Journal of Cardiovascular Electrophysiology最新文献

Background

Wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) can lead to refractory heart failure. A “lead paradox” occurs when patients with a Micra leadless pacemaker require lead-based Cardiac Contractility Modulation (CCM) therapy.

Case Summary

We detail the first co-implantation of CCM and Micra devices in a 78-year-old male with ATTRwt-CA and NYHA III heart failure. A multi-view fluoroscopic technique ensured spatial separation, while specific device programming mitigated electrical crosstalk post-procedure.

Conclusion

At 1 year, the patient stabilized to NYHA Class II without further hospitalizations. This dual-device strategy is a feasible and safe technical roadmap for this complex clinical problem.

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.

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.