Pub Date : 2025-11-01DOI: 10.1016/j.hroo.2025.08.028
Luis Quiñiñir MD, FACC, ECES , Pablo Salazar MD , Pasquale Santangeli MD, PhD
{"title":"Trans–right atrial access to the left ventricle for catheter ablation of ventricular tachycardia in a patient with double left-sided mechanical valves: First case report from Latin America","authors":"Luis Quiñiñir MD, FACC, ECES , Pablo Salazar MD , Pasquale Santangeli MD, PhD","doi":"10.1016/j.hroo.2025.08.028","DOIUrl":"10.1016/j.hroo.2025.08.028","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Pages 1843-1845"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546478","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}
The utility of ethanol infusion into the vein of Marshall (EIVOM) is limited in patients whose VOM is not visible.
Objective
We evaluated the feasibility of advancing a guidewire into previously non-visualized VOMs to extend the utility of EIVOM.
Methods
We included 249 patients with atrial fibrillation (AF) undergoing mitral isthmus (MI) ablation. If the VOM was not visualized by coronary sinus (CS) venography, we attempted to locate its entrance using a guidewire and double-coaxial guiding catheter technique at the Vieussens valve (VV). If unveiled, EIVOM was performed.
Results
CS venography visualized the VOM in 166 of 249 patients (67%). Among the remaining 83 patients, we successfully crossed a guidewire and unveiled previously non-visualized VOMs in 15 patients (18%). MI line block was fully achieved in 91% (146/160) of the visualized VOM group (A), 93% (14/15) of the unveiled VOM group (B), and 82% (61/74) of the non-EIVOM group (C) (A vs B, P = .78; A vs C, P < .05; B vs C, P = .29). However, no significant differences in AF recurrence were observed among the groups (A vs B, P = .84; A vs C, P = .63; B vs C, P = .68).
Conclusion
Using the VV as a landmark can enhance the feasibility of the EIVOM procedure. Despite this novel technique, EVIOM did not improve AF ablation outcomes. These findings regarding unveiled VOMs are preliminary, and are limited by the small sample size of this group.
背景乙醇输注到马歇尔静脉（EIVOM）的效用是有限的患者的VOM是不可见的。目的探讨将导丝推进到先前不可见的vom的可行性，以扩大EIVOM的应用范围。方法249例心房颤动（AF）患者行二尖瓣峡部（MI）消融术。如果冠脉窦（CS）静脉造影不能显示VOM，我们尝试在Vieussens瓣膜（VV）处使用导丝和双同轴引导导管技术定位其入口。如果被揭开，EIVOM就会被执行。结果249例患者中，有166例（67%）通过scs静脉造影显示VOM。在剩下的83例患者中，我们成功地穿过导丝，并在15例（18%）患者中发现了先前未可见的VOMs。显影VOM组(A) 91%（146/160）、未显影VOM组(B) 93%（14/15）、非eivom组(C) 82%（61/74）完全实现MI线阻滞（A vs B, P = 0.78; A vs C, P < 05; B vs C, P = 0.29）。然而，两组间房颤复发率无显著差异（A组vs B组，P = 0.84； A组vs C组，P = 0.63； B组vs C组，P = 0.68）。结论以VV为标志可提高EIVOM手术的可行性。尽管这项新技术，EVIOM并没有改善房颤消融的结果。这些关于暴露的VOMs的发现是初步的，并且受到该组小样本量的限制。
{"title":"A novel approach to enhance ethanol infusion utility in the non-visualized vein of Marshall","authors":"Masayuki Ishimura MD, PhD , Yuto Watanabe MD , Masanao Matsuno MD , Akiko Yoshimori CE , Masashi Yamamoto MD, PhD , Toshiharu Himi MD, PhD , Yoshio Kobayashi MD, PhD","doi":"10.1016/j.hroo.2025.08.005","DOIUrl":"10.1016/j.hroo.2025.08.005","url":null,"abstract":"<div><h3>Background</h3><div>The utility of ethanol infusion into the vein of Marshall (EIVOM) is limited in patients whose VOM is not visible.</div></div><div><h3>Objective</h3><div>We evaluated the feasibility of advancing a guidewire into previously non-visualized VOMs to extend the utility of EIVOM.</div></div><div><h3>Methods</h3><div>We included 249 patients with atrial fibrillation (AF) undergoing mitral isthmus (MI) ablation. If the VOM was not visualized by coronary sinus (CS) venography, we attempted to locate its entrance using a guidewire and double-coaxial guiding catheter technique at the Vieussens valve (VV). If unveiled, EIVOM was performed.</div></div><div><h3>Results</h3><div>CS venography visualized the VOM in 166 of 249 patients (67%). Among the remaining 83 patients, we successfully crossed a guidewire and unveiled previously non-visualized VOMs in 15 patients (18%). MI line block was fully achieved in 91% (146/160) of the visualized VOM group (A), 93% (14/15) of the unveiled VOM group (B), and 82% (61/74) of the non-EIVOM group (C) (A vs B, <em>P =</em> .78; A vs C, <em>P <</em> .05; B vs C, <em>P =</em> .29). However, no significant differences in AF recurrence were observed among the groups (A vs B, <em>P =</em> .84; A vs C, <em>P =</em> .63; B vs C, <em>P =</em> .68).</div></div><div><h3>Conclusion</h3><div>Using the VV as a landmark can enhance the feasibility of the EIVOM procedure. Despite this novel technique, EVIOM did not improve AF ablation outcomes. These findings regarding unveiled VOMs are preliminary, and are limited by the small sample size of this group.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Pages 1696-1705"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546944","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 : 2025-11-01DOI: 10.1016/j.hroo.2025.07.018
Prashanthan Sanders MBBS, PhD, FHRS , Jonathan P. Ariyaratnam MB BChir, PhD , Alexis Puvrez MD, PhD , Melissa E. Middeldorp MPH, PhD , Stephen J. Nicholls MBBS, PhD , Gijo Thomas PhD , Anand Ganesan MBBS, PhD , Vincent Paul MBBS, PhD , Stuart P. Thomas MBBS, PhD , Walter P. Abhayaratna MBBS, PhD , Martin K. Stiles MBBS, PhD, FHRS , Jonathan M. Kalman MBBS, PhD, FHRS
Background
Cardiac resynchronization therapy (CRT) is an important treatment modality for patients with symptomatic heart failure (HF) with reduced ejection fraction (HFrEF) and QRS prolongation on electrocardiogram. However, patients with atrial fibrillation (AF) appear to benefit less from CRT compared to patients in sinus rhythm. Atrioventricular (AV) node ablation has been shown in observational studies to improve the efficacy of CRT in patients with AF.
Objective
We aimed to evaluate the effect of AV node ablation on CRT efficacy in patients with permanent AF.
Methods
Participants with permanent AF and a reduced left ventricular ejection fraction (≤35%) who receive a CRT-defibrillator are randomized in a 1:1 fashion to AV node ablation or medical rate control for treatment of AF. A sample size of 590 participants allows a detection of a 25% reduction in the primary end point at 80% power.
Results
The primary end point is a composite of all-cause mortality and non-fatal HF events after 2 years of follow-up. The secondary end points include all-cause mortality, cardiovascular mortality, non-fatal HF events, 6-minute walking distance, quality-of-life, unscheduled hospitalizations, ventricular arrhythmias requiring device therapies, and biventricular pacing percentage.
Conclusion
The CRT And AV Node ablation trial in AF (CAAN-AF) will be the first randomized controlled trial to investigate the effect of AV node ablation on CRT efficacy in patients with AF and HFrEF. The results will guide physicians regarding the use of AV node ablation for patients with CRT and AF.
{"title":"Cardiac resynchronization therapy and AV node ablation in heart failure with reduced ejection fraction and atrial fibrillation: Rationale and design of the CAAN-AF trial","authors":"Prashanthan Sanders MBBS, PhD, FHRS , Jonathan P. Ariyaratnam MB BChir, PhD , Alexis Puvrez MD, PhD , Melissa E. Middeldorp MPH, PhD , Stephen J. Nicholls MBBS, PhD , Gijo Thomas PhD , Anand Ganesan MBBS, PhD , Vincent Paul MBBS, PhD , Stuart P. Thomas MBBS, PhD , Walter P. Abhayaratna MBBS, PhD , Martin K. Stiles MBBS, PhD, FHRS , Jonathan M. Kalman MBBS, PhD, FHRS","doi":"10.1016/j.hroo.2025.07.018","DOIUrl":"10.1016/j.hroo.2025.07.018","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac resynchronization therapy (CRT) is an important treatment modality for patients with symptomatic heart failure (HF) with reduced ejection fraction (HFrEF) and QRS prolongation on electrocardiogram. However, patients with atrial fibrillation (AF) appear to benefit less from CRT compared to patients in sinus rhythm. Atrioventricular (AV) node ablation has been shown in observational studies to improve the efficacy of CRT in patients with AF.</div></div><div><h3>Objective</h3><div>We aimed to evaluate the effect of AV node ablation on CRT efficacy in patients with permanent AF.</div></div><div><h3>Methods</h3><div>Participants with permanent AF and a reduced left ventricular ejection fraction (≤35%) who receive a CRT-defibrillator are randomized in a 1:1 fashion to AV node ablation or medical rate control for treatment of AF. A sample size of 590 participants allows a detection of a 25% reduction in the primary end point at 80% power.</div></div><div><h3>Results</h3><div>The primary end point is a composite of all-cause mortality and non-fatal HF events after 2 years of follow-up. The secondary end points include all-cause mortality, cardiovascular mortality, non-fatal HF events, 6-minute walking distance, quality-of-life, unscheduled hospitalizations, ventricular arrhythmias requiring device therapies, and biventricular pacing percentage.</div></div><div><h3>Conclusion</h3><div>The CRT And AV Node ablation trial in AF (CAAN-AF) will be the first randomized controlled trial to investigate the effect of AV node ablation on CRT efficacy in patients with AF and HFrEF. The results will guide physicians regarding the use of AV node ablation for patients with CRT and AF.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Pages 1828-1836"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546476","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}
Although cardiac computed tomography (CT) provides detailed anatomical information on the left atrial (LA), few studies have examined whether it can distinguish paroxysmal atrial fibrillation (PAF) from persistent atrial fibrillation (PerAF) based on structural features in an interpretable manner.
Objective
To develop a convolutional neural network (CNN) model trained on LA morphology derived from cardiac CT for classifying atrial fibrillation (AF) subtypes and to identify spatial remodeling patterns associated with PerAF to enhance understanding of AF progression.
Methods
We developed 3 types of 3-dimensional CNN to classify AF subtypes using cardiac CT-derived LA morphology. A total of 269 patients were used for model development with stratified 10-fold cross-validation. External validation was conducted in 151 independent patients. CNN performance was compared with LA volume and LA volume index from echocardiography and CT. We used gradient-weighted class activation mapping to identify regional remodeling patterns associated with predictions.
Results
Among the 3-dimensional-CNN, the 3D-DenseNet201 model achieved the highest performance in internal validation (area under the receiver operating characteristic curve 0.81 ± 0.08; accuracy 77.0 ± 6.2%) and maintained consistent accuracy in external validation (area under the receiver operating characteristic curve 0.81 ± 0.01; accuracy 76.7 ± 1.6%). gradient-weighted class activation mapping revealed that PerAF classification was primarily driven by activation in the anterosuperior LA wall (72.8%), right superior pulmonary vein antrum (49.4%), and septum (44.3%). The posterior wall showed minimal activation. CNN outperformed echocardiographic or CT-derived volume metrics.
Conclusion
The 3D-DenseNet201 model accurately classified AF subtypes and localized structural remodeling patterns relevant to PerAF. These findings highlight the potential of deep learning to improve the mechanistic understanding of AF progression.
{"title":"Development and validation of explainable deep learning models for classification of atrial fibrillation subtypes using cardiac computed tomography","authors":"Kazuya Takeda MSc , Yoshihiro Sobue MD, PhD , Hitoshi Matsuo MD, PhD , Eiichi Watanabe MD, PhD , Shigeki Kobayashi MD, PhD","doi":"10.1016/j.hroo.2025.08.031","DOIUrl":"10.1016/j.hroo.2025.08.031","url":null,"abstract":"<div><h3>Background</h3><div>Although cardiac computed tomography (CT) provides detailed anatomical information on the left atrial (LA), few studies have examined whether it can distinguish paroxysmal atrial fibrillation (PAF) from persistent atrial fibrillation (PerAF) based on structural features in an interpretable manner.</div></div><div><h3>Objective</h3><div>To develop a convolutional neural network (CNN) model trained on LA morphology derived from cardiac CT for classifying atrial fibrillation (AF) subtypes and to identify spatial remodeling patterns associated with PerAF to enhance understanding of AF progression.</div></div><div><h3>Methods</h3><div>We developed 3 types of 3-dimensional CNN to classify AF subtypes using cardiac CT-derived LA morphology. A total of 269 patients were used for model development with stratified 10-fold cross-validation. External validation was conducted in 151 independent patients. CNN performance was compared with LA volume and LA volume index from echocardiography and CT. We used gradient-weighted class activation mapping to identify regional remodeling patterns associated with predictions.</div></div><div><h3>Results</h3><div>Among the 3-dimensional-CNN, the 3D-DenseNet201 model achieved the highest performance in internal validation (area under the receiver operating characteristic curve 0.81 ± 0.08; accuracy 77.0 ± 6.2%) and maintained consistent accuracy in external validation (area under the receiver operating characteristic curve 0.81 ± 0.01; accuracy 76.7 ± 1.6%). gradient-weighted class activation mapping revealed that PerAF classification was primarily driven by activation in the anterosuperior LA wall (72.8%), right superior pulmonary vein antrum (49.4%), and septum (44.3%). The posterior wall showed minimal activation. CNN outperformed echocardiographic or CT-derived volume metrics.</div></div><div><h3>Conclusion</h3><div>The 3D-DenseNet201 model accurately classified AF subtypes and localized structural remodeling patterns relevant to PerAF. These findings highlight the potential of deep learning to improve the mechanistic understanding of AF progression.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Pages 1796-1806"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546591","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 : 2025-11-01DOI: 10.1016/j.hroo.2025.08.035
Samir Fareh MD , Stefano Nardi MD , Luigi Argenziano MD , Luca Poggio MD , Alessandro Costa MD , Fernando Scala MD , Alessandro Diamante MD , Giovanni Luzzi MD , Carlo Lavalle MD , Luca Checchi MD , Michele Magnocavallo MD , Massimo Stefano Silvetti MD , Daniele Porcelli MD , Domenico Gianfrancesco MD , Andrea Boncompagni MD , Paul Charles MD , Vittoria Marino MD , Monica Campari MS , Sergio Valsecchi PhD , Giulio Conte PhD, MD
Background
Insertable cardiac monitors (ICMs) enable continuous arrhythmia monitoring but generate high transmission volumes, increasing clinical workload. The LUX-Dx ICM (Boston Scientific) allows remote reprogramming of device alert settings, potentially reducing in-office visits.
Objective
This study aimed to evaluate the real-world use of remote reprogramming after its initial commercialization in Europe and its impact on transmission burden.
Methods
Deidentified data were collected from 697 consecutive patients across 23 European centers between 2022 and 2024.
Results
Syncope (48%) was the most frequent indication for ICM implantation. Patients were followed for a median of 9 months (25th–75th percentile 4–13). A total of 401 reprogramming events (0.8 per patient-year) occurred in 230 ICMs, with 38% (95% confidence interval 34–43) of devices reprogrammed within 1 year. Of these, 156 (39%) were performed remotely. The overall transmission rate was 3.0 per patient-month (95% confidence interval 2.9–3.1): alert transmissions (64%), scheduled transmissions (31%), patient-initiated interrogations (4%), and clinician-initiated interrogations (1%). The rate of recorded episodes varied significantly by indication (P < .001), with bradycardia the most frequent across groups. Reprogramming significantly reduced transmission rates (median 57%; 25th–75th percentile 4–86), alerts (78%; 25th–75th percentile 11–96), and recorded episodes (91%; 25th–75th percentile 47–99) (all P < .001).
Conclusion
ICM reprogramming plays a key role in optimizing device performance and reducing remote monitoring burden. Currently used in 39% of cases, remote reprogramming holds potential for broader adoption to minimize in-office visits. Efficiency may be further improved by transitioning to an alert-based monitoring strategy and eliminating scheduled transmissions.
{"title":"Real-world use of insertable cardiac monitor remote programming: A multicenter European experience","authors":"Samir Fareh MD , Stefano Nardi MD , Luigi Argenziano MD , Luca Poggio MD , Alessandro Costa MD , Fernando Scala MD , Alessandro Diamante MD , Giovanni Luzzi MD , Carlo Lavalle MD , Luca Checchi MD , Michele Magnocavallo MD , Massimo Stefano Silvetti MD , Daniele Porcelli MD , Domenico Gianfrancesco MD , Andrea Boncompagni MD , Paul Charles MD , Vittoria Marino MD , Monica Campari MS , Sergio Valsecchi PhD , Giulio Conte PhD, MD","doi":"10.1016/j.hroo.2025.08.035","DOIUrl":"10.1016/j.hroo.2025.08.035","url":null,"abstract":"<div><h3>Background</h3><div>Insertable cardiac monitors (ICMs) enable continuous arrhythmia monitoring but generate high transmission volumes, increasing clinical workload. The LUX-Dx ICM (Boston Scientific) allows remote reprogramming of device alert settings, potentially reducing in-office visits.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the real-world use of remote reprogramming after its initial commercialization in Europe and its impact on transmission burden.</div></div><div><h3>Methods</h3><div>Deidentified data were collected from 697 consecutive patients across 23 European centers between 2022 and 2024.</div></div><div><h3>Results</h3><div>Syncope (48%) was the most frequent indication for ICM implantation. Patients were followed for a median of 9 months (25th–75th percentile 4–13). A total of 401 reprogramming events (0.8 per patient-year) occurred in 230 ICMs, with 38% (95% confidence interval 34–43) of devices reprogrammed within 1 year. Of these, 156 (39%) were performed remotely. The overall transmission rate was 3.0 per patient-month (95% confidence interval 2.9–3.1): alert transmissions (64%), scheduled transmissions (31%), patient-initiated interrogations (4%), and clinician-initiated interrogations (1%). The rate of recorded episodes varied significantly by indication (<em>P</em> < .001), with bradycardia the most frequent across groups. Reprogramming significantly reduced transmission rates (median 57%; 25th–75th percentile 4–86), alerts (78%; 25th–75th percentile 11–96), and recorded episodes (91%; 25th–75th percentile 47–99) (all <em>P</em> < .001).</div></div><div><h3>Conclusion</h3><div>ICM reprogramming plays a key role in optimizing device performance and reducing remote monitoring burden. Currently used in 39% of cases, remote reprogramming holds potential for broader adoption to minimize in-office visits. Efficiency may be further improved by transitioning to an alert-based monitoring strategy and eliminating scheduled transmissions.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Pages 1735-1742"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546953","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 : 2025-11-01DOI: 10.1016/j.hroo.2025.08.030
Joerg Yogarajah MD , Julie Hutter MD , Patrick Kahle MD , Marko Tomic MD , Mirlinda Lüsebrink MD , Andreas Hain MD , Samuel Sossalla MD , Malte Kuniss MD , Thomas Neumann MD
Background
Pulsed field ablation (PFA) is an emerging non-thermal approach for pulmonary vein isolation (PVI) in atrial fibrillation (AF). Comparative real-world data between variable-loop circular catheter (VLCC; VARIPULSE™, Biosense Webster, Inc) and fixed-loop circular catheter (FLCC; PulseSelect™, Medtronic) catheters, including non-PVI ablation, are limited.
Objective
To compare acute efficacy, procedural characteristics, and safety of PVI, and adjunctive ablations performed with VLCC vs FLCC during clinical implementation.
Methods
Overall, 90 consecutive patients were studied (first 45 VLCC and 45 FLCC cases). FLCC procedures used fluoroscopic guidance; VLCC was integrated with 3-dimensional mapping, reflecting standard real-world use of each catheter. Additional ablations were performed at the operator’s discretion. Acute outcomes and complications were analyzed.
Results
Acute PVI success was 100% in both groups. Additional ablations (cavotricuspid isthmus [CTI], roof lines, posterior wall, superior vena cava [SVC]) were performed in 17 (VLCC) and 15 (FLCC) patients, achieving bidirectional block without Radiofrequency touch-ups. In PVI-only cases, FLCC was associated with shorter median procedure time (67.2 vs 76 min, P < .001), whereas VLCC had reduced fluoroscopy time (8.3 vs 11.4 min, P < .001). Major complication rates were low and comparable (2.2% vs 0%, P = 1).
Conclusion
This first clinical comparison demonstrated high acute efficacy and favorable safety profiles, with notable procedural differences reflecting their distinct workflows of 2 circular PFA catheter systems for AF ablation. Likewise, this includes the first reported successful CTI, SVC and mitral isthmus ablation using VLCC reflecting its versatility for ablation. Further research is warranted to assess long-term outcomes and lesion durability.
背景：脉冲场消融（PFA）是一种新兴的用于房颤（AF）肺静脉隔离（PVI）的非热方法。可变环环形导管（VLCC; VARIPULSE™，Biosense Webster, Inc .）和固定环环形导管（FLCC; PulseSelect™，Medtronic）包括非pvi消融在内的实际数据比较有限。目的比较PVI的急性疗效、手术特点和安全性，以及VLCC和FLCC在临床实施中的辅助消融。方法共对90例连续患者（45例VLCC和45例FLCC）进行研究。FLCC程序采用透视指导；VLCC与三维测绘相结合，反映了每个导管在现实世界中的标准使用情况。在操作者的判断下进行额外的消融。分析急性结局及并发症。结果两组患者急性PVI成功率均为100%。在17例（VLCC）和15例（FLCC）患者中进行了额外的消融（caavotricuspid峡[CTI]，顶线，后壁，上腔静脉[SVC]），实现了双向阻断，无需射频修补。在只有pvi的病例中，FLCC与较短的中位手术时间相关（67.2 vs 76分钟，P < 0.001），而VLCC缩短了透视时间（8.3 vs 11.4分钟，P < 0.001）。主要并发症发生率低且具有可比性（2.2% vs 0%, P = 1）。结论：首次临床比较表明，两种圆形PFA导管系统用于房颤消融具有较高的急性疗效和良好的安全性，其明显的程序差异反映了其不同的工作流程。同样，这包括首次报道的使用VLCC成功消融CTI、SVC和二尖瓣峡部，反映了其消融的通用性。需要进一步的研究来评估长期结果和损伤持久性。
{"title":"Real-world comparison of variable vs fixed-loop circular pulsed field ablation catheters: Acute outcomes including non-pulmonary vein ablation","authors":"Joerg Yogarajah MD , Julie Hutter MD , Patrick Kahle MD , Marko Tomic MD , Mirlinda Lüsebrink MD , Andreas Hain MD , Samuel Sossalla MD , Malte Kuniss MD , Thomas Neumann MD","doi":"10.1016/j.hroo.2025.08.030","DOIUrl":"10.1016/j.hroo.2025.08.030","url":null,"abstract":"<div><h3>Background</h3><div>Pulsed field ablation (PFA) is an emerging non-thermal approach for pulmonary vein isolation (PVI) in atrial fibrillation (AF). Comparative real-world data between variable-loop circular catheter (VLCC; VARIPULSE™, Biosense Webster, Inc) and fixed-loop circular catheter (FLCC; PulseSelect™, Medtronic) catheters, including non-PVI ablation, are limited.</div></div><div><h3>Objective</h3><div>To compare acute efficacy, procedural characteristics, and safety of PVI, and adjunctive ablations performed with VLCC vs FLCC during clinical implementation.</div></div><div><h3>Methods</h3><div>Overall, 90 consecutive patients were studied (first 45 VLCC and 45 FLCC cases). FLCC procedures used fluoroscopic guidance; VLCC was integrated with 3-dimensional mapping, reflecting standard real-world use of each catheter. Additional ablations were performed at the operator’s discretion. Acute outcomes and complications were analyzed.</div></div><div><h3>Results</h3><div>Acute PVI success was 100% in both groups. Additional ablations (cavotricuspid isthmus [CTI], roof lines, posterior wall, superior vena cava [SVC]) were performed in 17 (VLCC) and 15 (FLCC) patients, achieving bidirectional block without Radiofrequency touch-ups. In PVI-only cases, FLCC was associated with shorter median procedure time (67.2 vs 76 min, <em>P</em> < .001), whereas VLCC had reduced fluoroscopy time (8.3 vs 11.4 min, <em>P</em> < .001). Major complication rates were low and comparable (2.2% vs 0%, <em>P</em> = 1).</div></div><div><h3>Conclusion</h3><div>This first clinical comparison demonstrated high acute efficacy and favorable safety profiles, with notable procedural differences reflecting their distinct workflows of 2 circular PFA catheter systems for AF ablation. Likewise, this includes the first reported successful CTI, SVC and mitral isthmus ablation using VLCC reflecting its versatility for ablation. Further research is warranted to assess long-term outcomes and lesion durability.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Pages 1706-1715"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546945","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 : 2025-11-01DOI: 10.1016/j.hroo.2025.08.026
Lane A. McLendon MD , Madhuri S. Mulekar PhD , Lynn A. Batten MD
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Pub Date : 2025-11-01DOI: 10.1016/j.hroo.2025.10.001
{"title":"Erratum to “ID: 4348379 MAPPING THE INVISIBLE: SPATIAL ERP MAPPING AS A TARGETABLE MARKER OF ARRHYTHMOGENIC SUBSTRATE”, Volume 6, Issue 9S, pS41, September 2025","authors":"","doi":"10.1016/j.hroo.2025.10.001","DOIUrl":"10.1016/j.hroo.2025.10.001","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Page 1860"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546473","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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