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Aims: Intracardiac echocardiography (ICE) is increasingly incorporated into atrial fibrillation (AF) ablation workflows, enabling real-time anatomic guidance and procedural precision. Nevertheless, ICE utilization shows substantial geographic variability, and its clinical benefit remains incompletely understood. This meta-analysis evaluated the efficacy, safety, and procedural performance of ICE-guided versus non-ICE-guided AF ablation.

Methods and results: MEDLINE, the Cochrane Library, and Scopus were systematically searched through 3 August 2025. Three reviewers independently performed study selection, data extraction, and risk-of-bias assessment. Random-effects models were used to pool data from 44 AF ablation studies comprising 482,043 patients. ICE guidance was associated with lower odds of any complication (OR 0.69; 95% CI 0.53-0.89), including significant reductions in cardiac tamponade (OR 0.58; 95% CI 0.53-0.62) and mortality (OR 0.21; 95% CI 0.16-0.27). ICE-guided ablation was also associated with shorter total procedure and fluoroscopy times, reduced radiation exposure, and lower contrast agent utilization. Atrial tachyarrhythmia (AT) recurrence did not differ between groups (OR 0.92; 95% CI 0.79-1.06). However, ICE use was associated with higher odds of first-pass pulmonary vein isolation (OR 1.62; 95% CI 1.09-2.41) and successful isolation of all pulmonary veins at the end of the procedure (OR 2.12; 95% CI 1.37-3.27), and lower odds of repeat ablation (OR 0.65; 95% CI 0.59-0.72).

Conclusion: ICE-guided AF ablation is associated with superior procedural safety and efficiency and a similar risk of AT recurrence compared to non-ICE-guided approaches.

Background and aims: In the PRAGUE-25 study, the effect of lifestyle modification (LFM) in combination with antiarrhythmic drugs (AAD) in patients with atrial fibrillation (AF) and BMI 30-40 was smaller than that of catheter ablation (CA). The presented sub-analysis aims to assess the relationship between the actual weight reduction and the AF burden 12 months after randomization.

Methods: Per-protocol analysis of the PRAGUE-25 trial. Patients in the LFM+AAD group were stratified into tertiles based on the extent of relative weight reduction, and a comparison of AF burden was performed between the LFM+AAD tertiles and the CA group.

Results: The study analyzed 83 LFM+AAD patients (age 60 ±9 years, 31% women, 54% paroxysmal AF, mean weight 109±17 kg) and 99 CA patients (age 60±9 years, 32% women, 56% paroxysmal AF, weight 109±15 kg). Within the LFM+AAD group, 28 patients achieved a weight reduction of >8.3% (-15.46±6.16 kg), 27 patients were between 3.1-8.1% (-6.56±2.28 kg), and 28 patients were <3.1% (+1.38±4.03 kg). Compared to the CA group, the AF burden at 12 months (0 [IQR 0-0]) was significantly higher in the second (3.5% [0; 52] and third (1[0; 47] LFM-ADD tertiles, but did not differ from CA in the first tertile (0% [0; 11.], p=0.17).

Conclusion: In obese patients, the maintenance of SR on AADs is related to the level of weight reduction. The efficacy of AADs in obese patients with a significant weight loss at 12-months follow-up is close to catheter ablation, although the overall AF burden is still non-significantly higher.

Background: Intracardiac echocardiography (ICE)-based electroanatomical mapping (EAM) improves procedural efficiency and safety in atrial fibrillation (AF) ablation and remains the standard of care. The CARTOSOUND FAM (AI FAM) module uses a deep-learning algorithm that automates left atrial reconstruction without manual contouring.

Objective: This study aims to evaluate the one-year outcomes of AI FAM compared to standard-of-care EAM in AF ablation.

Methods: This study included 298 patients undergoing radiofrequency AF ablation between Jan 2021 to Dec 2023. Patients treated before Jan 2023 underwent standard-of-care EAM, while those in 2023 utilized AI FAM-based reconstruction. Baseline demographics, comorbidities, AF type, and medication use were recorded. Procedural characteristics, acute success, complications, and AF recurrence at one-year follow up were analyzed.

Results: Of the 298 patients, 115 underwent mapping with AI FAM and 183 with EAM. Baseline characteristics were comparable. AI FAM reduced mean total procedure time (122.5±23.5 vs 129.0±30.4min, P=0.046) and left atrial (LA) dwell time (78.3±21.45 vs 87.5±28.2min, P=0.001). Acute procedural success was 98.3% in AI FAM vs 98.9% in EAM with fewer complications observed in the AI FAM group (1 vs 4). At one year, freedom from AF recurrence was comparable (80.0% AI FAM vs 81.4% EAM at 1yr, LogRank P=0.610).

Conclusion: AI FAM was associated with incremental but significant procedural advantages over conventional contouring via reduced total procedure time and LA dwell time, without compromising acute and long-term safety and rhythm control efficacy. AI FAM integration with PFA will mark another step towards making AF ablation more streamlined and accessible.

Novel technologies and ablation techniques for identification of atrial fibrillation (AF) sources and personalized substrate modification may be required to improve outcomes for persistent AF. We hypothesize that a unison of electrophysiologic phase and optical flow mapping could be used to selectively prioritize ablation targets and optimize patient outcome while minimizing the tissue ablated. We aim to evaluate the efficacy of a novel electro-optic flow (EOF)-based ablation strategy for persistent AF patients using a virtual cohort of bi-atrial digital twins (DTs). A patient cohort (n=250) from a bi-atrial in silico population with different atrial fibrosis distributions was utilized to simulate five AF episodes per case. Phase singularity (PS) and average optical flow maps were computed for post-pulmonary vein isolation (PVI) sustained AF. Concordant regions, overlapping in at least three binarized PS maps were used to define regions to search for the highest optical curl cluster centroids as candidate EOF targets. Using optical curl as the weight, the centroid of five candidate EOF targets were computed and selected as an ablation target inside each concordant boundary. Six clinical ablation strategies were simulated. An inducibility-to-ablated tissue area metric was calculated to evaluate the efficacy of the tested ablation strategies. The pipeline automatically identified extra-PV targets and generated patient-specific EOF ablation plans. Electro-optic flow-guided ablations resulted in an average 32±2% AF inducibility, outperforming PVI (90±5%), and PVI+empiric (87±6%). Consensus-EOF further reduced inducibility to 20±5% while sparing 28±2% tissue as compared to PVI+PS ablation. Consensus mapping provides a novel method for assessing the dynamic nature of AF, while EOF offers a promising multimodal metric for identifying critical ablation targets outside of PVI. These findings underscore the potential of EOF-guided ablation planning in advancing the clinical translation of DT-based personalized therapy for PeAF patients.

Aims: We sought to systematically catalogue and compare outcomes definitions across prospective clinical trials and registries evaluating ablation in VT to assess the impact of heterogeneous definitions on reported outcomes.

Methods and results: A systematic review (PROSPERO: CRD 42024595265) was performed in accordance with PRISMA guidelines. We searched for prospective studies from January 2000 to November 2024. Randomized trials, single-arm feasibility studies, and prospective registries involving ≥10 patients undergoing VT ablation were included. Study outcomes and their definitions were extracted and categorized. Pooled analyses were performed for comparable randomized trial subgroups, and meta-regression evaluated the effect of VT outcome definitions on reported success and complications. Fifty-nine studies were included: 15 randomized trials, 6 feasibility studies, and 38 prospective studies/registries. Definitions of acute procedural success varied, with most using acute clinical VT non-inducibility and others using only elimination of the clinical VT. VT recurrence was the most frequently reported long-term outcome; however, definitions differed markedly (VT recurrence or recurrence causing device therapy). Pooled analysis of prophylactic ablation vs. delayed ablation showed reduced VT recurrence (HR 0.63, 95% CI: 46-0.86) but no difference in hospitalization or mortality. Meta-regression demonstrated that an outcome of any VT recurrence yielded a higher failure rate of 51.0% compared to stricter definitions, such as VT-causing therapy at 37.3% or VT-causing shock only at 23.4% (P = 0.002). Safety outcomes were inconsistently reported.

Conclusion: Outcome definition in VT ablation trials showed substantial heterogeneity, limiting cross-trial comparability and meta-analytic synthesis. Development of a minimum set of standardized outcomes for VT ablation may improve consistency and clinical interpretability of VT trials.

Aims: The rising burden of cardiovascular diseases, especially atrial fibrillation, has increased demand for electrophysiology (EP) procedures in Europe, driving greater reliance on disposable devices like diagnostic and ablation catheters. Reprocessing single-use medical devices offers potential economic and environmental benefits, yet concerns persist regarding device integrity and safety. Under the European Union Medical Device Regulation, reprocessing is permitted if national laws allow it; however, implementation varies across Member States. This systematic literature review evaluates the safety and performance of reprocessed cardiac EP catheters originally intended for single use.

Methods and results: Following PRISMA guidelines, literature searches of PubMed and Embase identified in vitro and in vivo studies that examined the safety and functionality of reprocessed EP catheters. Key outcomes included infection risk, device sterility, mechanical and electrical integrity, and adverse events. Twelve studies (four in vivo and eight in vitro) involving >1200 patients and multiple catheter brands were included. Under stringent reprocessing protocols, reprocessed EP catheters showed comparable safety and mechanical performance to new devices. However, gaps remain in evidence regarding prion and fungal contamination, the maximum number of safe reprocessing cycles, and the detection of rare complications.

Conclusion: The absence of adverse events and reliable performance associated with reprocessed EP catheters reported in this study may encourage European countries that have not yet authorized single-use medical device reprocessing to consider its adoption. However, the broader implementation of this practice remains contingent on its applicability and logistical feasibility within each national context.

Aims: Cardioneuroablation (CNA) is a catheter-based intervention for reflex syncope and functional bradyarrhythmias that consists in the modulation of the parasympathetic cardiac autonomic nervous by targeting ganglionated plexi (GPs).To compare an ablation strategy of selective GP targeting based on clinical phenotype (tailored approach) vs. the standard approach of targeting all GPs (standard approach).

Methods and results: This is a prospective, multicentre European study (ELEGANCE study), including 123 patients who underwent CNA (73 men; median age 50 years). Among them 54 (44%) were treated with a tailored approach, targeting the superior paraseptal ganglionated plexus (SPSGP) for sinus node dysfunction and the inferior paraseptal ganglionated plexus (IPSGP) for AV block. Procedural data and clinical outcomes were compared with the remaining 69 patients treated using a standard approach.Clinical phenotypes included isolated functional sinus node dysfunction (43.1%), isolated functional AV block (9.8%), and dual presentations (47.2%). In the tailored group 1.6 ± 0.7 GPs were targeted per patient. Compared to the standard approach, the tailored group had significantly shorter procedure times (63 vs. 85 min, P = 0.005) and reduced RF time (5.4 vs. 10.4 min, P < 0.001). Acute procedural success (tailored: 93% vs. standard: 90%, P = 0.98) and the increase in heart rate (tailored: 40 ± 30.7% vs. standard: 40 ± 31.4%, P = 0.96) were similar between groups. During a median 15.9 months [IQR: 9.8, 24.6] follow-up, there were no differences in syncope recurrence rate (log-rank P = 0.96). Inappropriate sinus tachycardia occurred in 8.1% of patients, (tailored 8.6% vs. standard 7.4%; P = 0.79).

Conclusion: An individualized CNA strategy, simplified by targeting specific GPs according to patient's pathophysiology, achieved outcomes equivalent to the standard approach while improving procedural efficiency through reduced RF delivery, shorter procedure duration, and limited ablation extent.