Effective pacing is essential for maximizing response to cardiac resynchronization therapy (CRT). High ineffective CRT (i-CRT) pacing has been linked to poor prognosis, but the characteristics of a high percentage of i-CRT (%i-CRT) and optimal follow-up settings remain unclear.
Objective
This study aimed to investigate the characteristics and efficacy of pacing optimization for patients with a high %i-CRT.
Methods
We assessed 225 consecutive patients (2018–2024) using EffectivCRT (Medtronic Inc). The %i-CRT was measured throughout the follow-up period. CRT response was defined as an improved left ventricular ejection fraction of ≥10% and/or reduced left ventricular end-systolic volume of ≥15%. High %i-CRT was defined as >2.0%.
Results
36 patients (16%) had high %i-CRT. They exhibited significantly lower CRT response rates than others (14 patients [48%] vs 129 patients [76%]; P = .003). The predominant causes were pseudo-fusion or latency (13 patients [36%]). Among patients with high %i-CRT, the time from CRT initiation to the maximum i-CRT was shorter (P = .012) and the maximum i-CRT was higher (P < .001) among those patients with pseudo-fusion or latency. Atrioventricular or interventricular delay optimization was performed for 10 patients, resulting in %i-CRT improvement from 64.6% (interquartile range 39.3%–87.5%) to 6.4% (interquartile range 1.8%–32.0%) (P = .005) and shortening of the QRS duration from 165 ± 31 ms to 138 ± 21 ms (P = .003). 3 of 7 initial nonresponders converted to CRT responders after optimization.
Conclusion
i-CRT occurred early, and the maximum i-CRT was high among patients with latency or pseudo-fusion. Optimization of atrioventricular or interventricular delay improved i-CRT and shortened the QRS duration.
{"title":"Optimization of pacing for patients receiving ineffective cardiac resynchronization therapy","authors":"Nobuhiko Ueda MD, PhD, Satoshi Oka MD, PhD, Kohei Ishibashi MD, PhD, Tsukasa Oshima MD, PhD, Toshihiro Nakamura MD, PhD, Yuichiro Miyazaki MD, PhD, Akinori Wakamiya MD, PhD, Kenzaburo Nakajima MD, PhD, Tsukasa Kamakura MD, PhD, Mitsuru Wada MD, Yuko Inoue MD, PhD, Koji Miyamoto MD, PhD, Takeshi Aiba MD, PhD, FHRS, Hideaki Kanzaki MD, PhD, Chisato Izumi MD, PhD, Teruo Noguchi MD, PhD, Kengo Kusano MD, PhD, FHRS","doi":"10.1016/j.hrthm.2025.10.030","DOIUrl":"10.1016/j.hrthm.2025.10.030","url":null,"abstract":"<div><h3>Background</h3><div>Effective pacing is essential for maximizing response to cardiac resynchronization therapy (CRT). High ineffective CRT (i-CRT) pacing has been linked to poor prognosis, but the characteristics of a high percentage of i-CRT (%i-CRT) and optimal follow-up settings remain unclear.</div></div><div><h3>Objective</h3><div>This study aimed to investigate the characteristics and efficacy of pacing optimization for patients with a high %i-CRT.</div></div><div><h3>Methods</h3><div>We assessed 225 consecutive patients (2018–2024) using EffectivCRT (Medtronic Inc). The %i-CRT was measured throughout the follow-up period. CRT response was defined as an improved left ventricular ejection fraction of ≥10% and/or reduced left ventricular end-systolic volume of ≥15%. High %i-CRT was defined as >2.0%.</div></div><div><h3>Results</h3><div>36 patients (16%) had high %i-CRT. They exhibited significantly lower CRT response rates than others (14 patients [48%] vs 129 patients [76%]; <em>P</em> = .003). The predominant causes were pseudo-fusion or latency (13 patients [36%]). Among patients with high %i-CRT, the time from CRT initiation to the maximum i-CRT was shorter (<em>P</em> = .012) and the maximum i-CRT was higher (<em>P</em> < .001) among those patients with pseudo-fusion or latency. Atrioventricular or interventricular delay optimization was performed for 10 patients, resulting in %i-CRT improvement from 64.6% (interquartile range 39.3%–87.5%) to 6.4% (interquartile range 1.8%–32.0%) (<em>P</em> = .005) and shortening of the QRS duration from 165 ± 31 ms to 138 ± 21 ms (<em>P</em> = .003). 3 of 7 initial nonresponders converted to CRT responders after optimization.</div></div><div><h3>Conclusion</h3><div>i-CRT occurred early, and the maximum i-CRT was high among patients with latency or pseudo-fusion. Optimization of atrioventricular or interventricular delay improved i-CRT and shortened the QRS duration.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 1","pages":"Pages e15-e24"},"PeriodicalIF":5.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.hrthm.2025.01.046
Ghaith Zaatari MD, MS , Jorge Bohorquez PhD , Laura E. Sutaria MD, MPH , Raul D. Mitrani MD, FHRS , Jason Ng MD, PhD , Jeffrey J. Goldberger MD, MBA, FHRS
Background
The electrocardiogram (ECG) in persistent atrial fibrillation (AF) is underused. Signal processing techniques can extract the f-waves from the QRS-T complex to generate the atrial ECG (A-ECG).
Objective
This study aimed to explore A-ECG technical and clinical issues.
Methods
Thirty patients (age, 62.6 ± 9.4 years; 80% male; CHA2DS2-VASc score, 2.2 ± 1.7; ejection fraction, 47.9% ± 10.4%) with persistent AF undergoing ablation were enrolled. ECGs were downloaded for offline analysis. A-ECG was derived by QRS-T subtraction and independent component analysis filtering. A-ECG short-term (DF10s, OI10s) and long-term (DF_Global, OI_Global) spectral features were derived. Optimal recording duration, temporal reproducibility, differences between leads, comparison to intracardiac dominant frequency (DF), acute ablation effect, and A-ECG differences based on ablation outcomes were evaluated.
Results
Time-frequency A-ECG analysis demonstrated dynamic spectral features. Repeated 10-second A-ECG recordings had higher coefficient of variation (7.5%–10.0%) compared with repeated 4- to 5-minute recordings (1.1%–3.4%). Short-term reproducibility of 2 recordings ∼30 minutes apart showed high correlation (r = 0.91–0.99; all P values < .0001). Regional lead analyses showed no significant differences except for the comparison of posterior leads V7–V9 vs V1–V3. A-ECG DF parameters correlated with right atrial DF (r = 0.64–0.72; P < .0001) and not left atrial DF. A-ECG DF declined after ablation (median-DF10s-1min, 5.94 ± 0.63 Hz vs 5.77 ± 0.63 Hz; P = .0003). Patients with successful ablation at 1 year had higher A-ECG DF vs those with recurrences (median-DF10s-5min, 6.04 ± 0.42 Hz vs 5.13 ± 0.93 Hz; P = .003).
Conclusion
This study provides the practical basis for further use of the A-ECG as a novel tool for evaluating persistent AF and demonstrates its clinical relevance. Further phenotypic classification of AF based on the A-ECG and assessment of treatment response should be explored.
{"title":"The atrial electrocardiogram in patients with persistent atrial fibrillation","authors":"Ghaith Zaatari MD, MS , Jorge Bohorquez PhD , Laura E. Sutaria MD, MPH , Raul D. Mitrani MD, FHRS , Jason Ng MD, PhD , Jeffrey J. Goldberger MD, MBA, FHRS","doi":"10.1016/j.hrthm.2025.01.046","DOIUrl":"10.1016/j.hrthm.2025.01.046","url":null,"abstract":"<div><h3>Background</h3><div><span>The electrocardiogram (ECG) in persistent atrial fibrillation (AF) is underused. Signal processing techniques can extract the </span><em>f</em>-waves from the QRS-T complex to generate the atrial ECG (A-ECG).</div></div><div><h3>Objective</h3><div>This study aimed to explore A-ECG technical and clinical issues.</div></div><div><h3>Methods</h3><div>Thirty patients (age, 62.6 ± 9.4 years; 80% male; CHA<sub>2</sub>DS<sub>2</sub><span><span>-VASc score, 2.2 ± 1.7; ejection fraction<span>, 47.9% ± 10.4%) with persistent AF undergoing ablation were enrolled. ECGs were downloaded for offline analysis. A-ECG was derived by QRS-T subtraction and </span></span>independent component analysis filtering. A-ECG short-term (DF</span><sub>10s</sub>, OI<sub>10s</sub>) and long-term (DF_Global, OI_Global) spectral features were derived. Optimal recording duration, temporal reproducibility, differences between leads, comparison to intracardiac dominant frequency (DF), acute ablation effect, and A-ECG differences based on ablation outcomes were evaluated.</div></div><div><h3>Results</h3><div>Time-frequency A-ECG analysis demonstrated dynamic spectral features. Repeated 10-second A-ECG recordings had higher coefficient of variation (7.5%–10.0%) compared with repeated 4- to 5-minute recordings (1.1%–3.4%). Short-term reproducibility of 2 recordings ∼30 minutes apart showed high correlation (<em>r</em> = 0.91–0.99; all <em>P</em> values < .0001). Regional lead analyses showed no significant differences except for the comparison of posterior leads V<sub>7</sub>–V<sub>9</sub> vs V<sub>1</sub>–V<sub>3</sub>. A-ECG DF parameters correlated with right atrial DF (<em>r</em> = 0.64–0.72; <em>P</em> < .0001) and not left atrial DF. A-ECG DF declined after ablation (median-DF<sub>10s</sub>-1min, 5.94 ± 0.63 Hz vs 5.77 ± 0.63 Hz; <em>P</em> = .0003). Patients with successful ablation at 1 year had higher A-ECG DF vs those with recurrences (median-DF<sub>10s</sub>-5min, 6.04 ± 0.42 Hz vs 5.13 ± 0.93 Hz; <em>P</em> = .003).</div></div><div><h3>Conclusion</h3><div>This study provides the practical basis for further use of the A-ECG as a novel tool for evaluating persistent AF and demonstrates its clinical relevance. Further phenotypic classification of AF based on the A-ECG and assessment of treatment response should be explored.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 1","pages":"Pages 77-88"},"PeriodicalIF":5.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.hrthm.2025.09.026
Salik ur Rehman Iqbal MD, MPH , Thomas Kueffer PhD , Sven Knecht PhD , Patrick Badertscher MD , Jens Maurhofer MD , Philipp Krisai MD , Corinne Jufer MS , Gregor Thalmann MD , Dik Heg PhD , Helge Servatius MD , Hildegard Tanner MD , Michael Kühne MD , Laurent Roten MD , Christian Sticherling MD , Tobias Reichlin MD , COMPARE-CRYO Trial Investigators
Background
Recurrence after atrial fibrillation (AF) ablation is commonly defined as any atrial arrhythmia lasting ≥30 seconds. It is unclear how alternative efficacy end point definitions would change the observed success rates and how they would relate to patients’ disease burden or health care utilization metrics.
Objective
This study aimed to evaluate the impact of alternative end point definitions after AF ablation based on AF-burden, duration or number of episodes using implantable cardiac monitors (ICM).
Methods
This is a prespecified substudy of the COMPARE-CRYO (COMPARison of the PolarX and the Arctic Front CRYOballoon for pulmonary vein isolation) study, which enrolled patients with paroxysmal AF undergoing cryoballoon ablation. All patients underwent ICM implantation, and the blanking period was 90 days. Details were collected on timing, duration, and number of episodes, and AF-burden between 91–365 days. Outcome measures were redo ablations and AF-related hospitalizations.
Results
The primary end point of any recurrence lasting ≥30 seconds occurred in 89 of 201 patients (44%). One-year success rates increased with increasing arrhythmia duration thresholds from 56% (≥30 sec) to 97% (≥24 hrs), with number of episode thresholds from 56% (≥1 episode) to 98% (≥100 episodes) and with AF-burden thresholds from 56% (AF-burden >0%) to 93% (AF-burden >2%). Rates of redo ablations and AF-related hospitalizations increased for AF-episode durations >1 hour, >6 AF-episodes, and an AF-burden >0.1%, and were highest for AF-episode durations >24 hours, >33 AF-episodes, and an AF-burden >1%.
Conclusion
Alternative efficacy end point definitions have a significant impact on reported outcomes and health care utilization metrics after AF ablation. These findings are important when considering end point definitions other than the traditional 30 seconds in the design of future AF-ablation trials.
{"title":"Impact of alternative efficacy end point definitions on reported outcomes after ablation of paroxysmal atrial fibrillation – Insights from the COMPARE-CRYO study using continuous rhythm monitoring","authors":"Salik ur Rehman Iqbal MD, MPH , Thomas Kueffer PhD , Sven Knecht PhD , Patrick Badertscher MD , Jens Maurhofer MD , Philipp Krisai MD , Corinne Jufer MS , Gregor Thalmann MD , Dik Heg PhD , Helge Servatius MD , Hildegard Tanner MD , Michael Kühne MD , Laurent Roten MD , Christian Sticherling MD , Tobias Reichlin MD , COMPARE-CRYO Trial Investigators","doi":"10.1016/j.hrthm.2025.09.026","DOIUrl":"10.1016/j.hrthm.2025.09.026","url":null,"abstract":"<div><h3>Background</h3><div>Recurrence after atrial fibrillation (AF) ablation is commonly defined as any atrial arrhythmia lasting ≥30 seconds. It is unclear how alternative efficacy end point definitions would change the observed success rates and how they would relate to patients’ disease burden or health care utilization metrics.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the impact of alternative end point definitions after AF ablation based on AF-burden, duration or number of episodes using implantable cardiac monitors (ICM).</div></div><div><h3>Methods</h3><div>This is a prespecified substudy of the COMPARE-CRYO (COMPARison of the PolarX and the Arctic Front CRYOballoon for pulmonary vein isolation) study, which enrolled patients with paroxysmal AF undergoing cryoballoon ablation. All patients underwent ICM implantation, and the blanking period was 90 days. Details were collected on timing, duration, and number of episodes, and AF-burden between 91–365 days. Outcome measures were redo ablations and AF-related hospitalizations.</div></div><div><h3>Results</h3><div>The primary end point of any recurrence lasting ≥30 seconds occurred in 89 of 201 patients (44%). One-year success rates increased with increasing arrhythmia duration thresholds from 56% (≥30 sec) to 97% (≥24 hrs), with number of episode thresholds from 56% (≥1 episode) to 98% (≥100 episodes) and with AF-burden thresholds from 56% (AF-burden >0%) to 93% (AF-burden >2%). Rates of redo ablations and AF-related hospitalizations increased for AF-episode durations >1 hour, >6 AF-episodes, and an AF-burden >0.1%, and were highest for AF-episode durations >24 hours, >33 AF-episodes, and an AF-burden >1%.</div></div><div><h3>Conclusion</h3><div>Alternative efficacy end point definitions have a significant impact on reported outcomes and health care utilization metrics after AF ablation. These findings are important when considering end point definitions other than the traditional 30 seconds in the design of future AF-ablation trials.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 1","pages":"Pages 63-69"},"PeriodicalIF":5.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.hrthm.2025.02.014
Martin H. Ruwald MD, PhD, DMSc, Arne Johannessen MD, DMSc, Rene Worck MD, PhD, Morten Lock Hansen MD, PhD, Martin Haugdal MSc, Jim Hansen MD, DMSc
Background
Pulsed field ablation (PFA) is a promising novel method of atrial ablation, with preclinical data suggesting it to be a viable option for ventricular arrhythmias.
Objective
The objective was to report the feasibility, safety, and clinical efficacy of PFA for ventricular arrhythmias.
Methods
All patients (N = 35) scheduled for ablation of premature ventricular complexes (PVCs; n = 24) or ventricular tachycardia (VT; n = 11) underwent focal PFA by use of a pulsed field generator and irrigated ablation catheters. Procedural and clinical outcomes were evaluated by 3-month Holter monitoring, implantable cardioverter-defibrillator home monitoring, and chart review.
Results
A total of 11 (31%) patients had experienced previously failed radiofrequency ablation. Most PVCs (58%) originated from the outflow tracts, and most VTs were caused by ischemic cardiomyopathy (55%). Average procedure time was 187 ± 59 minutes. Acute procedural success was achieved in 91% of the patients. PFA was delivered combined endocardially and through the cardiac venous system in 25% of the PVC patients. During a mean follow-up of 288 ± 149 days, the success was 75% for PVCs and 45% for VTs. A total of 5 patients were reablated during follow-up (4 VT, 1 PVC). We observed 7 (20%) minor and 2 (6%) major complications including 2 transient conduction system blocks related to pulsed field delivery and 1 stroke and 1 minor stroke.
Conclusion
Focal PFA exhibited satisfactory acute effectiveness for PVC and VT, but favorable clinical effectiveness was retained only in PVC patients. More data are needed to establish lesion durability, safety, and limitations of PFA in ventricular tissue.
{"title":"Feasibility and midterm effectiveness of focal pulsed field ablation for ventricular arrhythmias","authors":"Martin H. Ruwald MD, PhD, DMSc, Arne Johannessen MD, DMSc, Rene Worck MD, PhD, Morten Lock Hansen MD, PhD, Martin Haugdal MSc, Jim Hansen MD, DMSc","doi":"10.1016/j.hrthm.2025.02.014","DOIUrl":"10.1016/j.hrthm.2025.02.014","url":null,"abstract":"<div><h3>Background</h3><div>Pulsed field ablation (PFA) is a promising novel method of atrial ablation, with preclinical data suggesting it to be a viable option for ventricular arrhythmias.</div></div><div><h3>Objective</h3><div>The objective was to report the feasibility, safety, and clinical efficacy of PFA for ventricular arrhythmias.</div></div><div><h3>Methods</h3><div>All patients (N = 35) scheduled for ablation of premature ventricular complexes<span> (PVCs; n = 24) or ventricular tachycardia<span> (VT; n = 11) underwent focal PFA by use of a pulsed field generator and irrigated ablation catheters. Procedural and clinical outcomes were evaluated by 3-month Holter monitoring, implantable cardioverter-defibrillator home monitoring, and chart review.</span></span></div></div><div><h3>Results</h3><div><span>A total of 11 (31%) patients had experienced previously failed radiofrequency ablation. Most PVCs (58%) originated from the outflow tracts, and most VTs were caused by </span>ischemic cardiomyopathy<span> (55%). Average procedure time was 187 ± 59 minutes. Acute procedural success was achieved in 91% of the patients. PFA was delivered combined endocardially and through the cardiac venous system in 25% of the PVC patients. During a mean follow-up of 288 ± 149 days, the success was 75% for PVCs and 45% for VTs. A total of 5 patients were reablated during follow-up (4 VT, 1 PVC). We observed 7 (20%) minor and 2 (6%) major complications including 2 transient conduction system blocks related to pulsed field delivery and 1 stroke and 1 minor stroke.</span></div></div><div><h3>Conclusion</h3><div>Focal PFA exhibited satisfactory acute effectiveness for PVC and VT, but favorable clinical effectiveness was retained only in PVC patients. More data are needed to establish lesion durability, safety, and limitations of PFA in ventricular tissue.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 1","pages":"Pages 97-104"},"PeriodicalIF":5.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.hrthm.2025.02.006
Erich L. Kiehl MD , Stavros E. Mountantonakis MD , Moussa C. Mansour MD, FHRS , Devi G. Nair MD, FHRS , Dinesh Sharma MD, FHRS , Tyler L. Taigen MD , Petr Neuzil MD , Josef Kautzner MD , Jose Osorio MD, FHRS , Andrea Natale MD, FHRS , John D. Hummel MD, FHRS , Anish K. Amin MD, FHRS , Usman R. Siddiqui MD, FHRS , Alan Bulava MD , Shephal K. Doshi MD , Chinmay P. Patel MD , Yisachar J. Greenberg MD , Roderick H. Tung MD, FHRS , Doron Harlev MD, MBA , Paul Hultz MSc , Elad Anter MD
Background
The SPHERE Per-AF trial demonstrated noninferiority for a primary composite effectiveness endpoint in patients with persistent atrial fibrillation (AF) treated with a 9-mm, lattice-tip, pulsed field (PF)/radiofrequency (RF) system (74%) vs conventional contact force-sensing RF (65%). Although operators were highly experienced with the control, the vast majority was new to the investigational system.
Objective
The aim of this study was to assess the learning curve using this novel system.
Methods
Patients were grouped based on the sequential procedures performed per operator. Operators who performed ≤2 investigational procedures were excluded. The composite effectiveness endpoint was freedom from acute procedural failure, repeat ablation at any time, recurrence of arrhythmia, drug initiation/escalation, or cardioversion each at 1 year excluding a 3-month blanking period. Efficiency endpoints included “skin-to-skin” procedure time.
Results
The total cohort included 443 patients (235 investigational [31 roll-in], 208 control). Primary effectiveness in the investigational cohort improved significantly with increased procedural order. Efficacy was 65% (74 of 114) for the first 5 patients per operator, 75% (33 of 44) for patients 6 to 10, and 80% (60 of 75) for patients >10. Kaplan-Meier effectiveness estimates at 1-year follow-up were significantly higher in the investigational cohort after 10 procedures performed, compared with control (80% vs 65%, P < .05). With the investigational system, total procedure time was reduced by 25 minutes (100 vs 125) within the first 5 procedures performed (P < .001).
Conclusion
AF ablation with a novel dual-energy, lattice-tip ablation system resulted in greater clinical efficacy compared with conventional RF after a rapid operator learning curve, with superior procedural efficiency noted from the initial procedures onward.
Clinical Trial Registration
NCT05120193
背景：SPHERE Per-AF试验表明，与传统接触式力传感射频（65%）相比，使用9毫米点阵尖端脉冲场(PF)/射频（RF）系统治疗的持续性心房颤动（AF）患者的主要复合有效性终点（74%）无劣势。虽然操作员在控制方面经验丰富，但绝大多数是调查系统的新手。目的：评价该系统的学习曲线。方法：根据每位手术人员的手术顺序对患者进行分组。进行了≤2次调查操作的操作人员被排除在外。综合疗效终点为无急性手术失败、任何时间重复消融、心律失常复发、药物起始/升级或除3个月空白期外每一年的心律转复。效率终点包括“皮肤到皮肤”的手术时间。结果：总队列包括443例患者（235例为研究组[31入组]，208例为对照组）。随着程序顺序的增加，研究队列的主要有效性显著提高。每名操作者前5名患者的疗效为65%(74/114)，6-10名患者的疗效为75% (33/44)，bbb10名患者的疗效为80%（60/75）。与对照组相比，研究队列在进行10次手术后，1年随访时的Kaplan-Meier有效性估计显着高于对照组（80% vs 65%）。结论：在快速的操作人员学习曲线后，采用新型双能量、点阵尖端消融系统的房颤消融与传统射频相比具有更高的临床疗效，从初始手术开始就具有卓越的手术效率。
{"title":"Operator learning curve with a novel dual-energy lattice-tip ablation system","authors":"Erich L. Kiehl MD , Stavros E. Mountantonakis MD , Moussa C. Mansour MD, FHRS , Devi G. Nair MD, FHRS , Dinesh Sharma MD, FHRS , Tyler L. Taigen MD , Petr Neuzil MD , Josef Kautzner MD , Jose Osorio MD, FHRS , Andrea Natale MD, FHRS , John D. Hummel MD, FHRS , Anish K. Amin MD, FHRS , Usman R. Siddiqui MD, FHRS , Alan Bulava MD , Shephal K. Doshi MD , Chinmay P. Patel MD , Yisachar J. Greenberg MD , Roderick H. Tung MD, FHRS , Doron Harlev MD, MBA , Paul Hultz MSc , Elad Anter MD","doi":"10.1016/j.hrthm.2025.02.006","DOIUrl":"10.1016/j.hrthm.2025.02.006","url":null,"abstract":"<div><h3>Background</h3><div>The SPHERE Per-AF trial demonstrated noninferiority for a primary composite effectiveness endpoint in patients with persistent atrial fibrillation (AF) treated with a 9-mm, lattice-tip, pulsed field (PF)/radiofrequency (RF) system (74%) vs conventional contact force-sensing RF (65%). Although operators were highly experienced with the control, the vast majority was new to the investigational system.</div></div><div><h3>Objective</h3><div>The aim of this study was to assess the learning curve using this novel system.</div></div><div><h3>Methods</h3><div><span>Patients were grouped based on the sequential procedures performed per operator. Operators who performed ≤2 investigational procedures were excluded. The composite effectiveness endpoint was freedom from acute procedural failure, repeat ablation at any time, recurrence of arrhythmia, drug initiation/escalation, or </span>cardioversion each at 1 year excluding a 3-month blanking period. Efficiency endpoints included “skin-to-skin” procedure time.</div></div><div><h3>Results</h3><div>The total cohort included 443 patients (235 investigational [31 roll-in], 208 control). Primary effectiveness in the investigational cohort improved significantly with increased procedural order. Efficacy was 65% (74 of 114) for the first 5 patients per operator, 75% (33 of 44) for patients 6 to 10, and 80% (60 of 75) for patients >10. Kaplan-Meier effectiveness estimates at 1-year follow-up were significantly higher in the investigational cohort after 10 procedures performed, compared with control (80% vs 65%, <em>P</em> < .05). With the investigational system, total procedure time was reduced by 25 minutes (100 vs 125) within the first 5 procedures performed (<em>P</em> < .001).</div></div><div><h3>Conclusion</h3><div>AF ablation with a novel dual-energy, lattice-tip ablation system resulted in greater clinical efficacy compared with conventional RF after a rapid operator learning curve, with superior procedural efficiency noted from the initial procedures onward.</div></div><div><h3>Clinical Trial Registration</h3><div><span><span>NCT05120193</span><svg><path></path></svg></span></div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 1","pages":"Pages 89-96"},"PeriodicalIF":5.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Direct oral anticoagulants (DOACs) have been studied in nonvalvular atrial fibrillation (AF) (NVAF). Data are lacking in patients with nonmechanical valvular (NMV) AF.
Objective
We hypothesized that DOACs were safe and effective in patients with NMV AF.
Methods
A retrospective cohort study was designed within administrative health care databases. The cohort entry date was the first DOAC dispensation or 3 months after the NMV procedures. Follow-up was until the end of data availability or exposure to DOACs. The primary outcome was ischemic stroke or embolism. The secondary outcome was major bleeding. Event rates were compared with those in patients with NVAF in the same databases and included in a meta-analysis.
Results
A total of 692 patients were included. Of those, 100 patients (14.4%) received dabigatran, 229 (33.1%) rivaroxaban, and 363 (52.5%) apixaban. Owing to low event incidence, data were pooled. There were 7 ischemic strokes/embolisms in 699 person-years, an incidence rate of 1.00 per 100 person-years (95% confidence interval [CI] 0.48–2.10), and 12 major bleedings in 689 person-years, an incidence rate of 1.74 per 100 person-years (95% CI 0.99–3.07). NVAF cohorts demonstrated 554 ischemic strokes/embolisms in 6707.58 person-years, an incidence rate of 0.83 per 100 person-years (95% CI 0.76–0.90; P = .613), and 1907 major bleedings in 64,178.27 person-years, an incidence rate of 2.97 per 100 person-years (95% CI 2.84–3.11; P = .065). Event rates were overlapping with other studies.
Conclusion
This is the largest cohort of patients with NMV AF and DOACs to be described. Based on low event rates, our data support the prescribing of DOACs in this population.
{"title":"Safety and effectiveness of direct oral anticoagulants in AF patients with nonmechanical valves","authors":"Isabelle Greiss MD , Liliya Sinyavskaya PhD , Alexis Matteau MD, MPH , Paolo Costi MD , Benoit Coutu MD , Fadi Mansour MD , Jean-Marc Raymond MD , Wouter Saint-Phard MD , Madeleine Durand MD, MSc","doi":"10.1016/j.hrthm.2025.06.047","DOIUrl":"10.1016/j.hrthm.2025.06.047","url":null,"abstract":"<div><h3>Background</h3><div>Direct oral anticoagulants (DOACs) have been studied in nonvalvular atrial fibrillation (AF) (NVAF). Data are lacking in patients with nonmechanical valvular (NMV) AF.</div></div><div><h3>Objective</h3><div>We hypothesized that DOACs were safe and effective in patients with NMV AF.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was designed within administrative health care databases. The cohort entry date was the first DOAC dispensation or 3 months after the NMV procedures. Follow-up was until the end of data availability or exposure to DOACs. The primary outcome was ischemic stroke or embolism. The secondary outcome was major bleeding. Event rates were compared with those in patients with NVAF in the same databases and included in a meta-analysis.</div></div><div><h3>Results</h3><div>A total of 692 patients were included. Of those, 100 patients (14.4%) received dabigatran, 229 (33.1%) rivaroxaban, and 363 (52.5%) apixaban. Owing to low event incidence, data were pooled. There were 7 ischemic strokes/embolisms in 699 person-years, an incidence rate of 1.00 per 100 person-years (95% confidence interval [CI] 0.48–2.10), and 12 major bleedings in 689 person-years, an incidence rate of 1.74 per 100 person-years (95% CI 0.99–3.07). NVAF cohorts demonstrated 554 ischemic strokes/embolisms in 6707.58 person-years, an incidence rate of 0.83 per 100 person-years (95% CI 0.76–0.90; <em>P</em> = .613), and 1907 major bleedings in 64,178.27 person-years, an incidence rate of 2.97 per 100 person-years (95% CI 2.84–3.11; <em>P</em> = .065). Event rates were overlapping with other studies.</div></div><div><h3>Conclusion</h3><div>This is the largest cohort of patients with NMV AF and DOACs to be described. Based on low event rates, our data support the prescribing of DOACs in this population.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 1","pages":"Pages 70-76"},"PeriodicalIF":5.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.hrthm.2025.07.035
Aviram Hochstadt MD, MPH , Chirag R. Barbhaiya MD , Lior Jankelson MD, PhD , Joseph Levine MD
{"title":"Pulsed field ablation and periprocedural stroke risk—A step in the right direction","authors":"Aviram Hochstadt MD, MPH , Chirag R. Barbhaiya MD , Lior Jankelson MD, PhD , Joseph Levine MD","doi":"10.1016/j.hrthm.2025.07.035","DOIUrl":"10.1016/j.hrthm.2025.07.035","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 1","pages":"Pages e1-e2"},"PeriodicalIF":5.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号