Pace-Pacing and Clinical Electrophysiology最新文献

{"title":"First Experience Using a Novel Variable Loop Catheter for Mapping and Pulsed Field Ablation of Atrial Fibrillation.","authors":"Thomas Fink, Vanessa Sciacca, Kevin Bannmann, Maximilian Moersdorf, Sebastian Beyer, Alessandro Parlato, Denise Guckel, Mustapha El Hamriti, Moneeb Khalaph, Martin Braun, Maxim Didenko, Guram Imnadze, Dominik Linz, Kevin Vernooy, Philipp Sommer, Christian Sohns","doi":"10.1111/pace.15177","DOIUrl":"https://doi.org/10.1111/pace.15177","url":null,"abstract":"<p><strong>Background and aims: </strong>A novel multielectrode variable loop catheter (VLC) has been introduced for atrial fibrillation (AF) ablation enabling 3D electroanatomic mapping and concomitant pulsed field ablation (PFA). This study sought to investigate the VLC under routine clinical conditions for AF ablation.</p><p><strong>Methods: </strong>Consecutive patients with symptomatic AF undergoing first-time AF ablation were prospectively enrolled. All procedures were carried out using the VLC. Electroanatomic mapping pre and post-ablation was conducted with the VLC and a high-density multipolar mapping catheter. The general ablation protocol consisted of four ablation pulses per pulmonary vein (PV). All procedures were conducted in conscious sedation.</p><p><strong>Results: </strong>Forty-five patients (mean age 66.3 ± 6.1 years, 68.9% paroxysmal AF) were analyzed. Procedure duration was 66.3 ± 13.1 min. Acute pulmonary vein isolation (PVI) was achieved in 45 patients without periprocedural complications. Remapping after the initial 16 ablation pulses revealed sustained electrical conduction to at least one PV in six patients (13.3%). Repeat ablation was conducted and with an average of 7.5 ± 4.5 additional pulses. PV intubation during mapping was achieved in 168/180 PVs with the VLC (93.3%) and in 180/180PVs (100%) with the high-density mapping catheter (p < 0.001). Incomplete PV intubation during mapping did not result in incomplete PVI, as demonstrated by remapping utilizing the high-density mapping catheter. Adequate correlation between left atrial post-ablation remapping of low voltage areas and ablated regions was demonstrated in all patients.</p><p><strong>Conclusion: </strong>PFA-guided AF ablation using the novel VLC is safe and effective. The integration into a 3D-electroanatomic mapping system enables adequate mapping during PFA procedures.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Atrial Fibrillation Burden and Ischemic Stroke Incidence: A Case-Control Study on the CABANA Trial.","authors":"En-Ze Li, Zhen Cao, Xiao-Xia Liu, Chang-Sheng Ma","doi":"10.1111/pace.15186","DOIUrl":"https://doi.org/10.1111/pace.15186","url":null,"abstract":"<p><strong>Background: </strong>The relationship between the burden of atrial fibrillation (AF) and the risk of ischemic stroke is crucial yet complex. This study examines this relationship to enhance stroke prediction in patients with AF.</p><p><strong>Methods: </strong>The CABANA trial study from 2009 to 2016 analyzed the relationship between AF load, stroke, and anticoagulation. We matched age, gender, and race, as well as the control and case groups, at 1:4. Non-invasive electrocardiogram monitoring recorded load events and included the total cumulative load in the calculation. Next, we compared the net load between the stroke and control groups, and the relationship between net AF load and stroke was analyzed using univariate and multivariate logistic regression. This study also explored the interplay between stroke, AF load, and anticoagulation.</p><p><strong>Results: </strong>The first independent predictor of ischemic stroke risk is the net AF load (OR = 8.72, 95% CI: 3.11-24.4, p < 0.001). Stratified by the CHA2DS2VASc score, no significant change in net AF load between the high-risk and low-risk groups was observed (p = 0.96). Finally, we categorized all patients into adequate and inadequate anticoagulation groups based on whether they received adequate anticoagulation. The net AF load in the adequate anticoagulation group was higher than in the inadequate anticoagulation group (p < 0.001).</p><p><strong>Conclusion: </strong>AF burden is significantly associated with the risk of ischemic stroke. Determining the threshold of AF burden can improve stroke prevention strategies, indicating the need for targeted research on risk stratification and management of patients with AF.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right Bundle Branch Block After Transvenous Lead Extraction: An Unreported Complication With Potentially Severe Outcomes.","authors":"Karanjeet Chauhan, Alistair Royse, Colin Royse, Joseph Morton, Gareth Wynn","doi":"10.1111/pace.15182","DOIUrl":"https://doi.org/10.1111/pace.15182","url":null,"abstract":"<p><strong>Introduction: </strong>Right bundle branch block (RBBB) following cardiac device extraction has not been previously reported but may have catastrophic consequences.</p><p><strong>Methods and results: </strong>We present two cases of young male patients who developed RBBB following the extraction of single chamber TV ICD systems where the coil was adherent close to the superior tricuspid valve annulus. Both patients had a subcutaneous ICD (SICD) implanted but suffered an inappropriate shock due to T-wave oversensing, requiring very early SICD removal for one patient.</p><p><strong>Conclusion: </strong>The development of RBBB following the extraction of a TV ICD is a previously unreported complication and may cause significant sensing problems if an SICD is implanted subsequently. Placement of the ICD lead tip in the right ventricular outflow tract or high on the intraventricular septum may predispose to this complication.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iatrogenic Arteriovenous Fistula After Pacemaker Implantation: A Rare Case Report and Literature Review.","authors":"Xiaofei Li, Xiaohan Fan, Chen He, Bowen Fan, Lingan Liu, Haojie Zhu, Zhicheng Hu, Limin Liu, Tao Zhang, Yan Xiao, Kun Fang, Yan Yao","doi":"10.1111/pace.15174","DOIUrl":"https://doi.org/10.1111/pace.15174","url":null,"abstract":"<p><p>Severe vascular complications associated with pacemaker implantation rarely occur and then might be misjudged. We presented a case with an atypical and confusing presentation of arteriovenous fistulae after pacemaker implantation that was relatively late recognized post-procedure. Endovascular repairment was performed and a good clinical outcome was reached.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Pulmonary Vein Isolation by Local Potentials in FARAPULSE Pulsed Field Ablation System.","authors":"Saki Yamano, Tetsuma Kawaji, Misaki Naka, Kaisei Yanada, Yuki Ueda, Ryuta Ishida, Masashi Kato, Takafumi Yokomatsu, Shinji Miki","doi":"10.1111/pace.15176","DOIUrl":"https://doi.org/10.1111/pace.15176","url":null,"abstract":"<p><p>Herein, we propose a novel approach examining intra-spline bipolar potentials-rather than conventional cross-spline potentials-using the FARAWAVE catheter to assess pulmonary vein isolation in the FARAPULSE pulsed field ablation system. The novel intra-spline bipolar electrograms on the FARAWAVE catheter are useful for reducing far potentials during confirmation of the pulmonary vein isolation line.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transseptal Puncture in Children Weighing Less than 20 kg in Invasive Cardiac Catheterization and Electrophysiology.","authors":"Merve Maze Aydemir, Bekir Yukcu, Hasan Candas Kafali, Sezen Gulumser Sisko, Hacer Kamali, Alper Guzeltas, Yakup Ergul","doi":"10.1111/pace.15179","DOIUrl":"https://doi.org/10.1111/pace.15179","url":null,"abstract":"<p><strong>Background: </strong>Transseptal puncture (TSP) is a widely utilized technique for left-sided electrophysiological studies (EPS), interventions in left heart lesions, or creating interatrial shunts in congenital heart diseases (CHD). This study aims to evaluate the outcome of TSP in children under 20 kg.</p><p><strong>Methods: </strong>This retrospective study analyzed TSP procedures in infants and children <20 kg between December 2015 and January 2023. TSPs were performed with a biplane angiography system in the catheter angiography laboratory. A Brockenbrough needle (BRK Transseptal Needle; Abbott/St. Jude Medical, Inc.) was used for TSP. In patients whose Brockenbrough needles could not cross the interatrial septum, TSP was performed by applying cautery energy over the Brockenbrough needle.</p><p><strong>Results: </strong>Nineteen patients were studied (seven females, median age 2.3 years, median weight 10.3 kg), and 63% required TSP for CHD. The CHD group had younger patients (median age: 6.25 months) with smaller weights (median: 5.3 kg) than the catheter ablation group. There was no difference between groups in terms of gender and success rates. Procedure and fluoroscopy times were shorter in the ablation group (p < 0.05). Radiofrequency energy was used without complications in three cases when traditional methods failed. In four patients, the septum could not be traversed. The median weight of patients in whom TSP failed was 2.9 kg. The only major complication was pericardial tamponade developed in two patients diagnosed with hypoplastic left heart syndrome.</p><p><strong>Conclusion: </strong>TSP is a safe option when carefully selected but carries higher risks in complex CHD with abnormal cardiac anatomy compared to patients with normal anatomy used for electrophysiology procedures.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrocardiographic Imaging: A New Tool to Ensure Cardiac Resynchronization During Left Bundle Branch Pacing Implant.","authors":"Margarida Pujol-Lopez, Mariona Regany-Closa, Berta Pellicer-Sendra, Marta Martínez-Pérez, Rubén Molero, Freddy R Graterol, María S Guillem, Eduard Guasch, José M Tolosana, Lluís Mont","doi":"10.1111/pace.15172","DOIUrl":"https://doi.org/10.1111/pace.15172","url":null,"abstract":"","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced Atrioventricular Block in a Young Patient: Pacemaker Implantation Is No Longer the Only Choice.","authors":"Bruna Miers May, Eduardo Bartholomay, Adriano Nunes Kochi, Karina de Andrade, Thaís Coutinho Nicola, Giulia Bonatto Reichert","doi":"10.1111/pace.15153","DOIUrl":"10.1111/pace.15153","url":null,"abstract":"<p><p>A 40-year-old woman with symptomatic advanced atrioventricular (AV) block underwent cardioneuroablation (CNA) for the treatment of functional bradyarrhythmia, following the exclusion of reversible causes and intrinsic disease of the conduction system. Selective ablation of ganglia related to the AV node, performed exclusively in the left atrium, restored AV conduction, which has remained unchanged with 2 years of follow-up. CNA is a viable and effective option with low risk for the treatment of functional bradyarrhythmias, regardless of their severity.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"325-328"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and Safety of Pulsed-Field Ablation for Persistent Atrial Fibrillation: A Prospective Study.","authors":"Guocai Chen, Mingyang Gao, Yiwei Lai, Lihong Huang, Shijun Xia, Song Zuo, Xueyuan Guo, Nian Liu, Deyong Long, Jianzeng Dong, Liu He, Xin Du, Songnan Li, Caihua Sang, Changsheng Ma","doi":"10.1111/pace.15162","DOIUrl":"10.1111/pace.15162","url":null,"abstract":"<p><strong>Introduction: </strong>Pulsed-field ablation (PFA) is a novel nonthermal ablation approach using rapid electrical pulses to cause cardiac cell apoptosis via electroporation. Our study aims to investigate the feasibility and safety of PFA for persistent atrial fibrillation (PeAF).</p><p><strong>Methods: </strong>Thirty-two consecutive patients diagnosed with PeAF were enrolled in our study. All patients underwent PFA treatment using the strategy including pulmonary vein isolation (PVI), left atrial posterior wall (LAPW) isolation, cavotricuspid isthmus (CTI) block, and mitral isthmus (MI) block. Acute and follow-up procedure outcomes were evaluated, and adverse events related to the ablation procedure were also observed.</p><p><strong>Results: </strong>One-year survival free from atrial tachyarrhythmia post-ablation was 65.6%. Acute success rates for PVI, LAPW isolation, CTI block, and MI block were 100%, 100%, 96.9%, and 81.3%, respectively. Eleven cases (34.4%) experienced atrial tachyarrhythmia recurrence, with eight cases being atrial fibrillation (AF) recurrence and three cases being atrial flutter recurrence. Three patients underwent repeat ablation. Minor complications were encountered in four patients with asymptomatic cerebral lesions. Vagal responses were commonly observed during the procedure. No severe coronary vasospasm or severe hemolysis occurred in our cohort.</p><p><strong>Conclusion: </strong>PFA with the strategy including PVI, LAPW isolation, CTI block, and MI block is feasible, safe, and associated with a high rate of freedom from atrial tachyarrhythmia recurrence at 1 year in patients with PeAF.</p><p><strong>Trial registration: </strong>This study registered at the Chinese Clinical Trial Registry (ChiCTR2300068980).</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"302-310"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transseptal Sheath Perfused With High Concentration Heparinized Saline for Reducing Sheath-Associated Thrombus.","authors":"Juan Xu, Shi Peng, Yuanjun Sun, Zhenning Nie, Ya Zhen, Xiaomeng Yin, Xiaofeng Lu, Yan Liu, Xiaoyu Zhang, Dayang Huang, Shuai Guo, Yong Wei, Genqing Zhou, Yunlong Xia, Jun Li, Shaowen Liu, Songwen Chen","doi":"10.1111/pace.15115","DOIUrl":"10.1111/pace.15115","url":null,"abstract":"<p><strong>Background: </strong>Transseptal catheterization is critical for atrial fibrillation (AF) ablation but risks thromboembolism. Transseptal sheaths (TSS) were suggested for continuous heparinized saline solution flush. The safety and effectiveness of a simple TSS management to reduce sheath-associated thrombus development risk was investigated.</p><p><strong>Methods: </strong>AF patients who underwent radiofrequency ablation with the simple TSS management were studied under a retrospective multi-center observation study and a prospective single-center observation study. TSS and dilators were washed and perfused with high concentration heparinized saline (20 u/mL). Immediately after two successful transseptal punctures, activated clotting time ≥300 s was maintained by heparin infusion. TSS aspiration with negative suction and re-perfusion with high concentration heparinized saline (20 u/mL) was performed for the remaining procedure before and after catheter withdrawal.</p><p><strong>Results: </strong>A total of 4765 AF patients underwent 5367 ablation procedures were enrolled in the retrospective study, involving 156 (2.9% per procedure) complications. No acute stroke occurred during all the procedures. Perioperative thromboembolic complications occurred in 10 (0.21%) patients and in 10 (0.19%) procedures. Thromboembolic complications occurred within 24 h, between 24-48 h, and after 48 h post-procedure in six, two, and two patients, respectively. In the prospective observation study, neither sheath- nor catheter-associated thrombus were detected by the intracardiac echocardiography during all 127 procedures, without any perioperative thromboembolic complications. No hemorrhagic cerebrovascular complication was encountered in both observational studies.</p><p><strong>Conclusion: </strong>For AF radiofrequency ablation, it was safe and effective for TSS high concentration heparinized saline infusion only. This approach could avoid sheath-associated thrombus for interventional procedures.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"334-342"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}