Journal of Cardiovascular Electrophysiology最新文献

Background: Electrical storm (ES) is a life-threatening manifestation of recurrent ventricular arrhythmia. While anti-arrhythmic drugs (AADs) have historically been the first-line treatment, the role of catheter ablation (CA) as an initial therapy in ES remains incompletely defined. This meta-analysis evaluates the efficacy and safety of radiofrequency CA compared to escalating medical therapy in patients with ES.

Methods: A systematic search of PubMed, Science Direct, and Cochrane databases was conducted for studies published from 2010 to 2025 that compared CA with medical therapy as first-line treatment for ES. Outcomes of interest included ES recurrence, ventricular arrhythmia recurrence, in-hospital mortality, procedural complications, and follow-up survival. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models.

Results: Six studies encompassing 963 patients (473 CA, 490 medical therapy) were included. The mean age was 67.8 years, and 87.7% were male. The mean left ventricular ejection fraction was 33%, and ischemic cardiomyopathy was present in 77.5% of CA and 72.1% of MT patients. CA reduced the risk of ES recurrence by 71% compared to medical therapy (OR: 0.29; 95% CI: 0.15-0.53; p < 0.001; I² = 53%). Recurrence of any ventricular arrhythmia, in-hospital mortality, and long-term survival were also significantly improved with CA.

Conclusion: This meta-analysis suggests that CA is associated with lower ES and VA recurrence and in-hospital mortality and improved survival compared to medical therapy alone. These findings support consideration of catheter ablation as a first-line strategy. Larger prospective trials are needed to confirm these findings and guide patient selection.

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 and aims: The need for transvenous lead extraction (TLE) is rising due to increased cardiovascular device implantation and an aging population. While the superior access is standard, complex cases may benefit from the Tandem approach, combining femoral and superior access to improve efficacy and safety. This study evaluates outcomes and predictors associated with the Tandem approach as a primary strategy.

Methods: A retrospective analysis was conducted on 148 patients who underwent Tandem TLE at a high-volume UK center between September 2020 and December 2024. Data on procedural success, complete lead removal, complications, and outcome predictors were collected. The Needle's eye snare (NES) learning curve was assessed via fluoroscopy time.

Results: Median patient age was 72.4 years, with 42.6% considered high-risk (EROS 3). 319 leads were targeted, with 81.2% extracted via the Tandem approach. Clinical procedural success was 97.3%, and complete lead removal 93%. Use of Medtronic leads was the sole independent predictor of complete lead removal. Major complications occurred in 3.4% of cases, with no procedural mortality. BMI < 25 kg/m² and extraction of ≥ 3 leads were predictors of complications and 30-day mortality. NES proficiency improved significantly after 40 leads (p < 0.001), confirming a learning curve.

Conclusion: The Tandem approach is a safe and effective primary strategy for complex TLE, particularly in cases involving passive fixation, shock, and long dwell times leads. However, widespread use may be limited by resource intensity, increased fluoroscopy exposure, and the need for experienced operators.

Background: There is limited data on long-term safety and efficacy of subcutaneous implantable cardioverter defibrillator (S-ICD) in Asian patients with a lower body mass index (BMI) due to smaller body build.

Methods: We performed a 2 year prospective study in 5 Asian cities from May 2017 to May 2018 to investigate the safety and feasibility of S-ICD for primary or secondary prevention of sudden cardiac death in an Asian population.

Results: We enrolled 75 S-ICD recipients (77% males; age 49.6 ± 16.8 years) with a mean BMI of 24.6 ± 5.0 (range 15.9-40.9) with 67% (50/75) with BMI ≤ 23. The indications of S-ICD were primary and secondary prevention in 26 (35%) and 49 (65%) patients, respectively. Among them, 51 patients suffer from ischemic (30, 59%) or nonischemic (21, 41%) cardiomyopathy, and 25 patients have channelopathies. Their mean left ventricular ejection fraction was 44.4 ± 15.1%. All patients had successful S-ICD implantation with a mean procedural duration of 75.5 ± 28.1 min using conscious sedation in majority of patients (65/75, 87%); and defibrillation testing was performed in 62 patients (83%). After 2 years of follow-up, 8 patients developed serious adverse events, including 4 deaths (2 asystole, 1 sepsis, 1 myocardial infarction), 2 ventricular tachycardia storm, 1 pocket infection, and 1 lead failure requiring replacement. Both patients with ventricular tachycardia storm received appropriate shocks, and no patient developed inappropriate shocks.

Conclusions: S-ICD implantation for both primary and secondary prevention of sudden cardiac death was found to be safe in an Asian population, including those with a low BMI, and was associated with a low rate of device-related complications.