Heart Rhythm O2最新文献

{"title":"Early is on time: Minimizing implantable cardioverter-defibrillator shocks through expedited antitachycardia pacing","authors":"Steven Mullane MS , Camden Harrell MS , Valentina Kutyifa MD, PhD , Luigi Di Biase MD, PhD , Malini Madhavan MBBS , Gaurav A. Upadhyay MD , Jim W. Cheung MD","doi":"10.1016/j.hroo.2025.07.023","DOIUrl":"10.1016/j.hroo.2025.07.023","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 11","pages":"Pages 1722-1724"},"PeriodicalIF":2.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145546951","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}

{"title":"Increased lipoprotein(a) levels independently predict a higher incidence of ventricular arrhythmias: A comprehensive retrospective cohort study","authors":"Maryam M. Sani MD, MPH,&nbsp;Tarek Harb MD,&nbsp;Thorsten M. Leucker MD, PhD,&nbsp;Jonathan Chrispin MD","doi":"10.1016/j.hroo.2025.07.001","DOIUrl":"10.1016/j.hroo.2025.07.001","url":null,"abstract":"<div><h3>Background</h3><div>Lipoprotein(a) (Lp(a)) is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and has been linked to ventricular arrhythmias (VA). Beyond its role in cholesterol metabolism, Lp(a) promotes endothelial dysfunction, thrombogenesis, and inflammation, which may contribute to arrhythmogenesis independent of ASCVD.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the association between Lp(a) levels and the incidence of VA in a large, population-based cohort.</div></div><div><h3>Methods</h3><div>Adults aged ≥18 years with available Lp(a) measurements were identified from the TriNetX research network. Patients were stratified into low (≤75 nmol/L) and high Lp(a) groups (&gt;75 nmol/L). The primary outcome was the incidence of VA, defined as ventricular tachycardia, fibrillation, flutter, or cardiac arrest owing to cardiac causes. Propensity score matching was used to adjust for demographics, ASCVD risk factors, and comorbidities. Kaplan-Meier survival analysis and Cox proportional hazards models were performed after matching.</div></div><div><h3>Results</h3><div>Before propensity score matching, 75,655 patients were in the low Lp(a) group and 40,860 in the high Lp(a) group. After matching, each cohort included 39,414 patients. VA occurred in 889 patients in the low and 718 in the high Lp(a) cohort. Mean follow-up was 3.35 years [low Lp(a)] and 1.90 years [high Lp(a)]. The high Lp(a) group had lower VA-free survival (84.30% vs 86.06%, <em>P</em> &lt; .01). High Lp(a) was associated with increased VA risk (hazard ratio 0.855, 95% confidence interval 0.771–0.922, <em>P</em> = .045).</div></div><div><h3>Conclusion</h3><div>Elevated Lp(a) levels are independently associated with a higher incidence of VA, even after adjusting for ASCVD and its downstream consequences. Future research should explore mechanisms and therapeutic implications.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 10","pages":"Pages 1646-1651"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327032","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}

{"title":"Simplified left cardiac sympathetic denervation as an acute strategy for recurrent ventricular tachycardia in multimorbid patients with structural heart disease: A case series","authors":"Konstantin Krieger MD ,&nbsp;Innu Park MD ,&nbsp;Thomas Kemper MD ,&nbsp;Christoph Lösel MD ,&nbsp;Beate Schädlich MD ,&nbsp;Raphael Spittler MD, MSc ,&nbsp;Maren Kirchhöfer MD ,&nbsp;Christina Lohrenz MD ,&nbsp;Stefan Meierling MD ,&nbsp;Boris Alexander Hoffmann MD, BSc","doi":"10.1016/j.hroo.2025.07.009","DOIUrl":"10.1016/j.hroo.2025.07.009","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac sympathetic denervation as a treatment for drug-refractory ventricular arrhythmias (VAs) involves video-assisted thoracoscopic removal of the stellate ganglion (SG) and thoracic ganglia. A simplified approach sparing the SG and targeting left T2–T4 ganglia (left cardiac sympathetic denervation [LCSD]) may offer a less invasive alternative.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the efficacy and safety of simplified SG-sparing LCSD as a bailout procedure for multimorbid patients with structural heart disease and recurrent VAs refractory to antiarrhythmic drugs and/or catheter ablation.</div></div><div><h3>Methods</h3><div>All patients undergoing SG-sparing LCSD at our institution between June 2023 and June 2024 were included in this single-center retrospective study. Baseline demographics, procedural complications, and arrhythmia outcomes were analyzed.</div></div><div><h3>Results</h3><div>LCSD was performed in 7 patients (mean age 75.9 ± 6.7 years, mean LVEF 30.7 ± 10.9%) with structural heart disease (nonischemic cardiomyopathy, n = 3; ischemic cardiomyopathy, n = 4) mostly 1 day (interquartile range 1–21) after admission with a procedure duration of 20.7 ± 5.3 minutes. Initially, 4 patients (57.1%) had electrical storm. Apart from 1 pleural effusion requiring drainage, no major complications or Horner’s syndrome occurred. During a follow-up of 7 ± 2.6 months, median VA episodes requiring implantable cardioverter-defibrillator therapy decreased from 14 to 2 (<em>P</em> = .021) and median implantable cardioverter-defibrillator shocks from 1.5 to 0 (<em>P</em> = .034). Three patients remained free of sustained VAs; 1 patient died of coronavirus disease 2019.</div></div><div><h3>Conclusion</h3><div>In this case series of 7 patients, SG-sparing LCSD demonstrated promising results in terms of safety and efficacy for reducing VAs. Further studies are warranted to confirm long-term outcomes with this approach.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 10","pages":"Pages 1652-1658"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327043","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}

{"title":"Leveraging artificial intelligence for risk stratification of inherited cardiomyopathies in under-resourced settings","authors":"Salah H. Alahwany MD, PhD ,&nbsp;Omnia Kamel MD ,&nbsp;Amir Abdelghany MD ,&nbsp;Ahmed Ammar MD","doi":"10.1016/j.hroo.2025.07.020","DOIUrl":"10.1016/j.hroo.2025.07.020","url":null,"abstract":"<div><div>Inherited cardiomyopathies are a significant global cause of sudden cardiac death, particularly among younger individuals and those in under-resourced regions. Despite progress in diagnostics and therapeutics, screening and risk stratification remain challenging due to genetic complexity, variable clinical presentation, and the interpretive limitations of current electrophysiological and imaging tools. Artificial intelligence (AI)—particularly machine learning, deep learning, and natural language processing offers transformative potential by enabling large-scale analysis of complex data and detecting subtle disease patterns which could potentially improve diagnostic accuracy and cost-effectiveness, particularly in low-resource environments. This review evaluates the limitations of existing risk models, synthesizes disease-specific AI applications within a unified framework, and explores the role of AI in advancing personalized care and risk prediction in underserved populations.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 10","pages":"Pages 1659-1667"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327044","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}

{"title":"Improved spatial stability with a flexible tip ablation catheter in atrial fibrillation ablation","authors":"Michael A. Hoffer-Hawlik MD, MBA ,&nbsp;Lior Jankelson MD, PhD ,&nbsp;Elizabeth Rosinski BS ,&nbsp;Yan Huo MD, PhD ,&nbsp;Isaac Shai BS ,&nbsp;Anthony Aizer MD, FHRS ,&nbsp;Douglas Holmes MD ,&nbsp;Larry A. Chinitz MD, FHRS ,&nbsp;Chirag R. Barbhaiya MD, FHRS","doi":"10.1016/j.hroo.2025.07.015","DOIUrl":"10.1016/j.hroo.2025.07.015","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 10","pages":"Pages 1676-1678"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327047","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}

{"title":"Anatomical considerations for the nontransvenous implantable cardioverter-defibrillator implantation: A cadaver-based analysis","authors":"Peter Khalil MD, FHRS ,&nbsp;Mohammad Hossein Mohammadzadeh MS ,&nbsp;Malli Barremkala MD ,&nbsp;Brian Williamson MD","doi":"10.1016/j.hroo.2025.05.032","DOIUrl":"10.1016/j.hroo.2025.05.032","url":null,"abstract":"<div><h3>Background</h3><div>Sudden cardiac death is a severe health issue, responsible for many deaths annually in the United States. It occurs unexpectedly in individuals without a prior diagnosis of a life-threatening condition. Implantable cardiac defibrillators (ICDs), introduced in the 1980s, have been pivotal in improving survival rates for high-risk patients by detecting and correcting dangerous cardiac rhythms. Traditional transvenous ICD implantation, involving leads threaded through veins, carries risks such as vascular damage and infection. Nontransvenous ICD options, such as subcutaneous ICDs (S-ICDs) and extravascular ICDs, present alternative approaches that may reduce these risks. Implantation techniques for S-ICDdevices have evolved greatly over the years, with the most recently recommended approach being an intermuscular technique. However, this anatomical space has not been adequately studied.</div></div><div><h3>Objective</h3><div>The purpose of this study was to better understand the anatomical variations associated with S-ICD implantation.</div></div><div><h3>Methods</h3><div>This investigation involved a detailed examination of 18 cadaveric specimens (12 females and 6 males) to map the anatomical relationships between the latissimus dorsi muscle (LDM), the serratus anterior muscle, and the long thoracic nerve (LTN), which are critical for refining nontransvenous ICD implantation techniques. Measurements included the distance from the anterior border of the LDM to the back, the anterior-posterior diameter of the chest at the fifth and seventh rib levels, and the positioning of the LTN relative to the chest wall.</div></div><div><h3>Results</h3><div>The analysis showed that at the fifth rib level, the average distance from the back to the LDM border was 7.5 cm, and at the seventh rib level, it was 7.6 cm. The overall average distance from the back to the LDM border across both rib levels was 7.5 cm. The LTN was positioned at an average distance of 8.5 cm from the back at the fourth rib, decreasing to 5.7 cm at the sixth rib. The LTN tended to be more anterior in males than in females, but this difference was not statistically significant.</div></div><div><h3>Conclusion</h3><div>The findings highlight the importance of accurate anatomical knowledge for the effective placement of nontransvenous ICDs. Understanding the specific anatomical layout of the LDM, the serratus anterior muscle, and the LTN is crucial to prevent complications such as LTN injury and to improve the safety and efficacy of ICD implantation. The results advocate for personalized assessment approaches to improve procedural success and patient outcomes in nontransvenous ICD implantation.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 10","pages":"Pages 1575-1578"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327103","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}

{"title":"Lack of impact of baseline QRS morphology on the right heart during long-term left bundle branch pacing in patients with atrioventricular block","authors":"Catalin Pestrea MD, PhD,&nbsp;Ecaterina Cicala MD,&nbsp;Stefania Sisea-Polexa MD,&nbsp;Mircea Dobre MD,&nbsp;Roxana Enache MD,&nbsp;Florin Ortan MD","doi":"10.1016/j.hroo.2025.07.012","DOIUrl":"10.1016/j.hroo.2025.07.012","url":null,"abstract":"<div><h3>Background</h3><div>Insights into right ventricle (RV) activation during left bundle branch pacing (LBBP) have postulated direct transseptal and retrograde physiological pathways, which may be absent in patients with infranodal conduction abnormalities.</div></div><div><h3>Objective</h3><div>This study compared the long-term impact of LBBP on the right heart in patients with atrioventricular block (AVB) according to the baseline QRS morphology.</div></div><div><h3>Methods</h3><div>Overall, 82 patients with successful LBBP for AVB were prospectively evaluated for changes in right atrial volume (RAV), RV diameter, tricuspid annulus peak systolic elevation (TAPSE), RV S' wave, and tricuspid regurgitation (TR).</div></div><div><h3>Results</h3><div>A total of 41.5% had a baseline narrow QRS, 29.3% had right bundle branch block (RBBB), and 29.3% had left bundle branch block (LBBB). RV activation time was similar between the 3 groups. The patients were followed over a mean period of 715.7 ± 194.8 days. In the narrow QRS group, there were no changes between the follow-up and the baseline values for RA volumes, RV diameter, RVS'W, and TR, with a significant improvement in the TAPSE. In the LBBB group, there were no differences in RA volumes, RV diameter, RVS'W, and TAPSE at follow-up, but TR worsened from 0.7 ± 0.7 to 1 ± 0.9 (<em>P</em> = .04). Same changes were seen in the RBBB group, with an increase in TR from 0.6 ± 0.5 to 1 ± 0.7 (<em>P</em> = .02). There was no inter-group difference in the magnitude of change for each right heart echocardiographic parameter.</div></div><div><h3>Conclusion</h3><div>LBBP showed a similar long-term protective effect on the right heart chambers’ dimensions and function in patients with AVB, regardless of the baseline QRS morphology.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 10","pages":"Pages 1579-1586"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327104","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}

{"title":"High-density atrial mapping, P-wave analysis, and computational simulations in Brugada syndrome: Enhancing the understanding of atrial fibrillation","authors":"Beatrice Zanchi PhD ,&nbsp;Ali Gharaviri PhD ,&nbsp;Marco Bergonti MD, PhD ,&nbsp;Simone Pezzuto PhD ,&nbsp;Tardu Özkartal MD ,&nbsp;Maria Luce Caputo MD, PhD ,&nbsp;Esther Scheirlynck MD, PhD ,&nbsp;Carlo de Asmundis MD, PhD ,&nbsp;Francesca Faraci PhD ,&nbsp;Giulio Conte MD, PhD","doi":"10.1016/j.hroo.2025.06.027","DOIUrl":"10.1016/j.hroo.2025.06.027","url":null,"abstract":"<div><h3>Background</h3><div>An increased risk of atrial fibrillation (AF) has been reported in patients with Brugada syndrome (BrS). The pathophysiology of AF susceptibility in BrS is largely unknown.</div></div><div><h3>Objective</h3><div>This study aimed to characterize the atrial electrical properties of patients with BrS with and without AF based on P-wave and high-density atrial mapping analysis with a focus on conduction velocity (CV) and provide mechanistic insights on AF susceptibility using computer modeling.</div></div><div><h3>Methods</h3><div>Electrocardiographic signals were processed, and P-wave parameters were analyzed in a consecutive series of patients with and without BrS. High-density atrial mapping was performed in patients with BrS undergoing an electrophysiological procedure. CV vectors were numerically approximated at each recording point using polynomial surface fitting. AF initiation susceptibility was simulated in a 3-dimensional atrial model and compared with control simulations.</div></div><div><h3>Results</h3><div>A total of 133 subjects (89 patients with BrS and 44 controls) were included. AF history was present in 11% of patients with BrS. Patients with BrS had longer mean P-wave duration than controls (135 ms vs 124 ms, <em>P</em> &lt; .01), whereas no P-wave parameter was able to discriminate between patients with BrS with and without AF. CVs correlated with total atrial activation time (TAAT) (R² = 0.706), and TAATs mildly correlated with P-wave duration (R² = 0.12). A significantly higher conduction pattern complexity, quantified as the number of coexisting fibrillation waves, was observed in BrS than in control simulations. In all simulations, regardless of the degree of fibrosis, AF initiation rates were significantly higher in BrS than in control simulations.</div></div><div><h3>Conclusion</h3><div>Conventional P-wave parameters do not identify patients with BrS prone to AF. Increased TAAT is related to reduced local CVs, explaining the prolonged P-wave duration observed in patients with BrS. Simulation studies showed significantly higher AF susceptibility initiation in patients with BrS than in controls.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 10","pages":"Pages 1621-1631"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327027","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}

{"title":"Predictors of late gadolinium enhancement cardiac MRI image quality in patients with cardiac implantable electronic devices","authors":"Farah Amrani BSc ,&nbsp;Luuk H.G.A. Hopman PhD ,&nbsp;Pieter G. Postema MD, PhD ,&nbsp;Michiel J.B. Kemme MD, PhD ,&nbsp;Cornelis P. Allaart MD, PhD ,&nbsp;Jasper L. Selder MD ,&nbsp;Ramon B. van Loon MD, PhD ,&nbsp;Vokko P. van Halm MD, PhD ,&nbsp;Marco J.W. Götte MD, PhD ,&nbsp;Pranav Bhagirath MD, PhD","doi":"10.1016/j.hroo.2025.07.017","DOIUrl":"10.1016/j.hroo.2025.07.017","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac implantable electronic devices (CIEDs) can cause artifacts in late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (CMR), compromising diagnostic accuracy. No consensus exists on optimal CIED patient selection for LGE-CMR.</div></div><div><h3>Objective</h3><div>This study aims to identify predictors of LGE image quality in patients with CIEDS to optimize pre-scan selection.</div></div><div><h3>Methods</h3><div>Patients with CIEDs who underwent conventional 2D-LGE imaging were retrospectively identified from the Amsterdam UMC CMR database. Baseline clinical and device characteristics were collected, and generator-to-lead distance was measured on post-implantation chest X-rays. LGE quality was categorized as fully diagnostic, acceptable, or non-diagnostic. Multivariable regression and receiver operating characteristic (ROC) analysis determined independent predictors and exploratory generator-to-lead distance thresholds using a 90% sensitivity criterion.</div></div><div><h3>Results</h3><div>Overall, 80 patients (71.3% male, mean age 64 years) were included: 41.3% ICDs, 23.8% pacemakers (PMs), 23.8% cardiac resynchronization therapy defibrillators (CRT-Ds), and 2.5% cardiac resynchronization therapy pacemakers (CRT-Ps). LGE image quality was fully diagnostic in 48.8%, acceptable in 27.5%, and non-diagnostic in 23.8% of patients. PM/CRT-P patients had no non-diagnostic scans (92.9% fully diagnostic). Only 25.0% of ICD/CRT-D scans were fully diagnostic, while 36.5% were non-diagnostic (<em>P</em> &lt; .001). Generator-to-lead distance was significantly associated with LGE quality, with thresholds of 10 cm in ICDs and 8 cm in PMs for acceptable LGE quality.</div></div><div><h3>Conclusion</h3><div>Device type and positioning significantly impact LGE image quality. ICDs were associated with poorer image quality, while PMs consistently yielded diagnostic-quality images. Generator-to-lead distance emerged as a key predictor, providing a practical tool for optimizing LGE-CMR referrals. This study defines generator-to-lead distance thresholds by device type and proposes a structured pre-scan workflow to support LGE-CMR referral decisions in patients with CIEDs.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 10","pages":"Pages 1594-1600"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327106","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}

{"title":"The efficiency and safety of zero-exchange workflows in pulsed field ablation: Comprehensive insights from the DISRUPT-AF registry","authors":"Robert Eckart MD,FHRS ,&nbsp;Robert Brewer MD ,&nbsp;Devi Nair MD, FHRS ,&nbsp;Jonathan Dukes MD ,&nbsp;John Costello MD ,&nbsp;Matthew D. Martens PhD ,&nbsp;Saja Al-Dujaili PhD ,&nbsp;Brad S. Sutton MD ,&nbsp;Jose Osorio MD, FHRS ,&nbsp;Amin Al-Ahmad MD, FHRS ,&nbsp;DISRUPT-AF Investigators","doi":"10.1016/j.hroo.2025.07.014","DOIUrl":"10.1016/j.hroo.2025.07.014","url":null,"abstract":"<div><h3>Background</h3><div>Pulsed field ablation (PFA) has revolutionized catheter ablation procedures in terms of safety, efficiency, and efficacy. Streamlined zero-exchange workflows with therapy sheath integrated transseptal puncture (TSP) devices may offer further improvements. However, the impact of device exchanges on real-world PFA procedures remains unknown.</div></div><div><h3>Objective</h3><div>We aimed to describe and quantify procedural characteristics associated with different PFA workflows.</div></div><div><h3>Methods</h3><div>The DISRUPT-AF registry (NCT06335082) is an observational, prospective study assessing clinical experience with the pentaspline PFA system in the United States. Procedures are performed as per standard-of-care, where specific workflows and left atrial (LA) access devices were not mandated.</div></div><div><h3>Results</h3><div>A total of 873 cases (mean age, 68.0 ± 11.4 years; 38.6% women) with 62 unique operators across 20 centers were assessed. Of these, 10.1%, 63.1%, and 26.8% reported “0”-, “1–2”-, and “3+”-exchanges, respectively. Regardless of atrial fibrillation subtype, zero-exchange workflows were associated with significantly shorter and more consistent TSP times (0:5.7 ± 4.2 min; 1–2:15.3 ± 7.3 min; 3+:19.2 ± 9.3 min; <em>P &lt;</em>0.001), left atrium dwell times (0:26.9 ± 10.2 min; 1–2:36.8 ± 13.2 min; 3+:50.8 ± 17.8 min; <em>P &lt;</em> .001), and relative procedure times (0: 100%; 1–2: 152.7%; 3+: 209.4%; <em>P &lt;</em> .001), when compared with 1–2 and 3+-exchange procedures. Despite this increased efficiency, there were no differences in TSP success rates, PFA lesion count, acute pulmonary vein isolation rates, and procedural complication rates between the 3 workflows.</div></div><div><h3>Conclusion</h3><div>The adoption of zero-exchange workflows enabled by therapy sheath-integrated TSP devices results in significant improvements in procedural efficiency and predictability without compromising patient safety or acute outcomes.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"6 10","pages":"Pages 1508-1515"},"PeriodicalIF":2.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327387","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}