Pace-Pacing and Clinical Electrophysiology最新文献

{"title":"Intermediate Atrial Tachycardia During Persistent Atrial Fibrillation Ablation: A Sub-analysis of the Extent-AF Trial.","authors":"Kaige Li, Bosheng Xu, Yang Liu, Xinhua Wang, Bing Han, Ping Ye, Weifeng Jiang, Shaohui Wu, Kai Xu, Zheng Qidong, Yanzhe Wang, Mu Qin, Xu Liu, Xumin Hou","doi":"10.1111/pace.15180","DOIUrl":"10.1111/pace.15180","url":null,"abstract":"<p><strong>Background: </strong>The evidence supporting additional linear ablation for persistent atrial fibrillation (PerAF) remains limited. This study investigates the mechanisms of intermediate atrial tachycardia (AT), a transient state between PerAF and sinus rhythm (SR), during PerAF termination by catheter ablation, and provides evidence for these mechanisms.</p><p><strong>Methods: </strong>We analyzed 136 patients who converted to organized AT after PerAF termination in the Extent-AF study. Bi-atrial activation mapping combined with entrainment mapping was used to identify the mechanisms and critical isthmus of these ATs.</p><p><strong>Results: </strong>A total of 164 ATs were identified in 136 patients (average 1.2 per patient), with 143 (87%) ATs successfully mapped in 113 patients (average 1.3 per patient). The mechanisms of intermediate ATs included macro-reentry in 110 (77%), micro-reentry in 21 (15%), and focal AT in 12 (8%). Among the macro-reentrant ATs, the most common were perimitral ATs (PM-AT) in 52 (47%), followed by roof-dependent ATs (RF-AT) in 40 (36%) and typical atrial flutter (AFL) in 18 (16%). A total of 98 (72%) patients successfully underwent ablation for intermediate ATs. Of these, 88 (90%) required at least one of the perimitral line, roofline, or peritricuspid line to finally restore SR. After 12 months of follow-up, 63 (64.3%) of the patients with successfully ablated ATs were remained free of arrhythmia.</p><p><strong>Conclusions: </strong>The majority of intermediate ATs after PerAF termination were macro-reentrant ATs. Linear ablation targeting the mitral isthmus, roof, and tricuspid isthmus was crucial for restoring SR in up to 90% of patients, suggesting the importance of additional linear ablation in PerAF ablation.</p><p><strong>Trial registration: </strong>Optimization of intervention strategies for persistent atrial fibrillation: ChiCTR2200060075; chictr.org.cn.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"455-463"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626941","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":"Radiofrequency Versus Cryoballoon 180-Day Mortality Risk After Atrial Fibrillation Ablation: An 8-Year Analysis.","authors":"Michal Orczykowski, Marcin Kowalski, Maciej Bak, Anna Jargielo, Filip Machaj, Michal Swierczewski, Krystyna Guzek, Magdalena Topczewska, Piotr Urbanek, Bodalski Robert, Andrzej Glowniak, Pawel Derejko, Maciej Sterlinski, Maria Bilinska, Lukasz Szumowski","doi":"10.1111/pace.15164","DOIUrl":"10.1111/pace.15164","url":null,"abstract":"<p><strong>Introduction: </strong>Catheter ablation (CA) is a preferred treatment for atrial fibrillation (AF), often outperforming antiarrhythmic medications in maintaining sinus rhythm and managing symptoms. One of the most important features of any treatment method, alongside its effectiveness, is its safety.</p><p><strong>Methods: </strong>This study evaluates 180-day all-cause mortality rates post-ablation using data from the National Health Fund in Poland (NHF-P), encompassing over 99% of AF CAs and 100% of deaths in Poland from 2012 to 2019.</p><p><strong>Results: </strong>Our analysis, which included 31,214 ablations on 26,767 patients (34.8% female), compared cryoballoon and radiofrequency (RF) ablation techniques and assessed mortality rates and risk factors. The study revealed a 180-day mortality rate of 0.56%, with the highest rate observed in patients over 80 years old (2.67%) and the lowest in those aged 18-34 years (0.29%). Mortality did not significantly differ between cryoballoon (0.48%) and RF ablation (0.65%; p = 0.072). The risk of mortality did not differ between patients undergoing a first-time ablation and those having subsequent procedures (p = 0.90, OR 0.92). Significant risk factors for increased mortality included male sex, kidney disease, heart failure, diabetes, prior myocardial infarction, and a history of malignancy.</p><p><strong>Conclusion: </strong>The 180-day mortality rate after AF ablation procedure reached 0.56%, with no significant difference between cryoballoon and RF ablation. Further research, including matched control groups and extended follow-up periods, is essential to better understand the benefits and risks of CA for AF, particularly in the oldest patient groups.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"363-366"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441978","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}

{"title":"Leadless Pacemaker Implantation Following Lead Extraction in a Patient With Recent Percutaneous Tricuspid Valve Repair.","authors":"Luca Segreti, Marco Torre, Matteo Parollo, Lorenzo Pistelli, Andrea Di Cori, Giulio Zucchelli","doi":"10.1111/pace.15150","DOIUrl":"10.1111/pace.15150","url":null,"abstract":"<p><p>This case details the successful implantation of a leadless pacemaker following the extraction of transvenous leads in a 72-year-old female patient with a complex cardiovascular history. The patient had undergone a series of cardiac interventions, including a recent percutaneous tricuspid valve repair with a metal clip implant due to severe regurgitation. After presenting with an infection at the pacemaker site, methicillin-resistant Staphylococcus hominis was identified, necessitating the removal of the entire pacing system. A leadless pacemaker was subsequently implanted without complications, despite the recent tricuspid valve repair. This case highlights the efficacy and safety of leadless pacemakers in complex clinical scenarios, especially when traditional transvenous systems are no longer viable due to infections or other complications. The report underscores the importance of personalized management strategies for cardiac device infections, illustrating that leadless pacemakers offer a feasible and safe alternative even in patients with previous valvular interventions.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"320-324"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048495","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":"Enhanced Procedural Efficacy in Typical Atrial Flutter Ablation With a Visualizable Steerable Sheath.","authors":"Guo Fuding, Zhao Xiaohua, Yang Sen, He Chende, Lu Mei, Yang Jing, Li Dongyan, Liao Qiwei, Li Shaolong","doi":"10.1111/pace.15143","DOIUrl":"10.1111/pace.15143","url":null,"abstract":"<p><strong>Objective: </strong>The Vizigo sheath, a novel visualizable steerable sheath, has been utilized effectively in the clinical management of atrial fibrillation. However, its application in the ablation of typical atrial flutter (AFL) remains unexplored. This study aims to evaluate and compare the efficacy and safety of the Vizigo sheath against a conventional fixed sheath during catheter ablation for typical AFL.</p><p><strong>Methods: </strong>This single-center cohort study involved 60 patients undergoing their first AFL ablation procedure. Patients were divided into two groups: the Vizigo sheath group and the fixed sheath group. The primary endpoints included procedural efficiency, lesion quality, and recurrence rates.</p><p><strong>Results: </strong>The Vizigo sheath demonstrated significant advantages over the fixed sheath, including a shorter procedure time (59.8 ± 13.8 vs. 71.5 ± 11.8 min; p = 0.0008) and reduced fluoroscopy duration (0.96 ± 0.32 vs. 1.31 ± 0.24 min; p < 0.0001). The initial bidirectional block rate was also higher in the Vizigo sheath group (84% vs. 68%). A detailed analysis of the cavotricuspid isthmus (CTI) revealed significant differences in the anterior 2/3 of the CTI, where the Vizigo sheath demonstrated greater catheter contact force, higher ablation index, increased force-time integral, and larger impedance drops (all p < 0.05). In contrast, no significant differences were observed between groups in the posterior 1/3 of the CTI. Both groups achieved a 100% acute procedural success rate, with no major complications reported. During a mean follow-up period of 18.68 months, the AFL recurrence rates were comparable between the two groups (p = 0.75).</p><p><strong>Conclusions: </strong>The Vizigo sheath enhances procedural efficiency and lesion quality during AFL ablation, particularly in challenging anatomical regions, and offers notable advantages over traditional fixed sheaths. Further studies are needed to assess its long-term clinical benefits.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"294-301"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048472","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":"External DC Shocks of Symptomatic Supraventricular Tachycardia During Screw-In Leadless Pacemaker Implant: A Case Report.","authors":"Mattia Liccardo, Ersilia Cipolletta, Emma Arezzi, Monica Sicuranza, Maria Rea, Pietro Ricciardi, Giovanni Napolitano","doi":"10.1111/pace.15134","DOIUrl":"10.1111/pace.15134","url":null,"abstract":"<p><p>We present the case of a 64-year-old man who, during the implantation of an active-fixation leadless pacemaker (LP, Aveir VR, Abbott, USA), underwent several external defibrillation shocks up to 240 Joules, due to symptomatic sustained supraventricular tachycardia at 160 bpm. The shocks, delivered both before and after the screwing of the device in the low interventricular septum, did not cause any technical damage to the device, and no complications were observed. The device was then deployed successfully. To our knowledge, this is the first documented case of external cardioversion (ECV) in a patient with an active-fixation LP. The results suggest that ECV in these patients appears to be safe and feasible.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"315-319"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959081","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":"Pacing Below the Programmed Rate.","authors":"Danial Saleem, Jacob P Elrod, Vibhu Parcha, Harish Doppalapudi","doi":"10.1111/pace.15163","DOIUrl":"10.1111/pace.15163","url":null,"abstract":"","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"311-314"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Painful Left Bundle Branch Block Syndrome: A Systematic Review of Treatment Strategies in Case Reports.","authors":"Rodrigo Rufino Pereira Silva, Carolina Jerônimo Magalhães, Caio Correia da Silva, José Nunes de Alencar Neto","doi":"10.1111/pace.15156","DOIUrl":"10.1111/pace.15156","url":null,"abstract":"<p><strong>Background: </strong>Painful left bundle branch block (PLBBB) syndrome remains a poorly understood cardiac anomaly. This systematic review consolidates case report evidence to elucidate effective management strategies and patient outcomes.</p><p><strong>Methods: </strong>Databases including PubMed, Scopus, Web of Science, and Scielo were searched without restrictions on language or publication date. Following PRISMA guidelines, 128 articles were identified, with 31 meeting inclusion criteria. Data were extracted on patient demographics, clinical presentation, treatment regimens, and outcomes using Microsoft Excel and assessed for bias with the Joanna Briggs Institute's tool.</p><p><strong>Results: </strong>The analysis included 45 patients with a mean age of 55.46 ± 12.23. Predominantly, LBBB episodes occurred during exercise (73.3%). Initial treatments comprised beta-blockers/calcium channel blockers (55.56%), pacemaker implantation (13.3%), antianginal medications (13.3%), and other modalities (17.7%). Refractoriness to initial treatment was observed in 66.7% of patients, with subsequent pacemaker implantation resolving symptoms in most cases. An overall satisfactory response was seen in 73.3% of patients post-treatment adjustments.</p><p><strong>Conclusions: </strong>The diverse approaches in treatment highlight the necessity for tailored therapeutic strategies. While pacemakers have demonstrated efficacy in controlling symptoms in several reported cases, it is essential to recognize the complex nature of this intervention. Pacemaker implantation, being a surgical procedure, carries long-lasting implications for patients. Hence, the continuation of pharmacological treatments might still be preferable until more definitive research is available. This review emphasizes the urgent need for further research to establish evidence-based guidelines, particularly concerning the selection of first line of treatment, to optimize outcomes for PLBBB syndrome.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"343-350"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257420","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}