JACC. Asia最新文献

{"title":"Long-Term and Time-Dependent Association of Predictors on Mortality in Patients With Iliofemoral Artery Disease","authors":"Yoshimitsu Soga MD ,&nbsp;Mitsuyoshi Takahara MD, PhD ,&nbsp;Osamu Iida MD ,&nbsp;Kenji Suzuki MD ,&nbsp;Shinsuke Mori MD ,&nbsp;Daizo Kawasaki MD ,&nbsp;Kazuki Haraguchi MD ,&nbsp;Terutoshi Yamaoka MD ,&nbsp;Kenji Ando MD","doi":"10.1016/j.jacasi.2025.03.013","DOIUrl":"10.1016/j.jacasi.2025.03.013","url":null,"abstract":"<div><h3>Background</h3><div>Although several predictors affect long-term mortality in patients with lower extremity artery disease, long-term association of predictors on mortality over time remain unclear.</div></div><div><h3>Objectives</h3><div>The aim of this study was to explore the long-term and time-dependent association of baseline characteristics with mortality in patients with iliofemoral arterial disease.</div></div><div><h3>Methods</h3><div>This study is a multicenter retrospective analysis of 4,086 consecutive patients (mean age 72 ± 9 years, 74% men) who underwent endovascular therapy for symptomatic de novo iliofemoral arterial disease between January 2004 and December 2011 at 16 cardiovascular centers in Japan.</div></div><div><h3>Results</h3><div>During the median follow-up of 3.8 years (Q1-Q3: 1.4-7.4 years), 1,100 deaths, and 637 major adverse cardiovascular events (MACE) (defined as death, myocardial infarction, and stroke) were observed. Overall survival and MACE-free rates were estimated to be 56.1% and 50.6% at 10 years. Old age, chronic kidney disease stage, heart failure, the lack of renin-angiotensin-system inhibitor use, chronic limb threatening ischemia (CLTI), decreased ankle-brachial index, femoropopliteal lesion were significantly associated with an increased risk of mortality. while the prognostic impact of CLTI was significantly attenuated afterwards. Old age, chronic kidney disease stage, cerebrovascular disease, coronary artery disease, heart failure, warfarin use, the lack of statin use, and CLTI were significantly associated with an increased risk of MACE, while the prognostic impact of cerebrovascular disease and CLTI was significantly attenuated afterwards.</div></div><div><h3>Conclusions</h3><div>This study demonstrated long-term and time-dependent association of predictors on mortality and MACE following endovascular therapy. It highlights the need for continuous management of cardiovascular risk factors in this high-risk population.</div></div>","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":"5 9","pages":"Pages 1187-1195"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164102","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":"Postprocedure AntiBiotic prophylaXis For caRdiac Electrical devicE Implantation (ABxFREE)","authors":"Chih-Chieh Yu MD, PhD ,&nbsp;Kuan-Hung Yeh MD ,&nbsp;Hung-Yu Chang MD ,&nbsp;Ying-Chieh Liao MD ,&nbsp;Li-Ting Ho MD, PhD ,&nbsp;Ting-Chun Huang MD ,&nbsp;Lian-Yu Lin MD, PhD ,&nbsp;Ju-Yi Chen MD, PhD","doi":"10.1016/j.jacasi.2025.06.001","DOIUrl":"10.1016/j.jacasi.2025.06.001","url":null,"abstract":"","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":"5 9","pages":"Pages 1199-1201"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746307","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":"Addressing Frailty in Cardiology: Identifying Barriers Faced by Cardiologists and Health Care Professionals in Asia.","authors":"Jie Jun Wong, Rilong Hong, Terence Ing Wei Ong, Jae-Young Lim, Tingting Yan, Duk-Woo Park, Gabrielle H N Tan, Hongzhou Zhang, Thu Thi Hoai Nguyen, Huong Thi Thu Nguyen, Yanhong Dong, William K F Kong, Shang Li, Jack W C Tan, Huyen Thi Thanh Vu, Angela S Koh","doi":"10.1016/j.jacasi.2025.07.002","DOIUrl":"https://doi.org/10.1016/j.jacasi.2025.07.002","url":null,"abstract":"<p><strong>Background: </strong>Preventing frailty is crucial for improving outcomes in aging populations at heightened cardiovascular risk, yet implementation in real-world practice remains challenging. The authors previously reported low use of frailty strategies among cardiologists in Asia.</p><p><strong>Objectives: </strong>The aim of this study was to explore the barriers to frailty implementation among cardiologists, other physicians, and nurses.</p><p><strong>Methods: </strong>A multinational web-based survey was conducted targeting health care communities across Asia.</p><p><strong>Results: </strong>Among 238 respondents (median age 34.0 years; IQR: 12 years; 63.4% women), 172 were doctors, 57 nurses, and 8 allied health professionals. Among doctors, 59 were cardiologists representing various subspecialties, including critical care cardiology, interventional cardiology, and general cardiology. Among all respondents, one-quarter lacked confidence in identifying (22.7%) or treating (28.2%) frailty, and many were uncertain of the screening tools (34.9%) and subsequent steps (37.8%). Other barriers include inadequate multidisciplinary support (21%), communication difficulties (45.8%), resource limitations (52.9%), patient and caregiver unreceptiveness (21.8%), and insufficient community care collaborations (39.5%). Compared with other physicians, cardiologists reported being too busy (P = 0.041) and having less awareness of screening selection (P = 0.018) and appropriate assessment tools (P = 0.008). Nurses experienced fewer interdisciplinary communication difficulties (P = 0.003) than cardiologists. There were no significant differences in understanding, support received, and patients' and caregivers' receptiveness toward frailty interventions between nurses and cardiologists.</p><p><strong>Conclusions: </strong>Distinct barriers to frailty implementation exist at multiple levels, including gaps in provider expertise, insufficient support, and resource constraints that limit adequate frailty care provision. To address the diverse needs of stakeholders, a comprehensive implementation strategy leveraging interdisciplinary cardiogeriatric team resources and involving nurses could improve frailty care in cardiology.</p>","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002146","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":"The Persisting Burden of Rheumatic Heart Disease","authors":"Haochang Hu PhD ,&nbsp;Xianbao Liu MD, PhD","doi":"10.1016/j.jacasi.2025.06.007","DOIUrl":"10.1016/j.jacasi.2025.06.007","url":null,"abstract":"","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":"5 9","pages":"Pages 1184-1186"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934307","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":"Beyond the Sum of Their Parts","authors":"Kevin S. Tang MD, MMS ,&nbsp;Wenjun Fan MD, PhD","doi":"10.1016/j.jacasi.2025.07.013","DOIUrl":"10.1016/j.jacasi.2025.07.013","url":null,"abstract":"","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":"5 9","pages":"Pages 1168-1170"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932251","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":"Characteristics and Problems of Rheumatic Heart Disease in Indonesia","authors":"Amiliana Mardiani Soesanto MD, PhD ,&nbsp;Prima Almazini MD ,&nbsp;Rina Ariani MD ,&nbsp;Estu Rudiktyo MD ,&nbsp;Tengku Winda Ardini MD ,&nbsp;Hasanah Mumpuni MD ,&nbsp;Achmad Lefi MD, PhD ,&nbsp;Aussie Fitriani Ghaznawie MD ,&nbsp;Ni Made Ayu Wulan Sari MD ,&nbsp;Mefri Yanni MD ,&nbsp;Niniek Purwaningtyas MD ,&nbsp;Rille Puspitoadhi Harjoko MD ,&nbsp;Melawati Hasan MD ,&nbsp;Siti Elkana Nauli MD ,&nbsp;Fitranti Suciati Laitupa MD ,&nbsp;Novita Muchtar MD ,&nbsp;Wella Karolina MD ,&nbsp;Indah Puspita MD ,&nbsp;Gratiani Eben Haezer Reppi MD ,&nbsp;Dyna Evalina Syahlul MD ,&nbsp;Ario Soeryo Kuncoro MD","doi":"10.1016/j.jacasi.2025.03.010","DOIUrl":"10.1016/j.jacasi.2025.03.010","url":null,"abstract":"<div><h3>Background</h3><div>Rheumatic heart disease (RHD) presents a significant public health challenge. Unfortunately, there is a lack of national data regarding the incidence and prevalence of RHD in Indonesia.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to evaluate the characteristics, burdens, and problems of RHD in Indonesia.</div></div><div><h3>Methods</h3><div>We collected medical reports of RHD patients over 18 years of age from 21 hospitals. Secondary data about clinical and echocardiography was collected to describe the characteristics, disease conditions, and complications of the disease.</div></div><div><h3>Results</h3><div>We recruited 3,431 patients, average age was 44 years, and 64.4% (2,209 of 3,431) were women. Dyspnea was found in 85.7% (2,939 of 3,431), and 25% (862 of 3,431) of patients with NYHA functional class III to IV. Isolated mitral stenosis was the most prevalent valve lesion in 1,357 of 3,431 patients (39.6%). A total of 62.5 % (2,146 of 3,431) of patients had atrial fibrillation (AF), with the highest prevalence being in MV lesions. Vitamin K antagonist was prescribed in 2,411 of 3,431 (70.3%) of patients. A history of stroke was reported in 227 of 3,431 (6.6%) of patients and most frequently happened in isolated mitral stenosis patients 128 of 1,357 (9.4%). Finally, secondary prophylaxis was only administered in 1,279 of 3,431 (37.3%) of patients, and only 23.2% (796 of 3,431) had it regularly.</div></div><div><h3>Conclusions</h3><div>Our patients were predominantly women and had isolated mitral stenosis. Many patients came at a later stage of the disease, with older average age, a high prevalence of AF, pulmonary hypertension, and right heart involvement. The challenges were suboptimal use of anticoagulation despite the high prevalence of AF and underused secondary prophylaxis.</div></div>","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":"5 9","pages":"Pages 1171-1183"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044234","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":"A Novel Morphological Classification to Guide Transcatheter Mitral Valve Edge-to-Edge Repair for Commissural Mitral Regurgitation","authors":"Zhi-Nan Lu MD ,&nbsp;Xu-Nan Guo MD ,&nbsp;Yu-tong Ke MD ,&nbsp;Yihua He MD ,&nbsp;Xianbao Liu MD ,&nbsp;Zhengming Jiang MD ,&nbsp;Xinmin Liu MD ,&nbsp;Wenhui Wu MD ,&nbsp;Yi-Da Tang MD ,&nbsp;Dajun Chai MD ,&nbsp;Yansong Guo MD ,&nbsp;Yongjian Wu MD ,&nbsp;Yat-Yin Lam MD ,&nbsp;Nicolo Piazza MD, PhD ,&nbsp;Guangyuan Song MD","doi":"10.1016/j.jacasi.2025.05.008","DOIUrl":"10.1016/j.jacasi.2025.05.008","url":null,"abstract":"<div><h3>Background</h3><div>Mitral commissural prolapse poses significant anatomical challenges that can hinder the effectiveness of transcatheter edge-to-edge repair (TEER).</div></div><div><h3>Objectives</h3><div>The aim of this study was to estimate the safety and effectiveness of applying a novel morphological classification to guide TEER in patients with commissural degenerative mitral regurgitation (DMR).</div></div><div><h3>Methods</h3><div>In this prospective, multicenter study across 18 centers in China, we classified patients with severe commissural DMR into 4 morphological types through detailed echocardiographic analysis. Customized TEER strategies were applied accordingly. Procedural success, clinical outcomes, echocardiographic parameters, and quality of life were assessed over a follow-up period, with a median follow-up of 18 months (Q1-Q3: 15-21 months).</div></div><div><h3>Results</h3><div>Among 540 patients screened, 126 (23.3%) exhibited commissural involvement. Tailored TEER strategies were successfully applied to 68 patients, achieving a technical success rate of 100% (n = 68 of 68; 95% CI: 0.933-1.000) and a device success rate of 97.1% (n = 66 of 68, 95% CI: 0.888-0.992). The 1-year follow-up revealed that 94.1% (n = 64 of 68; 95% CI: 0.849-0.981) of patients had residual mitral regurgitation of grade ≤2+, with 82.4% (n = 56 of 68; 95% CI: 0.708-0.902) at grade ≤1+, and no major complications. Additionally, significant improvements were noted in left ventricular dimensions and functional status.</div></div><div><h3>Conclusions</h3><div>Our results highlight the value of the morphological classification system in enhancing TEER for commissural DMR. By addressing specific anatomical challenges, this system promotes tailored interventions that optimize procedural success and improve patient outcomes.</div></div>","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":"5 9","pages":"Pages 1137-1154"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934313","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":"Body Mass Index and Outcomes After Transcatheter Aortic Valve Replacement","authors":"Eric P. Cantey MD ,&nbsp;Ashraf Samhan MD ,&nbsp;Abigail S. Baldridge DrPH ,&nbsp;S. Chris Malaisrie MD ,&nbsp;Charles J. Davidson MD ,&nbsp;Alan C. Yeung MD ,&nbsp;William F. Fearon MD ,&nbsp;Do-Yoon Kang MD ,&nbsp;Seung-Jung Park MD ,&nbsp;Duk-Woo Park MD ,&nbsp;James D. Flaherty MD","doi":"10.1016/j.jacasi.2025.06.012","DOIUrl":"10.1016/j.jacasi.2025.06.012","url":null,"abstract":"<div><h3>Background</h3><div>Whereas some studies suggest an \"obesity paradox\" with improved outcomes in obese patients following transcatheter aortic valve replacement (TAVR), the impact of pre-TAVR body mass index (BMI) and post-TAVR BMI changes on clinical and echocardiographic outcomes remains unclear.</div></div><div><h3>Objectives</h3><div>This study sought to evaluate the influence of BMI at the time of TAVR and subsequent BMI changes on clinical and echocardiographic outcomes in patients undergoing TAVR.</div></div><div><h3>Methods</h3><div>We included 1,339 patients with severe, native aortic stenosis from 2015 to 2019, stratified by BMI according to World Health Organization classifications, from an international registry. The primary outcome was overall survival, with secondary outcomes including short- and long-term survival, bleeding, vascular injury, stroke, and acute kidney injury. Descriptive statistics and time-to-event analyses were performed.</div></div><div><h3>Results</h3><div>Underweight patients were older (n = 45; age 83.8 ± 6.6 years) compared to normal weight (n = 576; 81.5 ± 7.0 years), overweight (n = 438; age 81.0 ± 7.4 years), and obese (n = 280; age 77.4 ± 8.3 years; <em>P</em> &lt; 0.001) patients. Underweight patients had the highest rates of chronic kidney disease (66.7%) and moderate or greater aortic regurgitation (28.9%). Obese patients had the highest rates of atherosclerotic cardiovascular disease risk factors. Over a median follow-up of 1.1 (Q1-Q3: 0.6-2.7) years, there were no significant differences between BMI groups (<em>P</em> = 0.69). At 1-year follow-up, underweight patients showed improved left ventricular remodeling and favorable TAVR hemodynamics.</div></div><div><h3>Conclusions</h3><div>Pre-TAVR BMI did not significantly affect clinical outcomes in this diverse cohort, challenging the obesity paradox. However, underweight patients exhibited subtle improvements in left ventricular remodeling and valve hemodynamics post-TAVR, highlighting a nuanced role for BMI in recovery.</div></div>","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":"5 9","pages":"Pages 1124-1133"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934311","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":"Implication of the Dose of Mineralocorticoid Receptor Antagonist Following Transcatheter Edge-to-Edge Mitral Valve Repair","authors":"Teruhiko Imamura MD, PhD ,&nbsp;Shuhei Tanaka MD ,&nbsp;Nobuyuki Fukuda MD ,&nbsp;Hiroshi Ueno MD ,&nbsp;Koichiro Kinugawa MD ,&nbsp;Shunsuke Kubo MD ,&nbsp;Masanori Yamamoto MD ,&nbsp;Yuki Izumi MD ,&nbsp;Mike Saji MD ,&nbsp;Masahiko Asami MD ,&nbsp;Yusuke Enta MD ,&nbsp;Shinichi Shirai MD ,&nbsp;Masaki Izumo MD ,&nbsp;Shingo Mizuno MD ,&nbsp;Yusuke Watanabe MD ,&nbsp;Makoto Amaki MD ,&nbsp;Kazuhisa Kodama MD ,&nbsp;Junichi Yamaguchi MD ,&nbsp;Toru Naganuma MD ,&nbsp;Hiroki Bota MD ,&nbsp;Kentaro Hayashida MD","doi":"10.1016/j.jacasi.2025.03.014","DOIUrl":"10.1016/j.jacasi.2025.03.014","url":null,"abstract":"<div><h3>Background</h3><div>Mineralocorticoid receptor antagonists (MRAs) are integral components of medical therapy for patients with heart failure with reduced ejection fraction. However, implication of MRA dosing in older patients undergoing transcatheter edge-to-edge mitral valve repair (TEER) for secondary mitral regurgitation remains uncertain.</div></div><div><h3>Objectives</h3><div>The authors aimed to investigate the prognostic impacts of MRA dosing in older patients receiving TEER for secondary mitral regurgitation.</div></div><div><h3>Methods</h3><div>This study included patients who underwent TEER and were enrolled in the OCEAN (Optimized CathEter vAlvular iNtervention)-Mitral registry. Patients with a left ventricular ejection fraction &lt;50% and secondary mitral regurgitation were selected. The dose-dependent effects of MRA, administered at discharge, on the 2-year composite outcome of all-cause mortality and heart failure hospitalization were evaluated.</div></div><div><h3>Results</h3><div>A total of 2,026 patients (median age 77 years; 1,287 men) were included and followed for a median 416 days (Q1-Q3: 294-730 days). Post-TEER, the administration of MRA at a dose of ≥12.5 mg/d (ie, any doses of MRA) was independently associated with a lower 2-year cumulative incidence of the primary composite outcome, with an adjusted HR of 0.83 (95% CI: 0.69-0.99; <em>P =</em> 0.046). In contrast, higher doses of MRA were not significantly associated with a further reduction in the risk of the primary outcome <em>(P =</em> 0.97).</div></div><div><h3>Conclusions</h3><div>In older patients who underwent TEER for secondary mitral regurgitation caused by systolic heart failure, even a low-dose MRA was associated with improved clinical outcomes compared with no MRA administration. However, further up-titration of the MRA dose did not result in additional improvements in clinical outcomes. (OCEAN-Mitral registry; <span><span>UMIN000023653</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":"5 9","pages":"Pages 1095-1106"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164100","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":"Multicenter Practice of Non/Minimized Fluoroscopy Ablation for Paroxysmal AF in China: The PAF-ICE Trial.","authors":"Yunhe Wang, Deyong Long, Fangyi Xiao, Minglong Chen, Xingpeng Liu, Jidong Zhang, Yumei Xue, Jie Fan, Haixiong Wang, Mengzuo Wu, Rui Wang, Jia Li, Tao He, Weili Ge, Xiaobo Huang, Ruhong Jiang, Qiang Liu, Zuwen Zhang, Guosheng Fu, Chenyang Jiang","doi":"10.1016/j.jacasi.2025.07.011","DOIUrl":"https://doi.org/10.1016/j.jacasi.2025.07.011","url":null,"abstract":"<p><strong>Background: </strong>Intracardiac echocardiography (ICE)-guided non/minimized-fluoroscopy catheter ablation for atrial fibrillation (AF) has been reported, but its effectiveness and safety still lack multicenter evidence.</p><p><strong>Objectives: </strong>The authors sought to evaluate the effectiveness and safety of ICE-guided non/minimized-fluoroscopy catheter ablation compared with the traditional fluoroscopy-guided approach in patients with paroxysmal AF.</p><p><strong>Methods: </strong>A total of 448 patients with paroxysmal AF, from 15 centers in China, were randomly assigned in a 1:1 ratio to a non/minimized-fluoroscopy group (n = 223) and a traditional approach group (n = 225). The primary efficacy endpoint was freedom from AF recurrence after a single ablation procedure. The primary safety endpoint was a composite of death from any cause, stroke or transient ischemic attack, and other serious adverse events.</p><p><strong>Results: </strong>Pulmonary vein isolation was achieved in all patients. After a median follow-up of 12.2 (Q1-Q3: 8.8-17.7) months, 184 of 223 patients (82.5%) in the non/minimized-fluoroscopy group and 189 of 225 (84.0%) in the traditional approach group remained free from arrhythmia. Cox analysis showed a HR of 0.949 (95% CI: 0.774 to 1.164); P = 0.858, demonstrating the noninferiority of the non/minimized-fluoroscopy approach. The primary safety endpoint did not differ significantly in the 2 groups (P = 0.975). This protocol enabled near zero-radiation procedures (mean <1 mGy) in 7 of 15 centers (46.7%), and radiation-free AF ablation in 125 of 223 patients (56.1%), significantly reducing x-ray exposure and operator radiation protection equipment usage.</p><p><strong>Conclusions: </strong>ICE-combined non/minimized-fluoroscopy AF ablation was noninferior in effectiveness compared to traditional AF ablation, with no significant difference in safety endpoints, indicating its potential of widespread adoption.</p>","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002136","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}