Journal of Cardiovascular Electrophysiology最新文献

Background: Compared to permanent surgically created hemodialysis (HD) vascular access, tunneled vascular access catheters for HD may pose an even higher risk of blood stream infection (BSI). For patients with transvenous cardiac implantable electronic devices (CIEDs), the risk of device infection associated with tunneled HD catheter is not well-characterized.

Methods: The Nationwide Readmissions Database (NRD) 2016-2021 was used for analysis. Patients with end-stage kidney disease (ESKD) and a CIED who were admitted for any reason were identified by ICD-10 codes and stratified based on whether a new tunneled HD catheter was placed during the index admission. Readmissions with CIED infection within 180 days were compared between the two groups (new tunneled HD catheter during index admission vs. ESKD without need for new dialysis access).

Results: We identified 117 573 index admissions in patients with ESKD and a CIED, out of whom 8677 (7.4%) underwent placement of a new, tunneled HD catheter during the index admission. Readmission within 180 days occurred in 531 patients (6.1%) among those who required a new, HD catheter during index admission, compared to 3572 (3.3%) among those who did not. In multivariable models, a new, HD catheter during index admission was associated with a significantly increased risk of readmission with CIED infection within 180 days (adjusted odds ratio [aOR]: 1.92, 95% confidence interval [CI]: 1.66-2.22, p < 0.001). During the readmission, patients with a new tunneled catheter were more likely to present with blood stream infection (57.8 vs. 45.8%, p < 0.001), infectious endocarditis (13.4 vs. 10.1%, p < 0.001), and to experience in-hospital major adverse cardiovascular events (MACE) (10.5 vs. 9.9%, p = 0.006).

Conclusion: Among patients with CIEDs, placement of a new tunneled vascular access catheter for HD was associated with a roughly twofold increased risk of readmission with CIED infection within 180 days, compared to patients with ESKD who did not require new vascular access. Readmissions with CIED infection were associated with significantly worse outcomes, including higher in-hospital MACE. To the extent possible, temporary tunneled HD catheters should be avoided in ESKD patients with CIEDs.

Introduction: Despite data-driven 2015 expert consensus statement (consensus) guidelines on recommended PPM and ICD parameters, patients often fall short of optimal device programing. The purpose of this retrospective, observational, single-center study is to review device implant registry data both before and after the consensus update to determine whether there is an improvement in adherence to consensus-recommended device programming over time.

Methods: McKesson software was used to identify all patients pre- (1/1/2012-12/31/2013) and post- (1/1/2020-12/31/2022) consensus who underwent a single, dual, or BiV device implant and had at least one follow-up appointment in the electronic medical record. Groups were evaluated for adherence to consensus recommendations based on the type of device. BiV devices were evaluated based on the percent of total pacing, with > 98% pacing being considered compliant with the consensus. Single and dual-chamber ICDs were evaluated based on bradycardia and tachyarrhythmia programming parameters as outlined in the 2015 consensus document and the 2019 manufacturer-specific update. Due to significant implantation rates at our institution, and to maintain consistency, only Medtronic devices were evaluated in this study.

Results: In the BiV group, before the consensus, 41 (85.4%) patients were > 98% paced, compared with only 69 (58.0%) patients post-consensus. Forty-five (93.7%) patients were at least 90% paced in the pre-consensus group, compared with 109 (91.6%) in the post-consensus group. In the ICD group, bradycardia-pacing settings were similar in both groups (34/89.5% vs. 73/90.1%, p = 0.91). There was a trend toward improved adherence to tachyarrhythmia therapies post-consensus (15/39.5% vs. 37/45.7%, p = 0.52). Nonadherence was driven by 1:1 SVT logic initiation. If this parameter was excluded, both groups increased significantly (37/97.4% vs. 78/96.3%, p = 0.76).

Conclusions: This study adds to the growing body of literature showing a persistent disconnect between data-driven recommendations and real-world clinical practice. Larger studies are needed to better understand physician barriers to these guideline-driven recommendations.

Introduction: The conventional 3-month blanking period after atrial fibrillation (AF) ablation has been applied irrespective of energy modality. Pulsed field ablation (PFA), a nonthermal technique, may elicit different tissue responses, questioning the appropriateness of this timeframe. We performed a meta-analysis to evaluate whether early recurrence of atrial tachyarrhythmia (ERAT) after PFA predicts late recurrence (LRAT) and to assess the duration of the traditional blanking period.

Methods: We systematically searched PubMed, Embase, and Cochrane Library through April 2025 for studies reporting ERAT and LRAT following PFA for AF.

Results: Nine studies (N = 3384) met the inclusion criteria. ERAT within 3 months post-PFA occurred in 14% of patients. Patients with ERAT had significantly higher odds of LRAT (pooled OR: 8.66; 95% CI: 5.69-13.18; p < 0.001). Importantly, ERAT in the first month was not predictive of LRAT (OR: 1.30; p = 0.52), whereas ERAT in Months 2-3 strongly predicted LRAT.

Conclusion: ERAT after PFA is a strong predictor of LRAT, especially if occurring beyond the first month. These findings challenge the traditional 3-month blanking period for PFA and support shortening or individualizing this window. A tailored post-PFA surveillance approach focusing on arrhythmias beyond 1 month may improve timely interventions and long-term outcomes. Prospective studies are needed to refine blanking period duration for PFA.

Background: Cryoballoon ablation (CB) is a well-established thermal technique for pulmonary vein isolation (PVI), while balloon-in-basket pulsed field ablation (BiB-PFA) represents a novel non-thermal alternative. Both single-shot systems may trigger systemic inflammation and myocardial injury, yet direct comparisons are lacking. This study aimed to compare inflammatory and myocardial biomarker responses following first-time PVI using CB or BiB-PFA.

Methods: In this prospective, single-center study, 100 patients undergoing PVI for symptomatic paroxysmal or persistent atrial fibrillation (AF) were enrolled (CB: n =  50; BiB-PFA: n =  50). Venous blood samples were collected before and on the morning after ablation to assess leukocytes, C-reactive protein (CRP), platelets, troponin T, creatine kinase (CK), myoglobin, creatinine, and estimated glomerular filtration rate. Baseline characteristics, procedural data, and acute success were analyzed.

Results: Patients in the CB group were older (74 vs. 65 years; p =  0.01) and had higher CHA₂DS₂-VAcore (3.0 vs. 2.0; p  =  0.009). Acute PVI was achieved in all cases CB was associated with greater increases in leukocytes (Δ2.5 vs. 1.1 × 10⁹/L; p  =  0.05) and CRP (Δ5.8 vs. 3.4 mg/L; p =  0.02), whereas BiB-PFA showed higher rises in CK (Δ217 vs. 103 U/L; p  =  0.01) and troponin T (Δ1129 vs. 614.5 ng/L; p =  0.01). No significant correlation was found between energy delivery and biomarker changes.

Conclusion: CB and BiB-PFA elicit distinct systemic responses. CB provoked stronger inflammatory activation, while BiB-PFA caused greater myocardial biomarker release, suggesting energy- and device-specific effects.

Background: Ventricular tachycardia (VT) is a life-threatening arrhythmia frequently observed in structural heart diseases, including LMNA-related cardiomyopathy, a genetic disorder associated with high risk of sudden cardiac death and progressive systolic dysfunction. While catheter ablation is an established therapeutic option for VT, its efficacy in cardiac laminopathy remains poorly defined.

Objectives: To synthesize available evidence on the role and outcomes of VT ablation in patients with cardiac laminopathy.

Methods: A systematic review and single-arm meta-analysis was performed in accordance with PRISMA guidelines. PubMed, Embase, and Cochrane databases were searched for studies reporting VT ablation outcomes in LMNA-related cardiomyopathy. An inverse variance random-effects model was applied for meta-analysis of proportions.

Results: Seven studies (six cohorts, one abstract) comprising 62 patients (mean age 53.2 ± 9.7 years; 85% male; 88% with implantable cardioverter-defibrillator) were included. An endocardial/endo-epicardial approach was used in 93% of cases. Acute procedural success was achieved in 37% (95% CI: 14%-63%; I² = 27.4%), and 28% required multiple procedures. Over a median follow-up of 26 (9-35) months, VT recurrence occurred in 91% (95% CI: 76%-100%; I² = 37.2%). All-cause mortality was 54% (95% CI: 39%-70%; I² = 28%), predominantly from cardiac causes (51%, 95% CI: 25%-76%; I² = 53%), and 14% (95% CI: 1%-34%; I² = 42%) underwent heart transplantation.

Conclusions: In LMNA-related cardiomyopathy, catheter ablation is associated with high VT recurrence, limited long-term success, and substantial cardiovascular mortality and transplantation rates, underscoring the importance of ICD implantation and the need for alternative strategies, including variant-specific and molecularly targeted therapies.

Introduction: There is limited data regarding the use of pulsed-field ablation (PFA) for mitral isthmus (MI) ablation in patients with non-paroxysmal atrial fibrillation (AF). Our aim was to assess the acute efficacy of MI ablation using a pentaspline PFA catheter with two different ablation settings.

Methods: Patients with AF undergoing ablation were consecutively enrolled. All patients underwent pulmonary vein isolation and left atrial posterior wall ablation. MI ablation was performed in up to 4 series (9 PFA applications each) in Cohort A, or in up to 3 series (20 PFA applications each) in Cohort B. Each series was followed by a 20-min observation period to verify the durability of the MI block. The primary endpoints were a first-pass MI block and a final MI block after all ablation series.

Results: Between September 2024 and June 2025, 70 patients were enrolled: 30 in Cohort A and 40 in Cohort B. A first-pass MI block was achieved in 10 (33.3%) patients in Cohort A and 28 (70%) patients in Cohort B (p = 0.003). A final MI block was present in 27 (90%) and 35 (87.5%) patients in Cohort A and B, respectively (p = 1.00). The median reconduction time was 6 min (IQR 2.8-9.4) in Cohort A and 5 min (IQR 2.6-8.7) in Cohort B. No major complications occurred.

Conclusion: Using series of 20 PFA applications increased the success rate of a first-pass MI block to 70%. An observation period is recommended to verify the durability of MI block in PFA.

Clinical trial registration: NCT06803238.

Background: Catheter ablation is the key element of rhythm control in atrial fibrillation (AF), yet its reliance on fluoroscopy exposes patients and operators to radiation. A fluoroscopy-free procedure is possible using intracardiac echocardiography (ICE), but due to high cost, the learning curve, and added procedural steps, ICE is rarely used in Europe. Similarly, non-fluoroscopic tracking systems (NCTS) like MediGuide for near-zero fluoroscopy ablation have fallen out of favor. The SHORT LOOK study evaluates the efficiency and safety of a streamlined near-zero fluoroscopy workflow for first-time pulmonary vein isolation (PVI) based solely on advanced 3D mapping and an ultra-low-dose fluoroscopy protocol. The aim was to determine whether near-zero fluoroscopy ablation can be achieved using conventional techniques, enabling broader adoption in modern electrophysiology labs.

Methods: The SHORT LOOK registry is a single-center, investigator-initiated prospective standard-of-care study enrolling consecutive patients undergoing first-time PVI for AF. A total of 450 patients were included in the final analysis. The workflow used a 3D mapping system (CARTO3, J&J MedTec) with an ultra-low-dose fluoroscopy protocol, without adjunctive technologies. Baseline assessments included medical history, physical examination, labs, ECG, EQ-VAS, and echocardiography. The primary efficacy endpoint was median fluoroscopy time; the primary safety endpoint was a composite of procedure-related death or cardiovascular, neurological, or vascular events. Secondary endpoints included 1-year freedom from atrial arrhythmia > 30 s, skin-to-skin time, fluoroscopy dose, and proportion of procedures with fluoroscopy < 1 min. Patients were followed up for 1 year.

Results: The SHORT LOOK cohort (n = 450) achieved a median procedural time of 57 min, with median fluoroscopy time of 26 s and dose of 9.1 µGy*m². The complication rate was < 1% and no major adverse events occurred. Follow-up revealed that for paroxysmal atrial fibrillation, 86.1% were AT/AF-free at 3 months, decreasing to 82.6% at 12 months, while for persistent atrial fibrillation, the rates were 77.3% and 71.7%, respectively, confirming sustained rhythm control. EQ-VAS analyses revealed a significant improvement in health-related quality of life from baseline (p < 0.05). Compared to a historical NCTS group, our workflow leads to similarly low fluoroscopy times and radiation doses.

Conclusion: The streamlined workflow for initial atrial fibrillation ablation, which nearly eliminates fluoroscopy, demonstrates a significant reduction in both fluoroscopy time and radiation dose. This approach is feasible in any electrophysiology laboratory and offers a practical method for performing rapid, safe, and effective AF ablations while maintaining minimal radiation exposure-all without the need for additional adjunctive technologies.