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}
Pulsed field ablation (PFA) is a novel nonthermal modality for pulmonary vein isolation (PVI) in atrial fibrillation (AF). However, the completeness of lesion formation following PFA using a pentaspline catheter remains insufficiently studied.
Objective
This study aimed to evaluate the utility of 3-dimensional (3D) electroanatomical mapping in detecting incomplete lesion formation following pentaspline PFA in patients with AF.
Methods
This study included 100 consecutive patients undergoing first-time PFA with the FARAWAVE™ catheter (Boston Scientific) under fluoroscopic guidance. 50 patients with paroxysmal AF underwent PVI alone, whereas 50 with persistent AF received PVI plus posterior wall isolation (PWI). Post-ablation 3D mapping was performed using the CARTO 3 system (Biosense Webster). Incomplete lesions were defined as preserved electrical activity or conduction gaps on activation or electrogram mapping.
Results
Incomplete lesions were identified in 8 of 50 patients (16%) undergoing PVI alone and 24 of 50 patients (48%) undergoing PVI plus PWI (P < .001). The most common sites of residual conduction were the right inferior pulmonary vein (PVI group) and the mid-to-inferior posterior wall (PVI plus PWI group). 5 of 24 patients (21%) with incomplete PWI required multiple application–remapping cycles to achieve lesion completion. Analysis by quartile (n = 25) revealed no significant trend in detection rate over time for paroxysmal (P = .289) or persistent AF (P = .179).
Conclusion
3D electroanatomical mapping effectively identifies incomplete lesions following pentaspline PFA. Detection rates were unaffected by operator learning curve, instead reflecting limitations of conventional guidance based primarily on fluoroscopy in patients with anatomical variability.
{"title":"Assessment of incomplete lesions using 3-dimensional mapping following pentaspline pulsed field ablation for atrial fibrillation","authors":"Atsuhiko Yagishita MD, PhD, Kazuma Iimura MD, Aika Iijima MD, Mari Amino MD, PhD, Yuji Ikari MD, PhD, Koichiro Yoshioka MD, PhD","doi":"10.1016/j.hroo.2025.09.010","DOIUrl":"10.1016/j.hroo.2025.09.010","url":null,"abstract":"<div><h3>Background</h3><div>Pulsed field ablation (PFA) is a novel nonthermal modality for pulmonary vein isolation (PVI) in atrial fibrillation (AF). However, the completeness of lesion formation following PFA using a pentaspline catheter remains insufficiently studied.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the utility of 3-dimensional (3D) electroanatomical mapping in detecting incomplete lesion formation following pentaspline PFA in patients with AF.</div></div><div><h3>Methods</h3><div>This study included 100 consecutive patients undergoing first-time PFA with the FARAWAVE™ catheter (Boston Scientific) under fluoroscopic guidance. 50 patients with paroxysmal AF underwent PVI alone, whereas 50 with persistent AF received PVI plus posterior wall isolation (PWI). Post-ablation 3D mapping was performed using the CARTO 3 system (Biosense Webster). Incomplete lesions were defined as preserved electrical activity or conduction gaps on activation or electrogram mapping.</div></div><div><h3>Results</h3><div>Incomplete lesions were identified in 8 of 50 patients (16%) undergoing PVI alone and 24 of 50 patients (48%) undergoing PVI plus PWI (<em>P</em> < .001). The most common sites of residual conduction were the right inferior pulmonary vein (PVI group) and the mid-to-inferior posterior wall (PVI plus PWI group). 5 of 24 patients (21%) with incomplete PWI required multiple application–remapping cycles to achieve lesion completion. Analysis by quartile (n = 25) revealed no significant trend in detection rate over time for paroxysmal (<em>P</em> = .289) or persistent AF (<em>P</em> = .179).</div></div><div><h3>Conclusion</h3><div>3D electroanatomical mapping effectively identifies incomplete lesions following pentaspline PFA. Detection rates were unaffected by operator learning curve, instead reflecting limitations of conventional guidance based primarily on fluoroscopy in patients with anatomical variability.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1919-1927"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771845","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.2025.09.015
Rubén Aguayo MD , Fernando Lanas MSc , Hugo Verdejo MD , Pablo López MD , Álvaro Vargas MD , Richar Aguirre MD , Judith Riesgo BEng , Federico Levy MSc , Svetlana V. Doubova DSc , Ricardo Perez-Cuevas DSc , Claudio Muratore MD.
Background
Chile has limited data on the treatment of patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF).
Objective
This study aimed to evaluate adherence to the 2017 American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guideline recommendations, identify barriers to cardiac implantable electronic device (CIED) use, and assess the association between CIED implantation and mortality.
Methods
From March 2021 to December 2022, we conducted a prospective, multicenter observational cohort study across 6 hospitals. Adults aged ≥18 with HF with reduced EF ≤40% were enrolled. Sociodemographic, clinical, and treatment data were collected. Descriptive statistics and Cox univariable regression were performed.
Results
The study included 243 patients with HF (73.3% male, median age 63 years), with comorbidities, including hypertension (67.1%), diabetes (30%), and obesity (37%); 41.2% had a history of myocardial infarction. At baseline, most patients received beta-blockers (96%), mineralocorticoid receptor antagonists (84%), and diuretics (65%). Of the 215 patients with LVEF ≤35%, 34.4% (n = 74) had a baseline CIED: 41.9% (n = 31) implantable cardioverter-defibrillators (ICD), 25.7% (n = 19) cardiac resynchronization therapy defibrillators (CRT-D), 17.6% (n = 13) CRT with a pacemaker, and 14.9% (n = 11) pacemaker. During follow-up, 27 of 75 eligible patients received ICD or CRT-D as recommended by the 2017 ACC/AHA/HRS guideline, whereas 38 did not because of access issues. There were 26 deaths, with no significant mortality differences between those with and without ICD or CRT-D.
Conclusion
In Chile, patients with HF with reduced LVEF receive pharmacological therapy consistent with international standards; however, they face access barriers to CIEDs, which are underutilized despite their benefits.
{"title":"PLASMA Chile: A prospective, multicenter observational cohort study of patients with heart failure and reduced left ventricular ejection fraction","authors":"Rubén Aguayo MD , Fernando Lanas MSc , Hugo Verdejo MD , Pablo López MD , Álvaro Vargas MD , Richar Aguirre MD , Judith Riesgo BEng , Federico Levy MSc , Svetlana V. Doubova DSc , Ricardo Perez-Cuevas DSc , Claudio Muratore MD.","doi":"10.1016/j.hroo.2025.09.015","DOIUrl":"10.1016/j.hroo.2025.09.015","url":null,"abstract":"<div><h3>Background</h3><div>Chile has limited data on the treatment of patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF).</div></div><div><h3>Objective</h3><div>This study aimed to evaluate adherence to the 2017 American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guideline recommendations, identify barriers to cardiac implantable electronic device (CIED) use, and assess the association between CIED implantation and mortality.</div></div><div><h3>Methods</h3><div>From March 2021 to December 2022, we conducted a prospective, multicenter observational cohort study across 6 hospitals. Adults aged ≥18 with HF with reduced EF ≤40% were enrolled. Sociodemographic, clinical, and treatment data were collected. Descriptive statistics and Cox univariable regression were performed.</div></div><div><h3>Results</h3><div>The study included 243 patients with HF (73.3% male, median age 63 years), with comorbidities, including hypertension (67.1%), diabetes (30%), and obesity (37%); 41.2% had a history of myocardial infarction. At baseline, most patients received beta-blockers (96%), mineralocorticoid receptor antagonists (84%), and diuretics (65%). Of the 215 patients with LVEF ≤35%, 34.4% (n = 74) had a baseline CIED: 41.9% (n = 31) implantable cardioverter-defibrillators (ICD), 25.7% (n = 19) cardiac resynchronization therapy defibrillators (CRT-D), 17.6% (n = 13) CRT with a pacemaker, and 14.9% (n = 11) pacemaker. During follow-up, 27 of 75 eligible patients received ICD or CRT-D as recommended by the 2017 ACC/AHA/HRS guideline, whereas 38 did not because of access issues. There were 26 deaths, with no significant mortality differences between those with and without ICD or CRT-D.</div></div><div><h3>Conclusion</h3><div>In Chile, patients with HF with reduced LVEF receive pharmacological therapy consistent with international standards; however, they face access barriers to CIEDs, which are underutilized despite their benefits.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1968-1976"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771850","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.2025.09.014
Luuk H.G.A. Hopman PhD , Eric M. Schrauben PhD , Jules L. Nelissen MSc, PhD , Pieter J. Reitzema BSc , Machteld J. Boonstra PhD , Bart L.M. Smeets MSc , Renate W. Boekhoven PhD , Daniel Sunnarborg MSc , Jouke Smink PhD , Hans W.M. Niessen MD, PhD , Cornelis P. Allaart MD, PhD , Aart J. Nederveen PhD , Marco J.W. Götte MD, PhD
Background
Interventional cardiovascular magnetic resonance imaging (MRI) offers real-time, radiation-free guidance for complex procedures such as myocardial ablation, marking a promising advance in electrophysiology. However, further development is limited by challenges in magnetic resonance (MR)-compatible instrument testing, MRI sequence validation, and accurate correlation with histopathology, hindered by the limitations of in vivo tissue evaluation.
Objective
This study investigated the feasibility of real-time MR-guided radiofrequency (RF) ablation in an MR-compatible isolated beating pig heart platform and characterized ablation lesions using MRI and histopathology.
Methods
A heart from a pig slaughtered for human consumption was prepared under regulatory guidelines and connected to a custom-built, MR-compatible perfusion platform supporting left ventricular function in both Langendorff and working modes. Autologous heparinized blood circulated at physiological pressures and temperatures. MR-guided catheter navigation and RF ablation were performed on a Philips 3T scanner using active catheter tracking. Native T1 and T2 mapping were acquired before and after ablation. Lesions were confirmed by histologic analysis.
Results
RF ablation (50 W, 60 seconds) was successfully performed at 5 left ventricular sites. MRI showed focal reductions in T1 (936 ± 80 ms) surrounded by elevated T1 (1357 ± 18 ms) and T2 values (86 ± 10 ms) compared with nonablated myocardium (T1 1192 ± 26 ms; T2 66 ± 6 ms), consistent with necrosis and edema. Histology confirmed a necrotic core with a surrounding rim showing contraction band necrosis and erythrocyte extravasation.
Conclusion
This study demonstrates the feasibility of real-time MR-guided ablation in a beating pig heart platform. The setup allows high-resolution lesion assessment and histologic correlation, supporting future developments in MR-guided therapies.
{"title":"Real-time magnetic resonance-guided radiofrequency ablation and lesion evaluation in an magnetic resonance-compatible isolated beating pig heart platform","authors":"Luuk H.G.A. Hopman PhD , Eric M. Schrauben PhD , Jules L. Nelissen MSc, PhD , Pieter J. Reitzema BSc , Machteld J. Boonstra PhD , Bart L.M. Smeets MSc , Renate W. Boekhoven PhD , Daniel Sunnarborg MSc , Jouke Smink PhD , Hans W.M. Niessen MD, PhD , Cornelis P. Allaart MD, PhD , Aart J. Nederveen PhD , Marco J.W. Götte MD, PhD","doi":"10.1016/j.hroo.2025.09.014","DOIUrl":"10.1016/j.hroo.2025.09.014","url":null,"abstract":"<div><h3>Background</h3><div>Interventional cardiovascular magnetic resonance imaging (MRI) offers real-time, radiation-free guidance for complex procedures such as myocardial ablation, marking a promising advance in electrophysiology. However, further development is limited by challenges in magnetic resonance (MR)-compatible instrument testing, MRI sequence validation, and accurate correlation with histopathology, hindered by the limitations of in vivo tissue evaluation.</div></div><div><h3>Objective</h3><div>This study investigated the feasibility of real-time MR-guided radiofrequency (RF) ablation in an MR-compatible isolated beating pig heart platform and characterized ablation lesions using MRI and histopathology.</div></div><div><h3>Methods</h3><div>A heart from a pig slaughtered for human consumption was prepared under regulatory guidelines and connected to a custom-built, MR-compatible perfusion platform supporting left ventricular function in both Langendorff and working modes. Autologous heparinized blood circulated at physiological pressures and temperatures. MR-guided catheter navigation and RF ablation were performed on a Philips 3T scanner using active catheter tracking. Native T1 and T2 mapping were acquired before and after ablation. Lesions were confirmed by histologic analysis.</div></div><div><h3>Results</h3><div>RF ablation (50 W, 60 seconds) was successfully performed at 5 left ventricular sites. MRI showed focal reductions in T1 (936 ± 80 ms) surrounded by elevated T1 (1357 ± 18 ms) and T2 values (86 ± 10 ms) compared with nonablated myocardium (T1 1192 ± 26 ms; T2 66 ± 6 ms), consistent with necrosis and edema. Histology confirmed a necrotic core with a surrounding rim showing contraction band necrosis and erythrocyte extravasation.</div></div><div><h3>Conclusion</h3><div>This study demonstrates the feasibility of real-time MR-guided ablation in a beating pig heart platform. The setup allows high-resolution lesion assessment and histologic correlation, supporting future developments in MR-guided therapies.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 2001-2010"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771958","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}
Data comparing outcomes between cardiac resynchronization therapy (CRT) upgrade in patients with left bundle branch block (LBBB) or right ventricular (RV) pacing and de novo CRT in LBBB are limited.
Objective
To evaluate long-term outcomes of CRT upgrade in patients with LBBB or RV pacing compared with de novo CRT in LBBB.
Methods
We analyzed 395 consecutive patients who received CRT, classified into 3 groups: CRT upgrade for LBBB or RV pacing (Upgrade group, n = 111), de novo CRT for LBBB (LBBB group, n = 84), and CRT for non-LBBB (non-LBBB group, n = 200). The primary end point was a composite of all-cause mortality and heart failure hospitalization. The secondary end point was CRT response, defined as an improvement of ≥15% in left ventricular end-systolic volume.
Results
During the follow-up of 778 days, the risk of primary end point was higher in the Upgrade group than the LBBB group (log-rank, P = .03), and lower than the non-LBBB group (P = .03). In the Upgrade group, Kaplan-Meier analysis revealed that patients with left atrial diameter >50 mm, determined by receiver operating characteristic analysis, had a higher risk of the primary end point (log-rank, P < .001). Left atrial diameter >50 mm was a negative predictor of CRT response and an independent predictor of primary end point (hazard ratio 2.31, 95% confidence interval 1.10–4.85, P = .03).
Conclusion
CRT upgrade for LBBB or RV pacing offers less prognostic benefit than de novo CRT for LBBB.
背景：比较左束支传导阻滞（LBBB）或右心室起搏（RV）患者心脏再同步化治疗（CRT）升级与LBBB患者重新进行CRT治疗的结果的数据有限。目的评价LBBB或RV起搏患者CRT升级与LBBB患者重新CRT的远期疗效。方法对395例连续接受CRT治疗的患者进行分析，将其分为3组：LBBB或RV起搏的CRT升级组（升级组，n = 111）、LBBB的重新CRT （LBBB组，n = 84）和非LBBB的CRT（非LBBB组，n = 200）。主要终点是全因死亡率和心力衰竭住院率的综合。次要终点是CRT反应，定义为左心室收缩末期容积改善≥15%。结果随访778 d，升级组主要终点发生风险高于LBBB组（log-rank, P = .03），低于非LBBB组（P = .03）。在Upgrade组中，Kaplan-Meier分析显示，经受试者工作特征分析确定的左房直径为50mm的患者发生主要终点的风险更高（log-rank, P < .001）。左房内径>；50 mm是CRT反应的阴性预测因子，也是主要终点的独立预测因子（风险比2.31,95%可信区间1.10-4.85,P = 0.03）。结论对LBBB或RV起搏进行CRT升级治疗的预后效果不如对LBBB重新进行CRT治疗。
{"title":"Long-term outcomes of upgrading to cardiac resynchronization therapy in patients with left bundle branch block or right ventricular pacing","authors":"Yoshitake Oshima MD , Nobuhiko Ueda MD, PhD , Kohei Ishibashi MD, PhD , Toshihiro Nakamura MD, PhD , Satoshi Oka MD, PhD , Akinori Wakamiya MD, PhD , Kenzaburo Nakajima MD, PhD , Tsukasa Kamakura MD, PhD , Mitsuru Wada MD, PhD , Yuko Inoue MD, PhD , Koji Miyamoto MD, PhD , Satoshi Nagase MD, PhD , Takeshi Aiba MD, PhD, FHRS , Kengo Kusano MD, PhD, FHRS","doi":"10.1016/j.hroo.2025.09.009","DOIUrl":"10.1016/j.hroo.2025.09.009","url":null,"abstract":"<div><h3>Background</h3><div>Data comparing outcomes between cardiac resynchronization therapy (CRT) upgrade in patients with left bundle branch block (LBBB) or right ventricular (RV) pacing and de novo CRT in LBBB are limited.</div></div><div><h3>Objective</h3><div>To evaluate long-term outcomes of CRT upgrade in patients with LBBB or RV pacing compared with de novo CRT in LBBB.</div></div><div><h3>Methods</h3><div>We analyzed 395 consecutive patients who received CRT, classified into 3 groups: CRT upgrade for LBBB or RV pacing (Upgrade group, n = 111), de novo CRT for LBBB (LBBB group, n = 84), and CRT for non-LBBB (non-LBBB group, n = 200). The primary end point was a composite of all-cause mortality and heart failure hospitalization. The secondary end point was CRT response, defined as an improvement of ≥15% in left ventricular end-systolic volume.</div></div><div><h3>Results</h3><div>During the follow-up of 778 days, the risk of primary end point was higher in the Upgrade group than the LBBB group (log-rank, <em>P =</em> .03), and lower than the non-LBBB group (<em>P =</em> .03). In the Upgrade group, Kaplan-Meier analysis revealed that patients with left atrial diameter >50 mm, determined by receiver operating characteristic analysis, had a higher risk of the primary end point (log-rank, <em>P <</em> .001). Left atrial diameter >50 mm was a negative predictor of CRT response and an independent predictor of primary end point (hazard ratio 2.31, 95% confidence interval 1.10–4.85, <em>P =</em> .03).</div></div><div><h3>Conclusion</h3><div>CRT upgrade for LBBB or RV pacing offers less prognostic benefit than de novo CRT for LBBB.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 12","pages":"Pages 1960-1967"},"PeriodicalIF":2.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771849","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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