Journal of Arrhythmia最新文献_第9页

Wall Thickness-Guided vs. Voltage-Guided Pulmonary Vein Isolation for Atrial Fibrillation 壁厚引导vs电压引导肺静脉隔离治疗心房颤动。

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-10-27 DOI: 10.1002/joa3.70215

Moyuru Hirata, Ryuta Watanabe, Koichi Nagashima, Yuji Wakamatsu, Naoto Otsuka, Shu Hirata, Yuji Saito, Masanaru Sawada, Shiro Nakahara, Yasuo Okumura

Background

The efficacy and safety of tailored pulmonary vein isolation (PVI) guided by either left atrial wall thickness (LAWT) or bipolar voltage remain unclear.

Objective

The aim of this prospective study was to evaluate the efficacy and safety of each ablation strategy.

Methods

We conducted a prospective analysis of 97 patients with non-valvular atrial fibrillation (AF) who underwent an initial RF catheter ablation procedure known as an extensive encircling PVI. Fifty patients underwent PVI using a wall thickness (WT)-guided approach using ADAS 3D software and 47 patients using a voltage-guided approach. In each strategy, high-power short-duration (HPSD) ablation was applied to regions with increased LAWT or elevated bipolar voltage, respectively, while very high-power short-duration (vHPSD) ablation was delivered to the remaining regions.

Results

The first-pass PVI rate tended to be higher in the WT-guided group compared to the Voltage-guided group (43 [86%] vs. 34 [72%], p = 0.09), and the incidence of acute PV reconnection (APVR) tended to be lower (5 [10%] vs. 11 [23%], p = 0.07). The proportion of patients with PV gaps (defined as the combined occurrence of first-pass failure and/or APVR) was significantly lower in the WT-guided group (10 [20%] vs. 18 [38%], p = 0.04). The multivariable-adjusted analysis demonstrated that WT-guided ablation was significantly more effective than Voltage-guided ablation in preventing PV gaps. Both ablation strategies were performed without any procedural complications.

Conclusions

WT-guided ablation was associated with a significantly lower incidence of PV gaps than a conventional bipolar voltage-guided strategy.

背景：由左房壁厚度（LAWT）或双极电压引导的量身定制肺静脉隔离（PVI）的有效性和安全性尚不清楚。目的：本前瞻性研究的目的是评估各种消融策略的有效性和安全性。方法：我们对97例非瓣膜性心房颤动（AF）患者进行了前瞻性分析，这些患者最初接受了广泛环绕PVI的射频导管消融手术。50例患者使用ADAS 3D软件采用壁厚（WT）引导入路进行PVI， 47例患者采用电压引导入路。在每种策略中，高功率短时间（HPSD）消融分别应用于LAWT升高或双极电压升高的区域，而非常高功率短时间（vHPSD）消融则应用于其余区域。结果：与电压引导组相比，wt引导组PVI首通率更高（43 [86%]vs. 34 [72%], p = 0.09），急性PV重连（APVR）发生率更低（5 [10%]vs. 11 [23%], p = 0.07）。wt引导组出现PV间隙（定义为首次通过失败和/或APVR合并发生）的患者比例显著降低（10例[20%]vs. 18例[38%]，p = 0.04）。多变量调整分析表明，wt引导消融在预防PV间隙方面明显比电压引导消融更有效。两种消融术均无手术并发症。结论：与传统的双极电压引导策略相比，wt引导消融与PV间隙发生率显著降低相关。

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引用次数: 0

Feasibility of Hybriding Very High-Power Short-Duration and Ablation Index-Guided Pulmonary Vein Isolation 高功率短时间和消融指数引导下混合肺静脉隔离的可行性

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-10-24 DOI: 10.1002/joa3.70213

Kyong Hee Lee, Atsuhiko Yagishita, Susumu Sakama, Iimura Kazuma, Takuji Kitazawa, Yuji Ikari, Koichiro Yoshioka

Introduction

A novel temperature-controlled radiofrequency (RF) catheter enables pulmonary vein isolation (PVI) using very high-power short-duration (vHPSD) ablation, reducing esophageal injury risk but raising concerns about lesion durability in thicker atrial myocardium. This study aimed to assess the efficacy and safety of a hybrid approach that integrates conventional Ablation Index (AI)-guided PVI with vHPSD ablation.

Methods

This prospective, single-center study enrolled 160 consecutive patients with atrial fibrillation (AF) between January 2023 and December 2023, who were allocated into two groups. Group 1 (n = 80) underwent conventional AI-guided PVI using a 40 W setting, while Group 2 (n = 80) received a hybrid approach combining 90 and 50 W ablation with a temperature-controlled RF catheter (QDOT Micro, Biosense Webster Inc., Diamond Bar, CA).

Results

Group 2 demonstrated a significantly shorter duration for PVI compared to Group 1 (28 ± 11 min vs. 35 ± 10 min, p < 0.001), with similar rates of first pass isolation (86% vs. 89%, p = 0.63) and acute reconnection (10% vs. 5%, p = 0.23). Complication rates were comparable between the groups (1.3% vs. 1.3%, p = 1.00), with no cases of esophageal or phrenic nerve injury reported. Kaplan–Meier analysis showed no significant difference in freedom from AF at 1 year (84% vs. 83%, log-rank p = 0.78).

Conclusion

The integration of Ablation Index-guided ablation with vHPSD ablation, utilizing a novel temperature-controlled RF catheter, significantly reduces procedural duration while maintaining safety and efficacy comparable to conventional AI-guided PVI.

一种新型的温控射频（RF）导管通过高功率短时间（vHPSD）消融实现肺静脉隔离（PVI），降低了食管损伤的风险，但引起了对较厚心房心肌损伤持久性的关注。本研究旨在评估将传统消融指数（AI）引导的PVI与vHPSD消融相结合的混合方法的有效性和安全性。方法本前瞻性单中心研究在2023年1月至2023年12月期间连续招募了160例心房颤动（AF）患者，将其分为两组。第1组（n = 80）接受了传统的人工智能引导PVI，使用40 W的设置，而第2组（n = 80）接受了混合方法，结合90和50 W的消融和温度控制的射频导管（QDOT Micro, Biosense Webster Inc., Diamond Bar， CA）。结果2组PVI持续时间明显短于1组（28±11 min vs. 35±10 min, p < 0.001），第一次分离率（86% vs. 89%, p = 0.63）和急性重连率（10% vs. 5%, p = 0.23）相似。两组间并发症发生率相当（1.3% vs 1.3%, p = 1.00），无食管或膈神经损伤病例报告。Kaplan-Meier分析显示，1年后AF自由度无显著差异（84% vs. 83%, log-rank p = 0.78）。结论消融指数引导下的消融与vHPSD消融相结合，利用一种新型的温控射频导管，显著缩短了手术时间，同时保持了与传统ai引导下PVI相当的安全性和有效性。

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引用次数: 0

Reply to “Revisiting Cryoablation for AVNRT: A Commentary on Safety, Recurrence, and Clinical Implications” 回复“再次冷冻消融治疗AVNRT：关于安全性、复发性和临床意义的评论”

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-10-24 DOI: 10.1002/joa3.70214

Shinichi Tachibana, Yasuteru Yamauchi

<p>We are grateful to Ahmed Z et al. for their interest in our previous article [<span>1</span>] and for pointing out significant limitations. Our study compared the dynamics of atrioventricular block (AVB) during slow pathway modification for atrioventricular nodal reentrant tachycardia (AVNRT) using cryoablation versus radiofrequency ablation (RFA) and aimed to describe how AV conduction disturbance evolves intra-procedurally and how this relates to procedural safety near the His-bundle potential.</p><p>We acknowledge that transient AVB occurred more frequently with cryoablation than with RFA (CRYO group: 24.1% vs. RFA group: 6.4%, <i>p</i> < 0.01). However, no cases of permanent AVB were observed in the CRYO group, whereas three patients in the RFA group required pacemaker implantation. In our interpretation, safety refers to the absence of permanent AVB and the fully reversible nature of the AV conduction disturbances. Therefore, we argue that although operator caution is warranted due to the high incidence of transient AVB, the reversibility of AV conduction disturbances supports the safety of cryoablation procedures near the His-bundle potential.</p><p>Ahmed et al. question whether the longer time to second- or third-degree AVB with cryoablation (6.6 ± 3.7 s vs. 1.2 ± 0.3 s with RFA) translates into actionable safety benefits. In our protocol, continuous PR-interval monitoring and high-rate atrial burst pacing with 1:1 fast-pathway conduction were systematically used to promptly detect fast-pathway disturbances; freezing was stopped immediately if the PR-interval prolonged by > 50 ms or AVB occurred during cryoablation, and the catheter was withdrawn. Thus, the longer delay to AVB with cryoablation (6.6 ± 3.7 s vs. 1.2 ± 0.3 s with RFA) provided operators with a real-time safety margin, allowing them to interrupt freezing before irreversible injury developed and prevent progression to permanent AVB, which may explain why no permanent AVB occurred in the CRYO group.</p><p>We acknowledge the higher overall AVNRT recurrence in the CRYO group compared with the RFA during a median 221 ± 186-day follow-up (9.5% vs. 3.4%, <i>p</i> < 0.01). Two contextual factors may account for this finding. First, successful ablation sites located above the coronary sinus roof were more common with cryoablation (67.9% vs. 34.3%, <i>p</i> < 0.01), reflecting a safety-driven preference for more superior targeting near the His-bundle potential. Second, outcomes varied by anatomical region; for example, in region III (Figure 1 of our article), AVNRT recurrence was significantly more frequent in the CRYO group (12.2% vs. 3.4%, <i>p</i> < 0.001). These findings suggest that anatomy and target selection critically influence outcomes and should guide individualized procedural strategies. As we mentioned in our limitations, we did not capture detailed patient anatomy or cooling dynamics, which may relate to lesion durability. These aspects warrant investiga

我们感谢Ahmed Z等人对我们之前的文章[1]感兴趣，并指出了重大的局限性。我们的研究比较了使用冷冻消融和射频消融（RFA）治疗房室结型再入性心动过速（AVNRT）的慢通路修饰过程中房室传导阻滞（AVB）的动态，旨在描述房室传导障碍在术中是如何演变的，以及这与his束电位附近的手术安全性有何关系。我们承认冷冻消融组比RFA组更容易发生短暂性AVB （CRYO组：24.1% vs. RFA组：6.4%,p < 0.01）。然而，在CRYO组中没有观察到永久性AVB病例，而在RFA组中有3例患者需要植入起搏器。在我们的解释中，安全性是指没有永久的AVB和AV传导干扰的完全可逆性质。因此，我们认为，尽管由于瞬态AVB的高发生率，操作人员需要谨慎，但房室传导干扰的可逆性支持了在his束电位附近进行冷冻消融手术的安全性。Ahmed等人质疑冷冻消融术治疗二度或三度AVB的时间较长（6.6±3.7 s vs. RFA治疗1.2±0.3 s）是否可转化为可操作的安全性益处。在我们的方案中，系统地使用连续pr间期监测和1:1快速通道传导的高速率心房爆发起搏来及时检测快速通道紊乱；若pr -间期延长50 ms或在冷冻消融过程中出现AVB，立即停止冷冻，拔管。因此，冷冻消融对AVB的延迟较长（6.6±3.7 s vs. RFA的1.2±0.3 s）为操作人员提供了实时安全裕度，使他们能够在不可逆损伤发生之前中断冷冻，防止进展为永久性AVB，这可能解释了为什么冷冻组没有发生永久性AVB。我们承认，在中位221±186天的随访中，CRYO组的AVNRT总复发率高于RFA组（9.5% vs. 3.4%, p < 0.01）。两个背景因素可以解释这一发现。首先，冷冻消融成功的消融部位位于冠状窦顶上方更为常见（67.9% vs. 34.3%, p < 0.01），这反映了安全驱动的偏好，更优的定位在his束电位附近。其次，结果因解剖区域而异；例如，在III区（图1），CRYO组的AVNRT复发率明显更高（12.2% vs. 3.4%, p < 0.001）。这些发现表明解剖结构和靶标选择对结果有重要影响，并应指导个体化的手术策略。正如我们在局限性中提到的，我们没有捕获详细的患者解剖结构或冷却动力学，这可能与病变的持久性有关。这些方面值得在未来的前瞻性研究中进行调查。此外，需要更长的随访期才能完全确定长期的房室淋巴结安全性。重要的是，在我们的队列中，没有一例术中短暂性AVB患者在出院后发生永久性AVB，尽管随访时间很短，但我们认为这是一个与临床相关的观察结果。综上所述，我们的数据支持冷冻消融作为一种合理的选择，当他的束附近或较小的科赫三角形的患者预期消融。通过冷冻消融观察到的逐渐可逆的房室传导变化提供了一个实际的安全范围，允许操作人员在永久性房室形成之前进行干预。同时，我们认识到，在冷冻消融的背景下，AVNRT复发的风险可能更高，这取决于解剖特征和消融技术。因此，能量方式的选择应个体化，平衡并发症的风险、解剖限制和长期疗效。本研究已获得当地伦理委员会的批准。所有患者均获得书面知情同意。作者声明无利益冲突。

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引用次数: 0

Newly Diagnosed Atrial Fibrillation Indicators in Cryptogenic Stroke Survivors' P-Wave Indices: A Systematic Review and Meta-Analysis 隐源性卒中幸存者p波指数中新诊断心房颤动指标：系统回顾和meta分析。

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-10-22 DOI: 10.1002/joa3.70209

Haikal Balweel, Surya Sinaga Immanuel, Jordan Budiono, Fransiskus Xaverius Rinaldi, Yeziel Sayogo, Novaro Adeneur Tafriend, Agus Harsoyo

Background

Atrial fibrillation (AF) is the most common arrhythmia and a major cause of ischemic stroke recurrence. Cryptogenic stroke (CS) survivors face a higher risk for newly diagnosed AF (NDAF), with subtle ECG markers—prolonged P-wave duration (PWDur) and increased P-wave dispersion (PWDis)—potentially serving as early indicators. We aimed to quantify baseline PWDur and PWDis differences between CS survivors with NDAF and those in sinus rhythm.

Methods

Following PRISMA guidelines, we systematically searched nine databases through January 2025 for observational studies assessing baseline P-wave indices in adult CS patients in sinus rhythm. Data extraction and risk of bias assessment using the ROBINS-E tool were performed independently. Pooled mean differences (MD) with 95% confidence intervals (CI) were calculated using a random-effects inverse-variance model. Subgroup/sensitivity analyses were conducted by age groups, male proportion, region, follow-up duration, percentage of comorbidities, AF definition and detection methods, and ECG parameter. Heterogeneity was assessed using Cochran's Q, τ², and I² and interpreted using Cochrane thresholds; certainty was appraised with GRADE.

Results

Ten studies, encompassing 1508 patients (mean age 66.72 ± 13.74 years; 55.7% male), met the inclusion criteria. Baseline PWDur was longer in the NDAF (MD 6.36 ms, 95% CI: 0.69–12.03, p = 0.03, I² = 73%, GRADE: moderate). Sensitivity analysis confirmed the robustness. PWDis remained non-significant.

Conclusion

Prolonged baseline PWDur may serve as a non-invasive marker of atrial conduction abnormalities and a predictor of AF in CS survivors. Larger prospective studies are needed to validate its role in risk stratification and secondary stroke prevention.

Trial Registration

PROSPERO: CRD42025646135

背景：房颤（AF）是最常见的心律失常，也是缺血性卒中复发的主要原因。隐源性卒中（CS）幸存者新诊断为房颤（NDAF）的风险更高，微妙的ECG标记-p波持续时间延长（PWDur）和p波弥散度增加(PWDis)-可能作为早期指标。我们的目的是量化NDAF和窦性心律的CS幸存者之间基线PWDur和PWDis的差异。方法：遵循PRISMA指南，我们系统地检索了截至2025年1月的9个数据库，以评估窦性心律成人CS患者的基线p波指数。使用ROBINS-E工具独立进行数据提取和偏倚风险评估。使用随机效应反方差模型计算95%置信区间（CI）的合并平均差（MD）。按年龄组、男性比例、地区、随访时间、合并症百分比、房颤定义及检测方法、心电图参数进行亚组/敏感性分析。异质性采用科克伦Q、τ 2和i2进行评估，并采用科克伦阈值进行解释；确定性用GRADE来评价。结果：10项研究，1508例患者（平均年龄66.72±13.74岁，男性55.7%）符合纳入标准。NDAF患者的基线PWDur较长（MD为6.36 ms, 95% CI: 0.69-12.03, p = 0.03, I = 73%， GRADE：中度）。敏感性分析证实了稳健性。PWDis仍然不显著。结论：延长基线PWDur可作为CS幸存者心房传导异常的非侵入性标志物和房颤预测因子。需要更大规模的前瞻性研究来验证其在风险分层和继发性卒中预防中的作用。试验注册：PROSPERO: CRD42025646135。

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引用次数: 0

Unintended Electrical Isolation of the Left Atrial Appendage due to Anatomical Misidentification During Pulsed-Field Ablation: A Case Report 脉冲场消融术中解剖识别错误导致左心耳电隔离1例。

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-10-22 DOI: 10.1002/joa3.70188

Naoki Matsumoto, Kenji Shimeno, Masanori Matsuo, Yukio Abe, Daiju Fukuda

During pulsed-field ablation, unintended left atrial appendage isolation occurred due to anatomical misidentification with the left superior pulmonary vein. Left atrial appendage potentials improved after 1 month. This case highlights procedural tips to avoid this complication and emphasizes post-procedural monitoring and management strategies.

在脉冲场消融术中，由于解剖上与左上肺静脉的错误识别，发生了非预期的左心房附件分离。1个月后左心耳电位改善。本病例强调了避免这种并发症的手术技巧，并强调了术后监测和管理策略。

引用次数: 0

Explosion Risk of Cardiac Implantable Electronic Devices During Cremation: Experimental and Survey Findings From Japan 火化过程中心脏植入式电子装置的爆炸风险：来自日本的实验和调查结果

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-10-22 DOI: 10.1002/joa3.70211

Takanori Arimoto, Yasushi Oginosawa, Katsuya Ebe, Masatomo Takahashi, Eiichi Watanabe, Haruhiko Abe, Masahiko Takagi, Hiroshi Tada, the Japanese Heart Rhythm Society

Background

The widespread use of cardiac implantable electronic devices (CIEDs), combined with increasing global cremation rates, has raised concerns regarding potential explosion risks during cremation. Lithium batteries within these devices may rupture due to heat-induced internal pressure, potentially threatening crematorium infrastructure and staff safety. Despite these concerns, real-world data on explosion behavior and its consequences remain limited. This study aimed to assess the explosion characteristics of CIEDs during cremation and evaluate their impact on facility safety, with the goal of informing evidence-based guidelines.

Methods

Combustion experiments were performed using full-scale cremation furnaces set at 1100°C and 800°C. A total of 13 CIEDs (7 pacemakers and 6 implantable cardioverter-defibrillators) were tested, with synchronized audio-video monitoring. Additionally, nationwide survey data were collected from 2044 crematoria across Japan, focusing on cremation practices, reported damage, and staff injuries.

Results

All tested devices exploded, with mean ignition-to-explosion times of 4.3 ± 1.1 min at 1100°C and 5.4 ± 2.0 min at 800°C (p = 0.19). Seventeen explosion events were observed, yet no structural damage to the chambers occurred. Survey data revealed a decline in cremation refusal due to CIEDs—from 11.0% in 2012 to 4.6% in 2013 and 3.0% in 2014 (p < 0.001). According to respondents, this trend likely reflects an increased collaboration with medical associations, modernization of crematorium facilities, and dissemination of practical safety information.

Conclusions

Cremation of CIEDs without removal appears safe under modern, regulated facilities. However, region-specific guidelines remain necessary due to international variability in infrastructure and practices.

心脏植入式电子装置（CIEDs）的广泛使用，加上全球火葬率的增加，引起了人们对火葬过程中潜在爆炸风险的担忧。这些设备内的锂电池可能因热致内部压力而破裂，潜在地威胁到火葬场的基础设施和工作人员的安全。尽管存在这些担忧，但关于爆炸行为及其后果的真实数据仍然有限。本研究旨在评估火化过程中ied的爆炸特性，并评估其对设施安全的影响，目的是为循证指南提供信息。方法采用全尺寸火化炉，分别在1100℃和800℃进行燃烧实验。共测试13台cied（7台起搏器和6台植入式心律转复除颤器），并同步进行音频-视频监测。此外，从日本各地的2044个火葬场收集了全国性的调查数据，重点关注火葬做法、报告的损害和工作人员受伤情况。结果所有试验装置均发生爆炸，1100℃下平均起爆时间为4.3±1.1 min， 800℃下平均起爆时间为5.4±2.0 min （p = 0.19）。观察到17次爆炸事件，但没有发生对腔室的结构破坏。调查数据显示，由于cied导致的火葬拒绝率从2012年的11.0%下降到2013年的4.6%和2014年的3.0% （p < 0.001）。据答复者说，这一趋势可能反映了与医学协会的合作增加、火葬场设施现代化以及实用安全信息的传播。结论：在现代化、规范的设施下，不拔除的cied火化是安全的。然而，由于国际上基础设施和实践的差异，仍有必要制定针对特定区域的指导方针。

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引用次数: 0

Mapping Atrial Tachycardia Post-Pulmonary Vein Isolation Using the PulseSelect Catheter and Ensite NavX 利用脉冲选择导管和Ensite NavX定位肺静脉隔离后的房性心动过速。

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-10-22 DOI: 10.1002/joa3.70206

Takayuki Okamoto, Takashi Okajima, Shinji Ishikawa, Yusuke Uemura

The nine 3-mm electrodes, 3.75-mm fixed interelectrode space, and soft and slightly tilted shape of the PulseSelect catheter enables creating high-quality 3D electroanatomical mapping. Combined with an Ensite NavX 3D mapping system, it may be a superior option for managing atrial tachycardia after pulmonary vein isolation with pulsed field ablation.

9个3毫米的电极，3.75毫米的固定电极间空间，以及PulseSelect导管柔软且略微倾斜的形状，能够创建高质量的3D电解剖制图。结合Ensite NavX 3D制图系统，它可能是处理脉冲场消融肺静脉隔离后房性心动过速的优越选择。

引用次数: 0

Outcomes With Pulsed Field Ablation Versus Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation: A Meta-Analysis 脉冲场消融与传统热消融治疗阵发性心房颤动的结果：一项荟萃分析

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-10-22 DOI: 10.1002/joa3.70207

Ahmed Elmorsy Mohamed, Ahmed Farid Gadelmawla, Zeyad Kholeif, Mohamed Elnady, Ahmed Diaa, Rana Rashwan, Ameer Awashra, Aya Elalfy, Imad Tahhan, Mohab Elnashar, Ranem Afify, Eman Mohyeldin, Haytham A. M. Dwaik, Jeanwoo Yoo, Islam Y. Elgendy

Background

Pulmonary vein isolation is a standard therapy for paroxysmal atrial fibrillation (AF). Pulsed field ablation (PFA) has emerged as a novel approach aiming to improve efficacy and safety over conventional thermal ablation (CTA) (radiofrequency and cryoballoon). This meta-analysis evaluated outcomes of PFA versus thermal ablation in paroxysmal AF.

Methods

Electronic databases were searched through May 2025 for randomized controlled trials (RCTs) and observational studies that compared the efficacy and safety of PFA versus CTA. The primary outcome was AF recurrence. Summary estimates were conducted using random effects.

Results

A total of six studies, involving 1928 patients, were included. The incidence of AF recurrence was significantly lower among patients treated with PFA (risk ratio [RR] 0.67; 95% confidence interval [CI] 0.53–0.85). PFA was associated with a lower incidence of any atrial arrhythmia recurrence (RR 0.78, 95% CI: 0.61–0.99). The total procedure duration was significantly shorter with PFA (mean difference −21.46 min (95% CI: −26.04 to −16.88)), but there was no difference in fluoroscopy time. The rates of esophageal injury and phrenic nerve palsy were lower with PFA. However, the data were limited for these two outcomes, and a meta-analysis was not conducted for them. There was no difference between the two groups in the incidence of stroke or pericardial tamponade.

Conclusion

Among patients with paroxysmal AF undergoing catheter ablation, PFA is associated with favorable outcomes, including lower recurrence and shorter procedure time compared to conventional ablation modalities.

背景：肺静脉隔离是阵发性心房颤动（AF）的标准治疗方法。脉冲场消融（PFA）已经成为一种新的方法，旨在提高传统热消融（CTA）（射频和低温球囊）的疗效和安全性。该荟萃分析评估了PFA与热消融治疗阵发性房颤的结果。方法：电子数据库检索了截至2025年5月的随机对照试验（rct）和观察性研究，比较了PFA与CTA的疗效和安全性。主要终点为房颤复发。使用随机效应进行汇总估计。结果：共纳入6项研究，涉及1928例患者。经PFA治疗的患者房颤复发率明显降低（风险比[RR] 0.67； 95%可信区间[CI] 0.53-0.85）。PFA与较低的房性心律失常复发发生率相关（RR 0.78, 95% CI: 0.61-0.99）。PFA组的总手术时间明显缩短（平均差异为-21.46分钟（95% CI: -26.04至-16.88）），但透视时间没有差异。PFA组食道损伤和膈神经麻痹发生率较低。然而，这两个结果的数据有限，并且没有对它们进行荟萃分析。两组在卒中或心包填塞发生率上无差异。结论：在接受导管消融的阵发性房颤患者中，PFA与良好的预后相关，包括与传统消融方式相比更低的复发率和更短的手术时间。

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引用次数: 0

Low Body Mass Index as a Predictor of Amiodarone-Induced Pulmonary Toxicity 低体重指数作为胺碘酮诱导肺毒性的预测因子。

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-10-22 DOI: 10.1002/joa3.70205

Takuto Zaizen, Hidekazu Kondo, Teruo Noguchi, Reina Tonegawa-Kuji, Tsukasa Kamakura, Mitsuru Wada, Kohei Ishibashi, Yuko Inoue, Koji Miyamoto, Takeshi Aiba, Naohiko Takahashi, Kengo Kusano

Background

Amiodarone-induced pulmonary toxicity (APT) is one of the major side effects of the medication when used in the treatment of arrhythmia. However, the risk factors for developing APT have yet to be fully understood.

Methods and Results

We retrospectively analyzed 454 patients who were treated with amiodarone for arrhythmia between 2016 and 2020 at the National Cerebral and Cardiovascular Center, Osaka, Japan. During the median follow-up period of 207 days, 24 patients (5.4%) had APT. Using a multivariate analysis of the Cox proportional hazards model, lower body mass index (BMI) (hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.71–0.95), higher age (HR: 1.06, 95% CI: 1.02–1.10), and higher amiodarone maintenance dose (HR: 1.01, 95% CI: 1.003–1.02) were risk factors for APT. Specifically, the patients whose BMIs were < 22 kg/m² were approximately three times more likely to develop APT than the patient whose BMIs were ≥ 22 kg/m². The cutoff value for maximum KL-6 levels during amiodarone therapy as an APT screening test was 444 U/mL or higher, with a sensitivity of 70.8% and specificity of 88.1%.

Conclusion

Lower BMI, higher age, and a higher maintenance dose were identified as independent risk factors for APT. KL-6 levels during administration may be useful in suspecting the development of APT.

背景：胺碘酮引起的肺毒性（APT）是治疗心律失常的主要副作用之一。然而，发展10 + 3的风险因素尚未得到充分认识。方法和结果：我们回顾性分析了2016年至2020年在日本大阪国立脑心血管中心接受胺碘酮治疗心律失常的454例患者。在中位随访207天期间，24例患者（5.4%）发生APT。Cox比例风险模型多因素分析显示，体重指数（BMI）较低（风险比[HR]: 0.81, 95%可信区间[CI]: 0.71-0.95）、年龄较大（风险比：1.06,95% CI: 1.02-1.10）、胺碘酮维持剂量较高（风险比：1.01,95% CI: 1.01）；1.003-1.02)是发生APT的危险因素。具体而言，bmi为2的患者发生APT的可能性是bmi≥22 kg/m2患者的约3倍。胺碘酮治疗期间最大KL-6水平作为APT筛查试验的临界值为444 U/mL或更高，敏感性为70.8%，特异性为88.1%。结论：较低的BMI、较高的年龄和较高的维持剂量被确定为APT的独立危险因素。给药期间KL-6水平可能有助于怀疑APT的发展。

{"title":"Low Body Mass Index as a Predictor of Amiodarone-Induced Pulmonary Toxicity","authors":"Takuto Zaizen, Hidekazu Kondo, Teruo Noguchi, Reina Tonegawa-Kuji, Tsukasa Kamakura, Mitsuru Wada, Kohei Ishibashi, Yuko Inoue, Koji Miyamoto, Takeshi Aiba, Naohiko Takahashi, Kengo Kusano","doi":"10.1002/joa3.70205","DOIUrl":"10.1002/joa3.70205","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Amiodarone-induced pulmonary toxicity (APT) is one of the major side effects of the medication when used in the treatment of arrhythmia. However, the risk factors for developing APT have yet to be fully understood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>We retrospectively analyzed 454 patients who were treated with amiodarone for arrhythmia between 2016 and 2020 at the National Cerebral and Cardiovascular Center, Osaka, Japan. During the median follow-up period of 207 days, 24 patients (5.4%) had APT. Using a multivariate analysis of the Cox proportional hazards model, lower body mass index (BMI) (hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.71–0.95), higher age (HR: 1.06, 95% CI: 1.02–1.10), and higher amiodarone maintenance dose (HR: 1.01, 95% CI: 1.003–1.02) were risk factors for APT. Specifically, the patients whose BMIs were < 22 kg/m<sup>2</sup> were approximately three times more likely to develop APT than the patient whose BMIs were ≥ 22 kg/m<sup>2</sup>. The cutoff value for maximum KL-6 levels during amiodarone therapy as an APT screening test was 444 U/mL or higher, with a sensitivity of 70.8% and specificity of 88.1%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Lower BMI, higher age, and a higher maintenance dose were identified as independent risk factors for APT. KL-6 levels during administration may be useful in suspecting the development of APT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12541544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145354877","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}

引用次数: 0

Cryoballoon Ablation of the Left Common Pulmonary Vein Using a Size-Adjustable Cryoballoon: A Comparative Study 可调节大小的低温球囊消融左总肺静脉的比较研究

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia

Pub Date : 2025-10-17 DOI: 10.1002/joa3.70208

Hirofumi Arai, Yasuteru Yamauchi, Yuichiro Sagawa, Kazuya Murata, Atsuhito Oda, Yumi Yasui, Junichi Kishaba, Hideki Arima, Shinsuke Miyazaki, Tetsuo Sasano

Background

The efficacy of cryoballoon ablation (CBA) using a 28-mm or 31-mm cryoballoon for isolating the left common pulmonary vein (LCPV) remains poorly established. We aimed to evaluate procedural outcomes and long-term follow-up data of CBA for the LCPV using either POLARx with a fixed 28-mm cryoballoon or POLARx FIT with a size-adjustable 28-mm or 31-mm cryoballoon.

Methods

Patients with LCPV who underwent CBA for atrial fibrillation using POLARx or POLARx FIT between January 2022 and April 2024 were retrospectively analyzed. Procedural outcomes and long-term follow-up data were compared between the POLARx and POLARx FIT groups.

Results

Fifty-one patients (32 males [62.7%]; mean age, 66 ± 11.6 years) were analyzed. The POLARx group included 23 patients, and the POLARx FIT group included 28 patients. First-freeze pulmonary vein isolation (PVI) success was 1 (4.3%) versus 8 (28.6%) (p = 0.03), and radiofrequency touch-up ablation was required in 2 (8.7%) versus 0 patients (p = 0.2) in the POLARx and POLARx FIT groups, respectively. Nadir temperature was −53.6° ± 4.7°C versus −54.7° ± 5.6°C (p = 0.45); the number of applications was 3.2 ± 1 versus 2.3 ± 0.9 (p < 0.01); and total freezing time was 520.9 ± 164 s versus 377.7 ± 129.9 s (p < 0.01) for the POLARx and POLARx FIT groups, respectively. A single gastric hypomotility case was observed in the POLARx FIT group. The 1-year arrhythmia-free survival rates were 81.8% and 78.7% for the POLARx and POLARx FIT groups, respectively (p = 0.96).

Conclusions

POLARx FIT was useful for LCPV isolation, with a higher first-freeze PVI success rate, fewer applications, and shorter total freezing time compared to POLARx.

背景使用28毫米或31毫米低温球囊分离左肺静脉（LCPV）的低温球囊消融（CBA）的效果尚不明确。我们的目的是评估CBA治疗LCPV的手术结果和长期随访数据，使用固定的28-mm低温球囊的POLARx或尺寸可调节的28-mm或31-mm低温球囊的POLARx FIT。方法回顾性分析2022年1月至2024年4月期间使用POLARx或POLARx FIT进行房颤CBA治疗的LCPV患者。对POLARx组和POLARx FIT组的手术结果和长期随访数据进行比较。结果51例患者中男性32例，占62.7%，平均年龄66±11.6岁。POLARx组23例，POLARx FIT组28例。首次冻结肺静脉隔离（PVI）成功1例（4.3%）对8例（28.6%）（p = 0.03），在POLARx组和POLARx FIT组中，分别有2例（8.7%）和0例（p = 0.2）患者需要射频补强消融。谷底温度−53.6°±4.7°C和−54.7°±5.6°C (p = 0.45);应用次数为3.2±1对2.3±0.9 (p < 0.01)；总冻结时间分别为520.9±164 s和377.7±129.9 s （p < 0.01）。在极乐FIT组观察到1例胃动力低下。POLARx组和POLARx FIT组1年无心律失常生存率分别为81.8%和78.7% （p = 0.96）。结论：与POLARx相比，POLARx FIT具有更高的首次冻结PVI成功率、更少的应用和更短的总冻结时间，可用于LCPV分离。

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引用次数: 0