{"title":"Hemolysis Induced by Pulsed-Field Ablation of Atrial Arrhythmias: A Comparative Analysis of Current Systems.","authors":"Moeeza Fatima, Husnain Ahmad, Fatima Qasim, Isha Munir","doi":"10.1111/jce.70191","DOIUrl":"https://doi.org/10.1111/jce.70191","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Catheter ablation technology for atrial fibrillation (AF) has been improving annually, and pulsed field ablation (PFA) has recently become possible. The optimal protocol has yet to be elucidated, and considering variables, including catheter contact force, is essential for conducting more effective and safer ablation. This study was conducted using peak frequency (PF) mapping to analyze the catheter tip electrode frequency during PFA under the hypothesis that higher PF shows stronger myocardial contact and yields a more pronounced electrical current effect.
Methods
Between December 2024 and April 2025, 12 consecutive patients who underwent PFA for paroxysmal AF using the FARAPULSE system at our hospital were included in this study. Overall, 180 applications were analyzed. The PF before energy delivery was analyzed in the group in which the tip electrode potential disappeared following the first energy delivery using the flower-type configuration.
Results
The PF of the distal electrode in the group with potential disappearance following the first delivery was significantly higher than it was in the group without disappearance (291 ± 88 Hz vs. 267 ± 70 Hz, p = 0.02). When the potential at the tip electrode ranged from 0.5 to 1.5 mV, the area under the curve was 0.73. At a cutoff value of 261 Hz for peak frequency, sensitivity reached 67%, and specificity reached 60%.
Conclusion
Effective PFA may be achieved using the frequency of the catheter tip electrode as an index. Delivering energy to myocardial regions with higher PF may yield greater ablation efficacy.
导读：心房颤动（AF）的导管消融技术每年都在改进，脉冲场消融（PFA）最近成为可能。最佳方案尚未阐明，考虑包括导管接触力在内的变量对于进行更有效和更安全的消融至关重要。本研究采用峰值频率（PF）映射来分析PFA期间导管尖端电极的频率，假设较高的PF显示更强的心肌接触并产生更明显的电流效应。方法：于2024年12月至2025年4月，连续12例在我院使用FARAPULSE系统接受阵发性房颤PFA治疗的患者纳入本研究。总共分析了180份申请。在第一次使用花型结构的能量传递后尖端电极电位消失的组中，分析了能量传递前的PF。结果：首次分娩后电位消失组远端电极PF显著高于未消失组（291±88 Hz vs 267±70 Hz, p = 0.02）。当尖端电极电位在0.5 ~ 1.5 mV范围内时，曲线下面积为0.73。峰值频率截止值为261 Hz时，灵敏度达到67%，特异度达到60%。结论：以导管尖端电极频率为指标，可获得有效的PFA。将能量输送到PF较高的心肌区域可能产生更大的消融效果。
{"title":"Efficacy of Peak Frequency in Pulmonary Vein Isolation Using Pulsed Field Ablation for Atrial Fibrillation","authors":"Naoki Aizawa, Kaoru Tanno, Takahiro Furuya, Tomoyuki Ishinaga, Keita Shibata, Chisato Sato, Tenjin Nishikura, Naoko Ikeda, Kohei Wakabayashi","doi":"10.1111/jce.70187","DOIUrl":"10.1111/jce.70187","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Catheter ablation technology for atrial fibrillation (AF) has been improving annually, and pulsed field ablation (PFA) has recently become possible. The optimal protocol has yet to be elucidated, and considering variables, including catheter contact force, is essential for conducting more effective and safer ablation. This study was conducted using peak frequency (PF) mapping to analyze the catheter tip electrode frequency during PFA under the hypothesis that higher PF shows stronger myocardial contact and yields a more pronounced electrical current effect.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between December 2024 and April 2025, 12 consecutive patients who underwent PFA for paroxysmal AF using the FARAPULSE system at our hospital were included in this study. Overall, 180 applications were analyzed. The PF before energy delivery was analyzed in the group in which the tip electrode potential disappeared following the first energy delivery using the flower-type configuration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The PF of the distal electrode in the group with potential disappearance following the first delivery was significantly higher than it was in the group without disappearance (291 ± 88 Hz vs. 267 ± 70 Hz, <i>p</i> = 0.02). When the potential at the tip electrode ranged from 0.5 to 1.5 mV, the area under the curve was 0.73. At a cutoff value of 261 Hz for peak frequency, sensitivity reached 67%, and specificity reached 60%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Effective PFA may be achieved using the frequency of the catheter tip electrode as an index. Delivering energy to myocardial regions with higher PF may yield greater ablation efficacy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"36 12","pages":"3335-3342"},"PeriodicalIF":2.6,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jce.70187","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jose Delgado Moreno, Cesar Khazen, Roger G. Carrillo
Background
Large vegetations in cardiac implantable electronic devices (CIEDs) are associated with high mortality due to risks of major pulmonary artery obstruction. The rising incidence of CIEDs infections has complicated management, particularly in patients with delayed diagnoses. Current guidelines recommend open-heart surgery for vegetations > 2.5 cm, but this approach poses significant risks for high-morbidity patients. This study evaluates the feasibility and outcomes of percutaneous vacuum-assisted aspiration using the AngioVac system in managing giant vegetations (≥ 4.0 cm) in patients unsuitable for open surgery.
Materials and Methods
Fourteen patients with giant vegetations (≥ 4.0 cm), undergoing transvenous lead extraction, were treated with the AngioVac system. The procedure involved large-bore central venous cannulation and extracorporeal aspiration of vegetations. Outcomes assessed included procedural success, embolization management, and post-extraction microbiological findings.
Results
The cohort included 64% males with a median age of 73 years. Vegetation sizes ranged from 4.0 to ≥ 7.0 cm. Most patients (79%) presented with advanced heart failure symptoms (NYHA class III/IV). Despite pulmonary embolism in 29% of cases, all were successfully managed with mechanical aspiration. The procedure achieved 100% complete removal of all leads and vegetations, with no perioperative mortality, and all patients were discharged alive.
Conclusion
Percutaneous aspiration using the AngioVac system is a safe and effective alternative to open-heart surgery for high-risk patients with giant vegetations. This minimally invasive approach demonstrates potential for broader application in managing high-risk CIEDs infections, warranting further investigation in larger studies.
{"title":"Novel Percutaneous Management of Giant Vegetations With Pulmonary Emboli","authors":"Jose Delgado Moreno, Cesar Khazen, Roger G. Carrillo","doi":"10.1111/jce.70183","DOIUrl":"10.1111/jce.70183","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Large vegetations in cardiac implantable electronic devices (CIEDs) are associated with high mortality due to risks of major pulmonary artery obstruction. The rising incidence of CIEDs infections has complicated management, particularly in patients with delayed diagnoses. Current guidelines recommend open-heart surgery for vegetations > 2.5 cm, but this approach poses significant risks for high-morbidity patients. This study evaluates the feasibility and outcomes of percutaneous vacuum-assisted aspiration using the AngioVac system in managing giant vegetations (≥ 4.0 cm) in patients unsuitable for open surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Fourteen patients with giant vegetations (≥ 4.0 cm), undergoing transvenous lead extraction, were treated with the AngioVac system. The procedure involved large-bore central venous cannulation and extracorporeal aspiration of vegetations. Outcomes assessed included procedural success, embolization management, and post-extraction microbiological findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort included 64% males with a median age of 73 years. Vegetation sizes ranged from 4.0 to ≥ 7.0 cm. Most patients (79%) presented with advanced heart failure symptoms (NYHA class III/IV). Despite pulmonary embolism in 29% of cases, all were successfully managed with mechanical aspiration. The procedure achieved 100% complete removal of all leads and vegetations, with no perioperative mortality, and all patients were discharged alive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Percutaneous aspiration using the AngioVac system is a safe and effective alternative to open-heart surgery for high-risk patients with giant vegetations. This minimally invasive approach demonstrates potential for broader application in managing high-risk CIEDs infections, warranting further investigation in larger studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 1","pages":"96-101"},"PeriodicalIF":2.6,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dóra Krányák, Adél Novák, Noémi Pataky, László Sághy, Máté Vámos, Tamás Szili-Török, Róbert Pap, Other Members of the Szeged Electrophysiology Study Group
Introduction
Restoration and maintenance of sinus rhythm (SR) before pulmonary vein isolation (PVI) by antiarrhythmic drug (AAD) therapy can lead to a better outcome in persistent atrial fibrillation (AF). It is unknown, however if pharmacologic conversion by amiodarone loading itself, compared to the need for additional electrical cardioversion (ECV), predicts a better outcome of PVI. Furthermore, it remains controversial whether subsequent AF episodes occurring while on amiodarone before PVI, have any predictive value. Our aim was to assess whether amiodarone response before the procedure shows predictive value in patients with persistent AF undergoing PVI.
Methods and Results
We retrospectively collected data from consecutive patients with persistent AF who underwent PVI between 2013 and 2023, and who received temporary amiodarone therapy, with or without ECV to restore and maintain sinus rhythm before the intervention. A total of 353 patients (30% female, mean age: 63.76 ± 9.27 years) were included. Conversion to sinus rhythm was achieved solely by amiodarone therapy (AmioConv) in 96 patients (27%), while 257 patients (73%) required additional ECV as well. There were no differences between the two groups in terms of comorbidities, CHADS-VASc score (2.46 ± 1.43 vs. 2.26 ± 1.48, p = 0.27), or echocardiographic parameters, but the AmioConv group had a shorter history of AF (2.22 ± 2.96 years vs. 3.74 ± 4.64 years, p < 0.01). During a mean follow-up of 3.48 ± 2.32 years after PVI, patients in the AmioConv group less frequently experienced AF recurrences (41% vs. 56%, p = 0.016) and had significantly longer mean recurrence-free survival (5.21 ± 0.54 vs. 3.6 ± 0.35 years, p < 0.01), compared to the ECV group. The lack of pharmacologic conversion by amiodarone therapy (need for ECV) was found to be the only independent predictor of post PVI recurrences (adjusted HR 1.86, 95% CI 1.21–2.85, p < 0.01). On the contrary, breakthrough episodes of AF during amiodarone therapy, before ablation, were not predictive (adjusted HR 0.87, 95% CI 0.57–1.32, p = 0.51).
Conclusion
In patients with persistent atrial fibrillation the outcome after PVI is predicted by pharmacologic conversion during amiodarone loading, but not the reoccurrence of the arrhythmia during continued pre-ablation AAD therapy.
{"title":"Utility of Pharmacologic Conversion of Persistent Atrial Fibrillation by Amiodarone as a Predictor of Outcome After Pulmonary Vein Isolation","authors":"Dóra Krányák, Adél Novák, Noémi Pataky, László Sághy, Máté Vámos, Tamás Szili-Török, Róbert Pap, Other Members of the Szeged Electrophysiology Study Group","doi":"10.1111/jce.70155","DOIUrl":"10.1111/jce.70155","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Restoration and maintenance of sinus rhythm (SR) before pulmonary vein isolation (PVI) by antiarrhythmic drug (AAD) therapy can lead to a better outcome in persistent atrial fibrillation (AF). It is unknown, however if pharmacologic conversion by amiodarone loading itself, compared to the need for additional electrical cardioversion (ECV), predicts a better outcome of PVI. Furthermore, it remains controversial whether subsequent AF episodes occurring while on amiodarone before PVI, have any predictive value. Our aim was to assess whether amiodarone response before the procedure shows predictive value in patients with persistent AF undergoing PVI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>We retrospectively collected data from consecutive patients with persistent AF who underwent PVI between 2013 and 2023, and who received temporary amiodarone therapy, with or without ECV to restore and maintain sinus rhythm before the intervention. A total of 353 patients (30% female, mean age: 63.76 ± 9.27 years) were included. Conversion to sinus rhythm was achieved solely by amiodarone therapy (AmioConv) in 96 patients (27%), while 257 patients (73%) required additional ECV as well. There were no differences between the two groups in terms of comorbidities, CHADS-VASc score (2.46 ± 1.43 vs. 2.26 ± 1.48, <i>p</i> = 0.27), or echocardiographic parameters, but the AmioConv group had a shorter history of AF (2.22 ± 2.96 years vs. 3.74 ± 4.64 years, <i>p</i> < 0.01). During a mean follow-up of 3.48 ± 2.32 years after PVI, patients in the AmioConv group less frequently experienced AF recurrences (41% vs. 56%, <i>p</i> = 0.016) and had significantly longer mean recurrence-free survival (5.21 ± 0.54 vs. 3.6 ± 0.35 years, <i>p</i> < 0.01), compared to the ECV group. The lack of pharmacologic conversion by amiodarone therapy (need for ECV) was found to be the only independent predictor of post PVI recurrences (adjusted HR 1.86, 95% CI 1.21–2.85, <i>p</i> < 0.01). On the contrary, breakthrough episodes of AF during amiodarone therapy, before ablation, were not predictive (adjusted HR 0.87, 95% CI 0.57–1.32, <i>p</i> = 0.51).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In patients with persistent atrial fibrillation the outcome after PVI is predicted by pharmacologic conversion during amiodarone loading, but not the reoccurrence of the arrhythmia during continued pre-ablation AAD therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 1","pages":"90-95"},"PeriodicalIF":2.6,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pulmonary veins (PVs) morphology may affect the number of applications for acute antral PV isolation (PVI) with pulsed field ablation (PFA) using circular multielectrode catheters (PulseSelect, Medtronic) for atrial fibrillation (AF). We investigated the relationship between PV morphology and the number of PFA applications for antral PVI.
Methods
Forty-five patients (180 PVs) with AF underwent initial PFA. PV morphology was assessed by preprocedural computed tomography. The minimal PFA protocol was defined as four ostial and four antral applications per PV. Antral PVI was confirmed after the minimal PFA protocol by multielectrode mapping catheters on 3-dimensional electroanatomic mapping systems. PV morphology was compared between PVs with and without antral PVI by the minimal PFA protocol.
Results
Antral PVI by the minimal PFA protocol was obtained in 138 (77%) PVs. PVs without antral PVI by the minimal PFA protocol revealed larger long axis diameters (23.1 ± 5.4 vs. 20.1 ± 4.3 mm, p < 0.001), larger short axis diameters (19.0 ± 5.5 vs. 16.3 ± 4.0 mm, p = 0.005), and larger PV areas (PVAs) (362.7 ± 178.4 vs. 265.9 ± 115.2 mm2, p = 0.010). PVA was the only independent predictor among the clinical characteristics for antral PVI after the minimal PFA protocol (adjusted odds ratio per 10 mm2 0.867; 95% confidence interval 0.817–0.920; p < 0.001).
Conclusions
Antral PVI was not accomplished in 23% of PVs by the minimal PFA protocol using circular multielectrode catheters. Additional PFA should be considered for larger PVs.
肺静脉（PV）形态学可能会影响使用圆形多电极导管（PulseSelect, Medtronic）进行脉冲场消融（PFA）急性心房PV隔离（PVI）治疗心房颤动（AF）的应用数量。我们研究了PV形态与PFA应用于窦腔PVI的数量之间的关系。方法：45例（180名pv）房颤患者行初始PFA。术前计算机断层扫描评估PV形态。最小的PFA方案被定义为每个PV有4个孔道和4个心房应用。通过三维电解剖测图系统上的多电极测图导管，在最小PFA协议后确认心房PVI。通过最小PFA协议比较有和没有窦性PVI的PV形态。结果：在138例（77%）pv中，通过最小PFA方案获得了窦腔PVI。通过最小PFA方案，无正中PVI的pv显示更大的长轴直径（23.1±5.4 vs. 20.1±4.3 mm, p 2, p = 0.010）。PVA是最小PFA方案后唯一独立的PVI临床特征预测因子（每10 mm2调整优势比0.867；95%可信区间0.817-0.920;p）结论：23%的PVI患者在使用圆形多电极导管的最小PFA方案中未实现PVI。对于较大的pv，应考虑增加PFA。
{"title":"Impact of Pulmonary Vein Morphology on the Number of Pulsed Field Ablation Applications Using Circular Multielectrode Catheters","authors":"Takahiko Nagase, Haruwo Tashiro, Masafumi Himeno, Fumiaki Hayakawa, Yuka Karasawa, Chiyo Yoshino, Yoshinori Yoshida, Takahisa Tanaka, Mitsunori Ishino, Ryuichi Kato, Masao Kuwada","doi":"10.1111/jce.70185","DOIUrl":"10.1111/jce.70185","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pulmonary veins (PVs) morphology may affect the number of applications for acute antral PV isolation (PVI) with pulsed field ablation (PFA) using circular multielectrode catheters (PulseSelect, Medtronic) for atrial fibrillation (AF). We investigated the relationship between PV morphology and the number of PFA applications for antral PVI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Forty-five patients (180 PVs) with AF underwent initial PFA. PV morphology was assessed by preprocedural computed tomography. The minimal PFA protocol was defined as four ostial and four antral applications per PV. Antral PVI was confirmed after the minimal PFA protocol by multielectrode mapping catheters on 3-dimensional electroanatomic mapping systems. PV morphology was compared between PVs with and without antral PVI by the minimal PFA protocol.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Antral PVI by the minimal PFA protocol was obtained in 138 (77%) PVs. PVs without antral PVI by the minimal PFA protocol revealed larger long axis diameters (23.1 ± 5.4 vs. 20.1 ± 4.3 mm, <i>p</i> < 0.001), larger short axis diameters (19.0 ± 5.5 vs. 16.3 ± 4.0 mm, <i>p</i> = 0.005), and larger PV areas (PVAs) (362.7 ± 178.4 vs. 265.9 ± 115.2 mm<sup>2</sup>, <i>p</i> = 0.010). PVA was the only independent predictor among the clinical characteristics for antral PVI after the minimal PFA protocol (adjusted odds ratio per 10 mm<sup>2</sup> 0.867; 95% confidence interval 0.817–0.920; <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Antral PVI was not accomplished in 23% of PVs by the minimal PFA protocol using circular multielectrode catheters. Additional PFA should be considered for larger PVs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 1","pages":"71-80"},"PeriodicalIF":2.6,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This prospective, non-randomized study assessed the impact of irrigation flow rates on silent cerebral events (SCEs) during pulsed field ablation (PFA) using the VARIPULSE catheter.
Methods
Twenty patients underwent pulmonary vein isolation with either 4 mL/min (l-group) or 30 mL/min (H-group) irrigation.
Results
SCEs occurred in 2/10 patients in the l-group and 0/10 in the H-group. Given the small sample and rare events, we report descriptive estimates with exact (Clopper–Pearson) 95% CIs (l-group 20.0% [95% CI: 2.5–55.6]; H-group 0.0% [95% CI: 0.0–30.9]) and a Newcombe (Wilson) 95% CI for the risk difference ( − 20.0% [95% CI: − 51.0 to +22.1]); no hypothesis testing was performed for SCEs. Despite a larger irrigation volume in the H-group, no hemodynamic worsening was observed.
Conclusion
In this exploratory series, SCEs were not observed with 30 mL/min irrigation, but the study is underpowered to determine comparative safety.
{"title":"Evaluation of the Impact of Irrigation Flow Rate on Clinical Outcomes During Pulsed Field Ablation","authors":"Kennosuke Yamashita, Yohei Kikuchi, Keita Yoshiyama, Daiki Kumazawa, Yosuke Mizuno, Kosuke Onodera, Takehiro Nomura","doi":"10.1111/jce.70194","DOIUrl":"10.1111/jce.70194","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This prospective, non-randomized study assessed the impact of irrigation flow rates on silent cerebral events (SCEs) during pulsed field ablation (PFA) using the VARIPULSE catheter.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty patients underwent pulmonary vein isolation with either 4 mL/min (<span>l</span>-group) or 30 mL/min (H-group) irrigation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>SCEs occurred in 2/10 patients in the <span>l</span>-group and 0/10 in the H-group. Given the small sample and rare events, we report descriptive estimates with exact (Clopper–Pearson) 95% CIs (<span>l</span>-group 20.0% [95% CI: 2.5–55.6]; H-group 0.0% [95% CI: 0.0–30.9]) and a Newcombe (Wilson) 95% CI for the risk difference ( − 20.0% [95% CI: − 51.0 to +22.1]); no hypothesis testing was performed for SCEs. Despite a larger irrigation volume in the H-group, no hemodynamic worsening was observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this exploratory series, SCEs were not observed with 30 mL/min irrigation, but the study is underpowered to determine comparative safety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 1","pages":"181-185"},"PeriodicalIF":2.6,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiomyocyte lines are widely used in cardiovascular research. For cardiac ablation, the factors affecting cardiomyocytes by pulsed electrical field (PEF) ablation are being investigated due to the sensitivity of cardiomyocytes to electrical pulses. Previous studies have shown that AC16 death is independent of the number and frequency of PEF. We aim to investigate the relationship between the depth, size, and electric field strength of irreversible (reversible) electroporation formed by nanosecond PEF.
Methods and Results
This study used different detection methods to investigate the effects on AC16 cardiomyocytes under different electric fields strength of nanosecond PEF. Macroscopically, the impact of nanosecond PEF on the survival rate of AC16 cardiomyocytes was preliminarily determined through trypan blue staining and CCK-8. Then, apoptosis, protein expression, and cell morphology were observed by mitochondrial membrane potential, western blot analysis, and electron microscopy to determine the electric field threshold of irreversible (reversible) electroporation in AC16 cardiomyocytes and to study the relationship between pore formation and electric field strength changes.
Conclusions
For AC16 cardiomyocytes, increasing the electric field strength of nanosecond PEF induces progressive deepening of electroporation. Specifically, at 1500 V/cm, the pores reached an average depth of approximately 30 nm, while at 2200 V/cm, the depth extended to approximately 80 nm with localized membrane rupture. Pore diameter and density also increased with higher field strengths, and a clear electric field threshold distinguished reversible from irreversible electroporation.
{"title":"Irreversible Electroporation of AC16 Cardiomyocytes Induced by Nanosecond High Voltage Pulse In Vitro","authors":"Ping Ye, Haoyang Li, Mingyue Zhang","doi":"10.1111/jce.70163","DOIUrl":"10.1111/jce.70163","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardiomyocyte lines are widely used in cardiovascular research. For cardiac ablation, the factors affecting cardiomyocytes by pulsed electrical field (PEF) ablation are being investigated due to the sensitivity of cardiomyocytes to electrical pulses. Previous studies have shown that AC16 death is independent of the number and frequency of PEF. We aim to investigate the relationship between the depth, size, and electric field strength of irreversible (reversible) electroporation formed by nanosecond PEF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>This study used different detection methods to investigate the effects on AC16 cardiomyocytes under different electric fields strength of nanosecond PEF. Macroscopically, the impact of nanosecond PEF on the survival rate of AC16 cardiomyocytes was preliminarily determined through trypan blue staining and CCK-8. Then, apoptosis, protein expression, and cell morphology were observed by mitochondrial membrane potential, western blot analysis, and electron microscopy to determine the electric field threshold of irreversible (reversible) electroporation in AC16 cardiomyocytes and to study the relationship between pore formation and electric field strength changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>For AC16 cardiomyocytes, increasing the electric field strength of nanosecond PEF induces progressive deepening of electroporation. Specifically, at 1500 V/cm, the pores reached an average depth of approximately 30 nm, while at 2200 V/cm, the depth extended to approximately 80 nm with localized membrane rupture. Pore diameter and density also increased with higher field strengths, and a clear electric field threshold distinguished reversible from irreversible electroporation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 1","pages":"49-59"},"PeriodicalIF":2.6,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Role of Ethanol in the Era of Pulsed Field Ablation","authors":"Apoor Patel, Adi Lador, Miguel Valderrábano","doi":"10.1111/jce.70181","DOIUrl":"10.1111/jce.70181","url":null,"abstract":"","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yukiko Shimizu, Ayaka Yoshihara, Tomoari Kuriyama, Kazuki Mori, Kazuto Kujira, Mayu Arakawa, Seiko Kariya, Yukihito Sato
Background
Upper loop reentry (ULR) is a macroreentrant atrial flutter rotating around the upper right atrium. Initially described over 20 years ago as originating from conduction gaps in the crista terminalis, ULR has more recently been reported in association with cardiac surgeries and atrial fibrillation ablation. However, its clinical features and optimal ablation strategies remain poorly defined.
Methods
We retrospectively analyzed six consecutive cases diagnosed with ULR and treated with catheter ablation (5 males, age 61.2 ± 12.8 years) at our institution.
Results
ULR occurred in various clinical settings: following superior transseptal approaches (n = 2), after surgical repairs of congenital heart disease (n = 2), and related to atrial fibrillation ablation (n = 2). Slow conduction zones (SCZs) associated with ULR were variably located at the crista terminalis/sinus venosus, near surgical incision lines, or within low-voltage areas in the right atrium. In one case, no distinct SCZ was identified. Ablation strategies were individualized, including focal ablation at identifiable SCZs, linear ablation between anatomical structures, or intercaval linear ablation. In all cases, the tachycardia was successfully terminated, and no further arrhythmia was inducible.
Conclusion
This case series highlights the heterogeneous nature of ULR circuits and their occurrence across diverse clinical backgrounds. Tailored ablation strategies based on individual arrhythmia substrates are effective for successful elimination of ULR.
{"title":"Upper Loop Reentry Revisited: Clinical Features, Mechanisms, and Therapeutic Approaches—Insights From a Case Series","authors":"Yukiko Shimizu, Ayaka Yoshihara, Tomoari Kuriyama, Kazuki Mori, Kazuto Kujira, Mayu Arakawa, Seiko Kariya, Yukihito Sato","doi":"10.1111/jce.70180","DOIUrl":"10.1111/jce.70180","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Upper loop reentry (ULR) is a macroreentrant atrial flutter rotating around the upper right atrium. Initially described over 20 years ago as originating from conduction gaps in the crista terminalis, ULR has more recently been reported in association with cardiac surgeries and atrial fibrillation ablation. However, its clinical features and optimal ablation strategies remain poorly defined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed six consecutive cases diagnosed with ULR and treated with catheter ablation (5 males, age 61.2 ± 12.8 years) at our institution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ULR occurred in various clinical settings: following superior transseptal approaches (<i>n</i> = 2), after surgical repairs of congenital heart disease (<i>n</i> = 2), and related to atrial fibrillation ablation (<i>n</i> = 2). Slow conduction zones (SCZs) associated with ULR were variably located at the crista terminalis/sinus venosus, near surgical incision lines, or within low-voltage areas in the right atrium. In one case, no distinct SCZ was identified. Ablation strategies were individualized, including focal ablation at identifiable SCZs, linear ablation between anatomical structures, or intercaval linear ablation. In all cases, the tachycardia was successfully terminated, and no further arrhythmia was inducible.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case series highlights the heterogeneous nature of ULR circuits and their occurrence across diverse clinical backgrounds. Tailored ablation strategies based on individual arrhythmia substrates are effective for successful elimination of ULR.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15178,"journal":{"name":"Journal of Cardiovascular Electrophysiology","volume":"37 1","pages":"60-70"},"PeriodicalIF":2.6,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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