Journal of Cardiovascular Electrophysiology最新文献

Introduction: The circular array (CA) pulsed field ablation (PFA) system is the first FDA-approved PFA technology for atrial fibrillation (AF), but real-world long-term outcome data remain limited.

Objective: To compare 1-year procedural outcomes and arrhythmia recurrence following CA PFA versus clinically matched radiofrequency (RF) ablation.

Methods: In this prospective single-center study, 36 consecutive patients underwent de novo AF ablation with the CA catheter and were matched 1:1 to RF controls by age, sex, left atrial size, body mass index, ejection fraction, and AF type. A previously described lesion optimization strategy with pole 5 anchoring was applied in all PFA cases. The primary endpoint was a composite of AF recurrence, antiarrhythmic use, cardioversion beyond the blanking period, or repeat ablation at 1 year.

Results: Baseline characteristics were similar between groups. Procedure and left atrial dwell times were significantly shorter with CA PFA (124 vs. 179 min; 72 vs. 115 min; both p < 0.001). No complications occurred in the PFA group, compared with two access-site hematomas in RF. The composite endpoint occurred less often with PFA (22% vs. 36%, p = 0.195). In multivariable analysis, PFA was associated with a lower risk of recurrence (aOR: 0.50, p = 0.081).

Conclusions: CA PFA, performed with lesion optimization techniques, was safe, efficient, and at least as effective as RF ablation at 1 year. This study represents the first controlled, real-world comparison of long-term outcomes between CA PFA and RF ablation.

Introduction: Cryoballoon ablation is an established therapy for atrial fibrillation (AF); however, isolation of the right inferior pulmonary vein (RIPV) remains technically challenging due to unfavorable anatomy and difficulty achieving stable balloon-tissue contact. We describe a novel adaptation of the Balloon Anchor Technique, originally developed for complex percutaneous coronary interventions, to facilitate cryoballoon ablation in anatomically challenging RIPVs.

Methods and results: In this approach, a coronary balloon is positioned and inflated within a distal branch of the RIPV to provide anchoring support, enabling stable coaxial alignment and complete pulmonary vein occlusion. The technique was applied in 25 patients in whom standard techniques failed to achieve adequate RIPV occlusion. Complete RIPV isolation was successfully achieved in all cases without procedural complications. The anchor balloon improved catheter stability, facilitated effective occlusion, and reduced the need for repeated repositioning.

Conclusion: The Balloon Anchor Technique is a simple, reproducible, and safe adjunct to cryoballoon ablation that enables reliable RIPV isolation in patients with challenging pulmonary vein anatomy. This strategy may broaden the applicability of cryoballoon ablation and represents a valuable option when conventional techniques are insufficient, with potential implications for other energy-based ablation technologies.

Background: Although slow pathway (SP) ablation is highly effective for atrioventricular nodal reentrant tachycardia (AVNRT), the detailed activation sequence and the functional significance of electrogram components within the triangle of Koch (ToK) remain unclear.

Objective: To define the activation pattern within the ToK and clarify the mechanistic significance of sharp and dull potentials using ultra-high-resolution mapping and fractionated potential-guided cryoablation.

Methods: Thirty-five patients with slow-fast AVNRT underwent ultra-high-resolution mapping during sinus rhythm (SR) and/or AVNRT using the RHYTHMIA-system with LUMIPOINT tools. Propagation of sharp and dull potentials was analyzed by sliding the local activation window in 5-ms increments. Cryoablation targeted fractionated potential sites where AVNRT terminated during cryomapping.

Results: Two distinct electrogram components-sharp and dull potentials-were consistently identified in the mid-to-superior ToK. During SR, sharp potentials descended within the ToK, followed by dull potentials ascending toward and merging with His potentials. During AVNRT, ascending dull potentials preceded descending sharp potentials. Dull potentials were visualized with confidence levels ≥ 24% and consistently overlapped with sites causing transient atrioventricular block. Successful ablation sites were located immediately inferior to the dull-potential region and corresponded to the fractionated potential area during AVNRT. AVNRT terminated during cryomapping in 25 of 30 patients (mean 13 ± 4 s). No recurrences were observed during follow-up.

Conclusion: Sharp and dull potentials represent distinct components of atrial activation and nodal-His transitional conduction. Fractionated potential-guided cryoablation targeting early AVNRT termination enables safe and efficient ablation while avoiding injury to the nodal-His axis.

Introduction: Leadless atrial pacemakers are increasingly used, yet interactions with pulsed field ablation (PFA) remain poorly described.

Methods and results: We report the first documented case of transient loss of capture and pacing threshold elevation in an AVEIR leadless pacemaker temporally associated with monopolar PFA during right inferior pulmonary vein ablation. Threshold increased from 0.75 V @ 0.2 ms to 1.25 V @ 0.4 ms, recovering within 24 h.

Conclusion: Monopolar PFA can transiently interfere with atrial leadless pacing, emphasizing the need for device monitoring during ablation.

Introduction: As patients with atrial fibrillation (AF) present with increasing age and comorbidities, the understanding of the safety and efficacy of catheter ablation in older patients is paramount. We sought to investigate outcomes of octogenarians undergoing catheter ablation of AF in the era of pulsed field ablation (PFA).

Methods: We retrospectively analyzed AF patients who underwent PFA with a pentaspline catheter. Patients were divided into two groups based on age: octogenarians (age ≥ 80 years) and younger group (age < 80 years). Baseline characteristics, procedural data, and recurrence of atrial arrhythmia during the follow-up course were compared between the groups.

Results: Among 698 AF patients (69 ± 11 years old, 64% male), 124 (18%) were octogenarians and 574 (72%) were younger than 80 years. Octogenarians had a higher prevalence of comorbidities and underwent more extensive ablation, including the posterior wall and anterior wall. However, the procedure time, ablation catheter dwell time, and the fluoroscopy time did not differ between groups. There were zero complications in the octogenarian group and 9 in the younger group (p = 0.16). Early follow-up data showed comparable recurrence rate of atrial arrhythmias after an 8 week-blanking period (log-rank p = 0.80).

Conclusion: PFA was effective and demonstrated a highly safe profile for octogenarians despite higher baseline risks and more extensive ablation.

Objective: To evaluate procedural success, safety, and clinical outcomes of left atrial appendage closure (LAAC) in patients with cardiac amyloidosis (CA).

Background: CA is a progressive, infiltrative cardiomyopathy associated with an elevated risk of thromboembolic events, particularly in the setting of atrial fibrillation (AF). These patients are often elderly and at higher risk of bleeding. While LAAC offers an alternative to oral anticoagulation (OAC) for stroke prevention in high-bleeding-risk AF patients, data on its safety and efficacy in CA remain limited.

Methods: We retrospectively analyzed 21 patients with confirmed CA who underwent LAAC between January 2014 and December 2024. Data on demographics, procedural details, post-procedural management, and outcomes were collected. The primary endpoints were procedural success and incidence of post-procedure thromboembolic and bleeding events.

Results: Most patients had wild-type transthyretin amyloidosis (90.5%) and persistent AF (71.4%). Procedural success was achieved in 95% of patients, with no intra- or peri-procedural complications. Over a median follow-up of 24 months, there were no cases of device-related thrombosis or major peri-device leaks. Three patients (14.3%) experienced minor peri-device leak. Two patients (9.5%) had major bleeding, which occurred while on post-procedural OAC. Two patients (9.5%) experienced ischemic stroke or TIA, and both patients were given DOAC as a result (Central illustration).

Conclusion: LAAC appears to be a safe and feasible stroke prevention strategy for patients with CA, achieving high procedural success with low complication rates.