J. Pongratz MD, L. Riess MD, S. Hartl MD, B. Brueck MD, C. Tesche MD, MHBA, FESC, FSCCT, D. Olbrich MD, M. Wankerl MD, U. Dorwarth MD, E. Hoffmann MD, FESC, F. Straube MD, FEHRA, FESC, FHRS
Purpose
Pulmonary vein isolation (PVI) is effective in treating atrial fibrillation (AF), but outcomes are worse for persistent AF (persAF) patients than paroxysmal AF (PAF) patients. The study aimed to identify differences in left atrial (LA) and left atrial appendage (LAA) anatomy in different AF types.
Methods
In a single-center observational study, a blinded retrospective analysis of preprocedural cardiac computed tomography angiography (CCTA) images was performed. The study evaluated the dimensions of the LA and pulmonary veins (PV), as well as the size and morphology of the LAA using a 3D electroanatomical mapping system.
Results
Between 2012 and 2016, a total of 1103 patients underwent second-generation cryoballoon PVI. Of these, 725 patients (65.7%) had CCTA available, and 473 of these (65.2%) had sufficient quality for measurements. The mean age of the patients was 66.3 ± 9.5 years, and PAF was present in 277 (58.6%) participants. The study found that in persAF patients, LA dimensions such as LA volume [mL] (108; 125; p < .001) or PV ostial dimensions were significantly larger than in those with PAF. LAA volume [mL] (8.3; 9.2; p = .005) and LAA ostial area [mm2] (325; 353; p = .01) were enlarged in persAF. There were no significant differences regarding LAA morphology, with the overall distribution being “windsock” (51%), “chicken-wing” (20%), “cauliflower” (15%), and “cactus” (13%).
Conclusion
Compared to PAF, persAF patients had significantly larger LA as well as LAA dimensions. LAA morphological types were distributed equally in both groups suggesting that LAA morphology may not be associated with the underlying AF type.
{"title":"Comparative analysis of left atrial size and appendage morphology in paroxysmal and persistent atrial fibrillation patients","authors":"J. Pongratz MD, L. Riess MD, S. Hartl MD, B. Brueck MD, C. Tesche MD, MHBA, FESC, FSCCT, D. Olbrich MD, M. Wankerl MD, U. Dorwarth MD, E. Hoffmann MD, FESC, F. Straube MD, FEHRA, FESC, FHRS","doi":"10.1002/joa3.13224","DOIUrl":"10.1002/joa3.13224","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Pulmonary vein isolation (PVI) is effective in treating atrial fibrillation (AF), but outcomes are worse for persistent AF (persAF) patients than paroxysmal AF (PAF) patients. The study aimed to identify differences in left atrial (LA) and left atrial appendage (LAA) anatomy in different AF types.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In a single-center observational study, a blinded retrospective analysis of preprocedural cardiac computed tomography angiography (CCTA) images was performed. The study evaluated the dimensions of the LA and pulmonary veins (PV), as well as the size and morphology of the LAA using a 3D electroanatomical mapping system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 2012 and 2016, a total of 1103 patients underwent second-generation cryoballoon PVI. Of these, 725 patients (65.7%) had CCTA available, and 473 of these (65.2%) had sufficient quality for measurements. The mean age of the patients was 66.3 ± 9.5 years, and PAF was present in 277 (58.6%) participants. The study found that in persAF patients, LA dimensions such as LA volume [mL] (108; 125; <i>p</i> < .001) or PV ostial dimensions were significantly larger than in those with PAF. LAA volume [mL] (8.3; 9.2; <i>p</i> = .005) and LAA ostial area [mm<sup>2</sup>] (325; 353; <i>p</i> = .01) were enlarged in persAF. There were no significant differences regarding LAA morphology, with the overall distribution being “windsock” (51%), “chicken-wing” (20%), “cauliflower” (15%), and “cactus” (13%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Compared to PAF, persAF patients had significantly larger LA as well as LAA dimensions. LAA morphological types were distributed equally in both groups suggesting that LAA morphology may not be associated with the underlying AF type.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>A mechanism of paroxysmal atrial fibrillation (AF) involves trigger activity mainly originating from a pulmonary vein (PV). Catheter ablation of PV isolation, using recent advanced technologies, is a promising approach to prevent AF incidence and related complications. However, some AF triggers originate from non-PV foci, which are associated with AF recurrence despite complete PV isolation.<span><sup>1, 2</sup></span> Although various approaches and techniques have been introduced for induction and provocation of non-PV foci, identifying the exact location of non-PV foci in the broad area of the left and right atriums is still challenging. Fractionated signal area in the atrial muscle (FAAM) map-guided ablation is a recently developed technique that highlights the fractionated signal area using the LUMIPOINT software in the ultrahigh-density RHYTHMIA mapping system (Boston Scientific, Marlborough, MA). These fractionated signal areas are significantly associated with the location of non-PV foci.<span><sup>3</sup></span> The FAAM-guided ablation previously demonstrated a lower recurrence rate of atrial tachyarrhythmia compared to the non-FAAM ablation in patients with recurrent AF who underwent catheter ablation targeting non-PV foci.<span><sup>3</sup></span> Unfortunately, this specific FAAM map can only be used in the RHYTHMIA mapping system, underscoring the need for broader utility of this algorithm across all mapping systems in clinical practice.</p><p>In this issue of the <i>Journal of arrhythmia</i>, Kono. et al.<span><sup>1</sup></span> reported a successful non-PV foci ablation case for paroxysmal AF using a Complex Signal Identification (CSI) algorithm equipped with CARTO™ 3 system version 8 to automatically identify and tag complex fractionated potentials in atria. After PV isolation and cavotricuspid isthmus ablation, an additional ablation was performed using the CSI algorithm to target non-PV foci triggered by isoproterenol infusion, high-rate burst pacing, and adenosine triphosphate administration. High CSI tag scores were found in the anterior carina of the right superior PV (RSPV), extending to the anterior wall. The earliest activation site in the non-PV-foci corresponded to the highest CSI score of 9.8, with fractionated potentials where effective energization was applied. Additionally, the PV isolation line for the right superior PV was slightly extended to include the high CSI area of ≥7.5. At the end of the ablation, no AF was induced, and the patient maintained sinus rhythm without antiarrhythmic drugs for 6 months.</p><p>The CSI algorithm can arbitrarily calculate the abnormal potentials using four parameters: minimum fractionated score, time frame within the window of interest, bipolar amplitude of the complex signal, and minimum duration, implying a strict stratification for the relevant fractionated potentials from broad perspectives. Unfortunately, appropriate CSI setting and cutoff points have not been established,
{"title":"Editorial to “Novel mapping techniques for ablation of non-pulmonary vein foci using complex signal identification”","authors":"Yoshiaki Mizutani MD, PhD, Satoshi Yanagisawa MD, PhD, Yasuya Inden MD, PhD","doi":"10.1002/joa3.70006","DOIUrl":"10.1002/joa3.70006","url":null,"abstract":"<p>A mechanism of paroxysmal atrial fibrillation (AF) involves trigger activity mainly originating from a pulmonary vein (PV). Catheter ablation of PV isolation, using recent advanced technologies, is a promising approach to prevent AF incidence and related complications. However, some AF triggers originate from non-PV foci, which are associated with AF recurrence despite complete PV isolation.<span><sup>1, 2</sup></span> Although various approaches and techniques have been introduced for induction and provocation of non-PV foci, identifying the exact location of non-PV foci in the broad area of the left and right atriums is still challenging. Fractionated signal area in the atrial muscle (FAAM) map-guided ablation is a recently developed technique that highlights the fractionated signal area using the LUMIPOINT software in the ultrahigh-density RHYTHMIA mapping system (Boston Scientific, Marlborough, MA). These fractionated signal areas are significantly associated with the location of non-PV foci.<span><sup>3</sup></span> The FAAM-guided ablation previously demonstrated a lower recurrence rate of atrial tachyarrhythmia compared to the non-FAAM ablation in patients with recurrent AF who underwent catheter ablation targeting non-PV foci.<span><sup>3</sup></span> Unfortunately, this specific FAAM map can only be used in the RHYTHMIA mapping system, underscoring the need for broader utility of this algorithm across all mapping systems in clinical practice.</p><p>In this issue of the <i>Journal of arrhythmia</i>, Kono. et al.<span><sup>1</sup></span> reported a successful non-PV foci ablation case for paroxysmal AF using a Complex Signal Identification (CSI) algorithm equipped with CARTO™ 3 system version 8 to automatically identify and tag complex fractionated potentials in atria. After PV isolation and cavotricuspid isthmus ablation, an additional ablation was performed using the CSI algorithm to target non-PV foci triggered by isoproterenol infusion, high-rate burst pacing, and adenosine triphosphate administration. High CSI tag scores were found in the anterior carina of the right superior PV (RSPV), extending to the anterior wall. The earliest activation site in the non-PV-foci corresponded to the highest CSI score of 9.8, with fractionated potentials where effective energization was applied. Additionally, the PV isolation line for the right superior PV was slightly extended to include the high CSI area of ≥7.5. At the end of the ablation, no AF was induced, and the patient maintained sinus rhythm without antiarrhythmic drugs for 6 months.</p><p>The CSI algorithm can arbitrarily calculate the abnormal potentials using four parameters: minimum fractionated score, time frame within the window of interest, bipolar amplitude of the complex signal, and minimum duration, implying a strict stratification for the relevant fractionated potentials from broad perspectives. Unfortunately, appropriate CSI setting and cutoff points have not been established,","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Successful isolation of the superior vena cava (SVC) using a functional conduction block between the right atrium (RA) and SVC has been documented. However, a comparison of this approach with the conventional method (CM) of circumferential ablation of the RA-SVC junction, based on angiography, remains unexplored.
Objective
In this study, we employed the innovative omnipolar mapping technology (OT) to discern the RA-SVC connection and compared clinical outcomes with those from CM.
Methods
Sixty-two patients undergoing SVC isolation were randomly assigned in a 1:1 ratio to either the OT or CM group. No significant differences in the baseline characteristics were observed between the two groups. We assessed the efficacy and safety of both groups.
Results
Both groups showed comparable acute success rates (96%) in SVC isolation, but the procedure in the OT group required fewer radiofrequency (RF) applications (13.6 ± 6.0 vs. 19.8 ± 10.9, p = .046) and shorter procedure time (9.6 ± 6.8 min vs. 14.3 ± 6.8 min, p = .007). The overall absorbed dose was notably lower in the OT group (69.6 ± 47.6 mGy vs. 90.3 ± 30.3 mGy, p = .023).
Conclusions
The OT enhances the efficacy of SVC isolation, requiring fewer RF applications and reducing procedure time compared to conventional treatment methods.
{"title":"Novel omnipolar mapping technology for effective superior vena cava isolation: A randomized clinical trial","authors":"Naoto Oguri MD, Yousaku Okubo MD, PhD, Naoki Ishibashi MD, Junji Maeda MD, Takumi Sakai MD, Yukimi Uotani MD, Motoki Furutani MD, Shogo Miyamoto MD, Shunsuke Miyauchi MD, PhD, Sho Okamura MD, PhD, Takehito Tokuyama MD, PhD, Noboru Oda MD, PhD, Yukiko Nakano MD, PhD","doi":"10.1002/joa3.70007","DOIUrl":"10.1002/joa3.70007","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Successful isolation of the superior vena cava (SVC) using a functional conduction block between the right atrium (RA) and SVC has been documented. However, a comparison of this approach with the conventional method (CM) of circumferential ablation of the RA-SVC junction, based on angiography, remains unexplored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>In this study, we employed the innovative omnipolar mapping technology (OT) to discern the RA-SVC connection and compared clinical outcomes with those from CM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Sixty-two patients undergoing SVC isolation were randomly assigned in a 1:1 ratio to either the OT or CM group. No significant differences in the baseline characteristics were observed between the two groups. We assessed the efficacy and safety of both groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both groups showed comparable acute success rates (96%) in SVC isolation, but the procedure in the OT group required fewer radiofrequency (RF) applications (13.6 ± 6.0 vs. 19.8 ± 10.9, <i>p</i> = .046) and shorter procedure time (9.6 ± 6.8 min vs. 14.3 ± 6.8 min, <i>p</i> = .007). The overall absorbed dose was notably lower in the OT group (69.6 ± 47.6 mGy vs. 90.3 ± 30.3 mGy, <i>p</i> = .023).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The OT enhances the efficacy of SVC isolation, requiring fewer RF applications and reducing procedure time compared to conventional treatment methods.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To prevent cardiac tamponade caused by catheter tip slippage during the retraction of the protective sleeve in Aveir VR implantation, it is crucial to carefully evaluate not only the bulge of the protective sleeve but also the shape of the system's shaft using fluoroscopic imaging.
{"title":"A case of successful salvage despite right ventricular perforation during AVEIR VR leadless pacemaker implantation","authors":"Masanori Matsuo MD, PhD, Kenji Shimeno MD, PhD, Naoki Matsumoto MD, Yukio Abe MD, PhD, Daiju Fukuda MD, PhD","doi":"10.1002/joa3.70000","DOIUrl":"10.1002/joa3.70000","url":null,"abstract":"<p>To prevent cardiac tamponade caused by catheter tip slippage during the retraction of the protective sleeve in Aveir VR implantation, it is crucial to carefully evaluate not only the bulge of the protective sleeve but also the shape of the system's shaft using fluoroscopic imaging.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shintaro Yamagami MD, Shumpei Mori MD, PhD, Tomohiro Sato MD, Hirokazu Kondo MD, PhD, Toshihiro Tamura MD, PhD
The circular-shaped PulseSelect™ PFA catheter has demonstrated comparable efficacy to traditional thermal catheter ablation in achieving pulmonary vein isolation (PVI), while preventing thermally mediated complications. However, this catheter does not have any objective parameters to confirm real-time tissue-catheter contact. We report a case in which PVI was achieved through PFA using optimal biplane fluoroscopic angulations which were more useful for accurately assessing and adjusting the position and rotation of the circular catheter electrodes than the conventional fluoroscopic angulations.
{"title":"Use of optimal fluoroscopic angulation to facilitate effective pulsed field ablation in a patient with atrial fibrillation","authors":"Shintaro Yamagami MD, Shumpei Mori MD, PhD, Tomohiro Sato MD, Hirokazu Kondo MD, PhD, Toshihiro Tamura MD, PhD","doi":"10.1002/joa3.70005","DOIUrl":"10.1002/joa3.70005","url":null,"abstract":"<p>The circular-shaped PulseSelect™ PFA catheter has demonstrated comparable efficacy to traditional thermal catheter ablation in achieving pulmonary vein isolation (PVI), while preventing thermally mediated complications. However, this catheter does not have any objective parameters to confirm real-time tissue-catheter contact. We report a case in which PVI was achieved through PFA using optimal biplane fluoroscopic angulations which were more useful for accurately assessing and adjusting the position and rotation of the circular catheter electrodes than the conventional fluoroscopic angulations.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Radiofrequency (RF) ablation has become an established primary treatment for atrial fibrillation (AF), with pulmonary vein isolation (PVI) as the cornerstone of therapy. Multiple RF ablation catheter options and strategies are available, including high-power short-duration ablation using 50 W output. Recently, an innovative contact force (CF) sensing catheter featuring a mesh-shaped irrigation tip (TactiFlex™ SE, Abbott) has been introduced into clinical practice. However, clinical data remain limited, and the safety and efficacy of this catheter in real-world practice have yet to be fully clarified. In this article,<span><sup>1</sup></span> Matsumoto et al. evaluated the clinical safety and efficacy of the TactiFlex catheter for AF treatment. Their study reported that first-pass PVI was achieved in 82% of right pulmonary veins (RPV) and 87% of left pulmonary veins (LPV) in 100 AF patients, including those with paroxysmal AF (PAF) and non-PAF. Ablation parameters included a CF range of 5–20 g, an ablation duration of 15–20 s, and a fixed power of 50 W. The authors adjusted ablation duration based on impedance measurements; for pre-ablation impedance >120 ohms, the duration was 20 s, while for lower values, it was set at 15 s. The study reported only one gastric hypomotility following left atrial box ablation, with no fatal complications, including steam pops. The authors also identified a cut-off value for impedance drop to achieve first-pass isolation: 13.5 ohms for LPV and 14.5 ohms for RPV. This finding underscores the importance of monitoring impedance drop to achieve effective PVI. A previous study has shown that approximately 80% of steam pops occur when the impedance drop exceeds 18 ohms.<span><sup>2</sup></span> Interestingly, the threshold impedance drop for achieving first-pass isolation in this study (13.5–14.5 ohms) is close to the reported cut-off for preventing steam pops (18 ohms). While the risk of steam pop remains a concern, the TactiFlex catheter appears to have a significantly lower rate of steam pops compared to the SmartTouch Surround Flow (STSF) catheter (1.7% vs. 65.7% at 50 W).<span><sup>3</sup></span> This lower risk is attributed to the catheter's unique mesh-shaped irrigation tip, which enhances irrigation efficiency and reduces the risk of char and thrombus formation. One year after ablation, the AF-free rates were 81.7% in the PAF group and 76.3% in the non-PAF group. Among the 16 patients who experienced AF recurrence, 10 underwent a second ablation session. Of these, two had PV reconnection, five had residual potentials in the carina region without PV reconnection, and three had neither. These results demonstrate the durability of PVI lesions created with the TactiFlex catheter over the long term. Notably, the absence of significant differences in first-pass isolation rates between attending physicians and fellows (RPV: 81.3% vs. 83.3%, <i>p</i> = 0.839; LPV: 93.8% vs. 85.7%, <i>p</i> = 0.381) highlights the
{"title":"Editorial to “Feasibility and efficacy of 50 W ablation with the TactiFlex catheter for the initial pulmonary vein isolation of atrial fibrillation”","authors":"Naoto Otsuka MD, PhD, Yasuo Okumura MD, PhD","doi":"10.1002/joa3.13215","DOIUrl":"10.1002/joa3.13215","url":null,"abstract":"<p>Radiofrequency (RF) ablation has become an established primary treatment for atrial fibrillation (AF), with pulmonary vein isolation (PVI) as the cornerstone of therapy. Multiple RF ablation catheter options and strategies are available, including high-power short-duration ablation using 50 W output. Recently, an innovative contact force (CF) sensing catheter featuring a mesh-shaped irrigation tip (TactiFlex™ SE, Abbott) has been introduced into clinical practice. However, clinical data remain limited, and the safety and efficacy of this catheter in real-world practice have yet to be fully clarified. In this article,<span><sup>1</sup></span> Matsumoto et al. evaluated the clinical safety and efficacy of the TactiFlex catheter for AF treatment. Their study reported that first-pass PVI was achieved in 82% of right pulmonary veins (RPV) and 87% of left pulmonary veins (LPV) in 100 AF patients, including those with paroxysmal AF (PAF) and non-PAF. Ablation parameters included a CF range of 5–20 g, an ablation duration of 15–20 s, and a fixed power of 50 W. The authors adjusted ablation duration based on impedance measurements; for pre-ablation impedance >120 ohms, the duration was 20 s, while for lower values, it was set at 15 s. The study reported only one gastric hypomotility following left atrial box ablation, with no fatal complications, including steam pops. The authors also identified a cut-off value for impedance drop to achieve first-pass isolation: 13.5 ohms for LPV and 14.5 ohms for RPV. This finding underscores the importance of monitoring impedance drop to achieve effective PVI. A previous study has shown that approximately 80% of steam pops occur when the impedance drop exceeds 18 ohms.<span><sup>2</sup></span> Interestingly, the threshold impedance drop for achieving first-pass isolation in this study (13.5–14.5 ohms) is close to the reported cut-off for preventing steam pops (18 ohms). While the risk of steam pop remains a concern, the TactiFlex catheter appears to have a significantly lower rate of steam pops compared to the SmartTouch Surround Flow (STSF) catheter (1.7% vs. 65.7% at 50 W).<span><sup>3</sup></span> This lower risk is attributed to the catheter's unique mesh-shaped irrigation tip, which enhances irrigation efficiency and reduces the risk of char and thrombus formation. One year after ablation, the AF-free rates were 81.7% in the PAF group and 76.3% in the non-PAF group. Among the 16 patients who experienced AF recurrence, 10 underwent a second ablation session. Of these, two had PV reconnection, five had residual potentials in the carina region without PV reconnection, and three had neither. These results demonstrate the durability of PVI lesions created with the TactiFlex catheter over the long term. Notably, the absence of significant differences in first-pass isolation rates between attending physicians and fellows (RPV: 81.3% vs. 83.3%, <i>p</i> = 0.839; LPV: 93.8% vs. 85.7%, <i>p</i> = 0.381) highlights the ","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wei Sheng Jonathan Ong MBBS, Chi Keong Ching MBBS, FHRS
<p>Whether frequent premature ventricular contractions (PVCs) in patients without structural heart disease are of prognostic significance is a subject of debate.<span><sup>1</sup></span> Once considered to be a benign condition, it is now widely known that it can be causative for tachycardia-induced cardiomyopathy. While only a minority of patients with frequent PVCs (>1000 PVCs/day) develop ventricular dysfunction after 5 years of follow-up,<span><sup>2</sup></span> catheter ablation is curative for these patients with normalization of cardiac function. The minimal threshold for the development of LV dysfunction is a PVC burden of 10% while a PVC burden of >20% portends a higher risk. Upfront catheter ablation is also indicated in symptomatic patients without structural heart disease when the PVCs are of right ventricular outflow tract or fascicular origin.<span><sup>3</sup></span> Beyond the above select patient groups, however, it remains unclear whether frequent PVCs are associated with cardiovascular events in patients without structural heart disease.</p><p>In this issue of the <i>Journal of Arrhythmia</i>, Ogiso et al. conducted a single-center retrospective study with 6332 patients, stratified by the number of baseline PVCs and the presence or absence of non-sustained ventricular tachycardia (NSVT). The primary endpoint was defined as the incidence of cardiovascular events, including all-cause death, acute coronary syndrome, ischemic stroke, systemic embolism, and hospitalization for heart failure. The authors reported that, over a 3 year follow-up period, the frequency of PVCs was not associated with cardiovascular events while the presence of NSVT was associated with a higher risk of heart failure hospitalization. In the NSVT study population, only one of the five cases of heart failure had a reduced ejection fraction.</p><p>Notably, these results differ from previous studies<span><sup>4, 5</sup></span>; however, this can be explained on more careful examination of key study differences. Prior studies have shown that the decrease in cardiac function, increase in heart failure events, and mortality among patients with frequent PVCs were normally noted beyond 5 years of follow-up.<span><sup>4, 5</sup></span> This suggests that the 3 year follow-up period in the study may have been inadequate to detect these differences. Furthermore, as pointed out by the authors, increased use of medical interventions such as anti-arrhythmic drugs and catheter ablation in patients with a larger number of PVCs and NSVT may have contributed to a better prognosis and outcome.</p><p>Ogiso et al. reported that one patient with NSVT and heart failure was later diagnosed with hypertrophic cardiomyopathy. This was not detected at baseline with echocardiography. As frequent PVCs and NSVT may indicate subclinical abnormalities, the authors opined that further investigations, including cardiac magnetic resonance imaging (MRI), may be needed in select patients.
{"title":"Editorial to “Association between ventricular arrhythmia (premature ventricular contractions burden and non-sustained ventricular tachycardia) and cardiovascular events in patients without structural heart disease”","authors":"Wei Sheng Jonathan Ong MBBS, Chi Keong Ching MBBS, FHRS","doi":"10.1002/joa3.13219","DOIUrl":"10.1002/joa3.13219","url":null,"abstract":"<p>Whether frequent premature ventricular contractions (PVCs) in patients without structural heart disease are of prognostic significance is a subject of debate.<span><sup>1</sup></span> Once considered to be a benign condition, it is now widely known that it can be causative for tachycardia-induced cardiomyopathy. While only a minority of patients with frequent PVCs (>1000 PVCs/day) develop ventricular dysfunction after 5 years of follow-up,<span><sup>2</sup></span> catheter ablation is curative for these patients with normalization of cardiac function. The minimal threshold for the development of LV dysfunction is a PVC burden of 10% while a PVC burden of >20% portends a higher risk. Upfront catheter ablation is also indicated in symptomatic patients without structural heart disease when the PVCs are of right ventricular outflow tract or fascicular origin.<span><sup>3</sup></span> Beyond the above select patient groups, however, it remains unclear whether frequent PVCs are associated with cardiovascular events in patients without structural heart disease.</p><p>In this issue of the <i>Journal of Arrhythmia</i>, Ogiso et al. conducted a single-center retrospective study with 6332 patients, stratified by the number of baseline PVCs and the presence or absence of non-sustained ventricular tachycardia (NSVT). The primary endpoint was defined as the incidence of cardiovascular events, including all-cause death, acute coronary syndrome, ischemic stroke, systemic embolism, and hospitalization for heart failure. The authors reported that, over a 3 year follow-up period, the frequency of PVCs was not associated with cardiovascular events while the presence of NSVT was associated with a higher risk of heart failure hospitalization. In the NSVT study population, only one of the five cases of heart failure had a reduced ejection fraction.</p><p>Notably, these results differ from previous studies<span><sup>4, 5</sup></span>; however, this can be explained on more careful examination of key study differences. Prior studies have shown that the decrease in cardiac function, increase in heart failure events, and mortality among patients with frequent PVCs were normally noted beyond 5 years of follow-up.<span><sup>4, 5</sup></span> This suggests that the 3 year follow-up period in the study may have been inadequate to detect these differences. Furthermore, as pointed out by the authors, increased use of medical interventions such as anti-arrhythmic drugs and catheter ablation in patients with a larger number of PVCs and NSVT may have contributed to a better prognosis and outcome.</p><p>Ogiso et al. reported that one patient with NSVT and heart failure was later diagnosed with hypertrophic cardiomyopathy. This was not detected at baseline with echocardiography. As frequent PVCs and NSVT may indicate subclinical abnormalities, the authors opined that further investigations, including cardiac magnetic resonance imaging (MRI), may be needed in select patients.","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The clinical outcomes of a novel antitachycardia pacing (ATP) algorithm—intrinsic ATP (iATP)—compared to conventional ATP (cATP) have yet to be fully elucidated.
Methods
This retrospective study analyzed 128 patients and 1962 ventricular tachycardia (VT) episodes treated with the iATP or the cATP at Kokura Memorial Hospital. Patients were categorized into two groups: the iATP group (23 patients, 182 episodes) and the cATP group (105 patients, 1780 episodes). We evaluated ATP success rates and baseline patient characteristics on a per-patient basis. Additionally, we extracted VT that were not terminated by a single ATP and compared ATP success rates using propensity score matching.
Results
Per patient; The iATP group exhibited significantly lower creatinine levels (1.18 ± 0.40 mg/dL vs. 1.82 ± 1.61 mg/dL, p = .021) and a shorter follow-up period (609 ± 323 days vs. 1017 ± 252 days, p < .001) compared to the cATP group. ATP success was observed in 19 patients in the iATP group and 62 patients in the cATP group (82.6% vs. 59%, p = .054). Per episode; there was no significant difference in ATP success rate (91.8% vs. 92.7%, p = .645) or in acceleration rate (1.1% vs. 2.4%, p = .274). However, when limited to episodes in which VT was not terminated by a single ATP and propensity score matching was performed, the iATP showed a higher VT termination rate (84.1% vs. 53.6%, p < .001) and a lower acceleration rate (0% vs. 10.1%, p = .013) than the cATP.
Conclusions
The efficacy and safety of the iATP for VT that was not terminated by the first sequence of ATP was demonstrated.
背景：一种新的抗心动过速起搏（ATP）算法-内在ATP (iATP)-与传统ATP （cATP）相比的临床结果尚未完全阐明。方法：本回顾性研究分析了在小仓纪念医院接受iATP或cATP治疗的128例患者和1962例室性心动过速（VT）发作。患者分为两组：iATP组（23例，182次）和cATP组（105例，1780次）。我们在每位患者的基础上评估ATP成功率和基线患者特征。此外，我们提取了未被单个ATP终止的VT，并使用倾向评分匹配比较了ATP成功率。结果：每例；iATP组肌酐水平显著降低（1.18±0.40 mg/dL vs. 1.82±1.61 mg/dL, p = 0.021），随访时间较短（609±323天vs. 1017±252天，p = 0.054）。每集;ATP成功率（91.8% vs. 92.7%, p = .645）和加速率（1.1% vs. 2.4%, p = .274）差异无统计学意义。然而，当局限于VT未被单一ATP终止的发作时，并进行倾向评分匹配，iATP比cATP显示更高的VT终止率（84.1%对53.6%,p = 0.013）。结论：证明了ATP对未被ATP第一序列终止的VT的有效性和安全性。
{"title":"The efficacy and safety of intrinsic antitachycardia pacing","authors":"Koumei Onuki MD, Michio Nagashima MD, Masato Fukunaga MD, Keigo Misonou MD, Maiko Kuroda MD, Hiroyuki Kono MD, Tomonori Katsuki MD, Rei Kuji MD, Kengo Korai MD, Kenichi Hiroshima MD, Kenji Ando MD","doi":"10.1002/joa3.13221","DOIUrl":"10.1002/joa3.13221","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The clinical outcomes of a novel antitachycardia pacing (ATP) algorithm—intrinsic ATP (iATP)—compared to conventional ATP (cATP) have yet to be fully elucidated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study analyzed 128 patients and 1962 ventricular tachycardia (VT) episodes treated with the iATP or the cATP at Kokura Memorial Hospital. Patients were categorized into two groups: the iATP group (23 patients, 182 episodes) and the cATP group (105 patients, 1780 episodes). We evaluated ATP success rates and baseline patient characteristics on a per-patient basis. Additionally, we extracted VT that were not terminated by a single ATP and compared ATP success rates using propensity score matching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Per patient; The iATP group exhibited significantly lower creatinine levels (1.18 ± 0.40 mg/dL vs. 1.82 ± 1.61 mg/dL, <i>p</i> = .021) and a shorter follow-up period (609 ± 323 days vs. 1017 ± 252 days, <i>p</i> < .001) compared to the cATP group. ATP success was observed in 19 patients in the iATP group and 62 patients in the cATP group (82.6% vs. 59%, <i>p</i> = .054). Per episode; there was no significant difference in ATP success rate (91.8% vs. 92.7%, <i>p</i> = .645) or in acceleration rate (1.1% vs. 2.4%, <i>p</i> = .274). However, when limited to episodes in which VT was not terminated by a single ATP and propensity score matching was performed, the iATP showed a higher VT termination rate (84.1% vs. 53.6%, <i>p</i> < .001) and a lower acceleration rate (0% vs. 10.1%, <i>p</i> = .013) than the cATP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The efficacy and safety of the iATP for VT that was not terminated by the first sequence of ATP was demonstrated.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>In the current issue of the <i>Journal of Arrhythmia</i>, Takase et al.<span><sup>1</sup></span> reported a challenging patient with scleroderma-related structural heart disease who was admitted with recurrent ventricular tachycardia (VT) episodes after a failed endocardial catheter ablation alone. The authors' first challenge during an index catheter ablation was the hemodynamic instability during VT for mapping. The author's second challenge during the planned second catheter ablation was the anatomical neighboring of the left hepatic lobe to the subxiphoid epicardial access route. The authors have overcome both challenges with the carbon dioxide (CO<sub>2</sub>) insufflation method for facilitating the visibility of intrapericardial space and the hemodynamic support of extracorporeal membrane oxygenation. The endocardial and epicardial catheter ablation was successfully performed by overcoming these technical obstacles.</p><p>Catheter ablation is advised to reduce recurrent VT and the need for implantable cardioverter defibrillator shocks in patients with non-ischemic cardiomyopathy (NICM) and recurrent sustained monomorphic VT when antiarrhythmic medications are ineffective, contraindicated, or poorly tolerated.<span><sup>2</sup></span> VT developed as a result of left or right ventricular myocardial involvement, and successful catheter ablation has been previously reported in patients with systemic scleroderma.<span><sup>3</sup></span> However, due to the underlying mechanism of myocardial disease and VT (primarily caused by scar-related reentry<span><sup>3</sup></span>), endocardial catheter ablation alone might be insufficient to eliminate the VT focus. Furthermore, the contribution of ventricular scar to the electrophysiological abnormalities targeted for endocardial ablation of unstable VT differs between ischemic and non-ischemic cardiomyopathies. Since the case of Takase et al. also involved VT due to non-ischemic etiology, endocardial substrate ablation alone may have failed for hemodynamically unstable VT. Epicardial catheter ablation of VT can be useful after the failure of endocardial ablation because of the higher rate of the intramyocardial and epicardial substrate in patients with NICM.<span><sup>2</sup></span> Demonstrating a three-dimensional hyperboloid VT circuit structure is another reason that endocardial catheter ablation alone is ineffective in some patients.<span><sup>4</sup></span> Before epicardial catheter ablation, pre-procedural imaging techniques, such as cardiac computed tomography or magnetic resonance imaging, may play a critical role in procedural guidance and preventing complications by indicating neighboring structures.<span><sup>2</sup></span> Accessing the epicardium is typically achieved through a subxiphoid and trans pericardial puncture. However, epicardial access may be difficult due to anatomical obstacles and poor fluoroscopic visibility, which result in both acute and delayed complications. Carbo
{"title":"Editorial to “Carbon dioxide insufflation to facilitate epicardial access in extracorporeal membrane oxygenation-supported ventricular tachycardia ablation”: Blowing an exhaled gas for easy and safe pericardial puncture","authors":"Ugur Canpolat MD","doi":"10.1002/joa3.13216","DOIUrl":"10.1002/joa3.13216","url":null,"abstract":"<p>In the current issue of the <i>Journal of Arrhythmia</i>, Takase et al.<span><sup>1</sup></span> reported a challenging patient with scleroderma-related structural heart disease who was admitted with recurrent ventricular tachycardia (VT) episodes after a failed endocardial catheter ablation alone. The authors' first challenge during an index catheter ablation was the hemodynamic instability during VT for mapping. The author's second challenge during the planned second catheter ablation was the anatomical neighboring of the left hepatic lobe to the subxiphoid epicardial access route. The authors have overcome both challenges with the carbon dioxide (CO<sub>2</sub>) insufflation method for facilitating the visibility of intrapericardial space and the hemodynamic support of extracorporeal membrane oxygenation. The endocardial and epicardial catheter ablation was successfully performed by overcoming these technical obstacles.</p><p>Catheter ablation is advised to reduce recurrent VT and the need for implantable cardioverter defibrillator shocks in patients with non-ischemic cardiomyopathy (NICM) and recurrent sustained monomorphic VT when antiarrhythmic medications are ineffective, contraindicated, or poorly tolerated.<span><sup>2</sup></span> VT developed as a result of left or right ventricular myocardial involvement, and successful catheter ablation has been previously reported in patients with systemic scleroderma.<span><sup>3</sup></span> However, due to the underlying mechanism of myocardial disease and VT (primarily caused by scar-related reentry<span><sup>3</sup></span>), endocardial catheter ablation alone might be insufficient to eliminate the VT focus. Furthermore, the contribution of ventricular scar to the electrophysiological abnormalities targeted for endocardial ablation of unstable VT differs between ischemic and non-ischemic cardiomyopathies. Since the case of Takase et al. also involved VT due to non-ischemic etiology, endocardial substrate ablation alone may have failed for hemodynamically unstable VT. Epicardial catheter ablation of VT can be useful after the failure of endocardial ablation because of the higher rate of the intramyocardial and epicardial substrate in patients with NICM.<span><sup>2</sup></span> Demonstrating a three-dimensional hyperboloid VT circuit structure is another reason that endocardial catheter ablation alone is ineffective in some patients.<span><sup>4</sup></span> Before epicardial catheter ablation, pre-procedural imaging techniques, such as cardiac computed tomography or magnetic resonance imaging, may play a critical role in procedural guidance and preventing complications by indicating neighboring structures.<span><sup>2</sup></span> Accessing the epicardium is typically achieved through a subxiphoid and trans pericardial puncture. However, epicardial access may be difficult due to anatomical obstacles and poor fluoroscopic visibility, which result in both acute and delayed complications. Carbo","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The guidelines recommend anticoagulation management with uninterrupted warfarin or direct thrombin inhibitors (DTIs) during the atrial fibrillation (AF) ablation periprocedural period.
Objectives
To clarify the Japanese real-world latest periprocedural anticoagulation management during AF ablation.
Methods
This multicenter observational study included 6232 consecutive AF patients (68.7 ± 10.9 years, 4346 men) who underwent periprocedural anticoagulation therapy using direct oral anticoagulants (DOACs) between January 2022 and August 2023.
Results
The mean CHADS2 and CHA2DS2VASc scores were 1.2 ± 1.1 and 2.3 ± 1.5. Bleeding and thromboembolic events occurred in 79 (1.3%) and eight (0.12%) patients. During the periprocedural period, factor Xa inhibitors (FXaIs) were used in 3063 patients (rivaroxaban in 624, apixaban in 1093, and edoxaban in 1345) and DTIs in 3170 including 2583 in whom DTIs were switched from FXaIs. Both the bleeding (0.85% vs. 1.69%, p = .003) and thromboembolic event rates (0.03% vs. 0.23%, p = .036) were significantly lower in the DTI- than FXaI-group. A multivariate analysis showed periprocedural FXaI use was significantly associated with both bleeding events (odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.20–3.08, p = .006) and cardiac tamponade (OR = 2.74, 95% CI = 1.27–5.9, p = .01). The interval between the last DOAC administration and the procedure was significantly shorter in the DTI- than FXaI-group (4.2 ± 4.9 vs. 19.3 ± 10.7 h, p < .01). In the FXaI-group, the bleeding rate tended to be lower in the minimally interrupted (n = 2105) than uninterrupted group (n = 821) (1.47% vs. 2.56%, p = .06). Two patients in the uninterrupted FXaI-group required surgical management for cardiac tamponade.
Conclusions
Our multicenter real-world data demonstrated that anticoagulation with DTIs was a reasonable periprocedural anticoagulation regimen to reduce periprocedural complications.
背景：指南推荐在房颤消融围手术期使用不间断华法林或直接凝血酶抑制剂（DTIs）进行抗凝治疗。目的：了解日本最新的房颤消融围术期抗凝管理。方法：这项多中心观察性研究包括6232例AF患者（68.7±10.9岁，4346名男性），这些患者在2022年1月至2023年8月期间接受了直接口服抗凝剂（DOACs）的围手术期抗凝治疗。结果：CHADS2和CHA2DS2VASc的平均评分分别为1.2±1.1和2.3±1.5。79例（1.3%）和8例（0.12%）患者发生出血和血栓栓塞事件。在围手术期，3063例患者（624例为利伐沙班，1093例为阿哌沙班，1345例为依多沙班）使用了Xa因子抑制剂（FXaIs）， 3170例患者使用了dti，其中2583例患者的dti由FXaIs转换而来。DTI-组的出血发生率（0.85%比1.69%,p = 0.003）和血栓栓塞事件发生率（0.03%比0.23%,p = 0.036）均显著低于fxai组。多因素分析显示围手术期使用FXaI与出血事件（优势比[OR] = 1.92, 95%可信区间[CI] = 1.20-3.08, p = 0.006）和心脏填塞（OR = 2.74, 95% CI = 1.27-5.9, p = 0.01）均显著相关。DTI-组最后一次DOAC给药与手术的间隔时间明显短于fxai组（4.2±4.9 h vs. 19.3±10.7 h, p n = 2105），明显短于不间断组（n = 821） （1.47% vs. 2.56%, p = 0.06）。不间断fxai组2例患者因心脏填塞需要手术治疗。结论：我们的多中心真实数据表明，dti抗凝治疗是一种合理的围手术期抗凝治疗方案，可减少围手术期并发症。
{"title":"Real-world clinical practice of current periprocedural anticoagulation management in catheter ablation of atrial fibrillation: Data from a large prospective ablation registry","authors":"Yuta Taomoto MD, Shinsuke Miyazaki MD, FHRS, Yasutoshi Nagata MD, Junichi Nitta MD, Osamu Inaba MD, Yasuhiro Shirai MD, Yasuaki Tanaka MD, Yukio Sekiguchi MD, Yukihiro Inamura MD, Yuichiro Sagawa MD, Akira Mizukami MD, Koji Azegami MD, Shinsuke Iwai MD, Hitoshi Hachiya MD, Yuichi Ono MD, Atsushi Takahashi MD, Takeshi Sasaki MD, Yasuteru Yamauchi MD, Hiroyuki Okada MD, Atsushi Suzuki MD, Makoto Suzuki MD, Keita Handa MD, Kenzo Hirao MD, Jun Nakajima MD, Takuro Nishimura MD, Susumu Tao MD, Masateru Takigawa MD, Tetsuo Sasano MD","doi":"10.1002/joa3.13182","DOIUrl":"10.1002/joa3.13182","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The guidelines recommend anticoagulation management with uninterrupted warfarin or direct thrombin inhibitors (DTIs) during the atrial fibrillation (AF) ablation periprocedural period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To clarify the Japanese real-world latest periprocedural anticoagulation management during AF ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter observational study included 6232 consecutive AF patients (68.7 ± 10.9 years, 4346 men) who underwent periprocedural anticoagulation therapy using direct oral anticoagulants (DOACs) between January 2022 and August 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean CHADS<sub>2</sub> and CHA<sub>2</sub>DS<sub>2</sub>VASc scores were 1.2 ± 1.1 and 2.3 ± 1.5. Bleeding and thromboembolic events occurred in 79 (1.3%) and eight (0.12%) patients. During the periprocedural period, factor Xa inhibitors (FXaIs) were used in 3063 patients (rivaroxaban in 624, apixaban in 1093, and edoxaban in 1345) and DTIs in 3170 including 2583 in whom DTIs were switched from FXaIs. Both the bleeding (0.85% vs. 1.69%, <i>p</i> = .003) and thromboembolic event rates (0.03% vs. 0.23%, <i>p</i> = .036) were significantly lower in the DTI- than FXaI-group. A multivariate analysis showed periprocedural FXaI use was significantly associated with both bleeding events (odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.20–3.08, <i>p</i> = .006) and cardiac tamponade (OR = 2.74, 95% CI = 1.27–5.9, <i>p</i> = .01). The interval between the last DOAC administration and the procedure was significantly shorter in the DTI- than FXaI-group (4.2 ± 4.9 vs. 19.3 ± 10.7 h, <i>p</i> < .01). In the FXaI-group, the bleeding rate tended to be lower in the minimally interrupted (<i>n</i> = 2105) than uninterrupted group (<i>n</i> = 821) (1.47% vs. 2.56%, <i>p</i> = .06). Two patients in the uninterrupted FXaI-group required surgical management for cardiac tamponade.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our multicenter real-world data demonstrated that anticoagulation with DTIs was a reasonable periprocedural anticoagulation regimen to reduce periprocedural complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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