Heart Rhythm O2最新文献

英文中文

Electrophysiological outcomes of radiofrequency ablation for supraventricular tachycardias in patients with congenitally corrected transposition of the great arteries 射频消融治疗先天性大动脉转位患者室上性心动过速的电生理结果

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.09.016

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

Background

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.

背景：先天性纠正性大动脉转位（cc-TGA）患者易发生室上性心动过速；然而，关于导管消融（CA）结果的数据仍然有限。目的评价CA对cc-TGA患者室上性心动过速的临床影响。方法回顾性、单中心队列研究评估112例cc-TGA患者中的29例（26%），根据手术史将患者分为解剖修复组（n = 10/43, 23%）、生理性修复组（n = 14/32, 44%）和无手术史组（n = 5/37, 14%）。分析临床特点和手术结果。结果29例CA患者中解剖修复组10例，生理性修复组14例，非手术组5例。解剖修复组消融时的中位年龄（25.6岁）明显低于生理性修复组（40.6岁，P = 0.005）和非手术修复组（43.8岁，P = 0.01）。心律失常类型包括房内重入性心动过速（n = 20）、局灶性房性心动过速（n = 3）、阵发性室上性心动过速（n = 2）和房颤（n = 6）。在所有组中，腔二尖瓣峡部经常需要消融。在中位随访5.6年期间，3例患者需要重复消融；所有患者都经历了不同于索引程序的新的心律失常机制。结论室上型心动过速因手术背景而异，但腔二尖瓣峡部消融术是常见的。CA是cc-TGA患者长期节律管理的关键治疗策略。

{"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}

引用次数: 0

Prediction of cardiac resynchronization therapy super-response by left bundle branch area pacing using an artificial intelligence–enabled electrocardiogram 利用人工智能心电图预测左束支区起搏对心脏再同步化治疗的超反应

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-12-01 DOI: 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

引用次数: 0

Near-zero fluoroscopy pulsed field ablation using the circular-shaped catheter with ICE-guided real-time fifth electrode visualization: The FOCUS technique 近零透视脉冲场消融使用圆形导管与ice引导实时第五电极可视化：焦点技术

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.09.013

Shintaro Yamagami MD , Toyoki Okuda MD , Tsukasa Motoyoshi MD , Masanori Murayama CE , Masaya Akiyama CE , Yuta Nakano CE , Hirokazu Kondo MD, PhD , Toshihiro Tamura MD, PhD

引用次数: 0

Utility of omnipolar mapping–guided cavotricuspid isthmus block 全极测绘引导的颈三尖瓣峡块的应用

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.09.012

Hideyuki Hasebe MD , Yoshitaka Furuyashiki MD

Background

Omnipolar mapping is an emerging technology with the potential to identify the critical conduction site in the cavotricuspid isthmus (CTI).

Objective

This study aimed to elucidate the efficacy of omnipolar mapping–guided targeted ablation to create a CTI block.

Methods

Patients who underwent a CTI block using radiofrequency applications (RFAs) were included. Omnipolar mapping was performed during CTI-dependent atrial flutter or pacing from the coronary sinus with a drive train (S1) and a single extra stimulus (S2), and 2 omnipolar maps were created: one with annotation of local potentials after S1 pacing (S1 map) and the other after S2 pacing (S2 map). RFAs were preferentially attempted at the atrial activation focusing sites (AAFSs) where atrial electrical excitation conducts centripetally toward those sites and centrifugally away from them in the omnipolar map.

Results

50 patients were included. AAFSs were identified in 33 of 38 patients in whom an omnipolar map was created during sustained atrial flutter and in the S2 map in 11 of 12 patients in whom an omnipolar map was created during programmed pacing from the coronary sinus. No AAFS was identified in the S1 map. In the 44 patients in whom AAFSs were identified, a block line in the CTI was completed only by RFAs at the AAFSs, and a continuous linear ablation in the CTI was not necessary.

Conclusion

An omnipolar mapping system can identify critical sites for a CTI block by visualizing AAFSs. The AAFSs might be preferable ablation targets in a targeted CTI block.

多极定位是一项新兴的技术，有可能确定在颈三尖峡（CTI）的关键传导部位。目的研究全极定位引导下的靶向消融对CTI阻滞的影响。方法纳入采用射频应用（rfa）进行CTI阻滞的患者。在ct依赖性心房扑动或冠脉窦起搏时，通过驱动序列（S1）和单一额外刺激（S2）进行全极映射，并创建2个全极图：一个是S1起搏后的局部电位（S1图），另一个是S2起搏后的局部电位（S2图）。RFAs优先在心房激活聚焦位点（aafs）进行，心房电兴奋在全极图中向心指向这些位点，离心远离这些位点。结果共纳入50例患者。38例患者中33例在持续心房扑动期间建立全极图，12例患者中11例在冠脉窦程序性起搏期间建立全极图，在S2图中发现aafs。S1图中未发现AAFS。在发现aafs的44例患者中，CTI中的阻断线仅由aafs的射频消融术完成，并且CTI中的连续线性消融是不必要的。结论全极映射系统可以通过可视化aafs来识别CTI块的关键位点。aafs可能是靶向CTI块中较好的消融目标。

{"title":"Utility of omnipolar mapping–guided cavotricuspid isthmus block","authors":"Hideyuki Hasebe MD , Yoshitaka Furuyashiki MD","doi":"10.1016/j.hroo.2025.09.012","DOIUrl":"10.1016/j.hroo.2025.09.012","url":null,"abstract":"<div><h3>Background</h3><div>Omnipolar mapping is an emerging technology with the potential to identify the critical conduction site in the cavotricuspid isthmus (CTI).</div></div><div><h3>Objective</h3><div>This study aimed to elucidate the efficacy of omnipolar mapping–guided targeted ablation to create a CTI block.</div></div><div><h3>Methods</h3><div>Patients who underwent a CTI block using radiofrequency applications (RFAs) were included. Omnipolar mapping was performed during CTI-dependent atrial flutter or pacing from the coronary sinus with a drive train (S1) and a single extra stimulus (S2), and 2 omnipolar maps were created: one with annotation of local potentials after S1 pacing (S1 map) and the other after S2 pacing (S2 map). RFAs were preferentially attempted at the atrial activation focusing sites (AAFSs) where atrial electrical excitation conducts centripetally toward those sites and centrifugally away from them in the omnipolar map.</div></div><div><h3>Results</h3><div>50 patients were included. AAFSs were identified in 33 of 38 patients in whom an omnipolar map was created during sustained atrial flutter and in the S2 map in 11 of 12 patients in whom an omnipolar map was created during programmed pacing from the coronary sinus. No AAFS was identified in the S1 map. In the 44 patients in whom AAFSs were identified, a block line in the CTI was completed only by RFAs at the AAFSs, and a continuous linear ablation in the CTI was not necessary.</div></div><div><h3>Conclusion</h3><div>An omnipolar mapping system can identify critical sites for a CTI block by visualizing AAFSs. The AAFSs might be preferable ablation targets in a targeted CTI block.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1877-1885"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771995","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}

引用次数: 0

Catheter ablation vs antiarrhythmic drugs for persistent atrial fibrillation in hypertrophic cardiomyopathy 导管消融与抗心律失常药物治疗肥厚性心肌病持续性心房颤动

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.09.021

Zaid Shahrori MD , Abdalla Rayyan MD , Sheila Sharma BS, MS , Loura Sallam MD , Mauricio Arruda FHRS, MD , Judith Mackall FHRS, MD , Esseim Sharma FHRS, MD

引用次数: 0

Pulsed-field ablation and device-device procedural interactions with cardiac implantable electronic devices 脉冲场消融与心脏植入式电子装置的装置-装置程序相互作用

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.09.005

Kerollos Abdelsayed MD , Michael C. Downey MD , Ali Bahbah MD , Mariam Tarek Desouki MD , Dawn Witt PhD, MPH , Edwin Zishiri MD , Scott Sharkey MD , Raed H. Abdelhadi MD, FHRS , Jay D. Sengupta MD, FHRS

引用次数: 0

Real-world outcomes of left atrial appendage closure in very elderly compared with younger patients 与年轻患者相比，高龄患者左心耳关闭的实际结果

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-12-01 DOI: 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.

背景左心耳闭塞（LAAO）已成为老年心房颤动（AF）慢性抗凝治疗的一个有吸引力的替代方案。关于该手术在该人群中的效果和有效性的数据有限。目的本研究的目的是分析高龄LAAO患者的实际结果。方法回顾性分析来自美国最古老社区之一的一家医院中心的≥85岁高龄患者（平均88.1岁）与85岁高龄年轻患者（平均76.7岁）LAAO植入的结果。检查了手术成功（植入物）、手术并发症、45天器械相关再入院、器械相关血栓（DRT）、中风和1年内死亡。结果分析期内共实施LAAO器械植入342例，成功率高达98.5%，严重并发症发生率极低，仅为0.3%。两组患者的住院结果和并发症发生率均无差异。1年后缺血性卒中发生率为2.6%，两组间无显著差异。85岁以上患者的1年全因死亡率为14.6%，85岁以上患者的1年全因死亡率为7.9% （P = 0.09）。结论laao在老年人群中安全有效，并发症发生率极低。老年人的1年死亡率有上升的趋势。

{"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}

引用次数: 0

Differential subclinical hemolysis after pulsed field ablation using the FARAPULSE pentaspline catheter vs the PulseSelect circular multi-electrode array catheter 使用FARAPULSE五轴线导管与PulseSelect圆形多电极阵列导管进行脉冲场消融后亚临床溶血的差异

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.08.042

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

Background

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}

引用次数: 0

Early vs delayed ablation for new-onset atrial fibrillation: 5-Year real-world data outcomes 早期与延迟消融治疗新发房颤：5年真实世界数据结果

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-12-01 DOI: 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.

背景：最新指南承认导管消融是治疗症状性心房颤动（AF）的一线治疗方法。房颤诊断后导管消融的最佳时机仍不确定。目的本研究评估诊断至消融时间(DAT)≥1年与DAT≥1年对房颤复发和不良临床结局的影响。方法：我们在TriNetX研究网络中查询了2010年1月1日至2019年6月30日期间接受消融治疗的≥18岁诊断为房颤的患者。根据1年和≥1年的数据将患者分层为队列，并使用1:1倾向评分进行匹配，每个队列中有8403例患者。主要终点是房颤复发，定义为在3个月的空白期后3年和5年心律转复、抗心律失常用药或再消融的复合结果。次要结局包括心力衰竭加重、缺血性中风、全因住院和死亡率，以及个别成分。结果随访1年后，3年（校正优势比0.68[95%可信区间：0.64-0.72];P < 0.001）和5年（校正优势比0.68[95%可信区间：0.64-0.72];P < 001）的房颤复发率均显著降低。3年时，除脑血管意外和死亡率外，1年DAT组的所有次要结局均显著降低。5年时，1年DAT组的所有次要结局均显著降低。结论房颤诊断1年内导管消融与房颤复发率降低及主要不良临床结局相关。这些发现支持导管消融的早期转诊。

{"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}

引用次数: 0

Comparative analysis of conduction system pacing learning curves for atrioventricular block: A single-operator experience 传导系统起搏学习曲线对房室传导传导阻滞的比较分析：单操作者经验

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2

Pub Date : 2025-12-01 DOI: 10.1016/j.hroo.2025.10.002

Catalin Pestrea MD, PhD, Ecaterina Cicala MD, Stefania Sisea-Polexa MD, Mircea Dobre MD, Roxana Enache MD, Florin Ortan MD

引用次数: 0

首页上一页

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Heart Rhythm O2

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀