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Averaging real-time impedance enhances the prediction of steam pop risk and lesion characteristics. 平均实时阻抗增强了对汽爆风险和损伤特征的预测。
IF 7.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1093/europace/euaf315
Hidehiro Iwakawa, Masateru Takigawa, Junji Yamaguchi, Ryosuke Kato, Masaki Honda, Ryo Tateishi, Miho Negishi, Iwanari Kawamura, Kentaro Goto, Kensuke Ihara, Takuro Nishimura, Kazuya Yamao, Susumu Tao, Sayaka Suzuki, Takehiro Iwanaga, Iichiro Onishi, Shinsuke Miyazaki, Hiroyuki Watanabe, Tetsuo Sasano

Aims: A novel impedance filtering function that averages impedance values was developed to mitigate cardiac and respiratory oscillations. We aimed to evaluate the clinical significance of averaging real-time impedance in predicting steam pops (SPs) and lesion characteristics.

Methods and results: Radiofrequency (RF) ablation was performed in 20 swine using a flexible-tip temperature-controlled power regulation catheter. Both unfiltered and filtered (averaged) impedance values were recorded using the EnSite™ X system. For each RF application, absolute (ΔImp-drop) and relative (%Imp-drop) impedance drops were quantified. Associations between impedance parameters and SP occurrence, atrial lesion transmurality, and ventricular lesion dimensions were evaluated. Among 959 lesions, SPs occurred in 36 applications (3.8%), all within the ventricles. Notably, 6 SPs occurred within 90 s despite RF power ≤ 40 W, with 4 during left ventricular ablation under low systolic blood pressure (<40 mmHg). Lesions with SPs exhibited significantly greater unfiltered and averaged ΔImp-drop and %Imp-drop (all P < 0.001). Averaged %Imp-drop showed the highest predictive value for SPs (AUC = 0.93), with a 20.9% cut-off yielding 88.9% sensitivity and 85.5% specificity. The time to reach the initial 10%, 15%, and 20% reduction in averaged %Imp-drop was not associated with SP occurrence. Both unfiltered and averaged impedance drops correlated with atrial transmural lesion formation. Averaged impedance drops significantly improved estimation of lesion depth, surface area, and volume compared with unfiltered values (P < 0.01).

Conclusion: The averaged relative impedance drop demonstrated the strongest association with SP occurrence, and averaging impedance provided a more accurate assessment of lesion characteristics than unfiltered measurements.

背景:开发了一种新的阻抗滤波功能,可以平均阻抗值,以减轻心脏和呼吸振荡。目的:评价实时阻抗平均值在预测蒸汽爆点(SPs)和病变特征方面的临床意义。方法:采用柔性尖端温控功率调节导管对20头猪进行射频消融。使用EnSite™X系统记录未滤波和滤波(平均)阻抗值。对于每个射频应用,绝对(ΔImp-drop)和相对(% impp -drop)阻抗下降被量化。评估阻抗参数与SP发生、心房病变跨壁性和心室病变尺寸之间的关系。结果:959例病变中,36例(3.8%)发生sp,均在脑室内。值得注意的是,在RF功率≤40 W的情况下,90秒内发生6例SPs,在低收缩压(< 40 mmHg)左心室消融期间发生4例。结论:平均相对阻抗下降与SP的发生具有最强的相关性,平均阻抗比未过滤的测量值更准确地评估了病变特征。
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引用次数: 0
Left ventricular ejection fraction and myocardial fibrosis in sudden cardiac death. 心源性猝死左心室射血分数与心肌纤维化的关系
IF 7.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1093/europace/euaf306
Harri Silvola, Lauri Holmström, Lasse Pakanen, Ida King, Anette Eskuri, Jani Tikkanen, Juha Perkiömäki, Heikki Huikuri, Juhani Junttila

Aims: Left ventricular ejection fraction (LVEF) remains the key determinant in the evaluation for the risk of sudden cardiac death (SCD). Myocardial fibrosis has gained increasingly more interest in the context of various myocardial diseases. We determined the spectrum of LVEF and evaluated the association between myocardial fibrosis and pre-SCD LVEF in a population-based SCD cohort.

Methods and results: The Fingesture study and clinical data have been collected from consecutive autopsy-verified SCD victims from Northern Finland between 1998 and 2017 (n = 5869). The cause of death was verified in medicolegal autopsy in all subjects. Electronic health records were used to identify those with pre-mortem echocardiography data. The extent of myocardial fibrosis at autopsy was characterized macroscopically and from histology samples. The LVEF recorded median 2 years (interquartile range 1-5) prior to SCD was evaluated in 716 SCD subjects. Proportional LVEF values were as follows: 62.7% (n = 449) normal LVEF (≥50%), 21.9% (n = 157) mildly reduced LVEF (36-49%), and 15.4% (n = 110) severely reduced LVEF (≤35%). At autopsy 19.6% (n = 140) had substantial, 53.8% (n = 386) moderate, and 22.1% (n = 158) mild fibrosis, and 4.5% (n = 32) had no myocardial fibrosis. The extent of myocardial fibrosis and LVEF had poor correlation (Spearman's ρ 0.21, CI 0.141-0.285, P < 0.001). Only 21.4% of those with substantial fibrosis at autopsy had LVEF ≤35%.

Conclusion: The proportion of SCD subjects with LVEF ≤35% is low, and the prevalence of myocardial fibrosis is high. The LVEF has a weak correlation with the extent of myocardial fibrosis. Our study suggests that LVEF is a poor surrogate of myocardial fibrosis in SCD victims.

目的:左心室射血分数(LVEF)仍然是评估心源性猝死(SCD)风险的关键决定因素。在各种心肌疾病的背景下,心肌纤维化越来越引起人们的兴趣。在一个基于人群的SCD队列中,我们确定了LVEF的频谱,并评估了心肌纤维化与SCD前LVEF之间的关系。方法:从1998年至2017年芬兰北部连续SCD患者(n= 5,869)中收集finger - esture研究和临床数据。死因在所有受试者的法医尸检中得到证实。使用电子健康记录(EHR)来识别具有死前超声心动图数据的患者。尸检时心肌纤维化的程度是通过宏观和组织学样本来确定的。结果:对716名SCD患者进行了SCD前中位2年(IQR 1-5)的LVEF记录。LVEF比例值为:正常LVEF 62.7%(n=449)(≥50%),轻度降低LVEF 21.9% (n=157)(36-49%),严重降低LVEF 15.4% (n=110)(≤35%)。19.6% (n=140)为重度,53.8% (n=386)为中度,22.1% (n=158)为轻度,4.5% (n=32)为无心肌纤维化。心肌纤维化程度与LVEF的相关性较差(Spearman’s ρ 0.21, CI 0.141 ~ 0.285, p)。结论:SCD患者LVEF≤35%的比例较低,心肌纤维化发生率较高。LVEF与心肌纤维化程度相关性较弱。我们的研究表明,在SCD患者中,LVEF是一个很差的心肌纤维化替代指标。
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引用次数: 0
Catheter ablation vs. anti-arrhythmic drug therapy for ventricular tachycardia in ischaemic heart disease: a meta-analysis of randomized controlled trials. 缺血性心脏病室性心动过速的导管消融与抗心律失常药物治疗:随机对照试验的荟萃分析
IF 7.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1093/europace/euaf302
Francesco Santoro, Giacomo Mugnai, Laura Perrotta, Boldizsar Kovacs, Leon Dinshaw, Alvaro Marco Del Castillo, Christiane Jungen, Stefan Kurath-Koller, Stefan Stojković, Bert Vandenberk, Kevin Vernooy

Aims: Ventricular tachycardia (VT) in ischaemic heart disease (IHD) requires complex management strategies including catheter ablation (CA) and anti-arrhythmic drugs (AADs). The aim of this study is to compare efficacy and safety of CA vs. AADs in patients with IHD and VT.

Methods and results: We performed a meta-analysis of randomized controlled trials (RCTs) enrolling patients with IHD and ICD randomized to CA or AADs. Primary outcome was appropriate ICD therapy. Secondary outcomes included inappropriate ICD therapy, cardiovascular (CV) re-hospitalization, all-cause/CV mortality, and adverse events. Subgroup analyses were conducted for amiodarone and sotalol, with an exploratory evaluation of a composite endpoint (ICD shock, VT storm, all-cause death). Four RCTs including 947 patients (mean age 68 ± 2 years; 93% male) were analysed. CA significantly reduced the risk of appropriate ICD therapy compared with AADs (149/470 [31.7%] vs. 229/477 [48.0%]; RR 0.81; 95% CI [0.67, 0.97]; P = 0.02). Among secondary outcomes, CA decreased the incidence of CV re-hospitalization [RR 0.84; 95% CI (0.72, 0.99); P = 0.04] and adverse events [RR 0.42; 95% CI (0.28, 0.62); P < 0.01], while no differences were observed in all-cause/CV mortality and inappropriate ICD therapy. In subgroup analyses, CA was superior to sotalol in reducing the composite endpoint of ICD shock, VT storm and all-cause death [RR: 0.82, 95% CI (0.69, 0.98), P = 0.03]; whereas, no significant benefit was seen compared to amiodarone [RR: 0.92; 95% CI (0.78, 1.09), P = 0.32].

Conclusion: In ischaemic heart disease and VT, CA compared with anti-arrhythmic drugs is associated with a reduction of appropriate ICD therapy, cardiovascular re-hospitalization, and adverse events with benefits most evident versus sotalol.

背景:缺血性心脏病(IHD)的室性心动过速(VT)需要复杂的治疗策略,包括导管消融(CA)和抗心律失常药物(AADs)。研究目的:比较CA与AADs治疗IHD和vt患者的疗效和安全性。方法:我们对随机对照试验(RCTs)进行了荟萃分析,纳入IHD和ICD患者,随机分配到CA或AADs。主要结局是适当的ICD治疗。次要结局包括不适当的ICD治疗、心血管(CV)再住院、全因/CV死亡率和不良事件。对胺碘酮和索他洛尔进行亚组分析,并对复合终点(ICD休克、VT风暴、全因死亡)进行探索性评估。结果:共纳入4项随机对照试验,947例患者(平均年龄68±2岁,93%为男性)。与AADs相比,CA显著降低了适当ICD治疗的风险(149/470[31.7%]vs 229/477[48.0%]; RR 0.81; 95% CI[0.67, 0.97]; p=0.02)。在次要结局中,CA降低了心血管再住院的发生率(RR 0.84; 95% CI[0.72, 0.99]; p=0.04)和不良事件的发生率(RR 0.42; 95% CI[0.28, 0.62])。结论:在缺血性心脏病和VT中,与抗心律失常药物相比,导管消融与减少适当的ICD治疗、心血管再住院和不良事件相关,与索他洛尔相比,益处最为明显。
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引用次数: 0
Wall thickness-guided persistent atrial fibrillation ablation: have we found the holy grail? 壁厚引导的持续性房颤消融:我们找到了圣杯吗?
IF 7.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1093/europace/euaf241
Karan Saraf, Carlos Morillo
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引用次数: 0
Sarcopenia in atrial fibrillation: a risk factor for adverse outcomes in a UK Biobank study. 房颤中的肌肉减少症:英国生物库研究中不良结果的危险因素。
IF 7.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1093/europace/euaf286
Hong-Ju Kim, Pil-Sung Yang, Hanjin Park, Daehoon Kim, Han-Joon Bae, Chan-Hee Lee, Jang-Won Son, Ung Kim, Boyoung Joung

Aims: Sarcopenia, characterized by reduced muscle mass and function, has been increasingly implicated in cardiovascular disorders. However, its prognostic relevance in atrial fibrillation (AF) remains unclear. We aimed to evaluate the association between sarcopenia and adverse outcomes in individuals with AF using UK Biobank data.

Methods and results: This retrospective cohort study included individuals with AF enrolled between 2006 and 2010 at 22 centres. Sarcopenia was defined per European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria as low muscle strength and/or low muscle mass measured by handgrip and bioelectrical impedance analysis. Propensity score weighting adjusted for baseline differences. The primary outcome was a composite of all-cause mortality, major bleeding, thromboembolic events (stroke/systemic embolism), and heart failure admission; each component was also assessed individually. Among 5144 patients with AF (median age, 64.0 years; 24.1% female), 16.7% had sarcopenia. After propensity score weighting, sarcopenia was associated with a higher incidence of the primary composite outcome [43.9 per 1000 person-years (PYRs)], with an adjusted hazard ratio (HR) of 1.30 [95% confidence interval (CI), 1.15-1.46]. This risk was mainly driven by elevated rates of all-cause mortality (26.4 per 1000 PYRs; aHR, 1.44; 95% CI 1.24-1.68) and major bleeding (14.4 per 1000 PYRs; aHR, 1.34; 95% CI 1.10-1.65). Subgroup analyses demonstrated consistent results.

Conclusion: Even after PS weighting analysis, some residual confounders may remain; however, sarcopenia was independently associated with adverse clinical outcomes, particularly mortality and bleeding risk. Screening for sarcopenia may enhance risk stratification and management, particularly in patients receiving anticoagulation.

背景和目的:肌肉减少症以肌肉质量和功能减少为特征,与心血管疾病的关系日益密切。然而,其与房颤(AF)预后的相关性尚不清楚。本研究使用UK Biobank数据评估了AF患者肌肉减少症与不良结局之间的关系。方法:这项回顾性队列研究纳入了2006年至2010年间在22个中心登记的房颤患者。根据欧洲老年人肌肉减少症工作组2 (EWGSOP2)标准,肌肉减少症被定义为通过握力和生物电阻抗分析测量的肌肉力量和/或肌肉质量低。倾向得分加权调整基线差异。主要结局是全因死亡率、大出血、血栓栓塞事件(中风/全身栓塞)和心力衰竭入院的综合结果;每个组成部分也被单独评估。结果:在5144例房颤患者中(中位年龄64.0岁,24.1%为女性),16.7%患有肌肉减少症。倾向评分加权后,肌肉减少症与较高的主要复合结局发生率相关(43.9 / 1000人-年[PYRs]),校正风险比[HR]为1.30(95%可信区间[CI], 1.15-1.46)。这种风险主要是由全因死亡率升高(26.4 / 1000 pyr; aHR, 1.44; 95% CI, 1.24-1.68)和大出血(14.4 / 1000 pyr; aHR, 1.34; 95% CI, 1.10-1.65)引起的。亚组分析结果一致。结论:即使经过ps加权分析,仍可能存在一些残留混杂因素;然而,肌肉减少症与不良临床结果独立相关,特别是死亡率和出血风险。筛查肌肉减少症可以加强风险分层和管理,特别是在接受抗凝治疗的患者中。
{"title":"Sarcopenia in atrial fibrillation: a risk factor for adverse outcomes in a UK Biobank study.","authors":"Hong-Ju Kim, Pil-Sung Yang, Hanjin Park, Daehoon Kim, Han-Joon Bae, Chan-Hee Lee, Jang-Won Son, Ung Kim, Boyoung Joung","doi":"10.1093/europace/euaf286","DOIUrl":"10.1093/europace/euaf286","url":null,"abstract":"<p><strong>Aims: </strong>Sarcopenia, characterized by reduced muscle mass and function, has been increasingly implicated in cardiovascular disorders. However, its prognostic relevance in atrial fibrillation (AF) remains unclear. We aimed to evaluate the association between sarcopenia and adverse outcomes in individuals with AF using UK Biobank data.</p><p><strong>Methods and results: </strong>This retrospective cohort study included individuals with AF enrolled between 2006 and 2010 at 22 centres. Sarcopenia was defined per European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria as low muscle strength and/or low muscle mass measured by handgrip and bioelectrical impedance analysis. Propensity score weighting adjusted for baseline differences. The primary outcome was a composite of all-cause mortality, major bleeding, thromboembolic events (stroke/systemic embolism), and heart failure admission; each component was also assessed individually. Among 5144 patients with AF (median age, 64.0 years; 24.1% female), 16.7% had sarcopenia. After propensity score weighting, sarcopenia was associated with a higher incidence of the primary composite outcome [43.9 per 1000 person-years (PYRs)], with an adjusted hazard ratio (HR) of 1.30 [95% confidence interval (CI), 1.15-1.46]. This risk was mainly driven by elevated rates of all-cause mortality (26.4 per 1000 PYRs; aHR, 1.44; 95% CI 1.24-1.68) and major bleeding (14.4 per 1000 PYRs; aHR, 1.34; 95% CI 1.10-1.65). Subgroup analyses demonstrated consistent results.</p><p><strong>Conclusion: </strong>Even after PS weighting analysis, some residual confounders may remain; however, sarcopenia was independently associated with adverse clinical outcomes, particularly mortality and bleeding risk. Screening for sarcopenia may enhance risk stratification and management, particularly in patients receiving anticoagulation.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12722030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145476875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clarifying the definition and handling of the early post-ablation period in studies of persistent atrial fibrillation. 明确持续性房颤研究中消融后早期的定义和处理。
IF 7.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1093/europace/euaf305
Laurent Fauchier, Yassine Lemrini
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引用次数: 0
Clinical complexity in patients with atrial fibrillation: exploring differential risk profiles from European and Asian cohorts. 房颤患者的临床复杂性:探索欧洲和亚洲人群的不同风险概况。
IF 7.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1093/europace/euaf229
Andrea Galeazzo Rigutini, Tommaso Bucci, Michele Rossi, Enrico Tartaglia, Amir Askarinejad, Giulio Francesco Romiti, Cecilia Becattini, Giuseppe Boriani, Hung-Fat Tse, Tze-Fan Chao, Gregory Y H Lip

Aims: Clinical complexity (CC) in atrial fibrillation (AF) reflects overlapping risk factors that raise vulnerability to both thromboembolism and bleeding. Ethnic differences in the expression of CC remain poorly characterized.

Methods and results: We performed a post hoc analysis of the EORP-AF and APHRS-AF registries. CC was defined as a CHA₂DS₂-VASc score ≥2 plus ≥1 of: (i) age ≥75 and BMI <23 kg/m², (ii) chronic kidney disease, or (iii) prior major bleeding. Multivariable logistic regression identified predictors of CC, oral anticoagulant (OAC) use, and rhythm control. The primary outcome was a composite of all-cause death and major adverse cardiovascular events (MACE), defined as cardiovascular death, acute coronary syndromes, and thromboembolic events. Secondary outcomes included each individual component and major bleeding. Associations were assessed using Cox regression models. Among 14 055 patients, 2794 (19.9%) met CC criteria (mean age 77 ± 9 years; 46% female). Compared to Europeans, Asian patients with CC had a distinct clinical profile and were less likely to receive OAC (OR 0.75, 95% CI 0.57-1.01) or rhythm control (OR 0.53, 95% CI 0.41-0.69). CC was independently associated with increased risk of composite outcome (HR 1.55, 95% CI 1.35-1.77), all-cause death (HR 1.65, 95% CI 1.42-1.93), MACE (HR 1.50, 95% CI 1.26-1.80), cardiovascular death (HR 1.81, 95% CI 1.40-2.36), and major bleeding (HR 2.02, 95% CI 1.47-2.77). The excess risk of the composite outcome was greater in Asians (HR 2.28, 95% CI 1.57-3.32) than in Europeans (HR 1.51, 95% CI 1.31-1.75; P-interaction = 0.036).

Conclusion: Among AF patients with CC, those enrolled in Asia exhibited marked differences in clinical profiles, management strategies, and outcomes, suggesting greater vulnerability to CC in the Asian population.

背景和目的:房颤(AF)的临床复杂性(CC)反映了重叠的危险因素,增加了血栓栓塞和出血的易感性。CC表达的种族差异仍然缺乏特征。方法:我们对EORP-AF和APHRS-AF登记进行事后分析。CC定义为CHA₂DS₂-VASc评分≥2加上年龄≥75岁和BMI≥1。结果:14055例患者中,2794例(19.9%)符合CC标准(平均年龄77±9岁,46%为女性)。与欧洲患者相比,亚洲CC患者具有不同的临床特征,接受OAC (OR 0.75, 95%CI 0.57-1.01)或节律控制(OR 0.53, 95%CI 0.41-0.69)的可能性较小。CC与复合结局(HR 1.55, 95%CI 1.35-1.77)、全因死亡(HR 1.65, 95%CI 1.42-1.93)、MACE (HR 1.50, 95%CI 1.26-1.80)、心血管死亡(HR 1.81, 95%CI 1.40-2.36)和大出血(HR 2.02, 95%CI 1.47-2.77)的风险增加独立相关。亚洲人(相对危险度2.28,95%CI 1.57-3.32)高于欧洲人(相对危险度1.51,95%CI 1.31-1.75; p交互作用=0.036)。结论:在伴有CC的房颤患者中,来自亚洲的患者在临床概况、管理策略和结局方面表现出显著差异,表明亚洲人群更容易发生CC。
{"title":"Clinical complexity in patients with atrial fibrillation: exploring differential risk profiles from European and Asian cohorts.","authors":"Andrea Galeazzo Rigutini, Tommaso Bucci, Michele Rossi, Enrico Tartaglia, Amir Askarinejad, Giulio Francesco Romiti, Cecilia Becattini, Giuseppe Boriani, Hung-Fat Tse, Tze-Fan Chao, Gregory Y H Lip","doi":"10.1093/europace/euaf229","DOIUrl":"10.1093/europace/euaf229","url":null,"abstract":"<p><strong>Aims: </strong>Clinical complexity (CC) in atrial fibrillation (AF) reflects overlapping risk factors that raise vulnerability to both thromboembolism and bleeding. Ethnic differences in the expression of CC remain poorly characterized.</p><p><strong>Methods and results: </strong>We performed a post hoc analysis of the EORP-AF and APHRS-AF registries. CC was defined as a CHA₂DS₂-VASc score ≥2 plus ≥1 of: (i) age ≥75 and BMI <23 kg/m², (ii) chronic kidney disease, or (iii) prior major bleeding. Multivariable logistic regression identified predictors of CC, oral anticoagulant (OAC) use, and rhythm control. The primary outcome was a composite of all-cause death and major adverse cardiovascular events (MACE), defined as cardiovascular death, acute coronary syndromes, and thromboembolic events. Secondary outcomes included each individual component and major bleeding. Associations were assessed using Cox regression models. Among 14 055 patients, 2794 (19.9%) met CC criteria (mean age 77 ± 9 years; 46% female). Compared to Europeans, Asian patients with CC had a distinct clinical profile and were less likely to receive OAC (OR 0.75, 95% CI 0.57-1.01) or rhythm control (OR 0.53, 95% CI 0.41-0.69). CC was independently associated with increased risk of composite outcome (HR 1.55, 95% CI 1.35-1.77), all-cause death (HR 1.65, 95% CI 1.42-1.93), MACE (HR 1.50, 95% CI 1.26-1.80), cardiovascular death (HR 1.81, 95% CI 1.40-2.36), and major bleeding (HR 2.02, 95% CI 1.47-2.77). The excess risk of the composite outcome was greater in Asians (HR 2.28, 95% CI 1.57-3.32) than in Europeans (HR 1.51, 95% CI 1.31-1.75; P-interaction = 0.036).</p><p><strong>Conclusion: </strong>Among AF patients with CC, those enrolled in Asia exhibited marked differences in clinical profiles, management strategies, and outcomes, suggesting greater vulnerability to CC in the Asian population.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12722002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pre-procedural computed tomography predicts procedural complexity and complications in bidirectional rotational mechanical transvenous lead extraction. 术前心脏CT预测双向旋转机械经静脉铅提取术的程序复杂性和并发症。
IF 7.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1093/europace/euaf308
Federico Migliore, Raimondo Pittorru, Vincenzo Tarzia, Jacopo Rosso, Manuel De Lazzari, Andrea Ziggiotto, Gaia Zancanaro, Giulia Winnicki, Marco Gemelli, Matteo Micciolo, Antonio Guerrieri, Davide Margheri, Raffaella Motta, Valeria Pergola, Gino Gerosa, Domenico Corrado

Aims: Despite technical advances, transvenous lead extraction (TLE) remains a challenging procedure. Cardiac computed tomography (CT) has emerged as a valuable tool for pre-procedural assessment, but its role in predicting outcomes in rotational mechanical TLE as a first-line strategy is not well defined. The aim was to determine whether pre-procedural CT can predict complications and procedural complexity in patients undergoing rotational mechanical TLE.

Methods and results: This retrospective study included 115 patients. All had pre-procedural contrast-enhanced CT with a dedicated lead extraction protocol. Two procedural outcomes were evaluated: (i) complicated procedure, defined as major complication, incomplete lead removal, or snare use, and (ii) complex procedure, defined as requiring either a snare or a tissue stabilization sheath. Logistic regression and receiver operating characteristic analyses were used to identify predictors. A total of 215 leads were extracted (mean dwelling time 95 ± 73 months). Complicated procedures occurred in 20.9% and were independently associated with longest fibrosis length on CT (odds ratio 1.1; P < 0.001); a fibrosis length of >40 mm predicted complicated procedures [area under the curve (AUC) 0.92; 95% confidence interval (CI) 0.88-0.97]. Complex procedures occurred in 37.4% and were associated with longest fibrosis length, lead calcification, dwelling time, and systolic heart failure. A fibrosis length of >30 mm predicted complex procedures (AUC 0.72; 95% CI 0.64-0.81).

Conclusion: Pre-procedural CT allows accurate identification of high-risk anatomical features, particularly fibrosis length and calcifications, which independently predict both complicated and complex rotational mechanical TLE. These findings support the integration of CT imaging into procedural planning and individualized risk stratification.

目的:尽管技术进步,经静脉铅提取(TLE)仍然是一个具有挑战性的程序。心脏计算机断层扫描(CT)已成为一种有价值的术前评估工具,但其作为一线策略预测旋转机械TLE预后的作用尚未得到很好的定义。目的是确定术前CT是否可以预测旋转机械TLE患者的并发症和手术复杂性。方法与结果:本研究纳入115例患者。所有患者均行术前对比增强CT扫描,并采用专用的铅提取方案。评估了两种手术结果:(i)复杂手术,定义为主要并发症,不完整的铅清除或圈套使用;(ii)复杂手术,定义为需要圈套或组织稳定鞘。采用Logistic回归和受试者工作特征分析来确定预测因子。共取出215根导线(平均停留时间95±73个月)。复杂手术发生率为20.9%,与CT上最长纤维化长度独立相关(优势比1.1,P < 0.001);纤维化长度为40mm,预示手术复杂[曲线下面积(AUC) 0.92;95%置信区间(CI) 0.88-0.97]。37.4%的患者进行了复杂的手术,并与最长的纤维化长度、铅钙化、停留时间和收缩期心力衰竭相关。纤维化长度为bbb30 mm预示手术过程复杂(AUC 0.72; 95% CI 0.64-0.81)。结论:术前CT可以准确识别高危解剖特征,特别是纤维化长度和钙化,独立预测复杂和复杂旋转机械TLE。这些发现支持将CT成像整合到手术计划和个体化风险分层中。
{"title":"Pre-procedural computed tomography predicts procedural complexity and complications in bidirectional rotational mechanical transvenous lead extraction.","authors":"Federico Migliore, Raimondo Pittorru, Vincenzo Tarzia, Jacopo Rosso, Manuel De Lazzari, Andrea Ziggiotto, Gaia Zancanaro, Giulia Winnicki, Marco Gemelli, Matteo Micciolo, Antonio Guerrieri, Davide Margheri, Raffaella Motta, Valeria Pergola, Gino Gerosa, Domenico Corrado","doi":"10.1093/europace/euaf308","DOIUrl":"10.1093/europace/euaf308","url":null,"abstract":"<p><strong>Aims: </strong>Despite technical advances, transvenous lead extraction (TLE) remains a challenging procedure. Cardiac computed tomography (CT) has emerged as a valuable tool for pre-procedural assessment, but its role in predicting outcomes in rotational mechanical TLE as a first-line strategy is not well defined. The aim was to determine whether pre-procedural CT can predict complications and procedural complexity in patients undergoing rotational mechanical TLE.</p><p><strong>Methods and results: </strong>This retrospective study included 115 patients. All had pre-procedural contrast-enhanced CT with a dedicated lead extraction protocol. Two procedural outcomes were evaluated: (i) complicated procedure, defined as major complication, incomplete lead removal, or snare use, and (ii) complex procedure, defined as requiring either a snare or a tissue stabilization sheath. Logistic regression and receiver operating characteristic analyses were used to identify predictors. A total of 215 leads were extracted (mean dwelling time 95 ± 73 months). Complicated procedures occurred in 20.9% and were independently associated with longest fibrosis length on CT (odds ratio 1.1; P < 0.001); a fibrosis length of >40 mm predicted complicated procedures [area under the curve (AUC) 0.92; 95% confidence interval (CI) 0.88-0.97]. Complex procedures occurred in 37.4% and were associated with longest fibrosis length, lead calcification, dwelling time, and systolic heart failure. A fibrosis length of >30 mm predicted complex procedures (AUC 0.72; 95% CI 0.64-0.81).</p><p><strong>Conclusion: </strong>Pre-procedural CT allows accurate identification of high-risk anatomical features, particularly fibrosis length and calcifications, which independently predict both complicated and complex rotational mechanical TLE. These findings support the integration of CT imaging into procedural planning and individualized risk stratification.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12757581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145687338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Controversy: in heart failure patients with a reduced ejection fraction and left bundle branch block, conduction system pacing can be a valid alternative to biventricular pacing-pro and contra. 争议:在射血分数降低和左束支传导阻滞的心力衰竭患者中,传导系统起搏可以作为一种有效的替代双心室起搏——正反两种。
IF 7.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-12-01 DOI: 10.1093/europace/euaf312
Haran Burri, Christophe Leclercq, Nathalie Behar, Jean-Claude Deharo, Marek Jastrzebski, Jacqueline Joza, Jens Cosedis Nielsen

For patients with heart failure (HF) and bundle branch block, cardiac resynchronization therapy (CRT) by biventricular pacing (BiVP) has been found effective and has been widely used for around 20 years. The effects of BiVP are well documented in a row of large randomized controlled trials (RCTs) with long-term follow-up to include prolonged survival, less HF hospitalizations, and better quality of life for the patients. More recently, conduction system pacing (CSP) as His bundle pacing or left bundle branch area pacing has been introduced for CRT and shown to in best cases establish a normal or near-to-normal electrical activation of the left ventricular myocardium. Data from large RCTs documenting the beneficial effects of CSP are awaited. Currently, the question is to what extent the contemporary literature supports a transition from BiVP to CSP for CRT in patients with HF and bundle branch block. This Europace Controversy article presents opposing viewpoints on this topic. H.B., M.J., and J.J. argue in favour of CSP being superior to BiVP. Conversely, C.L., N.B., and J.C.D. advocate for BiVP still being the first choice for CRT. This Controversy aims to present data and their interpretation from different expert perspectives on an important topic in CRT for HF.

对于心力衰竭(HF)和束支传导阻滞患者,双心室起搏(BiVP)心脏再同步化治疗(CRT)被认为是有效的,并已被广泛应用了约20年。BiVP的效果在一系列长期随访的大型随机对照试验(rct)中得到了很好的证明,包括延长了患者的生存期,减少了HF住院治疗,改善了患者的生活质量。最近,传导系统起搏(CSP)作为他束起搏或左束分支区域起搏已被引入CRT,并显示在最好的情况下建立正常或接近正常的左心室心肌电激活。等待大型随机对照试验的数据来证明CSP的有益作用。目前的问题是,当代文献在多大程度上支持对HF和束支阻滞患者从BiVP到CSP的CRT过渡。这篇Europace Controversy文章提出了关于这个主题的对立观点。h.b., m.j.和J.J.认为CSP优于BiVP。相反,c.l., n.b.和J.C.D.主张BiVP仍然是CRT的首选。这一争议旨在从不同专家的角度就心衰CRT的一个重要主题提出数据及其解释。
{"title":"Controversy: in heart failure patients with a reduced ejection fraction and left bundle branch block, conduction system pacing can be a valid alternative to biventricular pacing-pro and contra.","authors":"Haran Burri, Christophe Leclercq, Nathalie Behar, Jean-Claude Deharo, Marek Jastrzebski, Jacqueline Joza, Jens Cosedis Nielsen","doi":"10.1093/europace/euaf312","DOIUrl":"10.1093/europace/euaf312","url":null,"abstract":"<p><p>For patients with heart failure (HF) and bundle branch block, cardiac resynchronization therapy (CRT) by biventricular pacing (BiVP) has been found effective and has been widely used for around 20 years. The effects of BiVP are well documented in a row of large randomized controlled trials (RCTs) with long-term follow-up to include prolonged survival, less HF hospitalizations, and better quality of life for the patients. More recently, conduction system pacing (CSP) as His bundle pacing or left bundle branch area pacing has been introduced for CRT and shown to in best cases establish a normal or near-to-normal electrical activation of the left ventricular myocardium. Data from large RCTs documenting the beneficial effects of CSP are awaited. Currently, the question is to what extent the contemporary literature supports a transition from BiVP to CSP for CRT in patients with HF and bundle branch block. This Europace Controversy article presents opposing viewpoints on this topic. H.B., M.J., and J.J. argue in favour of CSP being superior to BiVP. Conversely, C.L., N.B., and J.C.D. advocate for BiVP still being the first choice for CRT. This Controversy aims to present data and their interpretation from different expert perspectives on an important topic in CRT for HF.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":"27 12","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12724428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145818546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Characterization of sedation strategies in real-world use of pulsed field ablation Sub-analysis of the EU-PORIA registry. EU-PORIA登记的亚分析:在现实世界中使用脉冲场消融的镇静策略的特征。
IF 7.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-11-17 DOI: 10.1093/europace/euaf287
Kyoung Ryul Julian Chun, Karin Plank, Kars Neven, Tobias Reichlin, Yuri Blaauw, Jim Hansen, Raquel Adelino, Alexandre Ouss, Stefano Bordignon, Anna Füting, Laurent Roten, Bart A Mulder, Martin H Ruwald, Roberto Mené, Pepijn van der Voort, Nico Reinsch, Thomas Kueffer, Serge Boveda, Elizabeth M Albrecht, Jonathan D Raybuck, Scott Wehrenberg, Brad S Sutton, Boris Schmidt

Background: With the introduction of pulsed field ablation (PFA) to treat atrial fibrillation (AF), there is interest in studying workflow and sedation strategies to optimize integration into clinical practice. This sub-analysis characterizes early real-world use of general anesthesia versus deep sedation during AF ablation using the pentaspline PFA catheter.

Methods: EU-PORIA is an all-comer AF registry enrolling consecutive patients at seven high-volume centers in Europe. Patients were treated based on institutional standard-of-care. During follow-up, any episode of atrial tachycardia (AT) or AF >30s was considered an arrhythmia recurrence.

Results: EU-PORIA enrolled 1233 patients, of which 250 (20%) and 983 (80%) cases were performed using general anesthesia and deep sedation, respectively. Patients treated with general anesthesia were more often male and non-paroxysmal AF. In the general anesthesia group, 72% received pulmonary vein isolation (PVI)-only versus 90% in the deep sedation group (p<0.01), and 3D mapping was used in 60% of general anesthesia and 27% of deep sedation cases (p<0.01). Procedure and fluoroscopy times were shorter with deep sedation (51[36-84] vs 75[60-90] min; 13[8-19] vs 19[15-26] min; p<0.01). There were no differences in the incidence of serious adverse events. At 1-year follow-up, 74.8% and 73.8% of patients in the general anesthesia and deep sedation groups, respectively, were free from recurrent AF/AT (p=0.87).

Conclusion: AF ablation using deep sedation with the pentaspline PFA catheter demonstrated a safety and efficacy profile consistent with procedures performed under general anesthesia. This characterization of real-world use warrants further evaluation to understand optimal sedation strategies with PFA technologies.

背景:随着脉冲场消融(PFA)治疗心房颤动(AF)的引入,研究工作流程和镇静策略以优化与临床实践的结合成为人们关注的焦点。本亚分析分析了在房颤消融期间使用pentaspline PFA导管进行全麻与深度镇静的早期实际应用。方法:EU-PORIA是一项全面的房颤登记,在欧洲7个高容量中心连续招募患者。患者的治疗是基于机构的标准护理。在随访期间,任何心房心动过速(AT)或房颤(AF)的发作都被认为是心律失常复发。结果:EU-PORIA共纳入1233例患者,其中250例(20%)采用全麻,983例(80%)采用深度镇静。全麻治疗的患者多为男性和非阵发性房颤。在全麻组中,72%的患者仅接受了肺静脉隔离(PVI),而在深度镇静组中,这一比例为90%(结论:使用pentaspline PFA导管进行深度镇静的房颤消融显示出与全麻下操作一致的安全性和有效性)。这一现实世界使用的特征值得进一步评估,以了解PFA技术的最佳镇静策略。
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