialysis.","authors":"Kenji Hashimoto, Tomohiro Fujisaki, Tadao Aikawa, Masao Iwagami, Yoshihisa Miyamoto, Leandro Slipczuk, Luigi Di Biase, Alexandros Briasoulis, Jun Yasuhara, Hisato Takagi, Toshiki Kuno","doi":"10.1111/pace.15208","DOIUrl":"10.1111/pace.15208","url":null,"abstract":"<p><strong>Background: </strong>Optimal strategies for thromboembolism prevention, including vitamin K antagonists (VKA), direct oral anticoagulants (DOAC), and left atrial appendage occlusion (LAAO), for patients with atrial fibrillation (AF) and on dialysis have not been fully investigated. We aimed to investigate the efficacy and safety of thromboembolism prevention strategies in AF patients on dialysis through a network meta-analysis.</p><p><strong>Methods: </strong>Multiple databases were searched through January 2024. The primary efficacy endpoint was thrombotic events, defined as ischemic stroke or systemic thromboembolism, whereas the primary safety endpoint was major bleeding. These strategies were ranked using P-scores.</p><p><strong>Results: </strong>Our study identified 28 eligible studies (including 3 randomized controlled trials) that enrolled 144,630 AF patients on dialysis. The risks of thrombotic events in any DOAC and VKA were comparable to no-anticoagulant, whereas LAAO was associated with a lower risk of thrombotic events (HR [95% CI]: 0.19 [0.06-0.60]). Compared to no-anticoagulant, VKA, regular-dose rivaroxaban, and dabigatran were associated with a higher risk of major bleeding, but rivaroxaban 10 mg daily, and apixaban 2.5 or 5 mg twice daily were not. LAAO, rivaroxaban 10 mg daily and apixaban 2.5 or 5 mg twice daily were highly ranked in efficacy and safety outcomes.</p><p><strong>Conclusions: </strong>LAAO may possibly be the reasonable therapeutic option for AF patients on dialysis, but rivaroxaban 10 mg daily and apixaban 2.5 or 5 mg twice daily can also be considered. Further studies are warranted to confirm these findings.</p>","PeriodicalId":520740,"journal":{"name":"Pacing and clinical electrophysiology : PACE","volume":" ","pages":"733-753"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228420","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":"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":"782-789"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12266630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}