Pub Date : 2025-12-01DOI: 10.1016/j.hroo.2025.09.011
Adam Mohmand-Borkowski MD, PhD, FHRS , Nora Glass MEd, BSN , Tendoh Timoh MD , Peter L. Friedman MD, PhD, FHRS , Tomasz Rozmyslowicz MD, PhD
Background
Left atrial appendage occlusion (LAAO) has become an attractive alternative to chronic anticoagulation in the very elderly with atrial fibrillation (AF). Data on the outcomes and usefulness of this procedure in this population are limited.
Objective
The purpose of this study was to analyze the real-world outcomes of LAAO in the very elderly.
Methods
The outcomes of LAAO implantation in very elderly patients aged ≥85 years (average 88.1 years) compared with those in younger patients aged <85 years (average 76.7 years), from a single hospital center serving one of the oldest communities in the United States, were retrospectively analyzed. Successful procedures (at implant), procedural complications, 45-day device-related readmission, device-related thrombus (DRT), stroke, and death within 1 year were examined.
Results
A total of 342 LAAO device implantations were performed during the analysis period, with a high success rate of 98.5% and a very low major complication rate of 0.3%. There was no difference in the in-hospital outcomes or complication rates between the 2 groups. The ischemic stroke rate was 2.6% at 1 year and was not significantly different between the groups. The 1-year all-cause mortality was 14.6% in those aged ≥85 years as compared with 7.9% in those aged <85 years (P = .09).
Conclusion
LAAO is as safe and effective in the very elderly as in the younger population and may be performed with a very low complication rate. There is a trend toward increased 1-year mortality in the very elderly.
{"title":"Real-world outcomes of left atrial appendage closure in very elderly compared with younger patients","authors":"Adam Mohmand-Borkowski MD, PhD, FHRS , Nora Glass MEd, BSN , Tendoh Timoh MD , Peter L. Friedman MD, PhD, FHRS , Tomasz Rozmyslowicz MD, PhD","doi":"10.1016/j.hroo.2025.09.011","DOIUrl":"10.1016/j.hroo.2025.09.011","url":null,"abstract":"<div><h3>Background</h3><div>Left atrial appendage occlusion (LAAO) has become an attractive alternative to chronic anticoagulation in the very elderly with atrial fibrillation (AF). Data on the outcomes and usefulness of this procedure in this population are limited.</div></div><div><h3>Objective</h3><div>The purpose of this study was to analyze the real-world outcomes of LAAO in the very elderly.</div></div><div><h3>Methods</h3><div>The outcomes of LAAO implantation in very elderly patients aged ≥85 years (average 88.1 years) compared with those in younger patients aged <85 years (average 76.7 years), from a single hospital center serving one of the oldest communities in the United States, were retrospectively analyzed. Successful procedures (at implant), procedural complications, 45-day device-related readmission, device-related thrombus (DRT), stroke, and death within 1 year were examined.</div></div><div><h3>Results</h3><div>A total of 342 LAAO device implantations were performed during the analysis period, with a high success rate of 98.5% and a very low major complication rate of 0.3%. There was no difference in the in-hospital outcomes or complication rates between the 2 groups. The ischemic stroke rate was 2.6% at 1 year and was not significantly different between the groups. The 1-year all-cause mortality was 14.6% in those aged ≥85 years as compared with 7.9% in those aged <85 years (<em>P</em> = .09).</div></div><div><h3>Conclusion</h3><div>LAAO is as safe and effective in the very elderly as in the younger population and may be performed with a very low complication rate. There is a trend toward increased 1-year mortality in the very elderly.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1993-2000"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771957","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}
Pulsed field ablation (PFA) is a nonthermal ablation method characterized by favorable tissue selectivity and a low complication rate. However, hemolysis has recently emerged as a PFA-specific concern, particularly associated with the FARAPULSE system.
Objective
To assess the incidence and clinical relevance of hemolysis following atrial fibrillation (AF) ablation using the PulseSelect system, in comparison with FARAPULSE and conventional radiofrequency (RF) ablation.
Methods
This retrospective study included 120 consecutive patients who underwent AF ablation between October 2024 and February 2025 (RF: n = 15; FARAPULSE: n = 39; PulseSelect: n = 66). Hemolysis markers—free plasma hemoglobin, haptoglobin, lactate dehydrogenase (LDH), total bilirubin, and creatinine—were measured before and after ablation.
Results
PFA was associated with significantly higher the post-/pre-ablation ratio of free plasma hemoglobin, LDH, and total bilirubin, whereas the ratio of haptoglobin were significantly lower than with RF. The PulseSelect system resulted in less hemolysis than the FARAPULSE system, as evidenced by smaller increases in free plasma hemoglobin, LDH, and total bilirubin, and by higher haptoglobin. Notably, although free plasma hemoglobin increased after ablation with both the PulseSelect and FARAPULSE systems, in contrast to FARAPULSE, no correlation was observed between the number of PulseSelect applications and free plasma hemoglobin. No cases of acute kidney injury occurred in any group.
Conclusion
The PulseSelect system induced only mild, subclinical hemolysis—comparable to that seen with FARAPULSE—without any clinically significant anemia or acute kidney injury, even in the absence of a limit on the number of applications. These findings support the safe and flexible use of PulseSelect, not only for pulmonary vein isolation, but also for additional lesion sets in more complex ablation procedures.
脉冲场消融（PFA）是一种具有良好的组织选择性和低并发症发生率的非热消融方法。然而，溶血最近已成为pfa特异性关注的问题，特别是与FARAPULSE系统相关。目的评估脉冲选择系统与FARAPULSE和常规射频消融（RF）相比，房颤（AF）消融后溶血的发生率和临床相关性。方法本回顾性研究纳入了2024年10月至2025年2月期间连续接受房颤消融的120例患者（RF: n = 15; FARAPULSE: n = 39; PulseSelect: n = 66）。消融前后测定溶血标志物——游离血浆血红蛋白、接触红蛋白、乳酸脱氢酶（LDH）、总胆红素和肌酐。结果spfa与消融前后游离血浆血红蛋白、LDH、总胆红素比值显著升高，而与RF相关的触珠蛋白比值显著降低。与FARAPULSE相比，PulseSelect系统导致的溶血较少，这可以从游离血浆血红蛋白、LDH和总胆红素的增加较小以及接触珠蛋白的增加中得到证明。值得注意的是，尽管使用pulse seselect和FARAPULSE系统消融后游离血浆血红蛋白增加，但与FARAPULSE相比，pulse seselect应用数量与游离血浆血红蛋白之间没有相关性。两组均未发生急性肾损伤。结论：PulseSelect系统仅诱导轻度的亚临床溶血，与farapuls相当，即使在没有应用数量限制的情况下，也没有任何临床显著的贫血或急性肾损伤。这些发现支持PulseSelect安全灵活的使用，不仅用于肺静脉隔离，也用于更复杂消融过程中的附加病变组。
{"title":"Differential subclinical hemolysis after pulsed field ablation using the FARAPULSE pentaspline catheter vs the PulseSelect circular multi-electrode array catheter","authors":"Sayana Kuraoka MD , Masatsugu Nozoe MD, PhD , Hiroshi Mannoji MD, PhD , Ryo Miyake MD , Tomoki Uchikawa MD, PhD , Akihito Ishikita MD, PhD , Daisuke Nagatomo MD , Nobuhiro Suematsu MD, PhD , Toru Kubota MD, PhD","doi":"10.1016/j.hroo.2025.08.042","DOIUrl":"10.1016/j.hroo.2025.08.042","url":null,"abstract":"<div><h3>Background</h3><div>Pulsed field ablation (PFA) is a nonthermal ablation method characterized by favorable tissue selectivity and a low complication rate. However, hemolysis has recently emerged as a PFA-specific concern, particularly associated with the FARAPULSE system.</div></div><div><h3>Objective</h3><div>To assess the incidence and clinical relevance of hemolysis following atrial fibrillation (AF) ablation using the PulseSelect system, in comparison with FARAPULSE and conventional radiofrequency (RF) ablation.</div></div><div><h3>Methods</h3><div>This retrospective study included 120 consecutive patients who underwent AF ablation between October 2024 and February 2025 (RF: n = 15; FARAPULSE: n = 39; PulseSelect: n = 66). Hemolysis markers—free plasma hemoglobin, haptoglobin, lactate dehydrogenase (LDH), total bilirubin, and creatinine—were measured before and after ablation.</div></div><div><h3>Results</h3><div>PFA was associated with significantly higher the post-/pre-ablation ratio of free plasma hemoglobin, LDH, and total bilirubin, whereas the ratio of haptoglobin were significantly lower than with RF. The PulseSelect system resulted in less hemolysis than the FARAPULSE system, as evidenced by smaller increases in free plasma hemoglobin, LDH, and total bilirubin, and by higher haptoglobin. Notably, although free plasma hemoglobin increased after ablation with both the PulseSelect and FARAPULSE systems, in contrast to FARAPULSE, no correlation was observed between the number of PulseSelect applications and free plasma hemoglobin. No cases of acute kidney injury occurred in any group.</div></div><div><h3>Conclusion</h3><div>The PulseSelect system induced only mild, subclinical hemolysis—comparable to that seen with FARAPULSE—without any clinically significant anemia or acute kidney injury, even in the absence of a limit on the number of applications. These findings support the safe and flexible use of PulseSelect, not only for pulmonary vein isolation, but also for additional lesion sets in more complex ablation procedures.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1911-1918"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771844","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.2025.09.019
Jacob R. Heath MD , Sangwoo Han MD, PhD , Ashraf Alzahrani MBBCh , David Hamon MD , E. Michael Powers MD, MBA , Sergio Conti MD, PhD, FHRS , Peter D. Farjo MD, MS , Paari Dominic MBBS, MPH
Background
Updated guidelines recognize catheter ablation as a first-line therapy for symptomatic atrial fibrillation (AF). The optimal timing of catheter ablation following AF diagnosis remains uncertain.
Objective
This study assessed the impact of diagnosis-to-ablation time (DAT) <1 year vs DAT ≥1 year on AF recurrence and adverse clinical outcomes.
Methods
We queried the TriNetX Research Network for patients ≥18 years of age with a diagnosis of AF who underwent ablation between January 1, 2010, and June 30, 2019. Patients were stratified into cohorts based on DAT <1 year vs ≥1 year and matched using 1:1 propensity scores, resulting in 8403 patients in each cohort. The primary outcome was AF recurrence, defined as a composite of cardioversion, antiarrhythmic use, or re-ablation at 3 and 5 years, after a 3-month blanking period. Secondary outcomes included a composite of heart failure exacerbation, ischemic stroke, all-cause hospitalization, and mortality, along with individual components.
Results
DAT <1 year was associated with significantly lower AF recurrence both at 3 years (adjusted odds ratio 0.68 [95% confidence interval: 0.64–0.72]; P < .001) and 5 years (adjusted odds ratio 0.68 [95% confidence interval: 0.64–0.72]; P < .001). At 3 years, all secondary outcomes were significantly reduced in the DAT <1 year group, except for incident cerebrovascular accident and mortality. At 5 years, all secondary outcomes were significantly reduced in the DAT <1 year group.
Conclusion
Catheter ablation within 1 year of AF diagnosis is associated with reduced AF recurrence and major adverse clinical outcomes. These findings support early referral for catheter ablation.
{"title":"Early vs delayed ablation for new-onset atrial fibrillation: 5-Year real-world data outcomes","authors":"Jacob R. Heath MD , Sangwoo Han MD, PhD , Ashraf Alzahrani MBBCh , David Hamon MD , E. Michael Powers MD, MBA , Sergio Conti MD, PhD, FHRS , Peter D. Farjo MD, MS , Paari Dominic MBBS, MPH","doi":"10.1016/j.hroo.2025.09.019","DOIUrl":"10.1016/j.hroo.2025.09.019","url":null,"abstract":"<div><h3>Background</h3><div>Updated guidelines recognize catheter ablation as a first-line therapy for symptomatic atrial fibrillation (AF). The optimal timing of catheter ablation following AF diagnosis remains uncertain.</div></div><div><h3>Objective</h3><div>This study assessed the impact of diagnosis-to-ablation time (DAT) <1 year vs DAT ≥1 year on AF recurrence and adverse clinical outcomes.</div></div><div><h3>Methods</h3><div>We queried the TriNetX Research Network for patients ≥18 years of age with a diagnosis of AF who underwent ablation between January 1, 2010, and June 30, 2019. Patients were stratified into cohorts based on DAT <1 year vs ≥1 year and matched using 1:1 propensity scores, resulting in 8403 patients in each cohort. The primary outcome was AF recurrence, defined as a composite of cardioversion, antiarrhythmic use, or re-ablation at 3 and 5 years, after a 3-month blanking period. Secondary outcomes included a composite of heart failure exacerbation, ischemic stroke, all-cause hospitalization, and mortality, along with individual components.</div></div><div><h3>Results</h3><div>DAT <1 year was associated with significantly lower AF recurrence both at 3 years (adjusted odds ratio 0.68 [95% confidence interval: 0.64–0.72]; <em>P</em> < .001) and 5 years (adjusted odds ratio 0.68 [95% confidence interval: 0.64–0.72]; <em>P</em> < .001). At 3 years, all secondary outcomes were significantly reduced in the DAT <1 year group, except for incident cerebrovascular accident and mortality. At 5 years, all secondary outcomes were significantly reduced in the DAT <1 year group.</div></div><div><h3>Conclusion</h3><div>Catheter ablation within 1 year of AF diagnosis is associated with reduced AF recurrence and major adverse clinical outcomes. These findings support early referral for catheter ablation.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1886-1892"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771996","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.2025.08.039
Kevin Lee MD , Mashaal Ikram MD , Madhu Reddy MD, FHRS , Jason Meyers MD, FHRS , Alan Cheng MD, FHRS , Kurt Stromberg MS , Dedra Fagan PhD , Mark Metzl MD, FHRS
Background
Pacing-induced cardiomyopathy (PICM) has been reported among patients with transvenous pacemakers (TVP). Recent reports have suggested that the incidence may be lower among patients with leadless pacemakers (LP). We performed a multicenter retrospective study to better define these rates and to identify any potential risk factors.
Objective
To determine the rates of PICM between LP and TVP and risk factors for development of PICM in each cohort.
Methods
Patients implanted with either a Micra transcatheter LP or TVP between November 2015 and January 2022 were identified from medical records at 3 large medical centers. PICM was defined as a decrease in left ventricular ejection fraction (LVEF) from pre-implant in patients with a baseline LVEF of ≥50% with a resulting post-implant LVEF ≤40% who received at least 20% ventricular pacing. Logistic regression was used to determine univariate and multivariable predictors of PICM.
Results
A total of 176 patients with LP and 522 patients with TVP implantations were included for analysis. Of these, 6.3% of patients with LP and 7.9% of patients with TVP developed PICM (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.39–1.56, P = .480). Rates of PICM were not significantly different between the 3 centers. Multivariable analysis revealed prolonged paced QRS as a predictor of PICM (OR 1.02 [1.00–1.03], P = .009) and higher pre-implantation LVEF as protective against its development (OR 0.92 [0.88–0.97], P = .001).
Conclusion
PICM rates are comparable between LP and TVP implantation. Prolonged paced QRS is a predictor for development of PICM and higher pre-implantation LVEF is protective.
{"title":"Pacing-induced cardiomyopathy following leadless and transvenous pacemaker implantation: A multicenter retrospective study","authors":"Kevin Lee MD , Mashaal Ikram MD , Madhu Reddy MD, FHRS , Jason Meyers MD, FHRS , Alan Cheng MD, FHRS , Kurt Stromberg MS , Dedra Fagan PhD , Mark Metzl MD, FHRS","doi":"10.1016/j.hroo.2025.08.039","DOIUrl":"10.1016/j.hroo.2025.08.039","url":null,"abstract":"<div><h3>Background</h3><div>Pacing-induced cardiomyopathy (PICM) has been reported among patients with transvenous pacemakers (TVP). Recent reports have suggested that the incidence may be lower among patients with leadless pacemakers (LP). We performed a multicenter retrospective study to better define these rates and to identify any potential risk factors.</div></div><div><h3>Objective</h3><div>To determine the rates of PICM between LP and TVP and risk factors for development of PICM in each cohort.</div></div><div><h3>Methods</h3><div>Patients implanted with either a Micra transcatheter LP or TVP between November 2015 and January 2022 were identified from medical records at 3 large medical centers. PICM was defined as a decrease in left ventricular ejection fraction (LVEF) from pre-implant in patients with a baseline LVEF of ≥50% with a resulting post-implant LVEF ≤40% who received at least 20% ventricular pacing. Logistic regression was used to determine univariate and multivariable predictors of PICM.</div></div><div><h3>Results</h3><div>A total of 176 patients with LP and 522 patients with TVP implantations were included for analysis. Of these, 6.3% of patients with LP and 7.9% of patients with TVP developed PICM (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.39–1.56, <em>P =</em> .480). Rates of PICM were not significantly different between the 3 centers. Multivariable analysis revealed prolonged paced QRS as a predictor of PICM (OR 1.02 [1.00–1.03], <em>P</em> = .009) and higher pre-implantation LVEF as protective against its development (OR 0.92 [0.88–0.97], <em>P =</em> .001).</div></div><div><h3>Conclusion</h3><div>PICM rates are comparable between LP and TVP implantation. Prolonged paced QRS is a predictor for development of PICM and higher pre-implantation LVEF is protective.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1977-1984"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771851","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.2025.09.003
Jan-Per Wenzel Priv. Doz. , Sascha Hatahet Dr. med. , Raed Abdessadok , Charlotte Eitel Prof. , Julius Nikorowitsch Dr. , Roman Mamaev , Samuel Reincke Dr. , Sorin Popescu Dr. , Anna Traub , Suzanne de Waha Priv. Doz. , Tanja Zeller Prof. , Karl-Heinz Kuck Prof. , Roland Richard Tilz Prof.
Background
Pulsed field ablation (PFA) is a nonthermal technique for pulmonary vein isolation (PVI) in atrial fibrillation, offering lesion selectivity with minimal collateral damage. Despite its nonthermal nature, systemic inflammatory and myocardial responses may occur. Catheter design could modulate these effects.
Objective
The purpose of this study was to compare inflammatory and myocardial biomarker responses after PFA using balloon-in-basket vs pentaspline catheter systems.
Methods
This prospective, nonrandomized, single-center study involved venous blood sampling before and the morning after PFA-based PVI using either catheter type. Biomarkers analyzed included leukocytes, C-reactive protein (CRP), platelets, troponin T, creatine kinase (CK), CK-MB, and myoglobin.
Results
Eighty patients were included (balloon-in-basket: n = 40; pentaspline: n = 40). Baseline characteristics were comparable. All patients achieved acute and first-pass PVI. The balloon-in-basket group required fewer PFA applications (16 vs 32; P < .001). Leukocyte and CRP rose in both groups, more so with the pentaspline catheter (Δ leukocytes: 0.6 × 109/L vs 1.9 × 109/L, P = .026; Δ CRP: 3.4 mg/L vs 5.1 mg/L, P = .074). Platelet count decreased more in the balloon-in-basket group (Δ platelets −11 × 109/L vs −1 × 109/L; P = .005), while CK increased more in this group (Δ CK 219.5 U/L vs 97.0 U/L; P < .001). Troponin T, CK-MB, and myoglobin changes were similar.
Conclusion
Balloon-in-basket and pentaspline PFA catheters induce distinct inflammatory and myocardial biomarker profiles after PVI. The observed differences in leukocyte, CRP, and platelet responses highlight design-specific biological effects. These findings may support informed catheter selection and help guide postprocedural monitoring strategies.
脉冲场消融（PFA）是一种用于房颤肺静脉隔离（PVI）的非热技术，具有病变选择性和最小的附带损伤。尽管它的非热性质，全身性炎症和心肌反应可能发生。导管设计可以调节这些影响。目的：本研究的目的是比较球囊内导管系统与pentaspline导管系统在PFA后的炎症和心肌生物标志物反应。方法：本研究为前瞻性、非随机、单中心研究，采用两种导管分别在pfa - PVI术前和术后早晨采集静脉血。分析的生物标志物包括白细胞、c反应蛋白（CRP）、血小板、肌钙蛋白T、肌酸激酶（CK）、CK- mb和肌红蛋白。结果共纳入80例患者（球囊内装40例，pentaspline 40例）。基线特征具有可比性。所有患者均达到急性和首过期PVI。气球篮内组需要较少的PFA应用（16对32；P < .001）。两组患者白细胞和CRP均升高，尤以喷品导管组升高更明显（Δ白细胞：0.6 × 109/L vs 1.9 × 109/L, P = 0.026； Δ CRP: 3.4 mg/L vs 5.1 mg/L, P = 0.074）。球囊组血小板计数下降较多（Δ血小板- 11 × 109/L vs - 1 × 109/L； P = 0.005），而CK升高较多（Δ CK 219.5 U/L vs 97.0 U/L; P < .001）。肌钙蛋白T、CK-MB和肌红蛋白变化相似。结论球囊式PFA导管和pentaspline PFA导管在PVI后可诱导不同的炎症和心肌生物标志物。观察到的白细胞、CRP和血小板反应的差异突出了设计特异性的生物学效应。这些发现可能支持知情的导管选择，并有助于指导术后监测策略。
{"title":"Differential inflammatory and myocardial biomarker response after pulsed field ablation for atrial fibrillation using balloon-in-basket vs pentaspline catheters","authors":"Jan-Per Wenzel Priv. Doz. , Sascha Hatahet Dr. med. , Raed Abdessadok , Charlotte Eitel Prof. , Julius Nikorowitsch Dr. , Roman Mamaev , Samuel Reincke Dr. , Sorin Popescu Dr. , Anna Traub , Suzanne de Waha Priv. Doz. , Tanja Zeller Prof. , Karl-Heinz Kuck Prof. , Roland Richard Tilz Prof.","doi":"10.1016/j.hroo.2025.09.003","DOIUrl":"10.1016/j.hroo.2025.09.003","url":null,"abstract":"<div><h3>Background</h3><div>Pulsed field ablation (PFA) is a nonthermal technique for pulmonary vein isolation (PVI) in atrial fibrillation, offering lesion selectivity with minimal collateral damage. Despite its nonthermal nature, systemic inflammatory and myocardial responses may occur. Catheter design could modulate these effects.</div></div><div><h3>Objective</h3><div>The purpose of this study was to compare inflammatory and myocardial biomarker responses after PFA using balloon-in-basket vs pentaspline catheter systems.</div></div><div><h3>Methods</h3><div>This prospective, nonrandomized, single-center study involved venous blood sampling before and the morning after PFA-based PVI using either catheter type. Biomarkers analyzed included leukocytes, C-reactive protein (CRP), platelets, troponin T, creatine kinase (CK), CK-MB, and myoglobin.</div></div><div><h3>Results</h3><div>Eighty patients were included (balloon-in-basket: n = 40; pentaspline: n = 40). Baseline characteristics were comparable. All patients achieved acute and first-pass PVI. The balloon-in-basket group required fewer PFA applications (16 vs 32; <em>P</em> < .001). Leukocyte and CRP rose in both groups, more so with the pentaspline catheter (Δ leukocytes: 0.6 × 10<sup>9</sup>/L vs 1.9 × 10<sup>9</sup>/L, <em>P</em> = .026; Δ CRP: 3.4 mg/L vs 5.1 mg/L, <em>P</em> = .074). Platelet count decreased more in the balloon-in-basket group (Δ platelets −11 × 10<sup>9</sup>/L vs −1 × 10<sup>9</sup>/L; <em>P</em> = .005), while CK increased more in this group (Δ CK 219.5 U/L vs 97.0 U/L; <em>P</em> < .001). Troponin T, CK-MB, and myoglobin changes were similar.</div></div><div><h3>Conclusion</h3><div>Balloon-in-basket and pentaspline PFA catheters induce distinct inflammatory and myocardial biomarker profiles after PVI. The observed differences in leukocyte, CRP, and platelet responses highlight design-specific biological effects. These findings may support informed catheter selection and help guide postprocedural monitoring strategies.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1861-1869"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771960","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}
Increased left ventricular extracellular volume (ECV) measured by cardiac magnetic resonance imaging is associated with myocardial damage and has been considered to predict atrial fibrillation (AF) recurrence after catheter ablation (CA). However, recent reports suggest that AF recurrence is infrequent even with high ECV owing to advancing ablation technology.
Objective
This study aimed to evaluate the relationship between ECV quantified by computed tomography (CT-ECV), commonly performed before CA, and AF recurrence.
Methods
Consecutive 467 patients undergoing their first CA for AF at our hospital between January 2021 and June 2023 received pre-CA contrast-enhanced CT. The relationship between CT-ECV and AF recurrence within 400 days after CA was examined.
Results
AF recurrence occurred in 77 patients (16.5%), and CT-ECV in the nonrecurrence group was not significantly different from that in the recurrence group (28.0% vs 28.1%; P = .502). In the Cox proportional hazards model, CT-ECV did not predict AF recurrence (adjusted hazard ratio 1.018; P = .376). After dividing patients into low and high CT-ECV groups based on median CT-ECV (28.0%), Kaplan–Meier analysis showed no significant difference in AF recurrence between the groups (log-rank P = .727). Brain natriuretic peptide level, left ventricular ejection fraction, and left atrial volume index significantly improved even in the high CT-ECV group without AF recurrence.
Conclusion
CT-ECV was not significantly associated with AF recurrence within 400 days after the first CA. Regardless of the severity of ventricular myocardial damage, CA for AF is beneficial for preventing AF and improving cardiac function.
背景：心脏磁共振成像测量的左心室细胞外体积（ECV）增加与心肌损伤有关，并被认为可预测导管消融（CA）后房颤（AF）复发。然而，最近的报道表明，由于先进的消融技术，即使是高ECV的房颤复发也不常见。目的本研究旨在评估通常在CA前进行的计算机断层扫描（CT-ECV）量化的ECV与AF复发的关系。方法于2021年1月至2023年6月在我院连续467例房颤患者接受房颤前对比增强CT检查。检查CT-ECV与房颤400天内复发的关系。结果saf复发77例（16.5%），未复发组与复发组CT-ECV差异无统计学意义（28.0% vs 28.1%, P = .502）。在Cox比例风险模型中，CT-ECV不能预测房颤复发（校正风险比为1.018;P = 0.376）。根据中位CT-ECV（28.0%）将患者分为低CT-ECV组和高CT-ECV组，Kaplan-Meier分析显示两组间房颤复发无显著差异（log-rank P = .727）。脑利钠肽水平、左室射血分数和左房容积指数在没有房颤复发的高CT-ECV组也有显著改善。结论ct - ecv与首次房颤后400天内房颤复发无显著相关性，无论室性心肌损伤程度如何，房颤CA均有利于预防房颤和改善心功能。
{"title":"The usefulness of catheter ablation even in patients with myocardial impairment: Myocardial extracellular volume assessed by preablation planning computed tomography cannot predict atrial fibrillation recurrence","authors":"Yuichiro Tsuruta MD , Hisanori Kanazawa MD, PhD , Yuta Tsurusaki MD , Kohei Matsunaga MD , Hitoshi Sumi MD , Shozo Kaneko MD, PhD , Tadashi Hoshiyama MD, PhD , Yuichiro Shirahama MD, PhD , Naoto Kuyama MD, PhD , Masahiro Yamamoto MD, PhD , Takayoshi Yamashita MD, PhD , Fumi Oike MD, PhD , Kyoko Hirakawa MD, PhD , Noriaki Tabata MD, PhD , Masanobu Ishii MD, PhD , Hiroaki Kusaka MD, PhD , Shinsuke Hanatani MD, PhD , Yuichiro Arima MD, PhD , Yasushi Matsuzawa MD, PhD , Hiroki Usuku MD, PhD , Kenichi Tsujita MD, PhD","doi":"10.1016/j.hroo.2025.09.025","DOIUrl":"10.1016/j.hroo.2025.09.025","url":null,"abstract":"<div><h3>Background</h3><div>Increased left ventricular extracellular volume (ECV) measured by cardiac magnetic resonance imaging is associated with myocardial damage and has been considered to predict atrial fibrillation (AF) recurrence after catheter ablation (CA). However, recent reports suggest that AF recurrence is infrequent even with high ECV owing to advancing ablation technology.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the relationship between ECV quantified by computed tomography (CT-ECV), commonly performed before CA, and AF recurrence.</div></div><div><h3>Methods</h3><div>Consecutive 467 patients undergoing their first CA for AF at our hospital between January 2021 and June 2023 received pre-CA contrast-enhanced CT. The relationship between CT-ECV and AF recurrence within 400 days after CA was examined.</div></div><div><h3>Results</h3><div>AF recurrence occurred in 77 patients (16.5%), and CT-ECV in the nonrecurrence group was not significantly different from that in the recurrence group (28.0% vs 28.1%; <em>P</em> = .502). In the Cox proportional hazards model, CT-ECV did not predict AF recurrence (adjusted hazard ratio 1.018; <em>P</em> = .376). After dividing patients into low and high CT-ECV groups based on median CT-ECV (28.0%), Kaplan–Meier analysis showed no significant difference in AF recurrence between the groups (log-rank <em>P</em> = .727). Brain natriuretic peptide level, left ventricular ejection fraction, and left atrial volume index significantly improved even in the high CT-ECV group without AF recurrence.</div></div><div><h3>Conclusion</h3><div>CT-ECV was not significantly associated with AF recurrence within 400 days after the first CA. Regardless of the severity of ventricular myocardial damage, CA for AF is beneficial for preventing AF and improving cardiac function.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1936-1948"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771847","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.2025.09.004
Cristian Martignani MD , Giovanni Rovaris MD , Roland R. Tilz MD, FHRS , Marco Schiavone MD , Giuseppe Ciconte MD , Marzia Giaccardi MD , Gennaro Miracapillo MD , Andrea Giomi MD , Giuseppe Arena MD , Alberto Spadotto MD , Elisabetta Montemerlo MD , Raffaele Salerno MD , Elena Piazzi MD , Mattia Pozzi MD , Giovanni Battista Forleo MD , Andrea Angeletti MD , Matteo Ziacchi MD , Giulia Massaro MD , Igor Diemberger MD, FHRS , Mauro Biffi MD , Christian H. Heeger MD, FHRS
Background
Durable pulmonary vein isolation (PVI) for atrial fibrillation (AF) remains challenging. The visually guided laser balloon (VGLB) is a unique single-shot technology designed to simplify PVI.
Objective
This study aimed to assess the real-world safety and long-term effectiveness of the third-generation VGLB system for treating paroxysmal and persistent AF.
Methods
This prospective, multicenter registry enrolled 427 patients undergoing VGLB-PVI. Safety was assessed in all patients, whereas the primary effectiveness endpoint (12-month freedom from AF) was analyzed in 392 patients who completed follow-up. Cox regression models were used to identify predictors of recurrence.
Results
Acute PVI was achieved in all targeted veins. The system demonstrated a favorable safety profile; permanent phrenic nerve palsy occurred in 1 patient (0.2%). After a 3-month blanking period, the 12-month freedom from AF recurrence off antiarrhythmic drugs was 73.8%. This rate increased to 77.7% for procedures performed after the initial 15-case operator learning curve. Multivariate analysis identified procedures within the learning curve (hazard ratio [HR] 1.68), congestive heart failure (HR 2.04), and anatomic variants (HR 1.79) as independent predictors of recurrence.
Conclusion
In this large, real-world registry, third-generation VGLB ablation is a safe and effective strategy for achieving long-term freedom from AF. Operator experience beyond the initial learning curve is a key determinant of success, confirming VGLB as a viable and effective PVI option.
{"title":"Atrial fibrillation laser balloon ablation: Multicenter international study","authors":"Cristian Martignani MD , Giovanni Rovaris MD , Roland R. Tilz MD, FHRS , Marco Schiavone MD , Giuseppe Ciconte MD , Marzia Giaccardi MD , Gennaro Miracapillo MD , Andrea Giomi MD , Giuseppe Arena MD , Alberto Spadotto MD , Elisabetta Montemerlo MD , Raffaele Salerno MD , Elena Piazzi MD , Mattia Pozzi MD , Giovanni Battista Forleo MD , Andrea Angeletti MD , Matteo Ziacchi MD , Giulia Massaro MD , Igor Diemberger MD, FHRS , Mauro Biffi MD , Christian H. Heeger MD, FHRS","doi":"10.1016/j.hroo.2025.09.004","DOIUrl":"10.1016/j.hroo.2025.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Durable pulmonary vein isolation (PVI) for atrial fibrillation (AF) remains challenging. The visually guided laser balloon (VGLB) is a unique single-shot technology designed to simplify PVI.</div></div><div><h3>Objective</h3><div>This study aimed to assess the real-world safety and long-term effectiveness of the third-generation VGLB system for treating paroxysmal and persistent AF.</div></div><div><h3>Methods</h3><div>This prospective, multicenter registry enrolled 427 patients undergoing VGLB-PVI. Safety was assessed in all patients, whereas the primary effectiveness endpoint (12-month freedom from AF) was analyzed in 392 patients who completed follow-up. Cox regression models were used to identify predictors of recurrence.</div></div><div><h3>Results</h3><div>Acute PVI was achieved in all targeted veins. The system demonstrated a favorable safety profile; permanent phrenic nerve palsy occurred in 1 patient (0.2%). After a 3-month blanking period, the 12-month freedom from AF recurrence off antiarrhythmic drugs was 73.8%. This rate increased to 77.7% for procedures performed after the initial 15-case operator learning curve. Multivariate analysis identified procedures within the learning curve (hazard ratio [HR] 1.68), congestive heart failure (HR 2.04), and anatomic variants (HR 1.79) as independent predictors of recurrence.</div></div><div><h3>Conclusion</h3><div>In this large, real-world registry, third-generation VGLB ablation is a safe and effective strategy for achieving long-term freedom from AF. Operator experience beyond the initial learning curve is a key determinant of success, confirming VGLB as a viable and effective PVI option.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1870-1876"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771961","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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