The example illustrates the analysis and measurement of the ventriculo-atrial (VA) interval following atrial overdrive pacing from both the right atrium and the coronary sinus. At first glance, VA linking does not appear to be present in response to the AOP; however, closer inspection reveals that VA linking is, in fact, observed in the subsequent cycle.
To compare demographic, clinical, and laboratory profiles and short-term outcomes between pre-existing (chronic) atrial fibrillation (AF) and newly diagnosed AF among patients admitted to coronary care units (CCUs) in Turkey, and to identify factors associated with in-hospital mortality within AF subtypes.
This multicenter, prospective national registry analysis included 540 consecutive AF patients from 50 CCU centers across seven geographic regions in Turkey (MORCOR-TURK National Registry; September 1–30, 2022). Patients were categorized as pre-existing AF (documented AF prior to or at admission) or newly diagnosed AF (first detected during hospitalization). Demographics, comorbidities, admission diagnoses, laboratory biomarkers (including NT-proBNP and hs-troponin I), management, and outcomes were recorded. Multivariable logistic regression identified independent predictors of in-hospital mortality.
Pre-existing AF (n = 324) had higher prevalences of diabetes mellitus (42.3% vs. 31.5%; p = 0.012) and acute coronary syndromes (58.6% vs. 34.7%; p < 0.001). Newly diagnosed AF (n = 216) more frequently presented with heart failure (45.8% vs. 28.4%; p < 0.001) and dyspnea (67.1% vs. 48.5%; p < 0.001). Newly diagnosed AF exhibited higher inflammatory burden (CRP median 28.4 vs. 12.6 mg/L; p < 0.001) and lower hemoglobin (11.8 ± 2.1 vs. 12.9 ± 1.8 g/dL; p < 0.001). NT-proBNP was elevated in both groups and higher in newly diagnosed AF (median 4850 vs. 3240 pg/mL; p = 0.003). In-hospital mortality was greater with newly diagnosed AF (12.0% vs. 6.8%; p = 0.042). Independent mortality predictors included age, chronic kidney disease, cardiogenic shock, and log-transformed NT-proBNP, hs-troponin I, and CRP.
In Turkish CCUs, pre-existing and newly diagnosed AF constitute distinct clinical phenotypes with differing presentations, biomarker profiles, and short-term risk. Newly diagnosed AF is associated with greater inflammatory and hemodynamic stress and higher in-hospital mortality. Biomarker-enriched risk stratification may refine prognostication and guide targeted management within AF subtypes.
Pulsed Field Ablation (PFA) is a tissue-selective ablation energy source that has been introduced recently for atrial fibrillation (AF) ablation. Data on the use of 3D electroanatomic mapping (EAM) is limited in AF ablation by PFA with many centers electing to omit it.
This study sought to investigate the utility of high-density 3D EAM using PFA for AF ablation.
Seventy-four patients with symptomatic AF underwent PFA-based pulmonary vein isolation (PVI). Additional ablation, including left atrial posterior wall (LAPW) and mitral-isthmus (MI) ablation was performed in a subset of patients. The primary efficacy endpoint was freedom from atrial arrhythmia at 12 months. The primary safety endpoint was freedom from a composite of serious procedure- and device-related adverse events.
In 74 patients, 3D EAM post-PFA showed early PV reconnection in 7/74 cases, (9% cases; 289/296 PVs, 2.4% PVs), most commonly in the right superior PV (6/7, 85.7%). The LAPW reconnected in 3/55 cases (5.5%), while the MI line reconnected in 6/14 cases (30%), more commonly with an anterior approach compared to a posterior (57% vs. 15%). The procedure time was 88.3 ± 40.7 min and fluoroscopic time was 12.1 ± 8.0 min. At 1 year, estimated freedom from atrial arrhythmia was 78.4% (95% CI, 70.1 to 88.7). There was 1 case of pericardial tamponade.
Our results suggest that although there is a low incidence, early PV reconnection can still occur using PFA for PVI. Overall 3D EAM retains clinical value in AF ablation by PFA.
PVI by catheter ablation for atrial fibrillation via a superior approach is technically challenging. However, the circular multielectrode PFA catheter is feasible for PVI via a superior jugular vein approach. AP, anteroposterior; LAO, left anterior oblique; PA, posteroanterior; PFA, pulsed field ablation; PVI, pulmonary vein isolation.
Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation; however, recurrences often originate from non-pulmonary vein (non-PV) foci. The Complex Signal Identification (CSI) algorithm in CARTO 3 assigns electrogram-fractionation scores (0–10). This study evaluated the feasibility of CSI-assisted mapping for identifying non-PV triggers.
We retrospectively analyzed 23 consecutive patients undergoing first-time AF ablation between January and June 2024. After PVI, non-PV triggers were induced using isoproterenol and adenosine triphosphate (ATP). When ectopy was absent, rapid pacing during isoproterenol infusion followed by defibrillation was performed, and ATP testing was repeated. High-density CSI mapping was conducted during sinus rhythm or high right atrial pacing using system default settings, targeting atrial components after ventricular blanking.
A total of 33 non-PV foci were localized (20 left atrium [LA], 13 right atrium [RA]). The mean CSI scores of LA and RA foci were 9.0 ± 2.3 and 8.8 ± 2.7, respectively. ROC analysis showed an AUC of 0.917 for discriminating non-PV foci, with an optimal cutoff of 8.5 (sensitivity 87.9%, specificity 88.3%). At 12 months, arrhythmia-free survival was 82.4% under symptom-driven follow-up. Ablation was selectively performed at the earliest activation and adjacent high-CSI points, avoiding indiscriminate lesion delivery.
CSI-assisted mapping provided practical, adjunctive guidance to provocation and activation mapping for non-PV focus localization. While apparent discrimination was promising, the 8.5 threshold remains exploratory. Larger multicenter studies with standardized CSI settings and systematic post-ablation assessment are warranted to validate these preliminary findings.
Atrial fibrillation (AF), the most frequently occurring sustained arrhythmia in patients with hypertrophic cardiomyopathy (HCM), is linked to poor quality of life and increased thromboembolic risk. Chronic kidney disease (CKD) and reduced kidney function are known cardiovascular risk factors; however, their contributions to new-onset AF in patients with HCM remain unclear. Estimated glomerular filtration rate (eGFR) is a key marker for CKD management. This study aimed to elucidate the incidence of new-onset AF and to identify predictive factors in patients with HCM.
We analyzed 198 patients with HCM (121 men; mean age, 58 ± 17 years) without prior AF. The incidence and predictors of new-onset AF were evaluated with a focus on kidney function and left atrial (LA) size. Cox proportional hazards modeling was used to assess the associations.
Impaired kidney function (eGFR < 60 mL/min/1.73 m2) was present in 35 patients (17.7%). Over a median follow-up of 7.52 years, 43 patients (21.7%) developed new-onset AF for an incidence rate of 2.8 per 100 person-years. The multivariate analysis identified reduced eGFR and increased LA diameter (LAD) as independent predictors of AF. Kaplan–Meier curves showed a significantly higher cumulative AF incidence among patients with an eGFR ≤ 76.1 mL/min/1.73 m2 or an LAD ≥ 48.0 mm.
Decreased kidney function and LA dilatation were significantly associated with new-onset AF among patients with HCM. These findings suggest that this patient population requires closer monitoring for the early detection of AF.
Lead extraction and reimplantation in adult congenital heart disease (CHD) patients is challenging due to anatomical complexity.
A 76-year-old man with prior ventricular septal defect (VSD) patch repair and pacemaker implantation developed a device infection. Complete transvenous lead extraction (TLE) was achieved using laser and mechanical sheaths. A leadless pacemaker (Aveir VR) was implanted at the right ventricular outflow tract (RVOT) using pre-fixation mapping to avoid the VSD patch.
This case illustrates the effectiveness of pre-mapping in achieving safe reimplantation of a leadless pacemaker after TLE in complex CHD anatomy.
Heart rate score (HrSc) ≥ 70% reflects chronotropic incompetence and predicts prognosis in patients with cardiac implantable electronic devices (CIEDs) and left ventricular (LV) systolic dysfunction. However, its prognostic value in Japanese patients remains underexplored, and longitudinal changes in HrSc and their contributing factors are poorly characterized.
This post hoc analysis of the Heart Failure Indication and Sudden Cardiac Death Prevention Trial in Japan (HINODE) included 172 patients with CIEDs and LV ejection fraction ≤ 50%. HrSc, defined as the percentage of all atrial-paced and sensed beats in a single tallest 10 beat/min device histogram bin, was assessed using remote monitoring.
At baseline, the median HrSc was 53% (interquartile range, 41%–83%), with 68 (39.5%) patients having HrSc ≥ 70%. During the 2-year follow-up, the incidence of all-cause death or heart failure (HF) events was similar between patients with HrSc ≥ 70% and < 70% (31.1% vs. 29.4%, log-rank p = 0.862). However, among 142 patients whose follow-up data were available, HrSc increased from < 70% to ≥ 70% in 13 patients (13%) and decreased from ≥ 70% to < 70% in 19 (9.1%). An increase in HrSc was associated with lower LV ejection fraction, antiarrhythmic drug initiation, increased lower rate limit, and HF events.
In the HINODE study, baseline HrSc ≥ 70% was not predictive of 2-year cardiovascular outcomes. However, HrSc changed in approximately one-quarter of patients and was associated with clinical and device-related factors, as well as HF events. HrSc is not a static measure but a dynamic marker that reflects evolving patient conditions and CIED programming.
The Japanese Heart Rhythm Society established a nationwide, mandatory, multi-center, prospective, observational registry of transvenous lead extraction (TLE) named the Japanese lead extraction registry (J-LEX) in 2018. As of the end of 2024, a cumulative total of approximately 5400 cases has been registered across 140 participating centers since 2018. The registry includes all consecutive transvenous extractions, excluding surgical-only cases. The indication of TLE was an infection in 54.5%, and the guideline classification was class I in 59.8% and class IIa in 21.8%. As for non-infectious indications, TLE is performed for abandoned leads in case of lead failure or device upgrade, and for lead-related trouble such as pain, vessel stenosis or occlusion, too many leads, tricuspid valve regurgitation, and difficulty with radiation therapy. In 2024, the TLE procedure was attempted on patients with a median age of 71.3 years, female in 32.7%, in the hybrid operating room in 73.3%, and in a standard OR with a C-arm fluoroscope in 11.5%. The average implantation duration of the target leads was 8.5 years. Complete removal was achieved in 96.7% of the target leads, and clinical success in 97.3% of the patients. Perioperative complications were observed in 4.8% of the patients. Three patients died during a TLE operation, and 11 patients died in-hospital (cardiac death in three patients and non-cardiac death in eight patients).
Y. Mizunuma, M. Takahashi, T. Sasaki, et al., “Long-Term Follow-Up of Superior Vena Cava–Right Atrium Spontaneous Conduction Block Line Durability Using the White-Line Approach of Extended Early Meets-Late Rate Tools,” Journal of Arrhythmia 41, no. 4 (2025): e70161, https://doi.org/10.1002/joa3.70161.
In the originally published article, the title incorrectly included the word “Rate.” The correct title should read: “Long-Term Follow-Up of Superior Vena Cava–Right Atrium Spontaneous Conduction Block Line Durability Using the White-Line Approach of Extended Early Meets Late Tools.” Furthermore, the term “Early meets-late” was incorrectly used in several parts of the article. Specifically, this error appears in the article title, in the Background section of the Abstract (“…visualization of the SVC–RA conduction block line as a white line with the extended early meets-late (EEML) tool…”), and in the Background section of the main text (“The extended early meets-late (EEML) feature, which indicates a white line…”). In all of these locations, the correct wording should be “Early meets late,” without a hyphen.
In addition, in Table 2 on page 5, the label “Early meets rate lower threshold, %” should read “Early meets late lower threshold, %.”
The authors apologize for these errors.
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