Pub Date : 2025-10-01DOI: 10.1016/j.hroo.2025.06.024
Vera Maslova MD , Marie Ahrens , Ole Rosenthal , Theodor Bau , Peter Magerfleisch , Fabian Moser MD , Adrian Zaman MD , Mohammed Saad MD , Martina Spehlmann MD , Derk Frank MD , Evgeny Lian MD
Background
Pulmonary vein isolation (PVI) in obese patients under deep sedation (DS) is anticipated to be more complex owing to challenging airway and hemodynamic management and dose adjustment of sedation drugs.
Objective
This study aimed to compare the complexity of de novo PVI in obese vs nonobese patients, with a particular focus on periprocedural sedation.
Methods
All patients undergoing de novo PVI under DS between January 2022 and January 2024 in our center were prospectively included. Data on detailed monitoring of respiratory and hemodynamic parameters during the procedure were collected. Two groups were defined (group 1, body mass index [BMI] of ≥30 kg/m2; group 2, BMI of <30 kg/m2) and compared in terms of DS tolerance, safety, and procedural success.
Results
Overall, 381 patients were included (61% male, median age 69 years); 120 were assigned to group 1 (BMI of 33 kg/m2 [32–38]) and 261 to group 2 (BMI of 25 kg/m2 [23–27]); 69% underwent cryoballoon ablation, 22% radiofrequency ablation, and 9% pulsed field ablation. The incidence of hypotension did not differ between groups. Hypoxic episodes were more frequent in group 1 (4 vs 2, P < .05), but none required mechanical ventilation. In multivariate analysis, obesity alone was not an independent risk factor for hypoxia or hypotension. Procedural duration, left atrial (LA) dwell time, and radiation dose were significantly higher in group 1. Overall complication rate was 3.4%, with no difference between groups. The 1-year success rate was comparable (71% vs 63%, P = .13). Subgroup analysis for persistent atrial fibrillation revealed a higher 1-year success rate (70% vs 57%, P = .048) for group 1.
Conclusion
Obesity was not an independent risk factor for periprocedural hypoxia or hypotension and did not affect safety or long-term success. Obesity alone should not be considered a reason to exclude patients from undergoing PVI under DS.
背景：由于具有挑战性的气道和血流动力学管理以及镇静药物的剂量调整，肥胖患者在深度镇静（DS）下的肺静脉隔离（PVI）预计将更加复杂。目的本研究旨在比较肥胖与非肥胖患者新生PVI的复杂性，并特别关注围手术期镇静。方法前瞻性纳入所有于2022年1月至2024年1月在本中心接受DS下PVI新生的患者。收集了手术过程中呼吸和血流动力学参数的详细监测数据。定义两组（1组，体重指数[BMI]≥30 kg/m2； 2组，体重指数[BMI]≥30 kg/m2），并在DS耐受性、安全性和手术成功率方面进行比较。结果共纳入381例患者（男性61%，中位年龄69岁）；1组120例（BMI为33 kg/m2[32-38]）， 2组261例（BMI为25 kg/m2 [23-27]）；69%接受低温球囊消融，22%接受射频消融，9%接受脉冲场消融。两组间低血压发生率无差异。组1缺氧发作更频繁（4 vs 2, P < 0.05），但没有人需要机械通气。在多变量分析中，肥胖本身并不是缺氧或低血压的独立危险因素。1组手术时间、左房停留时间、辐射剂量均显著增高。总并发症发生率为3.4%，两组间无差异。1年的成功率比较（71% vs 63%, P = 0.13）。持续性心房颤动的亚组分析显示，1组的1年成功率更高（70% vs 57%, P = 0.048）。结论肥胖不是围手术期缺氧或低血压的独立危险因素，也不影响手术的安全性和长期成功。肥胖本身不应被认为是排除患者在退行性椎体滑移下接受PVI的原因。
{"title":"De novo pulmonary vein isolation in obese vs nonobese patients under deep sedation: Does obesity increase procedure complexity?","authors":"Vera Maslova MD , Marie Ahrens , Ole Rosenthal , Theodor Bau , Peter Magerfleisch , Fabian Moser MD , Adrian Zaman MD , Mohammed Saad MD , Martina Spehlmann MD , Derk Frank MD , Evgeny Lian MD","doi":"10.1016/j.hroo.2025.06.024","DOIUrl":"10.1016/j.hroo.2025.06.024","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary vein isolation (PVI) in obese patients under deep sedation (DS) is anticipated to be more complex owing to challenging airway and hemodynamic management and dose adjustment of sedation drugs.</div></div><div><h3>Objective</h3><div>This study aimed to compare the complexity of de novo PVI in obese vs nonobese patients, with a particular focus on periprocedural sedation.</div></div><div><h3>Methods</h3><div>All patients undergoing de novo PVI under DS between January 2022 and January 2024 in our center were prospectively included. Data on detailed monitoring of respiratory and hemodynamic parameters during the procedure were collected. Two groups were defined (group 1, body mass index [BMI] of ≥30 kg/m<sup>2</sup>; group 2, BMI of <30 kg/m<sup>2</sup>) and compared in terms of DS tolerance, safety, and procedural success.</div></div><div><h3>Results</h3><div>Overall, 381 patients were included (61% male, median age 69 years); 120 were assigned to group 1 (BMI of 33 kg/m<sup>2</sup> [32–38]) and 261 to group 2 (BMI of 25 kg/m<sup>2</sup> [23–27]); 69% underwent cryoballoon ablation, 22% radiofrequency ablation, and 9% pulsed field ablation. The incidence of hypotension did not differ between groups. Hypoxic episodes were more frequent in group 1 (4 vs 2, <em>P</em> < .05), but none required mechanical ventilation. In multivariate analysis, obesity alone was not an independent risk factor for hypoxia or hypotension. Procedural duration, left atrial (LA) dwell time, and radiation dose were significantly higher in group 1. Overall complication rate was 3.4%, with no difference between groups. The 1-year success rate was comparable (71% vs 63%, <em>P</em> = .13). Subgroup analysis for persistent atrial fibrillation revealed a higher 1-year success rate (70% vs 57%, <em>P</em> = .048) for group 1.</div></div><div><h3>Conclusion</h3><div>Obesity was not an independent risk factor for periprocedural hypoxia or hypotension and did not affect safety or long-term success. Obesity alone should not be considered a reason to exclude patients from undergoing PVI under DS.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 10","pages":"Pages 1524-1535"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.hroo.2025.07.005
David Spreen MSc , Thomas Kueffer PhD , Salik ur Rehman Iqbal MD , Patrick Badertscher MD , Jens Maurhofer MD , Philipp Krisai MD , Corinne Isenegger MD , Behnam Subin MD , Nicolas Schärli MD , Beat Schaer MD , Vincent Schlageter PhD , Maurice Pradella MD , Corinne Jufer MSc , Gregor Thalmann MD , Helge Servatius MD , Hildegard Tanner MD , Felix Mahfoud MD , Michael Kühne MD , Laurent Roten MD , Tobias Reichlin MD , Sven Knecht DSc
Background
Cryoballoon ablation is an established therapy for pulmonary vein (PV) isolation (PVI).
Objective
This study aimed to explore whether specific left atrial anatomical features are associated with both first-pass PVI success and long-term outcomes after cryoballoon ablation using 2 different cryoablation systems.
Methods
Left atrial reconstructions of patients with paroxysmal atrial fibrillation were analyzed. PVI was performed using either the Medtronic (Minneapolis, MN) Arctic Front Advance or the Boston Scientific (Marlborough, MA) POLARx cryoablation catheter. Anatomical features were assessed to predict first-pass PVI success after a single application and long-term outcomes on the basis of implantable cardiac monitor recordings.
Results
A total of 191 patients were enrolled (mean age 63.0 ± 9.8 years; 58 (30%) women). First-pass PVI was achieved in 69% of all procedures. Female sex was significantly associated with reduced first-pass isolation success, limited to the right superior PV (odds ratio [OR] 0.50; 95% confidence interval [CI] 0.26–0.97; P = .04). Anatomical predictors of failure of first-pass PVI included the absence of an orthogonal orientation of the left superior PV (OR 0.20; 95% CI 0.05–0.88; P = .033) and the left inferior PV (OR 0.36; 95% CI 0.13–0.99; P = .047) as well as the presence of a right middle PV for the right superior PV (OR 3.58; 95% CI 1.18–10.9; P = .024). The absence of an orthogonal orientation of the left superior PV was associated with atrial tachyarrhythmia recurrence (OR 4.12; 95% CI 1.90–9.11; P < .001).
Conclusion
The absence of an orthogonal orientation of the left-sided PVs was significantly associated with lower first-pass isolation rates and a higher risk of recurrence. These findings highlight the importance of preprocedural anatomical assessment to identify potential challenges and tailor ablation strategies.
低温球囊消融是治疗肺静脉隔离（PV）的一种成熟的治疗方法。目的：本研究旨在探讨特定左心房解剖特征是否与使用两种不同的冷冻球囊消融后的首次PVI成功和长期结果相关。方法对阵发性心房颤动患者的左心房重建进行分析。PVI使用美敦力（Minneapolis， MN） Arctic Front Advance或Boston Scientific (Marlborough， MA) POLARx冷冻消融导管进行。评估解剖特征，以预测单次应用后的首次PVI成功和基于植入式心脏监护仪记录的长期结果。结果共纳入191例患者，平均年龄（63.0±9.8岁），女性58例（30%）。69%的手术实现了首次PVI。女性与首过分离成功率降低显著相关，仅限于右侧优越PV（优势比[OR] 0.50； 95%可信区间[CI] 0.26-0.97; P = 0.04）。首次通过PVI失败的解剖学预测因素包括左上PV （OR 0.20; 95% CI 0.05-0.88; P = 0.033）和左下PV （OR 0.36; 95% CI 0.13-0.99; P = 0.047）以及右上PV存在右中PV （OR 3.58; 95% CI 1.18-10.9; P = 0.024）。左上PV正交定位缺失与房性心动过速复发相关（OR 4.12; 95% CI 1.90-9.11; P < 0.001）。结论左侧pv的正交定向缺失与较低的第一次分离率和较高的复发率显著相关。这些发现强调了术前解剖评估对于识别潜在挑战和定制消融策略的重要性。
{"title":"Impact of left atrial anatomy on pulmonary vein isolation with cryoballoon ablation: Insights from the randomized controlled COMPARE CRYO study","authors":"David Spreen MSc , Thomas Kueffer PhD , Salik ur Rehman Iqbal MD , Patrick Badertscher MD , Jens Maurhofer MD , Philipp Krisai MD , Corinne Isenegger MD , Behnam Subin MD , Nicolas Schärli MD , Beat Schaer MD , Vincent Schlageter PhD , Maurice Pradella MD , Corinne Jufer MSc , Gregor Thalmann MD , Helge Servatius MD , Hildegard Tanner MD , Felix Mahfoud MD , Michael Kühne MD , Laurent Roten MD , Tobias Reichlin MD , Sven Knecht DSc","doi":"10.1016/j.hroo.2025.07.005","DOIUrl":"10.1016/j.hroo.2025.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Cryoballoon ablation is an established therapy for pulmonary vein (PV) isolation (PVI).</div></div><div><h3>Objective</h3><div>This study aimed to explore whether specific left atrial anatomical features are associated with both first-pass PVI success and long-term outcomes after cryoballoon ablation using 2 different cryoablation systems.</div></div><div><h3>Methods</h3><div>Left atrial reconstructions of patients with paroxysmal atrial fibrillation were analyzed. PVI was performed using either the Medtronic (Minneapolis, MN) Arctic Front Advance or the Boston Scientific (Marlborough, MA) POLARx cryoablation catheter. Anatomical features were assessed to predict first-pass PVI success after a single application and long-term outcomes on the basis of implantable cardiac monitor recordings.</div></div><div><h3>Results</h3><div>A total of 191 patients were enrolled (mean age 63.0 ± 9.8 years; 58 (30%) women). First-pass PVI was achieved in 69% of all procedures. Female sex was significantly associated with reduced first-pass isolation success, limited to the right superior PV (odds ratio [OR] 0.50; 95% confidence interval [CI] 0.26–0.97; <em>P</em> = .04). Anatomical predictors of failure of first-pass PVI included the absence of an orthogonal orientation of the left superior PV (OR 0.20; 95% CI 0.05–0.88; <em>P</em> = .033) and the left inferior PV (OR 0.36; 95% CI 0.13–0.99; <em>P</em> = .047) as well as the presence of a right middle PV for the right superior PV (OR 3.58; 95% CI 1.18–10.9; <em>P</em> = .024). The absence of an orthogonal orientation of the left superior PV was associated with atrial tachyarrhythmia recurrence (OR 4.12; 95% CI 1.90–9.11; <em>P</em> < .001).</div></div><div><h3>Conclusion</h3><div>The absence of an orthogonal orientation of the left-sided PVs was significantly associated with lower first-pass isolation rates and a higher risk of recurrence. These findings highlight the importance of preprocedural anatomical assessment to identify potential challenges and tailor ablation strategies.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 10","pages":"Pages 1499-1507"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.hroo.2025.07.011
Rahul Ahuja MD, Michael Von Bargen MBA, Howard Klemmer MD, Daniel Cheng MD, Mahdi Veillet-Chowdhury MD, Todd Seto MD, MPH, Bert Matsuo PharmD, Kailie Wong NP, Sara Hamele NP, David Singh MD
Background
Atrial fibrillation (AF) in the emergency department (ED) is a growing public health burden, marked by significant variability in management, particularly regarding oral anticoagulation (OAC). Care process models (CPMs), supported by real-time decision tools, may improve standardization and outcomes.
Objective
This study aimed to evaluate the impact of a CPM on clinical outcomes, treatment patterns, and documentation for patients with AF presenting to EDs within a large integrated health care system.
Methods
We implemented a CPM in the Queen’s Health Systems (Hawaii), targeting ED patients with AF. Interventions included a structured treatment algorithm, an AF response team, best practice alerts (BPAs) for OAC and CHA2DS2-VASc documentation, and near-real-time data monitoring. Outcomes were assessed across 3 phases: pre-CPM, post-CPM/pre-BPA, and post-BPA. Primary outcomes included OAC compliance, documentation of OAC contraindications, cardioversion rates, length of stay (LOS), and admission rates.
Results
Among 3236 patients with AF (2020–2025), OAC compliance improved from 60.1% to 72.1% after BPA (P < .00001) and to 83% when excluding those with OAC contraindications. CHA2DS2-VASc documentation increased from 5% to 40% (P < .00001). Cardioversion rates increased from 11.9% to 16.8% (P < .0001). Hospital admissions declined from 44% to 38% (P = .004). ED LOS for discharged patients increased slightly (3.6–4.0 hours, P = .0005); inpatient LOS remained stable.
Conclusion
System-wide CPM implementation improved OAC use, documentation, and cardioversion rates, while reducing admissions. Despite a modest increase in ED LOS, the model supported more consistent, guideline-based AF care, reinforcing the value of multidisciplinary, algorithm-driven strategies in emergency settings.
{"title":"Impact of a care process model on outcomes in emergency department patients with atrial fibrillation","authors":"Rahul Ahuja MD, Michael Von Bargen MBA, Howard Klemmer MD, Daniel Cheng MD, Mahdi Veillet-Chowdhury MD, Todd Seto MD, MPH, Bert Matsuo PharmD, Kailie Wong NP, Sara Hamele NP, David Singh MD","doi":"10.1016/j.hroo.2025.07.011","DOIUrl":"10.1016/j.hroo.2025.07.011","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) in the emergency department (ED) is a growing public health burden, marked by significant variability in management, particularly regarding oral anticoagulation (OAC). Care process models (CPMs), supported by real-time decision tools, may improve standardization and outcomes.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the impact of a CPM on clinical outcomes, treatment patterns, and documentation for patients with AF presenting to EDs within a large integrated health care system.</div></div><div><h3>Methods</h3><div>We implemented a CPM in the Queen’s Health Systems (Hawaii), targeting ED patients with AF. Interventions included a structured treatment algorithm, an AF response team, best practice alerts (BPAs) for OAC and CHA<sub>2</sub>DS<sub>2</sub>-VASc documentation, and near-real-time data monitoring. Outcomes were assessed across 3 phases: pre-CPM, post-CPM/pre-BPA, and post-BPA. Primary outcomes included OAC compliance, documentation of OAC contraindications, cardioversion rates, length of stay (LOS), and admission rates.</div></div><div><h3>Results</h3><div>Among 3236 patients with AF (2020–2025), OAC compliance improved from 60.1% to 72.1% after BPA (P < .00001) and to 83% when excluding those with OAC contraindications. CHA<sub>2</sub>DS<sub>2</sub>-VASc documentation increased from 5% to 40% (P < .00001). Cardioversion rates increased from 11.9% to 16.8% (P < .0001). Hospital admissions declined from 44% to 38% (P = .004). ED LOS for discharged patients increased slightly (3.6–4.0 hours, P = .0005); inpatient LOS remained stable.</div></div><div><h3>Conclusion</h3><div>System-wide CPM implementation improved OAC use, documentation, and cardioversion rates, while reducing admissions. Despite a modest increase in ED LOS, the model supported more consistent, guideline-based AF care, reinforcing the value of multidisciplinary, algorithm-driven strategies in emergency settings.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 10","pages":"Pages 1556-1564"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.hroo.2025.07.013
Akshar Patel BS, Stanley Joseph BS, Caryl Bailey MD, Ashish Sakharpe MD, Mallikarjuna Devarapalli MBBS
This article explores how Natural Language Processing (NLP) models and agentic AI can streamline workflows in electrophysiology (EP). It discusses fine-tuning models such as BioBERT for EP-specific tasks, Named Entity Recognition for identifying key terms, real-time guideline updates using web scraping, and the integration of these components into a unified agentic AI workflow. The Hugging Face Transformers library and its pipeline() function are leveraged for various NLP tasks, including summarization, text generation, and translation, to automate literature reviews, guideline monitoring, and report generation.
本文探讨了自然语言处理（NLP）模型和代理人工智能如何简化电生理学（EP）的工作流程。它讨论了微调模型，如用于ep特定任务的BioBERT，用于识别关键术语的命名实体识别，使用网络抓取的实时指南更新，以及将这些组件集成到统一的代理AI工作流中。hugs Face Transformers库及其pipeline（）函数用于各种NLP任务，包括摘要、文本生成和翻译，以自动进行文献审查、指导方针监控和报告生成。
{"title":"Transforming electrophysiology workflows with natural language processing and agentic artificial intelligence","authors":"Akshar Patel BS, Stanley Joseph BS, Caryl Bailey MD, Ashish Sakharpe MD, Mallikarjuna Devarapalli MBBS","doi":"10.1016/j.hroo.2025.07.013","DOIUrl":"10.1016/j.hroo.2025.07.013","url":null,"abstract":"<div><div>This article explores how Natural Language Processing (NLP) models and agentic AI can streamline workflows in electrophysiology (EP). It discusses fine-tuning models such as BioBERT for EP-specific tasks, Named Entity Recognition for identifying key terms, real-time guideline updates using web scraping, and the integration of these components into a unified agentic AI workflow. The Hugging Face Transformers library and its pipeline() function are leveraged for various NLP tasks, including summarization, text generation, and translation, to automate literature reviews, guideline monitoring, and report generation.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 10","pages":"Pages 1613-1620"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.hroo.2025.06.019
Haseeb Valli MBBS, MRCP, PhD , Mahmoud Ehnesh PhD , Sam Coveney PhD , David G. Jones MBBS, MD (Res), MRCP , Zhong Chen MBBS, FRCP, PhD , Wajid Hussain MBChB, FRCP , Vias Markides MD, FRCP , Kumaraswamy Nanthakumar MD , Tom Wong MD, FRCP , Caroline Roney PhD , Shouvik Haldar MBBS, MD (Res), FRCP, FESC, FHRS
Background
Left atrial (LA) fibrosis is a key component of arrhythmogenic remodeling in atrial fibrillation (AF). LA low-voltage areas (LVAs) are considered surrogates for fibrosis and novel targets for ablation. However, there are no established criteria for identifying such potential pathogenic areas, particularly when using omnipolar technology (OT) mapping.
Objective
This study aimed to evaluate the correlation between OT and conventional bipolar voltage (BiV) in AF and regular rhythms.
Methods
Bipolar and OT mapping was performed in 17 patients undergoing de novo ablation for persistent AF. Mapping was performed in AF and coronary sinus pacing (CSP) at 600 ms. BiV of <0.5 mV was defined as low voltage.
Results
LA voltage in AF correlated poorly with CSP using either BiV (r = 0.15) or OT (r = 0.16). OT yielded higher voltages than BiV in AF (0.62 ± 0.24 vs 0.49 ± 0.18 mV, P < .050) and during CSP (1.85 ± 0.78 vs 1.60 ± 0.80 mV, P < .050). LVA burden, as a percentage of LA surface area, varied significantly depending on the atrial rhythm and mapping approach (AF-bipolar 65.0 ± 15.6%, AF-OT 56.2 ± 17.0%, CSP-bipolar 34.2 ± 18.9%, CSP-OT 24.56 ± 13.5%, P < .050). BiV thresholds of 0.5 mV during CSP and 0.3 mV in AF corresponded to an OT voltage of 0.84 mV and 0.40 mV, respectively.
Conclusion
The mapping tool and atrial rhythm significantly influence LA voltage and LVA burden for both bipolar and OT mapping. Applying a universal bipolar or OT cutoff for low voltage in AF and sinus rhythm will not accurately reflect the arrhythmogenic substrate. OT yields higher voltage than corresponding bipolar measurements; thus, threshold adjustments are required when using OT.
背景左心房（LA）纤维化是心房颤动（AF）致心律失常重构的关键组成部分。LA低压区（LVAs）被认为是纤维化的替代品和消融的新靶点。然而，尚无确定这些潜在致病区域的既定标准，特别是在使用全极技术（OT）制图时。目的探讨OT与房颤常规双极电压（BiV）及心律的相关性。方法对17例顽固性房颤从头消融患者进行双极和OT定位，并在房颤和冠状动脉窦起搏（CSP） 600 ms时进行定位。0.5 mV的BiV定义为低压。结果使用BiV （r = 0.15）或OT （r = 0.16）时AF的sla电压与CSP的相关性较差。OT在AF（0.62±0.24 vs 0.49±0.18 mV, P < 0.050）和CSP（1.85±0.78 vs 1.60±0.80 mV, P < 0.050）时产生的电压高于BiV。LVA负担占LA表面积的百分比，根据心房节律和测图方法的不同而有显著差异（AF-bipolar 65.0±15.6%,AF-OT 56.2±17.0%,CSP-bipolar 34.2±18.9%,CSP-OT 24.56±13.5%,P < 0.050）。CSP时BiV阈值为0.5 mV， AF时为0.3 mV，对应的OT电压分别为0.84 mV和0.40 mV。结论测图工具和心房节律对双极和OT测图的LA电压和LVA负荷均有显著影响。对房颤和窦性心律的低电压应用通用双极或OT切断不能准确反映致心律失常的底物。OT产生比相应双极测量更高的电压；因此，在使用OT时需要调整阈值。
{"title":"High-density evaluation of the arrhythmogenic substrate in persistent atrial fibrillation","authors":"Haseeb Valli MBBS, MRCP, PhD , Mahmoud Ehnesh PhD , Sam Coveney PhD , David G. Jones MBBS, MD (Res), MRCP , Zhong Chen MBBS, FRCP, PhD , Wajid Hussain MBChB, FRCP , Vias Markides MD, FRCP , Kumaraswamy Nanthakumar MD , Tom Wong MD, FRCP , Caroline Roney PhD , Shouvik Haldar MBBS, MD (Res), FRCP, FESC, FHRS","doi":"10.1016/j.hroo.2025.06.019","DOIUrl":"10.1016/j.hroo.2025.06.019","url":null,"abstract":"<div><h3>Background</h3><div>Left atrial (LA) fibrosis is a key component of arrhythmogenic remodeling in atrial fibrillation (AF). LA low-voltage areas (LVAs) are considered surrogates for fibrosis and novel targets for ablation. However, there are no established criteria for identifying such potential pathogenic areas, particularly when using omnipolar technology (OT) mapping.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the correlation between OT and conventional bipolar voltage (BiV) in AF and regular rhythms.</div></div><div><h3>Methods</h3><div>Bipolar and OT mapping was performed in 17 patients undergoing de novo ablation for persistent AF. Mapping was performed in AF and coronary sinus pacing (CSP) at 600 ms. BiV of <0.5 mV was defined as low voltage.</div></div><div><h3>Results</h3><div>LA voltage in AF correlated poorly with CSP using either BiV (r = 0.15) or OT (r = 0.16). OT yielded higher voltages than BiV in AF (0.62 ± 0.24 vs 0.49 ± 0.18 mV, <em>P</em> < .050) and during CSP (1.85 ± 0.78 vs 1.60 ± 0.80 mV, <em>P</em> < .050). LVA burden, as a percentage of LA surface area, varied significantly depending on the atrial rhythm and mapping approach (AF-bipolar 65.0 ± 15.6%, AF-OT 56.2 ± 17.0%, CSP-bipolar 34.2 ± 18.9%, CSP-OT 24.56 ± 13.5%, <em>P</em> < .050). BiV thresholds of 0.5 mV during CSP and 0.3 mV in AF corresponded to an OT voltage of 0.84 mV and 0.40 mV, respectively.</div></div><div><h3>Conclusion</h3><div>The mapping tool and atrial rhythm significantly influence LA voltage and LVA burden for both bipolar and OT mapping. Applying a universal bipolar or OT cutoff for low voltage in AF and sinus rhythm will not accurately reflect the arrhythmogenic substrate. OT yields higher voltage than corresponding bipolar measurements; thus, threshold adjustments are required when using OT.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 10","pages":"Pages 1536-1545"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.hroo.2025.07.008
Gábor Orbán MD, Márton Boga MD, Zoltán Salló MD, István Osztheimer MD, PhD, Klaudia Vivien Nagy MD, PhD, Péter Perge MD, PhD, Edit Tanai MD, Bence Czumbel, Bertalan Bakán, Ferenc Komlósi MD, Patrik Tóth MD, Arnold Béla Ferencz MD, Béla Merkely MD, PhD, DSc, László Gellér MD, PhD, DSc, Nándor Szegedi MD, PhD
Background
Pulsed-field ablation (PFA) has shown promise in improving atrial fibrillation (AF) ablation efficiency by reducing skin-to-skin procedure times while maintaining safety compared with advanced radiofrequency methods such as very high-power short-duration (vHPSD) ablation. Although PFA requires deeper sedation, its effect on total time spent in the operating room is unknown.
Objective
We aimed to compare the room time (the time between operating room entry and exit) and procedural subsections’ times of PFA and vHPSD procedures.
Methods
We enrolled consecutive patients who underwent PFA or vHPSD ablation at our center. Room and procedural subsections’ times were analyzed. Recurrence rates at 6 months were also compared.
Results
We included 131 patients (66 [55–71] years, 86 [65.6%] had paroxysmal AF). Eighty-seven patients (66%) underwent PFA, and 44 (34%) underwent vHPSD ablation. PFA outperformed vHPSD in terms of room time (71 [64–80] vs 88 [75–99.8] minutes, P < .001) and in most procedural subsections. One major nonfatal complication occurred with PFA, whereas no major complication occurred with vHPSD. There was no significant difference in 6-month recurrence rates between the 2 groups (PFA 15%, vHPSD 18%, P = .646).
Conclusion
In AF ablation, PFA results in significantly shorter room time than vHPSD, while maintaining similar 6-month recurrence rates. PFA may enhance time efficiency in the electrophysiology laboratory, even compared with the fastest radiofrequency technology.
背景：脉冲场消融（PFA）与先进的射频方法（如甚高功率短时间消融（vHPSD））相比，通过减少皮肤对皮肤的手术时间，同时保持安全性，在提高房颤（AF）消融效率方面表现出了希望。虽然PFA需要更深的镇静，但其对手术室总时间的影响尚不清楚。目的比较PFA和vHPSD手术的手术室时间（进出手术室时间）和手术分段时间。方法我们招募了在本中心接受PFA或vHPSD消融的连续患者。分析了房间和程序分段的时间。并比较6个月复发率。结果131例患者（66例[55-71]岁，86例[65.6%]为阵发性房颤）。87例患者（66%）行PFA， 44例（34%）行vHPSD消融术。PFA在室内时间方面优于vHPSD （71 [64-80] vs 88[75-99.8]分钟，P < 0.001）和大多数手术小节。PFA组出现一个主要的非致命性并发症，而vHPSD组没有出现主要并发症。两组患者6个月复发率差异无统计学意义（PFA 15%, vHPSD 18%, P = 0.646）。结论在房颤消融中，PFA的房间时间明显短于vHPSD，但保持相似的6个月复发率。即使与最快的射频技术相比，PFA也可以提高电生理实验室的时间效率。
{"title":"Comparison of room times between pulsed-field ablation and very high-power short-duration ablation","authors":"Gábor Orbán MD, Márton Boga MD, Zoltán Salló MD, István Osztheimer MD, PhD, Klaudia Vivien Nagy MD, PhD, Péter Perge MD, PhD, Edit Tanai MD, Bence Czumbel, Bertalan Bakán, Ferenc Komlósi MD, Patrik Tóth MD, Arnold Béla Ferencz MD, Béla Merkely MD, PhD, DSc, László Gellér MD, PhD, DSc, Nándor Szegedi MD, PhD","doi":"10.1016/j.hroo.2025.07.008","DOIUrl":"10.1016/j.hroo.2025.07.008","url":null,"abstract":"<div><h3>Background</h3><div>Pulsed-field ablation (PFA) has shown promise in improving atrial fibrillation (AF) ablation efficiency by reducing skin-to-skin procedure times while maintaining safety compared with advanced radiofrequency methods such as very high-power short-duration (vHPSD) ablation. Although PFA requires deeper sedation, its effect on total time spent in the operating room is unknown.</div></div><div><h3>Objective</h3><div>We aimed to compare the room time (the time between operating room entry and exit) and procedural subsections’ times of PFA and vHPSD procedures.</div></div><div><h3>Methods</h3><div>We enrolled consecutive patients who underwent PFA or vHPSD ablation at our center. Room and procedural subsections’ times were analyzed. Recurrence rates at 6 months were also compared.</div></div><div><h3>Results</h3><div>We included 131 patients (66 [55–71] years, 86 [65.6%] had paroxysmal AF). Eighty-seven patients (66%) underwent PFA, and 44 (34%) underwent vHPSD ablation. PFA outperformed vHPSD in terms of room time (71 [64–80] vs 88 [75–99.8] minutes, <em>P</em> < .001) and in most procedural subsections. One major nonfatal complication occurred with PFA, whereas no major complication occurred with vHPSD. There was no significant difference in 6-month recurrence rates between the 2 groups (PFA 15%, vHPSD 18%, <em>P</em> = .646).</div></div><div><h3>Conclusion</h3><div>In AF ablation, PFA results in significantly shorter room time than vHPSD, while maintaining similar 6-month recurrence rates. PFA may enhance time efficiency in the electrophysiology laboratory, even compared with the fastest radiofrequency technology.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 10","pages":"Pages 1546-1555"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.hroo.2025.06.028
Luke Byrne MB, BCh, BAO , Liam Maher MB, BCh, BAO , Caleb Powell MB, BCh, BAO , Mohamad Helmi MB, BCh, BAO , Gill Crowe MB, BCh, BAO , William Costello MB, BCh, BAO , Fiachra Clifford MB, BCh, BAO , Barry Kelly MB, BCh, BAO , Katie A. Walsh MB, BCh, BAO
Background
General anesthesia (GA) in radiofrequency ablation (RFA) for atrial fibrillation (AF) increases single procedure success rates and shortens procedure times vs conscious sedation (CS). In addition, high-frequency jet ventilation (HFJV) is associated with lower AF recurrence rates than conventional ventilation. Little data exist regarding the impact of sedation strategy on objective catheter stability and how this affects outcomes.
Objective
This study aimed to (1) measure catheter stability using the standard deviation (SD) of XYZ coordinates of catheter location, obtained in patients undergoing RFA for AF, and (2) compare catheter stability in CS, GA, and GA + HFJV groups.
Methods
All patients who underwent AF RFA at our center from April 2023 to June 2024 were eligible for inclusion in the study. Catheter stability was assessed using XYZ coordinates of catheter location, obtained via the CARTO 3 VisiTag module. The median SD of XYZ coordinates per ablation lesion was used to determine catheter stability.
Results
A total of 28 patients were included in the study, 8 in the CS group, 10 in the GA group, and 10 in the GA + HFJV group; 1,979,105 XYZ coordinates of RFA catheter location were analyzed. GA demonstrated an improvement in catheter stability compared with CS (median [interquartile range]) (0.54 [0.3–0.89] vs 1.51 [0.95–2.3], P < .001). GA + HFJV demonstrated further improvement in catheter stability vs GA (0.47 [0.25–0.87], P = .017).
Conclusion
The SD of XYZ coordinates of catheter location, obtained via the CARTO 3 VisiTag module, can be used to assess catheter stability during AF RFA. GA + HFJV offers superior catheter stability compared with GA and CS.
{"title":"The impact of sedation strategy on catheter stability in radiofrequency ablation for atrial fibrillation","authors":"Luke Byrne MB, BCh, BAO , Liam Maher MB, BCh, BAO , Caleb Powell MB, BCh, BAO , Mohamad Helmi MB, BCh, BAO , Gill Crowe MB, BCh, BAO , William Costello MB, BCh, BAO , Fiachra Clifford MB, BCh, BAO , Barry Kelly MB, BCh, BAO , Katie A. Walsh MB, BCh, BAO","doi":"10.1016/j.hroo.2025.06.028","DOIUrl":"10.1016/j.hroo.2025.06.028","url":null,"abstract":"<div><h3>Background</h3><div>General anesthesia (GA) in radiofrequency ablation (RFA) for atrial fibrillation (AF) increases single procedure success rates and shortens procedure times vs conscious sedation (CS). In addition, high-frequency jet ventilation (HFJV) is associated with lower AF recurrence rates than conventional ventilation. Little data exist regarding the impact of sedation strategy on objective catheter stability and how this affects outcomes.</div></div><div><h3>Objective</h3><div>This study aimed to (1) measure catheter stability using the standard deviation (SD) of XYZ coordinates of catheter location, obtained in patients undergoing RFA for AF, and (2) compare catheter stability in CS, GA, and GA + HFJV groups.</div></div><div><h3>Methods</h3><div>All patients who underwent AF RFA at our center from April 2023 to June 2024 were eligible for inclusion in the study. Catheter stability was assessed using XYZ coordinates of catheter location, obtained via the CARTO 3 VisiTag module. The median SD of XYZ coordinates per ablation lesion was used to determine catheter stability.</div></div><div><h3>Results</h3><div>A total of 28 patients were included in the study, 8 in the CS group, 10 in the GA group, and 10 in the GA + HFJV group; 1,979,105 XYZ coordinates of RFA catheter location were analyzed. GA demonstrated an improvement in catheter stability compared with CS (median [interquartile range]) (0.54 [0.3–0.89] vs 1.51 [0.95–2.3], <em>P</em> < .001). GA + HFJV demonstrated further improvement in catheter stability vs GA (0.47 [0.25–0.87], <em>P</em> = .017).</div></div><div><h3>Conclusion</h3><div>The SD of XYZ coordinates of catheter location, obtained via the CARTO 3 VisiTag module, can be used to assess catheter stability during AF RFA. GA + HFJV offers superior catheter stability compared with GA and CS.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 10","pages":"Pages 1491-1498"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.hroo.2025.07.010
Jason Silvestre MD , Ahmed Brgdar MD , Jay Chen MD , Thomas G. Di Salvo MD , Prafulla Mehrotra MD , Deborah Williams MD
Background
Waning interest and 2 additional years of fellowship training may be barriers to recruiting applicants to fill available training positions in clinical cardiac electrophysiology.
Objective
To understand changes in the annual number of training positions and applicants in clinical cardiac electrophysiology, match rates, unfilled training positions, and where applicants matched on their rank lists.
Methods
This was a cross-sectional analysis of all applicants for clinical cardiac electrophysiology training from 2019 to 2025. Match rates and applicant-to-training position ratios were calculated. Temporal trends were assessed with linear regression.
Results
Growth in the annual number of applicants (89–177, 99% increase) exceeded growth in the number of training positions (130–152, 17% increase) (P < .001). Accordingly, the annual applicant-to-training position ratio increased from 0.7 to 1.2 (P < .001). During each year, match rates for US allopathic graduates exceeded those for non-US allopathic graduates (P < .001). There was a significant growth in the number of submitted ranks per applicant (5.6–9.1 ranks, P < .001) and fewer applicants matched at 1of their top 3 fellowship choices over the study period (84%–61%, P < .001). Fewer available annual training positions went unfilled from 2019 to 2025 (38%–2%, P < .001).
Conclusion
Growth in the annual number of applicants for electrophysiology training exceeded growth in the number of available training positions, whereas match rates and the number of annual unfilled training positions have decreased. Although these trends are encouraging, future surveillance is warranted given projected shortages in the cardiac electrophysiologist workforce.
{"title":"Analysis of application and match rates for clinical cardiac electrophysiology training in the United States","authors":"Jason Silvestre MD , Ahmed Brgdar MD , Jay Chen MD , Thomas G. Di Salvo MD , Prafulla Mehrotra MD , Deborah Williams MD","doi":"10.1016/j.hroo.2025.07.010","DOIUrl":"10.1016/j.hroo.2025.07.010","url":null,"abstract":"<div><h3>Background</h3><div>Waning interest and 2 additional years of fellowship training may be barriers to recruiting applicants to fill available training positions in clinical cardiac electrophysiology.</div></div><div><h3>Objective</h3><div>To understand changes in the annual number of training positions and applicants in clinical cardiac electrophysiology, match rates, unfilled training positions, and where applicants matched on their rank lists.</div></div><div><h3>Methods</h3><div>This was a cross-sectional analysis of all applicants for clinical cardiac electrophysiology training from 2019 to 2025. Match rates and applicant-to-training position ratios were calculated. Temporal trends were assessed with linear regression.</div></div><div><h3>Results</h3><div>Growth in the annual number of applicants (89–177, 99% increase) exceeded growth in the number of training positions (130–152, 17% increase) (<em>P</em> < .001). Accordingly, the annual applicant-to-training position ratio increased from 0.7 to 1.2 (<em>P</em> < .001). During each year, match rates for US allopathic graduates exceeded those for non-US allopathic graduates (<em>P</em> < .001). There was a significant growth in the number of submitted ranks per applicant (5.6–9.1 ranks, <em>P</em> < .001) and fewer applicants matched at 1of their top 3 fellowship choices over the study period (84%–61%, <em>P</em> < .001). Fewer available annual training positions went unfilled from 2019 to 2025 (38%–2%, <em>P</em> < .001).</div></div><div><h3>Conclusion</h3><div>Growth in the annual number of applicants for electrophysiology training exceeded growth in the number of available training positions, whereas match rates and the number of annual unfilled training positions have decreased. Although these trends are encouraging, future surveillance is warranted given projected shortages in the cardiac electrophysiologist workforce.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 10","pages":"Pages 1632-1637"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In Aveir VR (Abbott Medical) leadless pacemaker implantation, commanded electrograms (cEGMs) are used before and after fixation to evaluate the suitability of the fixation site. However, no clinical studies have examined its predictive value or optimal cutoff values.
Objective
The purpose of this study was to investigate the association between the midterm pacing capture threshold (PCT) and cEGM parameters after Aveir VR implantation procedures.
Methods
We retrospectively analyzed consecutive 74 patients who underwent Aveir VR implantation at Sendai Kosei Hospital with analyzable cEGM data. cEGM parameters, including QRS amplitude, QRS duration, and current of injury (COI), were measured during the premapping and tether modes. The highest PCT recorded within 1 year of implantation was used as the primary outcome. An elevated PCT was defined as >1.5 V/0.4 ms. Correlations were analyzed, and receiver operating characteristic analyses identified optimal cutoff values for the COI and QRS amplitude.
Results
Both the COI and the QRS amplitude showed weak but significant correlations with the PCT. The area under the curve for the COI was 0.715 (premapping) and 0.668 (tether), with cutoff values of >2.0 mV. The COI was associated with a high PCT (premapping mode: odds ratio [OR] 7.5, 95% confidence interval [CI] 1.6–44.6; tether mode: OR 4.8, 95% CI 1.1–21.4). The QRS amplitude had area under the curves of 0.771 in the premapping mode and 0.840 in the tether mode, with cutoff values of >5.0 mV (OR 12.0; 95% CI 1.4–101.7) and >4.0 mV (OR 15.5; 95% CI 2.8–83.9), respectively.
Conclusion
Even before fixation, the COI and QRS amplitude are useful predictors of the midterm PCT after Aveir VR implantation. Combined assessment may enhance fixation strategies.
{"title":"Mapping the future: Predictive value of commanded electrogram parameters for the pacing performance in active-fixation leadless pacemakers","authors":"Takehiro Nomura MD, PhD, Kosuke Onodera MD, Daiki Kumazawa MD, Yosuke Mizuno MD, Kennosuke Yamashita MD, PhD, FJCC, FACC, FHRS","doi":"10.1016/j.hroo.2025.07.019","DOIUrl":"10.1016/j.hroo.2025.07.019","url":null,"abstract":"<div><h3>Background</h3><div>In Aveir VR (Abbott Medical) leadless pacemaker implantation, commanded electrograms (cEGMs) are used before and after fixation to evaluate the suitability of the fixation site. However, no clinical studies have examined its predictive value or optimal cutoff values.</div></div><div><h3>Objective</h3><div>The purpose of this study was to investigate the association between the midterm pacing capture threshold (PCT) and cEGM parameters after Aveir VR implantation procedures.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed consecutive 74 patients who underwent Aveir VR implantation at Sendai Kosei Hospital with analyzable cEGM data. cEGM parameters, including QRS amplitude, QRS duration, and current of injury (COI), were measured during the premapping and tether modes. The highest PCT recorded within 1 year of implantation was used as the primary outcome. An elevated PCT was defined as >1.5 V/0.4 ms. Correlations were analyzed, and receiver operating characteristic analyses identified optimal cutoff values for the COI and QRS amplitude.</div></div><div><h3>Results</h3><div>Both the COI and the QRS amplitude showed weak but significant correlations with the PCT. The area under the curve for the COI was 0.715 (premapping) and 0.668 (tether), with cutoff values of >2.0 mV. The COI was associated with a high PCT (premapping mode: odds ratio [OR] 7.5, 95% confidence interval [CI] 1.6–44.6; tether mode: OR 4.8, 95% CI 1.1–21.4). The QRS amplitude had area under the curves of 0.771 in the premapping mode and 0.840 in the tether mode, with cutoff values of >5.0 mV (OR 12.0; 95% CI 1.4–101.7) and >4.0 mV (OR 15.5; 95% CI 2.8–83.9), respectively.</div></div><div><h3>Conclusion</h3><div>Even before fixation, the COI and QRS amplitude are useful predictors of the midterm PCT after Aveir VR implantation. Combined assessment may enhance fixation strategies.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 10","pages":"Pages 1587-1593"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.hroo.2025.07.003
Ryan A.A. Bellfield PhD , Pablo Rendon Hormiga MSc , Ivan Olier PhD , Robyn Lotto PhD , Ian Jones PhD , Gregory Y.H. Lip MD , Sandra Ortega-Martorell PhD
Background
Atrial fibrillation (AF) is the most common arrhythmia worldwide, associated with an increased risk of serious health issues. As its prevalence rises, health care systems face significant challenges, including escalating treatment costs and the inherent difficulties of detecting AF, particularly in paroxysmal cases where symptoms are intermittent.
Objective
This study investigates the application of unsupervised machine learning, specifically generative topographic mapping (GTM), to support AF screening and risk stratification.
Methods
The supermarket/hypermarket opportunistic screening for atrial fibrillation study deployed single-lead electrocardiogram (ECG) sensors (MyDiagnostick) embedded in supermarket trolley handles across 4 sites in Northwest England. This community-based approach successfully engaged the public in opportunistic AF screening. However, diagnosis was limited by reliance on transient ECG recordings. To improve analysis, we selected a subset of 97 ECG traces (78 for training and 19 for testing) reviewed by a consultant cardiologist, comprising AF (n = 23), possible AF (n = 9), and normal rhythm (n = 65). From these, 477 20-second ECG snippets were extracted to train the GTM model.
Results
The GTM generated interpretable membership maps, clustering ECG snippets into visually distinct regions with similar features. These maps enable clinicians to explore heart rhythm dynamics over time and track patient trajectories across risk states.
Conclusion
This study demonstrates the potential of our proposed methodology to uncover latent patterns in ECG data, providing deeper insights into individual heart rhythm patterns and supporting more nuanced AF risk assessment and the overall effectiveness of AF detection and management. By embedding interpretable artificial intelligence in screening tools, we aimed to improve early detection and reduce the clinical burden of AF.
{"title":"AI-driven clustering and visualization of electrocardiogram signals to enhance screening for atrial fibrillation: The supermarket/hypermarket opportunistic screening for atrial fibrillation study","authors":"Ryan A.A. Bellfield PhD , Pablo Rendon Hormiga MSc , Ivan Olier PhD , Robyn Lotto PhD , Ian Jones PhD , Gregory Y.H. Lip MD , Sandra Ortega-Martorell PhD","doi":"10.1016/j.hroo.2025.07.003","DOIUrl":"10.1016/j.hroo.2025.07.003","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) is the most common arrhythmia worldwide, associated with an increased risk of serious health issues. As its prevalence rises, health care systems face significant challenges, including escalating treatment costs and the inherent difficulties of detecting AF, particularly in paroxysmal cases where symptoms are intermittent.</div></div><div><h3>Objective</h3><div>This study investigates the application of unsupervised machine learning, specifically generative topographic mapping (GTM), to support AF screening and risk stratification.</div></div><div><h3>Methods</h3><div>The supermarket/hypermarket opportunistic screening for atrial fibrillation study deployed single-lead electrocardiogram (ECG) sensors (MyDiagnostick) embedded in supermarket trolley handles across 4 sites in Northwest England. This community-based approach successfully engaged the public in opportunistic AF screening. However, diagnosis was limited by reliance on transient ECG recordings. To improve analysis, we selected a subset of 97 ECG traces (78 for training and 19 for testing) reviewed by a consultant cardiologist, comprising AF (n = 23), possible AF (n = 9), and normal rhythm (n = 65). From these, 477 20-second ECG snippets were extracted to train the GTM model.</div></div><div><h3>Results</h3><div>The GTM generated interpretable membership maps, clustering ECG snippets into visually distinct regions with similar features. These maps enable clinicians to explore heart rhythm dynamics over time and track patient trajectories across risk states.</div></div><div><h3>Conclusion</h3><div>This study demonstrates the potential of our proposed methodology to uncover latent patterns in ECG data, providing deeper insights into individual heart rhythm patterns and supporting more nuanced AF risk assessment and the overall effectiveness of AF detection and management. By embedding interpretable artificial intelligence in screening tools, we aimed to improve early detection and reduce the clinical burden of AF.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 10","pages":"Pages 1601-1612"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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