Heart rhythm最新文献

{"title":"Extrastimuli-assisted functional mapping improves ventricular tachycardia ablation outcomes: A systematic review, meta-analysis, and meta-regression","authors":"Bruno Wilnes ,&nbsp;Beatriz Castello-Branco ,&nbsp;Eduardo Maia Martins Pereira ,&nbsp;Luiza Marinho Lopes ,&nbsp;Vivian Barroso Santos ,&nbsp;Ana Clara Bicalho ,&nbsp;Lucas Melo ,&nbsp;Sara Regina Silva Cupertino ,&nbsp;Anna Terra França MD, MSc ,&nbsp;Marcos Roberto Queiroz França MD, MSc ,&nbsp;Gustavo de Araújo Silva MD, MSc ,&nbsp;Marina Pereira Mayrink MD ,&nbsp;Isabella Moreira Gonzalez Fonseca MD ,&nbsp;Reynaldo Castro de Miranda MD, PhD ,&nbsp;José Luiz Padilha da Silva PhD ,&nbsp;Maria Carmo Pereira Nunes MD, MSc, PhD ,&nbsp;Andre Assis Lopes do Carmo MD, MSc, PhD","doi":"10.1016/j.hrthm.2025.03.2000","DOIUrl":"10.1016/j.hrthm.2025.03.2000","url":null,"abstract":"<div><h3>Background</h3><div>In the context of ventricular tachycardia (VT) ablation, functional electroanatomic mapping techniques may help identify arrhythmogenic substrates in scarred and normal voltage areas. In addition, extrastimuli-assisted (dynamic) mapping may be more effective than intrinsic rhythm (static) approaches to uncover key ablation targets, potentially improving procedure outcomes.</div></div><div><h3>Objective</h3><div>We aimed to assess the efficacy and safety of functional mapping–assisted VT ablation and to compare procedural outcomes between dynamic and static mapping approaches.</div></div><div><h3>Methods</h3><div><span><span>PubMed/MEDLINE, Scopus<span>, Web of Science, and Cochrane databases were searched using </span></span>MeSH terms </span><span><span>ventricular tachycardia</span><em> ablation</em></span>, <em>functional mapping</em>, <em>recurrence</em>, <em>complications</em>, and similar keywords. Meta-analyses of single proportions, rates, and means were performed, employing random effects models and <em>P</em> &lt; .05. Subgroup analysis and meta-regression were performed.</div></div><div><h3>Results</h3><div><span>We included 16 studies, covering 674 patients, with follow-up ranging from 6 to 38.1 ± 29.7 months. Ischemic cause represented 490 (72.7%) patients; left ventricular ejection fraction varied from 25% ± 10% to 41.5% ± 13.8%. Dynamic mapping was used in 9 (57.1%) studies, 6 (37.5%) studies employed static techniques, and 1 (6.3%) study used a mixed approach. Procedure duration (</span><em>P</em> = .520) and complication incidence (<em>P</em> = .110) were similar between dynamic and static mapping modalities. The dynamic mapping subgroup exhibited significantly lower VT recurrence rate compared with the static mapping population (<em>P</em><span> &lt; .010). This result persisted on a meta-regression model adjusted for ischemic cause and left ventricular ejection fraction, demonstrating that dynamic functional mapping was independently associated with lower recurrence rates (</span><em>P</em> = .005).</div></div><div><h3>Conclusion</h3><div>Functional mapping was demonstrated to be safe for VT ablation. Dynamic functional mapping independently associated with reduced postablation recurrence rates without significantly increasing procedure duration.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages 632-644"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794707","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}

{"title":"Emerging trends in atrial fibrillation and flutter among younger adults in the United States","authors":"Issam Motairek MD,&nbsp;Chadi Tabaja MD,&nbsp;Arwa Younis MD,&nbsp;Ayman A. Hussein MD,&nbsp;Mohamad Mdaihly MD,&nbsp;Adele Watfa MD,&nbsp;Pasquale Santangeli MD, PhD,&nbsp;Mina Chung MD,&nbsp;Walid I. Saliba MD,&nbsp;Oussama M. Wazni MD, MBA","doi":"10.1016/j.hrthm.2025.05.068","DOIUrl":"10.1016/j.hrthm.2025.05.068","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages 774-775"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233957","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}

{"title":"Kerfed tip enhances catheter stability during accessory pathways ablation in children","authors":"Dustin Nash MD,&nbsp;Kathryn Collins MD,&nbsp;David Martin Runciman MD,&nbsp;Johannes von Alvensleben MD","doi":"10.1016/j.hrthm.2025.06.007","DOIUrl":"10.1016/j.hrthm.2025.06.007","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages 776-778"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301920","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}

{"title":"Catheter ablation of atrial fibrillation in patients with heart failure: Insights from the NCDR atrial fibrillation ablation registry","authors":"Omair Yousuf MD ,&nbsp;Joseph Akar MD, PhD ,&nbsp;Zhen Tan MS ,&nbsp;Mutaz Alkalbani MD ,&nbsp;Hameeda Tasneem MD ,&nbsp;Benjamin A. Steinberg MD, MHS, FHRS ,&nbsp;Jonathan C. Hsu MD, MAS, FHRS ,&nbsp;Brett Atwater MD, FHRS ,&nbsp;Eunice Yang MD, PhD ,&nbsp;John Spertus MD, MPH ,&nbsp;Hugh Calkins MD, FHRS ,&nbsp;James V. Freeman MD, MPH, MS","doi":"10.1016/j.hrthm.2025.06.048","DOIUrl":"10.1016/j.hrthm.2025.06.048","url":null,"abstract":"<div><h3>Background</h3><div>Catheter ablation (CA) for atrial fibrillation (AF) is a widely used treatment strategy in patients with and without heart failure (HF).</div></div><div><h3>Objective</h3><div>To evaluate patient characteristics, ablation strategies, and complications of CA for AF by HF status.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of patients undergoing CA between 2016 and 2022 from the National Cardiovascular Data Registry. Patients were grouped by: HF with reduced ejection fraction (HFrEF), HF with preserved EF (HFpEF), and no HF. Multivariable logistic regression was used to assess complication risk.</div></div><div><h3>Results</h3><div>Among 75,527 patients, 51,285 had no HF, 13,625 had HFrEF, and 10,617 had HFpEF. HF groups had a higher prevalence of hypertension, diabetes, and coronary disease. Patients with HFrEF received more adjunctive ablation than patients HFpEF or no HF, including linear (32%, 29.3%, and 23.4%, respectively) and cavotricuspid isthmus ablation (33.1%, 30.2%, and 30.1%, respectively) (<em>P &lt;</em> .0001). Complication rates were higher in HFrEF (4%) and HFpEF (3.8%) vs no HF (2%), with adjusted odds ratios (HFrEF: OR, 1.80; <em>P &lt;</em> .0001; HFpEF: OR, 1.42; <em>P &lt;</em> .0001). Complication rates declined from 2016 to 2022 across all groups (HFrEF: 5.2% to 2.9%, <em>P =</em> .0002; HFpEF: 5.9% to 3.0%, <em>P &lt;</em> .0001; no HF: 2.8% to 1.6%, <em>P &lt;</em> .0001). Ablation volume increased from 2018 to 2022 by 138% (HFrEF), 191% (HFpEF), and 113% (no HF).</div></div><div><h3>Conclusion</h3><div>Patients with HFrEF and HFpEF have more comorbidities, undergo more adjunctive ablation, and experience higher complication rates. Despite this, ablation volumes rose and complications declined across all groups over time.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages 613-622"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753214","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}

{"title":"Oxidative stress mediates cardiac electrophysiological injury in inhalation exposure to flavored vaping products","authors":"Obada Abou-Assali MS ,&nbsp;Bojjibabu Chidipi PhD ,&nbsp;Mengmeng Chang PhD ,&nbsp;Michelle Reiser MS ,&nbsp;Ryan Asswaytte BS ,&nbsp;Yuting Zhang MD ,&nbsp;Van Bao Long Duong BS ,&nbsp;Charles Szekeres PhD ,&nbsp;Laurent Calcul PhD ,&nbsp;Sami F. Noujaim PhD","doi":"10.1016/j.hrthm.2025.09.006","DOIUrl":"10.1016/j.hrthm.2025.09.006","url":null,"abstract":"<div><h3>Background</h3><div>Electronic nicotine delivery systems (ENDS) use “E-liquids” to generate “E-vapor,” an inhalable aerosolized mixture containing nicotine and flavors. Flavored ENDS are very popular among teens who vape, however, the possible cardiac electrophysiological harm of inhalation exposure to flavored ENDS are not fully understood.</div></div><div><h3>Objective</h3><div>To test if inhalation exposure to flavoring carbonyls in E-liquids compromises mitochondrial integrity, increases oxidative stress, and leads to cardiac electrophysiological toxicity.</div></div><div><h3>Methods</h3><div>Gas chromatography mass spectrometry (GC/MS), and flow cytometry, oxygen consumption rate measurement, in vivo programmed electrical stimulation (PES), and multielectrode array (MEA) were used in atrial like HL-1 myocytes, human induced pluripotent stem cells-derived cardiomyocytes, and in mice overexpressing the antioxidant mitochondrial catalase (mCAT) exposed to flavored E-vapor.</div></div><div><h3>Results</h3><div>We compared the toxicity of E-vapor exposure from 30 differently flavored E-liquids (70% vegetable glycerin, 30% propylene glycol, with 6 mg/mL nicotine) in HL-1 cells using apoptotic annexin V flow cytometry. The toxicity of most E-liquids was significantly higher than air control. We subsequently determined the composition and quantified the concentrations of major flavoring carbonyls (cinnamaldehyde, vanillin, ethyl vanillin, maltol, and ethyl maltol) in the E-liquids using GC/MS. Linear regression analysis showed that toxicity correlated with carbonyl concentration. We then measured in HL-1 cells exposed to vanilla flavored E-vapor reactive oxygen species (ROS) and mitochondrial membrane potential (ΔΨ) with flow cytometry, respectively. ROS increased in exposed cells, but this was prevented by N-acetylcysteine antioxidant pretreatment, and ΔΨ was depolarized in exposed cells. In vivo inhalation exposure to vanilla flavored E-vapor increased the duration of PES-induced ventricular tachycardia in wild type but not in mCAT mice, compared with air controls. Finally, MEA recordings in hiPSC-derived cardiomyocytes monolayers exposed to vanilla flavored E-vapor, with or without nicotine, resulted in decreased activation time, and increased corrected field potential duration.</div></div><div><h3>Conclusion</h3><div>Inhalation exposure to flavored ENDS negatively affects ventricular electrophysiology, in part via adverse mitochondrial remodeling, and increased oxidative stress.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages 751-765"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033077","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}

{"title":"Endo–epicardial electrical disarray in arrhythmogenic cardiomyopathy with ventricular arrhythmias","authors":"Johanna B. Tonko MD, PhD ,&nbsp;Gema Cabero-Vidal MEng ,&nbsp;Samuel Ruipérez-Campillo MSc, MEng ,&nbsp;Eva Cabrera-Borrego MD, PhD ,&nbsp;Cristina Lozano MD, PhD ,&nbsp;Elisa Ramírez MEng ,&nbsp;Javier Moreno MD ,&nbsp;Pablo Sánchez-Millán MD ,&nbsp;Anthony Chow MD ,&nbsp;Juan Jiménez-Jáimez MD PhD ,&nbsp;José Millet PhD ,&nbsp;Francisco Castells PhD ,&nbsp;Pier D. Lambiase MD, PhD, FHRS","doi":"10.1016/j.hrthm.2025.09.012","DOIUrl":"10.1016/j.hrthm.2025.09.012","url":null,"abstract":"<div><h3>Background</h3><div>Arrhythmogenic cardiomyopathy (ACM) is a hereditary condition frequently presenting with ventricular arrhythmias (VA). VA burden may be disproportionate to detectable structural alterations.</div></div><div><h3>Objective</h3><div>To quantify local disorganization of electrical propagation using the vector field heterogeneity (VFH) metric in patients with ACM and to assess whether VFH may unmask subclinical substrate missed in conventional voltage maps.</div></div><div><h3>Methods</h3><div>High-density endo–epicardial substrate maps acquired with a 16-pole grid catheter in patients with ACM were retrospectively reviewed. Directional vector maps of electrical propagation were computed offline from 4 × 4 unipolar arrays. VFH, ranging from 0 (perfect planar wave) to 1 (maximal disorganization), was estimated as a quantitative measure of local propagation heterogeneity. VFH values were compared between endo- and epicardial maps and across omnipolar voltage (OV)-defined regions: normal (OV &gt;1.5 mV), border zone (0.3–1.5 mV), scar (&lt;0.3 mV), as well as isochronal deceleration zones (DZs).</div></div><div><h3>Results</h3><div>Overall, 23 patients were included. VFH differed significantly across voltage categories (<em>P</em> &lt; .001) with highest VFH observed in regions OV &lt;0.3 mV (epi 0.57 [0.28] vs endo 0.56 [0.30]). In border zone regions, epicardial VFH exceeded endocardial VFH (0.41 [0.42] vs 0.39 [0.45]), whereas in normal OV areas, endocardial VFH was higher than epicardial VFH (epi 0.17 [0.27] vs endo 0.29 [0.34]). Highest VFH were recorded at sites of DZs (0.59 [0.25]), with a trend toward increased electrical disarray during sensed extras (0.62 [0.28], <em>P</em> = .88).</div><div>Notably, in epicardial regions with normal-voltage directly adjacent to low-voltage substrate, VFH was significantly elevated compared with overall normal-voltage areas (0.26 [0.32] vs 0.17 [0.27], <em>P &lt;</em> .001).</div></div><div><h3>Conclusion</h3><div>In patients with ACM, VFH identified a significantly increased heterogeneity in electrical propagation at sites of scar and DZs, but also in normal-voltage areas adjacent to low-voltage areas and on the endocardium. This could indicate microstructural alterations and/or transmural disease progression that are missed in traditional assessments but unmasked by VFH, and could complement existing substrate mapping approaches in ACM.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages 654-664"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039932","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}

{"title":"Association of phenotypic age acceleration with risk of sudden cardiac arrest: Evidence from a large retrospective cohort","authors":"Chuxian Guo MD, MD ,&nbsp;Zenghui Zhang MD ,&nbsp;Yan Li MD ,&nbsp;Shaojie Han MD ,&nbsp;Yuanqi Su BMed ,&nbsp;Feifei Wang MD ,&nbsp;Jui-Ning Yeh MD ,&nbsp;Panpan Li MD ,&nbsp;Chunyan Jian MD ,&nbsp;Xin Song MD ,&nbsp;Yan Feng MD ,&nbsp;Fangli Wang MD ,&nbsp;Shan Zhuo MD ,&nbsp;Haoran Li BMed ,&nbsp;Huimin Zhu MD ,&nbsp;Zhaoyu Liu MD, PhD ,&nbsp;Jun Guo MD, PhD, FHRS","doi":"10.1016/j.hrthm.2025.10.064","DOIUrl":"10.1016/j.hrthm.2025.10.064","url":null,"abstract":"<div><h3>Background</h3><div>Biological processes of aging significantly contribute to cardiovascular disease (CVD) development. Phenotypic age acceleration (PhenoAgeAccel) is recognized as convenient proxy for biological aging. However, its relationship with sudden cardiac arrest (SCA) remains unclear.</div></div><div><h3>Objective</h3><div>The purpose of this study was to evaluate associations between the PhenoAgeAccel and the risk of incident SCA.</div></div><div><h3>Methods</h3><div>This retrospective cohort analysis included 360,663 participants in the UK Biobank with available PhenoAgeAccel data and no history of SCA. Cox proportional hazards models assessed the association between PhenoAgeAccel and SCA risk. Moreover, accelerated failure time models were used to investigate the timing of SCA onset. The impact of dynamic increases in PhenoAgeAccel levels on SCA risk was evaluated using restricted cubic splines.</div></div><div><h3>Results</h3><div>Over a median follow-up period of 13.68 years, 2194 cases of SCA were recorded. Multivariate Cox regression analysis revealed an 83% increase in SCA risk per 10-year increase in PhenoAgeAccel (adjusted hazard ratio = 1.83, 95% confidence interval 1.69–1.98). Accelerated failure time models indicated earlier median times to SCA occurrence with increasing quartiles of PhenoAgeAccel than with the lowest quartile (<em>P</em> for trend &lt; .05). SCA risk increased linearly with gradual increases in PhenoAgeAccel levels (<em>P</em> for linearity = .629). Sex-stratified analyses showed stronger associations in women.</div></div><div><h3>Conclusion</h3><div>Accelerated biological aging could increase the risk of SCA, especially for women, and could reduce the life expectancy of people without CVD. The identification of populations with accelerated biological aging has important implications for reducing the risk of SCA and the risk of decreased life expectancy.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages e428-e435"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582163","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}

{"title":"Left ventricular ejection fraction response after atrial fibrillation ablation: Clinical predictors and development of the PACED score","authors":"Sayed Al-Aidarous MBBS ,&nbsp;Saffron Rajappan ,&nbsp;Nikhil Ahluwalia MBBS, PhD ,&nbsp;Christopher Patrick Uy MD ,&nbsp;Hatem Abdelgawad MBBS ,&nbsp;Caterina Vidal Horrach MSc ,&nbsp;Sofiane Kouadria MBBS ,&nbsp;Zhen Hua ,&nbsp;Gurkiran Sandhar ,&nbsp;Theo Cooke ,&nbsp;Salman Rasheed MBBS ,&nbsp;Suria Geran MBBS ,&nbsp;Kayla Chiew MBBS ,&nbsp;Meher Lehri MBBS ,&nbsp;Dimitrios Palaiologos MBBS ,&nbsp;Arsalan Khalil MBBS ,&nbsp;Brett Kennedy MBBS ,&nbsp;Richard Balasubramaniam MBChB, PhD ,&nbsp;Shahana Hussain MBBS ,&nbsp;Lauren Stanton MBBS ,&nbsp;Shohreh Honarbakhsh MRCP, PhD","doi":"10.1016/j.hrthm.2025.11.039","DOIUrl":"10.1016/j.hrthm.2025.11.039","url":null,"abstract":"<div><h3>Background</h3><div>Catheter ablation for atrial fibrillation (AF) in left ventricular systolic dysfunction (LVSD) improves outcomes, yet left ventricular ejection fraction (LVEF) response is difficult to prospectively predict.</div></div><div><h3>Objective</h3><div>This study aimed to identify preprocedural predictors of LVEF response after AF ablation in patients with LVSD and develop a pragmatic score to stratify patients.</div></div><div><h3>Methods</h3><div>This multicenter cohort study included patients with AF and an LVEF of &lt;50% undergoing index ablation. The primary endpoint was responder status defined as ≥10% increase in LVEF or improvement to ≥50% on follow-up echocardiography after the final ablation. Multivariable logistic regression modeling, stratified by follow-up rhythm, was used to identify predictors and derive a simplified scoring tool.</div></div><div><h3>Results</h3><div>Among 366 patients (aged 64.4 ± 10.6 years; 82% male), 70.8% were left ventricular responders at follow-up. Predictors of nonresponse in the sinus rhythm subgroup included heart failure etiology, QRS duration of &gt;105 ms, paroxysmal AF, and type 2 diabetes. These were incorporated into the PACED score, which stratified response (score &lt;2, 87% probability of response; score ≥3, 71% of nonresponse) with good discrimination (c-statistic 0.83; 95% confidence interval 0.77–0.89). In the largest contemporary multicenter cardiac magnetic resonance subcohort, late gadolinium enhancement was more frequent among nonresponders (84.6% vs 53.6%; <em>P</em> &lt; .001). Guideline-directed medical therapy at baseline was not independently associated with recovery.</div></div><div><h3>Conclusion</h3><div>LVEF response post-AF ablation in patients with LVSD can be accurately predicted precatheter ablation with a bedside score. Left ventricular response depends primarily on substrate and conduction characteristics rather than pharmacotherapy in a guideline-directed medical therapy–optimized cohort. Late gadolinium enhancement on cardiac magnetic resonance is associated with an increased chance of being a nonresponder to ablation.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages e392-e402"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145632498","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}

{"title":"Best practices IV in cryoballoon ablation of atrial fibrillation: Important clinical and practical differences for new compliant and size-adjustable cryoballoon systems","authors":"Wilber Su MD, FHRS ,&nbsp;Rong Bai MD, FHRS ,&nbsp;Gian-Battista Chierchia MD ,&nbsp;Sing-Chien Yap MD, PhD ,&nbsp;Claudio Tondo MD, PhD, FHRS ,&nbsp;Richard Schilling MD ,&nbsp;Kevin Makati MD ,&nbsp;Emrie D. Tomaiko-Clark BA ,&nbsp;Jason G. Andrade MD, FHS","doi":"10.1016/j.hrthm.2025.04.002","DOIUrl":"10.1016/j.hrthm.2025.04.002","url":null,"abstract":"<div><h3>Background</h3><div>This paper aims to review and compare the mechanical and technical similarities and differences between the Arctic Front series cryoballoons from Medtronic and the next-generation cryoballoons, including POLARx and POLARx FIT from Boston Scientific and Nordica from Synaptic. As cryoballoon technology continues to evolve, the introduction of lower-pressure and selectable-size balloons presents new considerations for both safety and efficacy of cryoablation<span> of atrial fibrillation.</span></div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages 603-612"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969752","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}

{"title":"Network meta-analysis on efficacy of nerve stimulation or modulation in patients with heart failure","authors":"Ping-Tao Tseng MD, PhD ,&nbsp;Bing-Yan Zeng MD ,&nbsp;Chih-Wei Hsu MD ,&nbsp;Chao-Ming Hung MD, PhD ,&nbsp;Brendon Stubbs PhD ,&nbsp;Yen-Wen Chen MD ,&nbsp;Tien-Yu Chen MD, PhD ,&nbsp;Wei-Te Lei MD, PhD ,&nbsp;Jiann-Jy Chen MD ,&nbsp;Yow-Ling Shiue PhD ,&nbsp;Chih-Sung Liang MD","doi":"10.1016/j.hrthm.2025.04.004","DOIUrl":"10.1016/j.hrthm.2025.04.004","url":null,"abstract":"<div><h3>Background</h3><div>Dysfunction of the autonomic nervous system (characterized by excessive sympathetic activation and reduced parasympathetic activity) is regarded as 1 of the primary mechanisms of heart failure. Theoretically, nerve stimulation or modulation targeting this autonomic imbalance could improve outcomes in heart failure, but current evidence is inconclusive.</div></div><div><h3>Objective</h3><div>This systematic review and network meta-analysis (NMA) aimed to compare the efficacy of various nerve stimulation/modulation approaches in patients with heart failure.</div></div><div><h3>Methods</h3><div>We conducted a frequentist-based NMA of randomized controlled trials<span> (RCTs) investigating nerve stimulation or modulation techniques for heart failure management. The primary outcomes included objective measures (such as brain natriuretic peptide [BNP] serum levels) and subjective measures (such as psychosocial functioning and quality of life).</span></div></div><div><h3>Results</h3><div>Interventions targeting both arms of the autonomic nervous system, including sympathetic and parasympathetic nervous systems<span>, and the vasculature<span><span> (carotid or renal arteries) demonstrated preferable results. Interventions dealing only with the autonomic nervous system did not provide significant results. Specifically, only renal sympathetic denervation was significantly associated with a more significant reduction in BNP levels than in the control group. Additionally, </span>baroreflex<span> activation therapy was the only treatment significantly associated with improving quality of life.</span></span></span></div></div><div><h3>Conclusion</h3><div>This study provides comparative evidence supporting the use of specific nerve stimulation/modulation techniques in treating heart failure. Further well-designed RCTs, incorporating appropriate blinding, are recommended to minimize potential biases.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"23 3","pages":"Pages 623-631"},"PeriodicalIF":5.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999323","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}