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The risk still remains: left circumflex artery subocclusion after radiofrequency application inside the coronary sinus during mitral isthmus block.
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-04-08 DOI: 10.1007/s10840-025-02039-2
Muhieddine Omar Chokr, Luan Vieira Rodrigues, Wlademir Dos Santos Junior, Jose Roberto Maiello, Omar Samir Choukr, Afonso Dalmazio Souza Mario, Eduardo Pelegrineti Targueta, Mauricio Ibrahim Scanavacc

Introduction: In ablation procedures for patients with perimitral atrial tachycardia, it is often necessary to apply radiofrequency energy inside the coronary sinus. Although this location is anatomically close to the left circumflex artery, its occlusion is a rare complication. A 40-year-old man underwent ablation for perimitral atrial tachycardia with radiofrequency applications inside the coronary sinus to create a lateral mitral block line. Minutes after the tachycardia was interrupted, the patient suddenly developed ST-segment elevation in the inferior leads and underwent successful angioplasty of the circumflex artery, with good clinical evolution over a 30-month follow-up period.

Discussion: Coronary artery injury secondary to radiofrequency ablation procedures is a rare complication. However, the incidence of circumflex artery injury during applications inside the coronary sinus may be underestimated, as suggested by some studies. Several strategies, including meticulous procedural planning, can help mitigate this risk. However, further research is essential to develop strategies that eliminate the risk altogether.

{"title":"The risk still remains: left circumflex artery subocclusion after radiofrequency application inside the coronary sinus during mitral isthmus block.","authors":"Muhieddine Omar Chokr, Luan Vieira Rodrigues, Wlademir Dos Santos Junior, Jose Roberto Maiello, Omar Samir Choukr, Afonso Dalmazio Souza Mario, Eduardo Pelegrineti Targueta, Mauricio Ibrahim Scanavacc","doi":"10.1007/s10840-025-02039-2","DOIUrl":"https://doi.org/10.1007/s10840-025-02039-2","url":null,"abstract":"<p><strong>Introduction: </strong>In ablation procedures for patients with perimitral atrial tachycardia, it is often necessary to apply radiofrequency energy inside the coronary sinus. Although this location is anatomically close to the left circumflex artery, its occlusion is a rare complication. A 40-year-old man underwent ablation for perimitral atrial tachycardia with radiofrequency applications inside the coronary sinus to create a lateral mitral block line. Minutes after the tachycardia was interrupted, the patient suddenly developed ST-segment elevation in the inferior leads and underwent successful angioplasty of the circumflex artery, with good clinical evolution over a 30-month follow-up period.</p><p><strong>Discussion: </strong>Coronary artery injury secondary to radiofrequency ablation procedures is a rare complication. However, the incidence of circumflex artery injury during applications inside the coronary sinus may be underestimated, as suggested by some studies. Several strategies, including meticulous procedural planning, can help mitigate this risk. However, further research is essential to develop strategies that eliminate the risk altogether.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Breaking barriers in atrial ablations: pulsed field ablation over left atrial scar lesions.
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-04-08 DOI: 10.1007/s10840-025-02032-9
Panteleimon E Papakonstantinou, Kifayat Qazalbash, Gabor Szeplaki
{"title":"Breaking barriers in atrial ablations: pulsed field ablation over left atrial scar lesions.","authors":"Panteleimon E Papakonstantinou, Kifayat Qazalbash, Gabor Szeplaki","doi":"10.1007/s10840-025-02032-9","DOIUrl":"https://doi.org/10.1007/s10840-025-02032-9","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The use of cardiac imaging in patients undergoing atrial fibrillation ablation.
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-04-07 DOI: 10.1007/s10840-025-02035-6
Gaia Filiberti, Giulia Antonelli, Giulio Falasconi, Alessandro Villaschi, Stefano Figliozzi, Martina Maria Ruffo, Antonio Taormina, Guido Del Monaco, Alessia Chiara Latini, Sebastiano Carli, Kamil Stankowski, Stefano Valcher, Nicola Cesani, Francesco Amata, Alessandro Giaj Levra, Filippo Giunti, Giacomo Carella, David Soto-Iglesias, Dario Turturiello, Federico Landra, Andrea Saglietto, Emanuele Curti, Pietro Francia, Julio Martí-Almor, Diego Penela, Antonio Berruezo

Cardiac imaging (CI), including echocardiography, multidetector computed tomography (MDCT), and cardiac magnetic resonance (CMR), is gaining increasing interest to aid atrial fibrillation (AF) ablation procedures, from pre-procedural planning to intra-procedural guidance. Transthoracic echocardiography is widely used for imaging, especially for preprocedural assessment, while transesophageal and intracardiac echocardiography (ICE) are used for intraprocedural guidance during transseptal puncture. Cardiac MDCT, leveraging its high spatial resolution, offers a detailed anatomical visualization of cardiac chambers and adjacent structures; moreover, left atrial wall thickness assessed by MDCT may guide radiofrequency energy titration to enhance procedural safety and efficiency. At the same time, CMR allows for detailed myocardial tissue characterization and the detection of fibrosis. ICE, MDCT, and CMR also permit intra-procedural image integration with electroanatomical maps, allowing to be aware of a greater amount of intra-procedural real-time information regarding the anatomy and the local characteristics of the tissue in contact with the ablation catheter. One of the primary objectives of performing CI-aided AF ablations is to increase procedural safety and to permit more personalized procedures, according to the characteristics of each patient. This review offers a comprehensive overview of the current applications of CI during the different phases of AF ablation and explores the potential future applications of CI in this context.

{"title":"The use of cardiac imaging in patients undergoing atrial fibrillation ablation.","authors":"Gaia Filiberti, Giulia Antonelli, Giulio Falasconi, Alessandro Villaschi, Stefano Figliozzi, Martina Maria Ruffo, Antonio Taormina, Guido Del Monaco, Alessia Chiara Latini, Sebastiano Carli, Kamil Stankowski, Stefano Valcher, Nicola Cesani, Francesco Amata, Alessandro Giaj Levra, Filippo Giunti, Giacomo Carella, David Soto-Iglesias, Dario Turturiello, Federico Landra, Andrea Saglietto, Emanuele Curti, Pietro Francia, Julio Martí-Almor, Diego Penela, Antonio Berruezo","doi":"10.1007/s10840-025-02035-6","DOIUrl":"https://doi.org/10.1007/s10840-025-02035-6","url":null,"abstract":"<p><p>Cardiac imaging (CI), including echocardiography, multidetector computed tomography (MDCT), and cardiac magnetic resonance (CMR), is gaining increasing interest to aid atrial fibrillation (AF) ablation procedures, from pre-procedural planning to intra-procedural guidance. Transthoracic echocardiography is widely used for imaging, especially for preprocedural assessment, while transesophageal and intracardiac echocardiography (ICE) are used for intraprocedural guidance during transseptal puncture. Cardiac MDCT, leveraging its high spatial resolution, offers a detailed anatomical visualization of cardiac chambers and adjacent structures; moreover, left atrial wall thickness assessed by MDCT may guide radiofrequency energy titration to enhance procedural safety and efficiency. At the same time, CMR allows for detailed myocardial tissue characterization and the detection of fibrosis. ICE, MDCT, and CMR also permit intra-procedural image integration with electroanatomical maps, allowing to be aware of a greater amount of intra-procedural real-time information regarding the anatomy and the local characteristics of the tissue in contact with the ablation catheter. One of the primary objectives of performing CI-aided AF ablations is to increase procedural safety and to permit more personalized procedures, according to the characteristics of each patient. This review offers a comprehensive overview of the current applications of CI during the different phases of AF ablation and explores the potential future applications of CI in this context.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Long-term outcomes of pace-and-ablate strategy in patients with atrial fibrillation.
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-04-07 DOI: 10.1007/s10840-025-02038-3
Johan van Koll, Madelon D E A Engels, Jesse H J Rijks, Madelon Salari, Jelle Luijten, Joost Lumens, Vanessa P M van Empel, Sjoerd W Westra, Antonius M W van Stipdonk, Theo A R Lankveld, Sevasti M Chaldoupi, Jacqueline Joza, Rypko J Beukema, Justin G L M Luermans, Dominik K Linz, Kevin Vernooy

Background: The pace-and-ablate strategy is second -line therapy to obtain rate control in patients with persistent symptomatic atrial fibrillation (AF) when other treatment options fail. This study aims to evaluate long-term effects on clinical outcomes following pace-and-ablate strategy in AF patients.

Methods: This retrospective study includes patients who underwent successful pacemaker implantation (right ventricular pacing (RVP) or cardiac re-synchronization therapy (CRT)) followed by atrioventricular node ablation (AVNA) between 2010 and 2020. Patients were treated according to the prevailing guidelines. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization (HFH). Secondary endpoints were individual outcomes of all-cause mortality, HFH, and left-ventricular ejection fraction (LVEF) change.

Results: Two hundred ninety-eight patients were included, 162 undergoing RVP, and 136 receiving CRT, with a median follow-up of 5.8 years [4.1-8.0]. The primary endpoint occured in 47% of the RVP group and 49% of the CRT group (p = 0.206). All-cause mortality occurred in 36% of the RVP group and in 45% of the CRT group (p = 0.005). HFH occurred in 22% of the RVP group and in 15% of the CRT group (p = 0.328), with 17(10%) upgrades to CRT in the RVP group. Median LVEF in the RVP group remained stable (56% [49-60] to 53% [43-57]; p = 0.081), while it improved in the CRT group (31% [22-38] to 43% [32-51]; p < 0.001).

Conclusion: Mortality and HFH in patients with AF managed through a pace-and-ablate strategy are high. Reassuringly, LVEF deterioration requiring upgrade to CRT is uncommon in patients undergoing RVP with normal baseline LVEF before AVNA. CRT improves LVEF in patients with reduced LVEF before AVNA.

{"title":"Long-term outcomes of pace-and-ablate strategy in patients with atrial fibrillation.","authors":"Johan van Koll, Madelon D E A Engels, Jesse H J Rijks, Madelon Salari, Jelle Luijten, Joost Lumens, Vanessa P M van Empel, Sjoerd W Westra, Antonius M W van Stipdonk, Theo A R Lankveld, Sevasti M Chaldoupi, Jacqueline Joza, Rypko J Beukema, Justin G L M Luermans, Dominik K Linz, Kevin Vernooy","doi":"10.1007/s10840-025-02038-3","DOIUrl":"https://doi.org/10.1007/s10840-025-02038-3","url":null,"abstract":"<p><strong>Background: </strong>The pace-and-ablate strategy is second -line therapy to obtain rate control in patients with persistent symptomatic atrial fibrillation (AF) when other treatment options fail. This study aims to evaluate long-term effects on clinical outcomes following pace-and-ablate strategy in AF patients.</p><p><strong>Methods: </strong>This retrospective study includes patients who underwent successful pacemaker implantation (right ventricular pacing (RVP) or cardiac re-synchronization therapy (CRT)) followed by atrioventricular node ablation (AVNA) between 2010 and 2020. Patients were treated according to the prevailing guidelines. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization (HFH). Secondary endpoints were individual outcomes of all-cause mortality, HFH, and left-ventricular ejection fraction (LVEF) change.</p><p><strong>Results: </strong>Two hundred ninety-eight patients were included, 162 undergoing RVP, and 136 receiving CRT, with a median follow-up of 5.8 years [4.1-8.0]. The primary endpoint occured in 47% of the RVP group and 49% of the CRT group (p = 0.206). All-cause mortality occurred in 36% of the RVP group and in 45% of the CRT group (p = 0.005). HFH occurred in 22% of the RVP group and in 15% of the CRT group (p = 0.328), with 17(10%) upgrades to CRT in the RVP group. Median LVEF in the RVP group remained stable (56% [49-60] to 53% [43-57]; p = 0.081), while it improved in the CRT group (31% [22-38] to 43% [32-51]; p < 0.001).</p><p><strong>Conclusion: </strong>Mortality and HFH in patients with AF managed through a pace-and-ablate strategy are high. Reassuringly, LVEF deterioration requiring upgrade to CRT is uncommon in patients undergoing RVP with normal baseline LVEF before AVNA. CRT improves LVEF in patients with reduced LVEF before AVNA.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Acute outcomes and learning curve from the initial patients treated with the PulseSelect system: a real-world multicenter experience of pulsed field ablation.
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-04-03 DOI: 10.1007/s10840-025-02036-5
Giulio Molon, Stefano Nardi, Gianfranco Mitacchione, Antonio Dello Russo, Danilo Ricciardi, Roberto Mantovan, Luca Bontempi, Alessandro Costa, Luigi Argenziano, Edoardo Casali, Vincenzo Turco, Giuseppe Boriani

Introduction: Catheter ablation is a cornerstone in managing patients with symptomatic, drug-refractory atrial fibrillation (AF), and while effective, traditional thermal ablation techniques are associated with rare but significant complications due to a non-selective thermal energy transfer to all biologic tissues. Pulsed field ablation (PFA) offers a non-thermal approach, targeting myocardial tissue selectively while sparing adjacent structures. The PulseSelect system is a novel PFA platform, and this analysis examines the procedural outcomes, acute complications, and the learning curve associated with introduction of the PulseSelect system in six European centers.

Methods: The One Shot to Pulmonary Vein Isolation (1STOP) project prospectively included 131 patients with paroxysmal or persistent AF treated with the PulseSelect system across six centers. Procedural data, patient characteristics, and acute outcomes were summarized. Additionally, sedation protocols, fluoroscopic times, and acute success rates were reported.

Results: Patients (mean age 61.7 ± 9.7 years; 31.3% female) had predominantly paroxysmal AF (80.9%). Median procedural and fluoroscopy times were 55.0 and 16.0 min, respectively. General anesthesia was used in 75.5% of cases, while in the remaining 24.5% moderate sedation protocols allowed procedures (even in 15.1% without an anesthesiologist). Acute PVI success was 100%, and no major complications were observed. A short learning curve was noted, with significant reductions in procedural times after the initial 2-3 cases at each center.

Conclusion: The PulseSelect system showed short procedural times, with a rapid learning curve, thus leading with high procedural efficiency. In 1 out of 4 cases general anesthesia was not applied, and no major complications were observed.

导言:导管消融术是治疗有症状、药物难治性心房颤动(房颤)患者的基石,传统的热消融技术虽然有效,但由于热能不能选择性地传递到所有生物组织,因此很少出现严重的并发症。脉冲场消融(PFA)提供了一种非热方法,可选择性地靶向心肌组织,同时保护邻近结构。PulseSelect 系统是一种新型 PFA 平台,本分析研究了欧洲六家中心引进 PulseSelect 系统后的手术效果、急性并发症和学习曲线:方法:"一针肺静脉隔离"(1STOP)项目前瞻性地纳入了在六个中心接受 PulseSelect 系统治疗的 131 名阵发性或持续性房颤患者。总结了手术数据、患者特征和急性结果。此外,还报告了镇静方案、透视时间和急性期成功率:患者(平均年龄 61.7 ± 9.7 岁;31.3% 为女性)主要为阵发性房颤(80.9%)。手术和透视的中位时间分别为 55.0 分钟和 16.0 分钟。75.5%的病例采用了全身麻醉,其余24.5%的病例采用了适度镇静方案(甚至有15.1%的病例没有麻醉师)。急性 PVI 成功率为 100%,未发现重大并发症。学习曲线很短,每个中心在最初的 2-3 个病例之后,手术时间显著缩短:结论:PulseSelect 系统的手术时间短,学习曲线快,因此手术效率高。在 4 个病例中,有 1 个病例没有进行全身麻醉,也没有发现重大并发症。
{"title":"Acute outcomes and learning curve from the initial patients treated with the PulseSelect system: a real-world multicenter experience of pulsed field ablation.","authors":"Giulio Molon, Stefano Nardi, Gianfranco Mitacchione, Antonio Dello Russo, Danilo Ricciardi, Roberto Mantovan, Luca Bontempi, Alessandro Costa, Luigi Argenziano, Edoardo Casali, Vincenzo Turco, Giuseppe Boriani","doi":"10.1007/s10840-025-02036-5","DOIUrl":"https://doi.org/10.1007/s10840-025-02036-5","url":null,"abstract":"<p><strong>Introduction: </strong>Catheter ablation is a cornerstone in managing patients with symptomatic, drug-refractory atrial fibrillation (AF), and while effective, traditional thermal ablation techniques are associated with rare but significant complications due to a non-selective thermal energy transfer to all biologic tissues. Pulsed field ablation (PFA) offers a non-thermal approach, targeting myocardial tissue selectively while sparing adjacent structures. The PulseSelect system is a novel PFA platform, and this analysis examines the procedural outcomes, acute complications, and the learning curve associated with introduction of the PulseSelect system in six European centers.</p><p><strong>Methods: </strong>The One Shot to Pulmonary Vein Isolation (1STOP) project prospectively included 131 patients with paroxysmal or persistent AF treated with the PulseSelect system across six centers. Procedural data, patient characteristics, and acute outcomes were summarized. Additionally, sedation protocols, fluoroscopic times, and acute success rates were reported.</p><p><strong>Results: </strong>Patients (mean age 61.7 ± 9.7 years; 31.3% female) had predominantly paroxysmal AF (80.9%). Median procedural and fluoroscopy times were 55.0 and 16.0 min, respectively. General anesthesia was used in 75.5% of cases, while in the remaining 24.5% moderate sedation protocols allowed procedures (even in 15.1% without an anesthesiologist). Acute PVI success was 100%, and no major complications were observed. A short learning curve was noted, with significant reductions in procedural times after the initial 2-3 cases at each center.</p><p><strong>Conclusion: </strong>The PulseSelect system showed short procedural times, with a rapid learning curve, thus leading with high procedural efficiency. In 1 out of 4 cases general anesthesia was not applied, and no major complications were observed.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Left bundle branch area pacing prevails over His bundle pacing for heart failure patients undergoing atrioventricular node ablation in permanent atrial fibrillation: a network meta-analysis.
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-04-03 DOI: 10.1007/s10840-025-02034-7
Jing-Wen Ding, Yu-Ang Jiang, Qiu-Ting Wang, Chu Guo, Jian-Hui Yao, Gong-Qiang Dai, Jing-Chen, Huai-Sheng Ding

Background: Atrioventricular node ablation (AVNA) and pacemaker implantation enhance prognosis in heart failure patients experiencing rapid ventricular response due to atrial fibrillation. This meta-analysis assessed the clinical benefits of various pacing modalities following AVNA.

Methods: The electrophysiological endpoint was defined as QRS duration, while the echocardiographic endpoint was the change in left ventricular ejection fraction. Secondary endpoints included pacing threshold, mortality rates, and improvements in the 6-min walk test.

Results: This meta-analysis of 13 studies involving 1257 patients suggested that His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) conferred an advantage in narrowing QRS duration compared to biventricular pacing (BVP) (HBP vs BVP OR = - 59.05, 95%CI = - 73.12 to - 44.97; LBBAP vs BVP OR = - 48.64, 95%CI = - 64.05 to - 33.24). The findings of echocardiographic endpoints suggested that LBBAP and HBP emerged as the optimal strategies over RVP (vs HBP OR = - 7.59, 95%CI = - 11.85 to - 3.32; vs LBBAP OR = - 6.58, 95%CI = - 12.08 to - 1.07). LBBAP reduced all-cause mortality compared to BVP (OR = 0.10, 95%CI = 0.01-0.78); however, no significant differences in all-cause mortality were observed between LBBAP and HBP. The pacing threshold of LBBAP was significantly lower than HBP (OR = - 0.40, 95%CI = - 0.57 to - 0.23).

Conclusion: LBBAP not only demonstrated superior clinical outcomes regarding mortality compared to ventricular pacing strategies, but also was associated with a lower pacing threshold than HBP, thereby indicating its potential advantage over HBP in patients undergoing AVNA and subsequent pacemaker implantation.

{"title":"Left bundle branch area pacing prevails over His bundle pacing for heart failure patients undergoing atrioventricular node ablation in permanent atrial fibrillation: a network meta-analysis.","authors":"Jing-Wen Ding, Yu-Ang Jiang, Qiu-Ting Wang, Chu Guo, Jian-Hui Yao, Gong-Qiang Dai, Jing-Chen, Huai-Sheng Ding","doi":"10.1007/s10840-025-02034-7","DOIUrl":"https://doi.org/10.1007/s10840-025-02034-7","url":null,"abstract":"<p><strong>Background: </strong>Atrioventricular node ablation (AVNA) and pacemaker implantation enhance prognosis in heart failure patients experiencing rapid ventricular response due to atrial fibrillation. This meta-analysis assessed the clinical benefits of various pacing modalities following AVNA.</p><p><strong>Methods: </strong>The electrophysiological endpoint was defined as QRS duration, while the echocardiographic endpoint was the change in left ventricular ejection fraction. Secondary endpoints included pacing threshold, mortality rates, and improvements in the 6-min walk test.</p><p><strong>Results: </strong>This meta-analysis of 13 studies involving 1257 patients suggested that His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) conferred an advantage in narrowing QRS duration compared to biventricular pacing (BVP) (HBP vs BVP OR = - 59.05, 95%CI = - 73.12 to - 44.97; LBBAP vs BVP OR = - 48.64, 95%CI = - 64.05 to - 33.24). The findings of echocardiographic endpoints suggested that LBBAP and HBP emerged as the optimal strategies over RVP (vs HBP OR = - 7.59, 95%CI = - 11.85 to - 3.32; vs LBBAP OR = - 6.58, 95%CI = - 12.08 to - 1.07). LBBAP reduced all-cause mortality compared to BVP (OR = 0.10, 95%CI = 0.01-0.78); however, no significant differences in all-cause mortality were observed between LBBAP and HBP. The pacing threshold of LBBAP was significantly lower than HBP (OR = - 0.40, 95%CI = - 0.57 to - 0.23).</p><p><strong>Conclusion: </strong>LBBAP not only demonstrated superior clinical outcomes regarding mortality compared to ventricular pacing strategies, but also was associated with a lower pacing threshold than HBP, thereby indicating its potential advantage over HBP in patients undergoing AVNA and subsequent pacemaker implantation.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
How to interpret fibrillatory wave amplitude in patients receiving pulmonary vein isolation for atrial fibrillation.
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-03-31 DOI: 10.1007/s10840-025-02030-x
Fuyu Fujii, Naoya Kataoka, Teruhiko Imamura
{"title":"How to interpret fibrillatory wave amplitude in patients receiving pulmonary vein isolation for atrial fibrillation.","authors":"Fuyu Fujii, Naoya Kataoka, Teruhiko Imamura","doi":"10.1007/s10840-025-02030-x","DOIUrl":"https://doi.org/10.1007/s10840-025-02030-x","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Transient AV block during focal pulsed field ablation in a patient with a PFO occluder.
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-03-29 DOI: 10.1007/s10840-025-02037-4
Sebastian Weyand, Stephanie Löbig, Peter Seizer
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引用次数: 0
Performance of a new respiratory compensated stability algorithm during radiofrequency ablation for atrial fibrillation.
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-03-27 DOI: 10.1007/s10840-025-02031-w
Benjamin Berte, Chiara Valeriano, Sophie Rissotto, Alona Sigal, Ofer Klemm, Saagar Mahida, Tom De Potter, Helmut Pürerfellner, Richard Kobza

Background: Short-duration radiofrequency ablation is designed to enhance efficiency of pulmonary vein isolation (PVI). We investigated the performance of a novel stability algorithm (STABILITY +).

Methods: In a prospective, single-center study, consecutive patients undergoing first-time PVI were included. Patients were categorized into four groups: Group 1, Hybrid (anterior, 50 W, 550 AI; posterior, 90 W 4 s) using Viistag; Group 2, Hybrid using STABILITY + ; Group 3, 90 W (anterior and posterior, 90 W 4 s) using Visitag; Group 4, 90 W using STABILITY + . Clinical, procedural and follow-up data were systematically collected.

Results: A total of 268 patients were included. In total, 130 patients had Hybrid ablation while 138 underwent 90-W ablation. Procedure time was comparable in Groups 1, 2, and 3 however was lower in Group 4 (65 min, 65 min, 70 min, 54 min, p < 0.001). RF-time was longer in Group 1 and 2 vs 3 and 4 (11.6 min, 9.7 min, 4.5 min, 5.2 min, p < 0.001). First-pass isolation rates were comparable between all 4 groups (88%, 91%, 83.9%, 90%, p = 0.480). Freedom from arrhythmia at 6 months was also comparable (9%, 9%, 16.6%, 10.4%, p = 0.341). Complications were comparable and low and restricted to vascular access-related complications (2%, 1%, 0%, 2%, p = 0.388).

Conclusions: Irrespective of the mode of ablation, the novel STABILITY + algorithm can be used in PVI ablations without compromising safety and efficiency and has the potential to improve first-pass isolation using 90-W HPSD ablation.

{"title":"Performance of a new respiratory compensated stability algorithm during radiofrequency ablation for atrial fibrillation.","authors":"Benjamin Berte, Chiara Valeriano, Sophie Rissotto, Alona Sigal, Ofer Klemm, Saagar Mahida, Tom De Potter, Helmut Pürerfellner, Richard Kobza","doi":"10.1007/s10840-025-02031-w","DOIUrl":"https://doi.org/10.1007/s10840-025-02031-w","url":null,"abstract":"<p><strong>Background: </strong>Short-duration radiofrequency ablation is designed to enhance efficiency of pulmonary vein isolation (PVI). We investigated the performance of a novel stability algorithm (STABILITY +).</p><p><strong>Methods: </strong>In a prospective, single-center study, consecutive patients undergoing first-time PVI were included. Patients were categorized into four groups: Group 1, Hybrid (anterior, 50 W, 550 AI; posterior, 90 W 4 s) using Viistag; Group 2, Hybrid using STABILITY + ; Group 3, 90 W (anterior and posterior, 90 W 4 s) using Visitag; Group 4, 90 W using STABILITY + . Clinical, procedural and follow-up data were systematically collected.</p><p><strong>Results: </strong>A total of 268 patients were included. In total, 130 patients had Hybrid ablation while 138 underwent 90-W ablation. Procedure time was comparable in Groups 1, 2, and 3 however was lower in Group 4 (65 min, 65 min, 70 min, 54 min, p < 0.001). RF-time was longer in Group 1 and 2 vs 3 and 4 (11.6 min, 9.7 min, 4.5 min, 5.2 min, p < 0.001). First-pass isolation rates were comparable between all 4 groups (88%, 91%, 83.9%, 90%, p = 0.480). Freedom from arrhythmia at 6 months was also comparable (9%, 9%, 16.6%, 10.4%, p = 0.341). Complications were comparable and low and restricted to vascular access-related complications (2%, 1%, 0%, 2%, p = 0.388).</p><p><strong>Conclusions: </strong>Irrespective of the mode of ablation, the novel STABILITY + algorithm can be used in PVI ablations without compromising safety and efficiency and has the potential to improve first-pass isolation using 90-W HPSD ablation.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Efficacy of Cardioneuroablation versus Midodrine in Patients with Vasovagal Syncope: Design and Rationale for the CAMPAIGN Trial.
IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-03-21 DOI: 10.1007/s10840-025-02029-4
Pakezhati Maimaitijiang, Bin Tu, Zihao Lai, Aiyue Chen, Zhuxin Zhang, Likun Zhou, Simin Cai, Lihui Zheng, Yan Yao

Background: Current treatment strategies for vasovagal syncope (VVS) patients recommended by the guidelines are diverse, but effects of these therapies are still unsatisfactory with respective limitations on the indications. Cardioneuroablation (CNA), an innovative and promising therapy, has shown potently effective against syncopal recurrences in numerous observational studies. Recently, a single-center randomized clinical trial has reported CNA was superior to non-pharmacologic therapy for VVS patients. Therefore, this study is designed to compare the efficacy of CNA with pharmacologic treatment in a multicenter and randomized fashion.

Methods and results: The Cardioneuroablation versus Midodrine in Patients with Vasovagal Syncope (CAMPAIGN) study is an international multicenter, prospective, open-label, randomized controlled trial. The recurrent VVS patients with a positive response to tilt testing despite sufficient conventional treatment will be predominantly enrolled at different medical centers in China, Russia, and Turkey. All eligible participants will be randomized in a ratio of 1:1 to treatment with CNA versus midodrine, and followed up for 12 months after randomization. Approximately 184 subjects are projected to enroll from April 2023 to December 2024 with follow-up until 2025. The primary endpoint is the recurrence rate of syncope at 12 months of follow-up. The secondary endpoints are comprised of quality of life assessed with the Impact of Syncope on Quality of Life, tilt-induced syncope, blood pressure, cardiac deceleration capacity, and heart rate variability.

Conclusion: A prospective and multicenter clinical trial to compare outcomes of CNA with drug therapy is still lacking. The CAMPAIGN study will provide outcome-based evidence for VVS treatment strategy.

Trial registration: Clinicaltrials.gov: NCT05803148 (Date: March 9, 2023).

{"title":"The Efficacy of Cardioneuroablation versus Midodrine in Patients with Vasovagal Syncope: Design and Rationale for the CAMPAIGN Trial.","authors":"Pakezhati Maimaitijiang, Bin Tu, Zihao Lai, Aiyue Chen, Zhuxin Zhang, Likun Zhou, Simin Cai, Lihui Zheng, Yan Yao","doi":"10.1007/s10840-025-02029-4","DOIUrl":"https://doi.org/10.1007/s10840-025-02029-4","url":null,"abstract":"<p><strong>Background: </strong>Current treatment strategies for vasovagal syncope (VVS) patients recommended by the guidelines are diverse, but effects of these therapies are still unsatisfactory with respective limitations on the indications. Cardioneuroablation (CNA), an innovative and promising therapy, has shown potently effective against syncopal recurrences in numerous observational studies. Recently, a single-center randomized clinical trial has reported CNA was superior to non-pharmacologic therapy for VVS patients. Therefore, this study is designed to compare the efficacy of CNA with pharmacologic treatment in a multicenter and randomized fashion.</p><p><strong>Methods and results: </strong>The Cardioneuroablation versus Midodrine in Patients with Vasovagal Syncope (CAMPAIGN) study is an international multicenter, prospective, open-label, randomized controlled trial. The recurrent VVS patients with a positive response to tilt testing despite sufficient conventional treatment will be predominantly enrolled at different medical centers in China, Russia, and Turkey. All eligible participants will be randomized in a ratio of 1:1 to treatment with CNA versus midodrine, and followed up for 12 months after randomization. Approximately 184 subjects are projected to enroll from April 2023 to December 2024 with follow-up until 2025. The primary endpoint is the recurrence rate of syncope at 12 months of follow-up. The secondary endpoints are comprised of quality of life assessed with the Impact of Syncope on Quality of Life, tilt-induced syncope, blood pressure, cardiac deceleration capacity, and heart rate variability.</p><p><strong>Conclusion: </strong>A prospective and multicenter clinical trial to compare outcomes of CNA with drug therapy is still lacking. The CAMPAIGN study will provide outcome-based evidence for VVS treatment strategy.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov: NCT05803148 (Date: March 9, 2023).</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of Interventional Cardiac Electrophysiology
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