Background: It is uncertain whether bipolar voltage cutoffs should be adjusted based on rhythm, sex, or region.
Objective: This study aimed to determine (1) the bipolar voltage cutoff values for the entire left atrium (LA) and the low-voltage areas in different regions of the LA and (2) whether sex-based differences exist in the bipolar voltage cutoff points for low-voltage areas.
Methods: 30 patients with persistent atrial fibrillation (AF) underwent high-density voltage mapping first in sinus rhythm and subsequently during induced AF. The 7 parts of the map are respectively taken from 9 regions with the same position and location. The average low voltage of these area points was analyzed. Correlation was assessed using scatter plots, and agreement was evaluated with Bland-Altman analysis. The generalized additive model was used to predict the bipolar voltage cutoff points.
Results: A total of 1268 regions were obtained. For the entire LA, a cutoff of 0.27 mV in AF predicted a sinus rhythm voltage of 0.5 mV (95% confidence interval 0.12-2.02). Region-specific AF voltage cutoffs were as follows: posterior wall 0.19 mV, inferior wall 0.17 mV, anterior wall 0.27 mV, LA appendage 0.27 mV, and roof 0.45 mV. Regarding different sexes, the values were 0.13 mV for males and 0.32 mV for females, respectively.
Conclusion: It is possible to establish a new cutoff value for AF with acceptable validity in predicting sinus voltage of <0.5 mV, but sex differences need to be taken into account.
{"title":"Comparative cardiac electrophysiological analysis between sinus rhythm and atrial fibrillation: The correlation of left atrial low-voltage substrate of sex and rhythm.","authors":"Guifang Zhao, Xuefeng Zhu, Pingping Liu, Faxin Ren, Ronghang Liu, Yanyan Jing, Hongxia Chu","doi":"10.1016/j.hroo.2025.11.026","DOIUrl":"https://doi.org/10.1016/j.hroo.2025.11.026","url":null,"abstract":"<p><strong>Background: </strong>It is uncertain whether bipolar voltage cutoffs should be adjusted based on rhythm, sex, or region.</p><p><strong>Objective: </strong>This study aimed to determine (1) the bipolar voltage cutoff values for the entire left atrium (LA) and the low-voltage areas in different regions of the LA and (2) whether sex-based differences exist in the bipolar voltage cutoff points for low-voltage areas.</p><p><strong>Methods: </strong>30 patients with persistent atrial fibrillation (AF) underwent high-density voltage mapping first in sinus rhythm and subsequently during induced AF. The 7 parts of the map are respectively taken from 9 regions with the same position and location. The average low voltage of these area points was analyzed. Correlation was assessed using scatter plots, and agreement was evaluated with Bland-Altman analysis. The generalized additive model was used to predict the bipolar voltage cutoff points.</p><p><strong>Results: </strong>A total of 1268 regions were obtained. For the entire LA, a cutoff of 0.27 mV in AF predicted a sinus rhythm voltage of 0.5 mV (95% confidence interval 0.12-2.02). Region-specific AF voltage cutoffs were as follows: posterior wall 0.19 mV, inferior wall 0.17 mV, anterior wall 0.27 mV, LA appendage 0.27 mV, and roof 0.45 mV. Regarding different sexes, the values were 0.13 mV for males and 0.32 mV for females, respectively.</p><p><strong>Conclusion: </strong>It is possible to establish a new cutoff value for AF with acceptable validity in predicting sinus voltage of <0.5 mV, but sex differences need to be taken into account.</p>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"7 2","pages":"273-283"},"PeriodicalIF":2.9,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12925902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147285465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05eCollection Date: 2026-02-01DOI: 10.1016/j.hroo.2025.11.025
Olivier Meste, Michael Y Sun, Daniel O Cervantes, Giulia Piccinini, Bob Qian, Zoë Volney, Belinda Nyantakyi, Georgette A Cosentino, Aaron Yancoskie, Sudhir Jain, Jason T Jacobson, Malik Bisserier, Marcello Rota
Background: Metabolic syndrome (MetS) is a cluster of conditions that increases the risk of cardiovascular complications and all-cause mortality. MetS manifests reduced heart rate variability, but factors underlying the process remain to be fully elucidated.
Objective: To gain new insights into the effects of MetS on heart rhythm dynamics, we developed a custom algorithm to analyze the distribution and span of R-R intervals.
Methods: MetS was induced in male and female mice by Western diet feeding (WD mice), whereas animals on regular chow were used as controls (Ctrl mice). The sequence of R-R intervals of electrocardiograms and their deviation were sorted and normalized using an approximation of the distribution function to obtain sequences of the R-R interval duration (sortRR) and the R-R interval deviation (sortRRdev).
Results: sortRR sequences revealed shorter intervals in WD mice than in Ctrl mice within the range of intermediate and long R-R intervals, indicating that mice with MetS have limited capability to lower heart rate. Moreover, sortRRdev sequences had smaller amplitudes for WD mice, consistent with reduced heart rate variability. Inhibition of sympathetic inputs abrogated differences in sortRR sequences for the 2 groups of mice, whereas inhibition of parasympathetic inputs suppressed differences in the sortRRdev series. Interestingly, Western diet feeding in animals lacking β-adrenergic receptors minimally affected heart rate dynamics in female mice, but revealed significant alterations in male animals, which were abrogated by parasympathetic inhibition.
Conclusion: These results support the notion that sympathoexcitation and parasympathetic withdrawal occur with MetS and affect the duration, functional range, and variability of R-R intervals.
{"title":"A custom analysis of R-R interval properties reveals alterations in the brain-heart axis in experimental animals with metabolic syndrome.","authors":"Olivier Meste, Michael Y Sun, Daniel O Cervantes, Giulia Piccinini, Bob Qian, Zoë Volney, Belinda Nyantakyi, Georgette A Cosentino, Aaron Yancoskie, Sudhir Jain, Jason T Jacobson, Malik Bisserier, Marcello Rota","doi":"10.1016/j.hroo.2025.11.025","DOIUrl":"https://doi.org/10.1016/j.hroo.2025.11.025","url":null,"abstract":"<p><strong>Background: </strong>Metabolic syndrome (MetS) is a cluster of conditions that increases the risk of cardiovascular complications and all-cause mortality. MetS manifests reduced heart rate variability, but factors underlying the process remain to be fully elucidated.</p><p><strong>Objective: </strong>To gain new insights into the effects of MetS on heart rhythm dynamics, we developed a custom algorithm to analyze the distribution and span of R-R intervals.</p><p><strong>Methods: </strong>MetS was induced in male and female mice by Western diet feeding (WD mice), whereas animals on regular chow were used as controls (Ctrl mice). The sequence of R-R intervals of electrocardiograms and their deviation were sorted and normalized using an approximation of the distribution function to obtain sequences of the R-R interval duration (sortRR) and the R-R interval deviation (sortRRdev).</p><p><strong>Results: </strong>sortRR sequences revealed shorter intervals in WD mice than in Ctrl mice within the range of intermediate and long R-R intervals, indicating that mice with MetS have limited capability to lower heart rate. Moreover, sortRRdev sequences had smaller amplitudes for WD mice, consistent with reduced heart rate variability. Inhibition of sympathetic inputs abrogated differences in sortRR sequences for the 2 groups of mice, whereas inhibition of parasympathetic inputs suppressed differences in the sortRRdev series. Interestingly, Western diet feeding in animals lacking β-adrenergic receptors minimally affected heart rate dynamics in female mice, but revealed significant alterations in male animals, which were abrogated by parasympathetic inhibition.</p><p><strong>Conclusion: </strong>These results support the notion that sympathoexcitation and parasympathetic withdrawal occur with MetS and affect the duration, functional range, and variability of R-R intervals.</p>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"7 2","pages":"354-371"},"PeriodicalIF":2.9,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12925940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147285462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-04eCollection Date: 2026-02-01DOI: 10.1016/j.hroo.2025.11.023
Adrian M Petzl, Haran Yogasundaram, Corentin Chaumont, Andrea Hammond, Rory P Dowd, David Lin, Cory Tschabrunn, Timothy M Markman, Andres Enriquez, Francis E Marchlinski, Jeffrey R Winterfield, Matthew C Hyman
{"title":"High-density vs point-by-point mapping in ventricular tachycardia ablation: A comparative analysis of substrate characterization.","authors":"Adrian M Petzl, Haran Yogasundaram, Corentin Chaumont, Andrea Hammond, Rory P Dowd, David Lin, Cory Tschabrunn, Timothy M Markman, Andres Enriquez, Francis E Marchlinski, Jeffrey R Winterfield, Matthew C Hyman","doi":"10.1016/j.hroo.2025.11.023","DOIUrl":"https://doi.org/10.1016/j.hroo.2025.11.023","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"7 2","pages":"429-431"},"PeriodicalIF":2.9,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12925912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147285528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Posterior wall isolation (PWI) is a supplemental modality to pulmonary vein isolation in radiofrequency ablation for persistent atrial fibrillation. Residual epicardial connections may contribute to nondurable PWI and increased atrial fibrillation recurrence.
Objective
The study aimed to investigate the use of a novel high-amplitude pacing (HAP) technique to unmask epicardial connections after PWI.
Methods
100 consecutive patients underwent pulmonary vein isolation/PWI radiofrequency ablation with roof and floor lines and segmental ablation for posterior wall (PW) entrance block. The PW was divided into 4 quadrants, each subdivided into 4 segments, labeled 1–16. After the PW entrance block, bipolar pacing was performed in each segment with standard pacing (10 mA at 2 ms) and HAP (20 mA at 2 ms). Exit block was defined as a lack of atrial capture from within PW.
Results
Patients were divided into groups 1 (unable to achieve complete PWI) and 2 (PWI achieved). We categorized patients into subgroups based on the presence/absence of entrance blocks, captures, and exit blocks. PW entrance block was not achieved in 2 patients (2%); 17 patients (17%) demonstrated bidirectional PW block with standard pacing. HAP-only capture was seen in 74 of the remaining 81 patients. Mid-PW had the highest frequency of HAP-only capture. Additional ablation was performed in 63 HAP patients without PW exit block, with final PWI achieved in 51 of 63 patients (80.9%) compared with 18 of 18 (100%) in the cohort with HAP noncapture/exit block (P = .045).
Conclusion
Our novel protocol of HAP unmasked possible epicardial capture in 63% of patients, with true PWI with additional ablation in 80.9% patients. HAP may help unmask epicardial connections and facilitate durable PWI to improve long-term procedural success.
{"title":"High-amplitude pacing can identify epicardial connections in the posterior wall during ablation for atrial fibrillation","authors":"Arshad Muhammad Iqbal MD , Suhaib Bajwa MD , Cory Smith MD , Supraja Thunuguntla MD , Sandeep Gautam MD, FHRS","doi":"10.1016/j.hroo.2025.09.023","DOIUrl":"10.1016/j.hroo.2025.09.023","url":null,"abstract":"<div><h3>Background</h3><div>Posterior wall isolation (PWI) is a supplemental modality to pulmonary vein isolation in radiofrequency ablation for persistent atrial fibrillation. Residual epicardial connections may contribute to nondurable PWI and increased atrial fibrillation recurrence.</div></div><div><h3>Objective</h3><div>The study aimed to investigate the use of a novel high-amplitude pacing (HAP) technique to unmask epicardial connections after PWI.</div></div><div><h3>Methods</h3><div>100 consecutive patients underwent pulmonary vein isolation/PWI radiofrequency ablation with roof and floor lines and segmental ablation for posterior wall (PW) entrance block. The PW was divided into 4 quadrants, each subdivided into 4 segments, labeled 1–16. After the PW entrance block, bipolar pacing was performed in each segment with standard pacing (10 mA at 2 ms) and HAP (20 mA at 2 ms). Exit block was defined as a lack of atrial capture from within PW.</div></div><div><h3>Results</h3><div>Patients were divided into groups 1 (unable to achieve complete PWI) and 2 (PWI achieved). We categorized patients into subgroups based on the presence/absence of entrance blocks, captures, and exit blocks. PW entrance block was not achieved in 2 patients (2%); 17 patients (17%) demonstrated bidirectional PW block with standard pacing. HAP-only capture was seen in 74 of the remaining 81 patients. Mid-PW had the highest frequency of HAP-only capture. Additional ablation was performed in 63 HAP patients without PW exit block, with final PWI achieved in 51 of 63 patients (80.9%) compared with 18 of 18 (100%) in the cohort with HAP noncapture/exit block (<em>P</em> = .045).</div></div><div><h3>Conclusion</h3><div>Our novel protocol of HAP unmasked possible epicardial capture in 63% of patients, with true PWI with additional ablation in 80.9% patients. HAP may help unmask epicardial connections and facilitate durable PWI to improve long-term procedural success.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1928-1935"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771846","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 : 2025-12-01DOI: 10.1016/j.hroo.2025.09.024
Qing Zhang MD, PhD , Guohao Wang PhD , Zhangpu Yan BS , Weiling Xu MD , Shaofeng Zhang BS , Jun Li MD , Ling Liang MD, PhD , Changqing Sun MD, PhD , Rong Tang MD , Joachim Pircher MD, PhD , Qiang Xie MD, PhD, FHRS , Wuyang Zheng MD, PhD
Background
Clonal hematopoiesis of indeterminate potential (CHIP) has emerged as an independent cardiovascular risk factor, with recent studies suggesting a link to atrial fibrillation (AF). However, the causal nature of this relationship, particularly the role of DNMT3a and TET2 mutations, remains unclear.
Objective
This study aimed to assess the causal relationship between CHIP and AF and identify potential mediating pathways.
Methods
We conducted a bidirectional Mendelian randomization (MR) analysis using genome-wide association study data for CHIP from the UK Biobank (n = 368,526) and AF data from 2 large, independent cohorts (287,805 individuals from FinnGen and 1,030,836 from 6 additional AF studies). A 2-step MR mediation analysis was used to explore potential intermediate risk factors.
Results
Inverse variance weighted MR analysis demonstrated a causal effect of CHIP on increased AF risk (meta-inverse variance weighted, odds ratio [OR] 1.057; P = .001), including both DNMT3a- and TET2-related CHIP (DNMT3a, OR 1.048, P = 4.56 × 10-4; TET2, OR 1.038, P = .025). Causal associations between overall CHIP, including DNMT3a-CHIP, and AF were validated by a 2-sample MR study in 2 independent cohorts. Reverse MR showed no evidence of AF causing CHIP. The mediation analysis identified elevated systolic blood pressure as a key mediator in the DNMT3a-CHIP–AF pathway, accounting for 7.8% of the effect (P = .034).
Conclusion
Our findings provide genetic evidence that CHIP, particularly DNMT3a-related mutations, causally but modestly increases AF risk. There is no support for reverse causation. Elevated systolic blood pressure was identified as a significant mediator linking DNMT3a-CHIP to AF.
克隆造血不确定电位(CHIP)已成为一个独立的心血管危险因素,最近的研究表明其与心房颤动(AF)有关。然而,这种关系的因果性质,特别是DNMT3a和TET2突变的作用仍不清楚。目的探讨CHIP与房颤之间的因果关系,并确定可能的介导途径。方法:我们使用来自UK Biobank的CHIP全基因组关联研究数据(n = 368,526)和来自2个大型独立队列的AF数据(来自FinnGen的287,805名个体和来自另外6项AF研究的1,030,836名个体)进行了双向孟德尔随机化(MR)分析。采用两步MR中介分析探讨潜在的中间危险因素。结果反向方差加权MR分析显示CHIP与AF风险增加有因果关系(meta-inverse方差加权,优势比[OR] 1.057; P = .001),包括DNMT3a和TET2相关CHIP (DNMT3a, OR 1.048, P = 4.56 × 10-4; TET2, OR 1.038, P = 0.025)。包括DNMT3a-CHIP在内的总体CHIP与房颤之间的因果关系通过2个独立队列的2样本MR研究得到验证。反向MR未显示AF引起CHIP的证据。中介分析发现收缩压升高是DNMT3a-CHIP-AF通路的关键中介,占7.8%的效应(P = 0.034)。结论:我们的研究结果提供了遗传证据,证明CHIP,特别是dnmt3a相关突变,会导致但适度地增加房颤风险。没有证据支持反向因果关系。收缩压升高被确定为DNMT3a-CHIP与房颤之间的重要中介。
{"title":"Clonal hematopoiesis of indeterminate potential as a risk factor for atrial fibrillation: Evidence of a causal relationship by Mendelian randomization study","authors":"Qing Zhang MD, PhD , Guohao Wang PhD , Zhangpu Yan BS , Weiling Xu MD , Shaofeng Zhang BS , Jun Li MD , Ling Liang MD, PhD , Changqing Sun MD, PhD , Rong Tang MD , Joachim Pircher MD, PhD , Qiang Xie MD, PhD, FHRS , Wuyang Zheng MD, PhD","doi":"10.1016/j.hroo.2025.09.024","DOIUrl":"10.1016/j.hroo.2025.09.024","url":null,"abstract":"<div><h3>Background</h3><div>Clonal hematopoiesis of indeterminate potential (CHIP) has emerged as an independent cardiovascular risk factor, with recent studies suggesting a link to atrial fibrillation (AF). However, the causal nature of this relationship, particularly the role of DNMT3a and TET2 mutations, remains unclear.</div></div><div><h3>Objective</h3><div>This study aimed to assess the causal relationship between CHIP and AF and identify potential mediating pathways.</div></div><div><h3>Methods</h3><div>We conducted a bidirectional Mendelian randomization (MR) analysis using genome-wide association study data for CHIP from the UK Biobank (n = 368,526) and AF data from 2 large, independent cohorts (287,805 individuals from FinnGen and 1,030,836 from 6 additional AF studies). A 2-step MR mediation analysis was used to explore potential intermediate risk factors.</div></div><div><h3>Results</h3><div>Inverse variance weighted MR analysis demonstrated a causal effect of CHIP on increased AF risk (meta-inverse variance weighted, odds ratio [OR] 1.057; <em>P</em> = .001), including both DNMT3a- and TET2-related CHIP (DNMT3a, OR 1.048, <em>P</em> = 4.56 × 10<sup>-4</sup>; TET2, OR 1.038, <em>P</em> = .025). Causal associations between overall CHIP, including DNMT3a-CHIP, and AF were validated by a 2-sample MR study in 2 independent cohorts. Reverse MR showed no evidence of AF causing CHIP. The mediation analysis identified elevated systolic blood pressure as a key mediator in the DNMT3a-CHIP–AF pathway, accounting for 7.8% of the effect (<em>P</em> = .034).</div></div><div><h3>Conclusion</h3><div>Our findings provide genetic evidence that CHIP, particularly DNMT3a-related mutations, causally but modestly increases AF risk. There is no support for reverse causation. Elevated systolic blood pressure was identified as a significant mediator linking DNMT3a-CHIP to AF.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1949-1959"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771848","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 : 2025-12-01DOI: 10.1016/j.hroo.2025.09.026
Leonardo J. Uribe-Cavero MD , Fabian A. Chavez-Ecos MD , Kiara Camacho-Caballero MD , José Carlos Grados-Pintos MD , Patricia Vera-Maccha MD , Anthony Siguas-Huasasquiche MD , Dinesh Sharma MD , Carlos J. Toro-Huamanchumo MD MMed
Background
Bioelectrical impedance analysis (BIA) is widely used to assess body composition. However, its safety in patients with cardiac implantable electronic devices (CIEDs) remains uncertain owing to potential electromagnetic interference (EMI).
Objective
This study aimed to evaluate potential complications associated with clinical-grade BIA use in patients with CIEDs, based on currently available evidence.
Methods
We conducted a systematic review of studies published up to December 26, 2024, identified through PubMed, Embase, Scopus, and the Cochrane Library. The primary outcome was the occurrence of adverse events, including EMI, device malfunction, or arrhythmias.
Results
Of 3668 records, 6 cohort studies (n = 531 patients) met the inclusion criteria. These included patients with pacemakers (n = 175), implantable cardioverter-defibrillators (n = 268), and cardiac resynchronization therapy defibrillators (n = 154). BIA protocols varied in frequency (5–500 kHz) and current intensity (typically ≤0.8 mA). No study reported clinically significant EMI, device malfunctions, or BIA-induced arrhythmias. Device parameters (eg, lead impedance, pacing thresholds) remained stable before and after BIA exposure. Risk of bias was rated as good in 1 study and fair in 5.
Conclusion
Current evidence suggests that clinical-grade BIA is safe in patients with CIEDs, with no reported adverse effects or device interferences. These findings contribute to informing and potentially updating previous recommendations that discouraged BIA in this population. However, further high-quality studies are needed to confirm safety across different BIA protocols and device types. Importantly, these findings apply to clinical-grade BIA and should not be extrapolated to consumer-grade wearables, which may present a theoretical risk of CIED interference.
{"title":"Safety of bioelectrical impedance analysis in patients with cardiac implantable electronic devices: A systematic review","authors":"Leonardo J. Uribe-Cavero MD , Fabian A. Chavez-Ecos MD , Kiara Camacho-Caballero MD , José Carlos Grados-Pintos MD , Patricia Vera-Maccha MD , Anthony Siguas-Huasasquiche MD , Dinesh Sharma MD , Carlos J. Toro-Huamanchumo MD MMed","doi":"10.1016/j.hroo.2025.09.026","DOIUrl":"10.1016/j.hroo.2025.09.026","url":null,"abstract":"<div><h3>Background</h3><div>Bioelectrical impedance analysis (BIA) is widely used to assess body composition. However, its safety in patients with cardiac implantable electronic devices (CIEDs) remains uncertain owing to potential electromagnetic interference (EMI).</div></div><div><h3>Objective</h3><div>This study aimed to evaluate potential complications associated with clinical-grade BIA use in patients with CIEDs, based on currently available evidence.</div></div><div><h3>Methods</h3><div>We conducted a systematic review of studies published up to December 26, 2024, identified through PubMed, Embase, Scopus, and the Cochrane Library. The primary outcome was the occurrence of adverse events, including EMI, device malfunction, or arrhythmias.</div></div><div><h3>Results</h3><div>Of 3668 records, 6 cohort studies (n = 531 patients) met the inclusion criteria. These included patients with pacemakers (n = 175), implantable cardioverter-defibrillators (n = 268), and cardiac resynchronization therapy defibrillators (n = 154). BIA protocols varied in frequency (5–500 kHz) and current intensity (typically ≤0.8 mA). No study reported clinically significant EMI, device malfunctions, or BIA-induced arrhythmias. Device parameters (eg, lead impedance, pacing thresholds) remained stable before and after BIA exposure. Risk of bias was rated as good in 1 study and fair in 5.</div></div><div><h3>Conclusion</h3><div>Current evidence suggests that clinical-grade BIA is safe in patients with CIEDs, with no reported adverse effects or device interferences. These findings contribute to informing and potentially updating previous recommendations that discouraged BIA in this population. However, further high-quality studies are needed to confirm safety across different BIA protocols and device types. Importantly, these findings apply to clinical-grade BIA and should not be extrapolated to consumer-grade wearables, which may present a theoretical risk of CIED interference.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1985-1992"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771988","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}
Preclinical studies showed inconsistent results regarding the influence of adipose tissue on effective pulsed field ablation (PFA), raising questions about its efficacy in patients with elevated epicardial adipose tissue (EAT) levels.
Objective
Elevated EAT levels may lead to higher atrial fibrillation (AF) recurrence rates after pulmonary vein isolation using PFA than high-power, short-duration radiofrequency (RF) ablation.
Methods
103 patients with body mass index of >29 kg/m2 with paroxysmal or short-term persistent AF who underwent first-time AF ablation were prospectively enrolled (PFA n = 41; RF n = 62). All patients received preablation photon-counting computed tomography imaging to volumetrically quantify left and right atrial EAT levels. PFA was performed using a pentaspline catheter, and RF ablation was performed using high-power, short-duration energy.
Results
Median EAT volumes were 71.85 mL (interquartile range 50.35–93.35 mL) in the RF group and 65.61 mL (interquartile range 40.45–90.8 mL) in the PFA group (P = .1352). Median follow-up was 367 days, excluding a 6-week blanking period. Atrial arrhythmia recurrence at 1 year was 33.87% in the RF group vs 17.07% in the PFA group (P = .077). Cox regression showed that, in the PFA group, left atrial EAT was the only significant predictor of recurrence (hazard ratio 1.06; 95% confidence interval 1.01–1.12; P = .022), corresponding to a 6.2% increased risk per mL. In the RF group, left atrial EAT was not significantly associated with recurrence (hazard ratio 1.00; 95% confidence interval 0.97–1.03; P = .846).
Conclusion
PFA showed good 1-year results after pulmonary vein isolation in patients with a body mass index of >29 kg/m2. However, EAT may have a more significant impact on AF recurrences after PFA than RF ablation.
{"title":"Epicardial adipose tissue and ablation outcomes in obese patients with paroxysmal atrial fibrillation: A comparison of pulsed field and radiofrequency ablation","authors":"Florian Englert MD , Theresa Obermeyer , Fabian Bahlke MD , Miruna Popa MD , Hannah Krafft MD , Alex Tunsch Martinez MD , Jan Syväri MD , Madeleine Tydecks MD , Dominic Dischel MD , Eva Koops MD , Theresa Reiter MD , Marta Telishevska MD , Sarah Lengauer MD , Kenno Bressem MD , Martin Hadamitzky MD , Gabriele Hessling MD , Isabel Deisenhofer MD, FHRS , Nico Erhard MD","doi":"10.1016/j.hroo.2025.09.020","DOIUrl":"10.1016/j.hroo.2025.09.020","url":null,"abstract":"<div><h3>Background</h3><div>Preclinical studies showed inconsistent results regarding the influence of adipose tissue on effective pulsed field ablation (PFA), raising questions about its efficacy in patients with elevated epicardial adipose tissue (EAT) levels.</div></div><div><h3>Objective</h3><div>Elevated EAT levels may lead to higher atrial fibrillation (AF) recurrence rates after pulmonary vein isolation using PFA than high-power, short-duration radiofrequency (RF) ablation.</div></div><div><h3>Methods</h3><div>103 patients with body mass index of >29 kg/m<sup>2</sup> with paroxysmal or short-term persistent AF who underwent first-time AF ablation were prospectively enrolled (PFA n = 41; RF n = 62). All patients received preablation photon-counting computed tomography imaging to volumetrically quantify left and right atrial EAT levels. PFA was performed using a pentaspline catheter, and RF ablation was performed using high-power, short-duration energy.</div></div><div><h3>Results</h3><div>Median EAT volumes were 71.85 mL (interquartile range 50.35–93.35 mL) in the RF group and 65.61 mL (interquartile range 40.45–90.8 mL) in the PFA group (<em>P</em> = .1352). Median follow-up was 367 days, excluding a 6-week blanking period. Atrial arrhythmia recurrence at 1 year was 33.87% in the RF group vs 17.07% in the PFA group (<em>P</em> = .077). Cox regression showed that, in the PFA group, left atrial EAT was the only significant predictor of recurrence (hazard ratio 1.06; 95% confidence interval 1.01–1.12; <em>P</em> = .022), corresponding to a 6.2% increased risk per mL. In the RF group, left atrial EAT was not significantly associated with recurrence (hazard ratio 1.00; 95% confidence interval 0.97–1.03; <em>P</em> = .846).</div></div><div><h3>Conclusion</h3><div>PFA showed good 1-year results after pulmonary vein isolation in patients with a body mass index of >29 kg/m<sup>2</sup>. However, EAT may have a more significant impact on AF recurrences after PFA than RF ablation.</div></div><div><h3>Trial Registration Number</h3><div>NCT06559787</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1901-1910"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771998","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}
Patients with congenitally corrected transposition of the great arteries (cc-TGA) are predisposed to supraventricular tachycardias; however, data regarding the outcomes of catheter ablation (CA) remain limited.
Objective
This study aimed to assess the clinical impact of CA for supraventricular tachycardias in patients with cc-TGA.
Methods
This retrospective, single-center cohort study evaluated 29 of 112 cc-TGA patients (26%) who underwent CA. Patients were stratified into 3 groups based on surgical history: anatomical repair (n = 10/43, 23%), physiologic repair (n = 14/32, 44%), and no prior surgery (n = 5/37, 14%). Clinical characteristics and procedural outcomes were analyzed.
Results
Of the 29 patients who underwent CA, 10 belonged to the anatomical repair group, 14 to the physiologic repair group, and 5 to the non-surgical group. Median age at ablation was significantly lower in the anatomical repair group (25.6 years), compared with physiologic (40.6 years, P = .005) and non-surgical patients (43.8 years, P = .01). The arrhythmia types included intra-atrial reentrant tachycardia (n = 20), focal atrial tachycardia (n = 3), paroxysmal supraventricular tachycardia (n = 2), and atrial fibrillation (n = 6). Cavomitral isthmus ablation was frequently required across all groups. Over a median follow-up of 5.6 years, 3 patients required repeat ablation; all experienced new arrhythmia mechanisms distinct from the index procedure.
Conclusion
Supraventricular tachycardia patterns varied by surgical background, but cavomitral isthmus ablation was commonly indicated. CA is a key therapeutic strategy in the long-term rhythm management of cc-TGA patients.
{"title":"Electrophysiological outcomes of radiofrequency ablation for supraventricular tachycardias in patients with congenitally corrected transposition of the great arteries","authors":"Toshihiro Nakamura MD, PhD , Yoshiaki Kato MD, PhD , Heima Sakaguchi MD, PhD , Kenzaburo Nakajima MD, PhD , Aki Mori MD, PhD , Kenichi Kurosaki MD, PhD , Hideo Ohuchi MD, PhD , Kengo Kusano MD, PhD, FHRS","doi":"10.1016/j.hroo.2025.09.016","DOIUrl":"10.1016/j.hroo.2025.09.016","url":null,"abstract":"<div><h3>Background</h3><div>Patients with congenitally corrected transposition of the great arteries (cc-TGA) are predisposed to supraventricular tachycardias; however, data regarding the outcomes of catheter ablation (CA) remain limited.</div></div><div><h3>Objective</h3><div>This study aimed to assess the clinical impact of CA for supraventricular tachycardias in patients with cc-TGA.</div></div><div><h3>Methods</h3><div>This retrospective, single-center cohort study evaluated 29 of 112 cc-TGA patients (26%) who underwent CA. Patients were stratified into 3 groups based on surgical history: anatomical repair (n = 10/43, 23%), physiologic repair (n = 14/32, 44%), and no prior surgery (n = 5/37, 14%). Clinical characteristics and procedural outcomes were analyzed.</div></div><div><h3>Results</h3><div>Of the 29 patients who underwent CA, 10 belonged to the anatomical repair group, 14 to the physiologic repair group, and 5 to the non-surgical group. Median age at ablation was significantly lower in the anatomical repair group (25.6 years), compared with physiologic (40.6 years, <em>P =</em> .005) and non-surgical patients (43.8 years, <em>P =</em> .01). The arrhythmia types included intra-atrial reentrant tachycardia (n = 20), focal atrial tachycardia (n = 3), paroxysmal supraventricular tachycardia (n = 2), and atrial fibrillation (n = 6). Cavomitral isthmus ablation was frequently required across all groups. Over a median follow-up of 5.6 years, 3 patients required repeat ablation; all experienced new arrhythmia mechanisms distinct from the index procedure.</div></div><div><h3>Conclusion</h3><div>Supraventricular tachycardia patterns varied by surgical background, but cavomitral isthmus ablation was commonly indicated. CA is a key therapeutic strategy in the long-term rhythm management of cc-TGA patients.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1893-1900"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771997","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 : 2025-12-01DOI: 10.1016/j.hroo.2025.08.038
Xiaoke Liu MD, PhD , Xiaoyan Li MD , Paul Friedman MD , Yong-Mei Cha MD , Abhishek Deshmukh MD , Siva Mulpuru MD , Samuel Asirvatham MD
{"title":"Prediction of cardiac resynchronization therapy super-response by left bundle branch area pacing using an artificial intelligence–enabled electrocardiogram","authors":"Xiaoke Liu MD, PhD , Xiaoyan Li MD , Paul Friedman MD , Yong-Mei Cha MD , Abhishek Deshmukh MD , Siva Mulpuru MD , Samuel Asirvatham MD","doi":"10.1016/j.hroo.2025.08.038","DOIUrl":"10.1016/j.hroo.2025.08.038","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 2019-2021"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771935","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}