Pace-Pacing and Clinical Electrophysiology最新文献

{"title":"Voltage-Guided and Non-Voltage-Guided Superior Vena Cava Isolation in Patients With Atrial Fibrillation.","authors":"Jumpei Saito, Kato Daiki, Sato Hirotoshi, Toshihiko Matsuda, Yui Koyanagi, Katsuya Yoshihiro, Yuma Gibo, Ishigaki Shigehiro, Soichiro Usumoto, Wataru Igawa, Toshitaka Okabe, Naoei Isomura, Masahiko Ochiai","doi":"10.1111/pace.15093","DOIUrl":"10.1111/pace.15093","url":null,"abstract":"<p><strong>Background: </strong>In addition to the pulmonary vein, the superior vena cava (SVC) is an important focus of atrial fibrillation (AF). However, SVC isolation may cause serious complications, and appropriate settings and techniques for SVC isolation are lacking.</p><p><strong>Methods: </strong>This study enrolled 86 consecutive patients with AF who underwent SVC isolation. Voltage mapping using a multi-electrode catheter and ablation were performed under the guidance of an electro-anatomical mapping system. The lines encircling the SVC were divided into eight anatomic segments on the SVC geometry, and each segment was subjected to voltage-guided (VG) ablation in decreasing order of voltage (starting from the segment with the highest voltage). Non-VG (NVG) ablation was performed anatomically from the anterior wall toward the septum with one-round cautery.</p><p><strong>Results: </strong>A total of 86 cases (66 males, mean age 69 [60, 74], mean CHA₂DS₂ VASc score 2 [1, 3], 58 paroxysmal AF) with AF were included for ablation. Electrical SVC isolation was successfully achieved in all patients. The length of the myocardial sleeves, as measured from the SVC-RA junction to the end of the local signal, was 37 [28, 45] mm. Major axis of the RA-SVC junction was 15 [13, 17] and minor axis of the RA-SVC junction was 11 [9, 13]. The number of ablation points with VG SVC isolation was fewer than that for NVG SVC isolation (8 [5, 11.5] vs. 11.5 [8.8, 13.3]; p = 0.001). The procedure time of VG SVC isolation was greater than that of NVG SVC isolation (259 s [154, 379] vs. 167 s [115, 222]; p = 0.012). There were no significant differences in the complication rates.</p><p><strong>Conclusions: </strong>VG SVC isolation reduced the number of ablation points compared with NVG SVC isolation.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1604-1610"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513121","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":"Randomized Controlled Trial Comparing Training of Transseptal Puncture With or Without Intracardiac Echocardiography.","authors":"Qi Guo, Caihua Sang, Yiwei Lai, Mingyang Gao, Xueyuan Guo, Wenli Dai, Songnan Li, Nian Liu, Song Zuo, Deyong Long, Jianzeng Dong, Changsheng Ma","doi":"10.1111/pace.15081","DOIUrl":"10.1111/pace.15081","url":null,"abstract":"<p><strong>Background: </strong>Intracardiac echocardiography (ICE) has been widely used in the catheter ablation of atrial fibrillation (AF). However, the value of ICE in the training of transseptal puncture (TSP) is unclear.</p><p><strong>Methods: </strong>ICE-Training Study was a single-center, parallel-group, unmasked, randomized controlled trial registered in ChineseClinicalTrials.gov. Participants were randomly assigned (1:1) to different groups (1) the ICE simulator training group (ICE-ST), in which TSP was trained and performed under the guidance of both ICE and x-ray; and (2) the conventional simulator training group (Con-ST), in which TSP was trained and performed only under the guidance of x-ray. The trainees need to undergo the training stage and the evaluation stage.</p><p><strong>Results: </strong>From October 2022 to December 2022, 18 consecutive fellows (age 32.4 ± 4.4 years, 12 males) without experience of TSP were included. The training period (16.9 ± 6.6 vs. 29.6 ± 8.7 times, p = 0.003) and the fluoroscopy time (120.3 ± 25.3 vs. 189.3 ± 40.2 s, p < 0.001) of the ICE-ST group was significantly shorter than that of the Con-ST group. No significant difference was found in the comprehensive performance of TSP in the ICE-ST group (composite score 96.7 ± 5.7) and the Con-ST group (composite score 95.9 ± 6.3, p = 0.62), but the selection of TSP sites in the ICE-ST group was commonly better than that in the Con-ST group.</p><p><strong>Conclusions: </strong>ICE could improve the efficiency of TSP training and optimize the site of TSP to facilitate catheter manipulation in the ablation.</p><p><strong>Trial registration: </strong>ChineseClinicalTrials.gov identifier: ChiCTR2200058377.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1670-1678"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481118","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":"Left-bundle branch optimized CRT implantation in a patient with persistent left superior vena cava.","authors":"Enes Elvin Gul, Jamshid Sodikov, Ahmet Lutfu Sertdemir, Akmal Yakubov","doi":"10.1111/pace.15068","DOIUrl":"10.1111/pace.15068","url":null,"abstract":"<p><p>Persistent left superior vena cava (PLSVC) is one of the anatomical variations, which can make device implantation more challenging and lead to incorrect lead placement, dislodgement, and procedure failure. Conduction system pacing (CSP) can be an alternative to traditional CRT implantation. Herein, we describe a brief case report of successful LBBAP-optimized CRT (LOT-CRT) via an innominate vein in a patient with PLSVC.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1627-1631"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127367","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":"Synthesized V7 QRS Amplitude and Oversensing Episodes in Patients With Subcutaneous Implantable Cardioverter-Defibrillators.","authors":"Takashi Okajima, Shinji Ishikawa, Satoshi Yanagisawa, Takayuki Okamoto, Yusuke Uemura, Kenji Takemoto, Yasuya Inden, Toyoaki Murohara, Masato Watarai","doi":"10.1111/pace.15086","DOIUrl":"10.1111/pace.15086","url":null,"abstract":"<p><strong>Background: </strong>Patients with subcutaneous implantable cardioverter-defibrillators (S-ICDs) experience an oversensing episode (OS) more frequently than those with transvenous ICDs. However, no established electrocardiography (ECG) parameters can accurately detect an OS. This study aimed to evaluate the incidence of an OS in real-world clinical practice and the association of synthesized 18-lead ECG (syn18-ECG) parameters with an OS.</p><p><strong>Methods: </strong>We retrospectively included 21 consecutive patients who underwent S-ICD implantation and collected syn18-ECG parameters. We placed the generator in a deep posterior position and defined an OS as an inappropriate charging episode caused by cardiac or noncardiac signals. A SMART pass filter and two tachyarrhythmia zones were programed.</p><p><strong>Results: </strong>The most frequent underlying heart disease was Brugada/J wave syndrome (n = 7). During a median follow-up period of 1188 days, an OS was observed in six patients (28.6%). The QRS amplitude in synthesized V7 lead (synV7) was significantly lower in the OS group than in the non-OS group (0.59 ± 0.17 vs. 0.91 ± 0.35 mV, p = 0.019). The optimal cutoff value of synV7 QRS amplitude was 0.61 mV, with a sensitivity of 80.0% and a specificity of 83.7% for predicting an OS. Univariate logistic analysis showed that a synV7 QRS amplitude of <0.61 mV was only associated with an OS (odd ratio, 20.0; 95% confidence interval, 1.66-241.72; p = 0.018).</p><p><strong>Conclusions: </strong>In patients with S-ICDs, an OS was not a rare complication during long-term follow-up. A low synV7 QRS amplitude was associated with a high OS incidence.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"1565-1573"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378620","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":"Distinguishing Wolff-Parkinson-White Syndrome From Fasciculoventricular Pathway Using QRS-T Angle Analysis.","authors":"Ryo Nakagawa, Kazuhisa Sato, Yoko Yoshida, Tsugutoshi Suzuki, Yoshihide Nakamura","doi":"10.1111/pace.15114","DOIUrl":"https://doi.org/10.1111/pace.15114","url":null,"abstract":"<p><strong>Background: </strong>Wolff-Parkinson-White (WPW) syndrome and fasciculoventricular pathway (FVP) present electrocardiographic manifestations characterized by delta waves, differentiating these two is challenging. Specifically, WPW type B with QRS width ≤120 ms, resembles typical FVP features. Because of the presence of repolarization abnormalities in WPW syndrome, our hypothesis centered on the potential utility of the QRS-T angle for distinguishing WPW syndrome from FVP. To determine the discriminative value of the QRS-T angle for delineating WPW syndrome from FVP.</p><p><strong>Methods: </strong>We included cases of WPW syndrome treated with catheter ablation and FVP diagnosed via adenosine triphosphate administration between 2007 and 2023. We excluded cases with WPW type A, QRS width >120 ms, intermittent WPW, congenital heart disease or myocardial damage, ablation history, tachycardia, palpitations within 3 months, and WPW syndrome featuring an accessory pathway on the left lateral wall. Eventually, we identified 40 and 54 patients from the WPW and FVP groups, respectively. The QRS-T angle was compared between the WPW and FVP cohorts.</p><p><strong>Results: </strong>The QRS-T angle in the WPW group was significantly larger than in the FVP group (45.7 ± 46.3° vs. 17.8 ± 13.9°, p < 0.001). Receiver operating characteristic curve analysis with a sensitivity and specificity of 65.0% and 72.6%, respectively, demonstrated that the optimal cut-off value for the QRS-T angle was 22° for distinguishing WPW from FVP. Remarkably, all cases with a QRS-T angle >65° were within the WPW group.</p><p><strong>Conclusions: </strong>The QRS-T angle can offer promising utility in differentiating WPW syndrome from FVP.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741398","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":"Comparative Study of Arctic Front Advance Pro and POLARx Cryoballoons for Linear Ablation of the Left Atrial Roof.","authors":"Takatoshi Shigeta, Yuichiro Sagawa, Hirofumi Arai, Atsuhito Oda, Koji Sudo, Kazuya Murata, Kaoru Okishige, Manabu Kurabayashi, Masahiko Goya, Tetsuo Sasano, Yasuteru Yamauchi","doi":"10.1111/pace.15112","DOIUrl":"https://doi.org/10.1111/pace.15112","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness of cryoballoon ablation (CBA) of the left atrial (LA) roof in addition to pulmonary vein isolation (PVI) using a novel cryoballoon catheter, POLARx, remains unclear.</p><p><strong>Methods: </strong>This study compared the efficacy of LA roof line ablation and PVI using POLARx (Boston Scientific) or AFA-Pro (Medtronic) in 100 patients with persistent atrial fibrillation. The right superior pulmonary vein (PV) anchoring and raise-up techniques were consistently used for LA roof line ablation, and rapid right ventricular pacing was applied if the cryoballoon temperature did not reach -40°C.</p><p><strong>Results: </strong>Complete conduction block at the LA roof could be obtained in all patients with POLARx and in 98.0% of patients with AFA-Pro. Rapid right ventricular pacing was needed in 64.0% of patients with AFA-Pro and in no patients with POLARx. During LA roof line ablation, the nadir cryoballoon temperature was significantly lower with POLARx than with AFA-Pro (right: -54.2°C ± 4.4°C vs. -46.0°C ± 5.4°C; central: -56.8°C ± 4.4°C vs. -45.7°C ± 4.8°C; left: -56.1°C ± 4.3°C vs. -46.1°C ± 5.7°C), and the cryoballoon temperature reached -40°C earlier with POLARx than with AFA-Pro (right: 30.8 ± 7.4 s vs. 74.1 ± 37.7 s; central: 28.2 ± 5.2 s vs. 62.9 ± 30.9 s; left: 29.8 ± 5.8 s vs. 69.6 ± 40.7 s).</p><p><strong>Conclusion: </strong>The nadir cryoballoon temperature with POLARx was approximately 10°C lower than with AFA-Pro, consistently dropping below -40°C during LA roof line CBA. Thus, a complete conduction block of the LA roof line can be easily accomplished using right superior PV anchoring and the raise-up techniques without the need for rapid right ventricular pacing with POLARx.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741397","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":"Trends and Disparities in Atrial Fibrillation and Stroke Related Mortality in the United States from 1999 to 2020.","authors":"Vardhmaan Jain, Birju Rao, Eduardo Quintero, Anand D Shah, Faisal M Merchant, Mikhael F El-Chami, Neal Bhatia, Stacy Westerman, Michael S Lloyd","doi":"10.1111/pace.15111","DOIUrl":"https://doi.org/10.1111/pace.15111","url":null,"abstract":"","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741399","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":"Characteristics of Patients With Asymptomatic Atrial Fibrillation and Ischemic Stroke-Insights From the GLORIA-AF Registry (Phase 2).","authors":"Tobias Heer, Uwe Zeymer, Christopher J Schwarzbach, Karlheinz Seidl, Ursula Rauch-Kröhnert, Sabrina Marler, Christine Teutsch, Hans-Christoph Diener, Jochen Senges, Gregory Y H Lip, Menno V Huisman","doi":"10.1111/pace.15113","DOIUrl":"https://doi.org/10.1111/pace.15113","url":null,"abstract":"<p><strong>Background: </strong>Asymptomatic nonvalvular atrial fibrillation is often suspected in patients with cryptogenic stroke which constitute 20%-30% of ischemic strokes. Detection of atrial fibrillation (AF) and treatment with anticoagulation can reduce the risk of stroke. We sought to investigate the prevalence of asymptomatic atrial fibrillation (aAF) in patients with a history of stroke or an acute stroke on admission.</p><p><strong>Methods: </strong>From November 2011 until December 2014, 15,308 patients with a first episode of AF were enrolled in phase 2 of the international, prospective, multicenter global registry on long-term oral anticoagulation treatment in patients with AF (GLORIA-AF) Registry. For the present analysis, we focused on patients with aAF regarding the prevalence of stroke.</p><p><strong>Results: </strong>One third of patients (n = 4892, 32%) had aAF. Of these, 611 (12.5%) had a history of stroke or an acute stroke on admission. In contrast, 519 of 10,416 (5.0%) patients with symptomatic AF (sAF) had a history of stroke or an acute stroke on admission. Higher age, male gender, permanent AF, stroke, and the combination of stroke, TIA or systemic embolism were associated with a higher prevalence of aAF on admission. In a multivariable analysis, patients with aAF had a 2.3-fold (95% confidence interval (CI), 2.02-2.54) risk for stroke compared to patients with sAF. Other independent risk factors for stroke were a history of prior bleeding (odds ratio 1.62, 95% CI, 1.34-1.92), chronic kidney disease (1.38, 1.21-1.56), and diabetes mellitus (1.24, 1.10-1.41).</p><p><strong>Conclusion: </strong>aAF is reported in about one third of patients with newly diagnosed AF and is associated with a 2.3-fold risk for stroke compared to sAF. Therefore, screening for aAF in high-risk patients might be appropriate to prevent further embolic cerebrovascular events.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741383","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":"Warfarin and Aspirin Versus Warfarin Alone in Patients With HeartMate 3 Left Ventricular Assist Device: A Systematic Review and Meta-Analysis.","authors":"Patricia Viana, Lucca Moreira Lopes, Thamiris Dias Delfino Cabral, Jorge Persson, Vanessa de Oliveira Tapioca, Camila Veronica S Freire, Jessica Hoffmann Relvas, Yasmin Mesquita, Isabela Reis Marques, Wilton Francisco Gomes","doi":"10.1111/pace.15110","DOIUrl":"https://doi.org/10.1111/pace.15110","url":null,"abstract":"<p><strong>Background and aims: </strong>HeartMate 3 (HM3), a fully magnetically levitated ventricular assist device (LVAD), has been associated with reduced thromboembolic events compared to HeartMate II. However, bleeding events remained significant. Among patients undergoing HM3 implantation, the standard antithrombotic regimen comprises both warfarin and aspirin (ASA), but there is a lack of evidence on the optimum antithrombotic therapy. We performed a systematic review and meta-analysis assessing the impact of combined ASA and warfarin therapy compared to warfarin alone on the incidence of non-surgical bleeding events in patients with HM3 LVAD.</p><p><strong>Methods: </strong>MEDLINE, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) and observational studies comparing warfarin alone with warfarin combined with ASA in patients with HM3 LVAD. Binary endpoints were analyzed using computed risk ratios (RRs) with 95% confidence intervals (CIs). A random-effect model was applied for all endpoints.</p><p><strong>Results: </strong>Five studies (one RCT and four observational) encompassing 869 patients were included, with 424 (48.8%) prescribed warfarin alone, and 662 (76.2%) being male. Compared with the combined anticoagulation regimen, warfarin alone significantly reduced non-surgical bleeding (RR 0.30; 95% CI 0.09-0.95; p = 0.04) and gastrointestinal bleeding (RR 0.26; 95% CI 0.12-0.58; p < 0.001). There was no statistically significant difference between the groups for all-cause mortality (RR 1.02; 95% CI 0.45-2.32; p = 0.963).</p><p><strong>Conclusions: </strong>Our findings indicate that the use of warfarin alone for anticoagulation in HM3 patients is associated with a reduced risk of bleeding events when compared to the combined therapy with ASA.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683695","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":"Maintenance of Sinus Rhythm Is Associated With Lower Incidence of Stroke in Patients With Drug-Refractory Atrial Fibrillation.","authors":"Soohyun Kim, Kyung An Kim, Soyoon Park, Hwajung Kim, Young Choi, Yong-Seog Oh, Sung-Hwan Kim","doi":"10.1111/pace.15105","DOIUrl":"https://doi.org/10.1111/pace.15105","url":null,"abstract":"<p><strong>Background and objectives: </strong>Recent studies have demonstrated that early rhythm control for first-line treatment of atrial fibrillation (AF) improved cardiovascular outcomes. However, there is limited data regarding the long-term outcome of patients who failed antiarrhythmic drugs and who refuse radiofrequency catheter ablation (RFCA).</p><p><strong>Methods: </strong>Patients with AF who were refractory to antiarrhythmic drugs and had refused further rhythm control attempts via RFCA were retrospectively identified and propensity-score (PS) matched with those who had been treated with RFCA. The primary outcome of interest was all-cause mortality or ischemic stroke.</p><p><strong>Results: </strong>A total of 169 patients who refused rhythm control with RFCA and PS matched 169 patients who had been treated with RFCA were included for analysis. During a mean follow-up of 4.3 (2.3;6.9) years, maintenance of sinus rhythm was more achieved in RFCA group (7 [4.1%] in Refuse group vs. 133 [78.7%] in RFCA group, p < 0.001). The incidence of ischemic stroke was significantly higher in patients who refused RFCA compared with patients who underwent RFCA (2.96 per 100 person-years in the Refused group vs. 0.74 per 100 person-years in the RFCA group, log-rank p < 0.001), but all-cause mortality was not significantly different (log-rank p = 0.8). Refusal of attempted rhythm control via RFCA was an independent risk factor for ischemic stroke on multivariate Cox analysis (hazard ratio [HR] 3.2; 95% confidence interval [CI] 1.2-8.53, p = 0.02).</p><p><strong>Conclusion: </strong>In patients with antiarrhythmic drug-refractory AF, the risk of stroke was significantly higher in patients who refused rhythm control via RFCA compared with that of those treated with RFCA.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683693","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}