Indian Pacing and Electrophysiology Journal最新文献

英文中文

Indian experience with cryoablation for paroxysmal and persistent atrial fibrillation 印度冷冻消融治疗阵发性和持续性心房颤动的经验。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2025-11-01 Epub Date: 2025-12-04 DOI: 10.1016/j.ipej.2025.11.016

Sudipta Mondal , Nayani Makkar , Usnish Adhikari , Kakarla Saikiran , Jyothi Vijay , Sreevilasam P. Abhilash , Sabari Saravanan , Narayanan Namboodiri

Background

While the safety and efficacy of cryoablation procedures have been well-established in Western populations, data regarding these outcomes in the subcontinent remain limited.

Methods

This retrospective observational study included patients with paroxysmal atrial fibrillation (PAF) or persistent atrial fibrillation (PsAF) treated with cryoballoon catheter ablation according to standard clinical practice. The primary efficacy endpoints (mean follow-up of 15.3 months) were freedom from AF/atrial flutter (AFL)/atrial tachycardia (AT) lasting ≥30 s. The primary safety endpoint was the occurrence of serious procedure-related adverse events within 30 days of the procedure.

Results

The study population included 66 consecutive patients with recurrent symptomatic atrial fibrillation despite medications and underwent the cryoablation procedure for rhythm control. The cohort had a mean age of 55 ± 14 years, was 77 % male, had a CHA2DS2-VASc score of 1.63 ± 1.53, and had been diagnosed with AF for a mean of 2.93 ± 3.25 years before cryoablation. Patients with PAF comprised 75.8 % of the total cohort. The PsAF subgroup had a significantly larger mean left atrial (LA) diameter (42 mm vs. 36 mm; p < 0.01), lower LVEF (57 % vs 63 %; p = 0.016), fewer presyncope episodes (6 % vs. 30 %; p = 0.048), and higher amiodarone use within last one year (69 % vs. 22 %; p < 0.01). Two serious procedure-related events (3.03 %) occurred (phrenic nerve injury), both of which resolved within 3 months’ follow-up. Freedom from recurrence of atrial arrhythmia at 12 months was 71 % (95 % CI 55–81 %), with a significant difference between PAF 84 % (95 % CI 68–92 %) and PsAF 34 % (95 % CI 10–60 %) groups. Presence of atrial arrhythmia at the beginning of the study (87 % vs 51 %) and failure to terminate it after completion of ablative procedure, requiring electrical cardioversion, impose a higher risk (83 % vs 28 %) of recurrence. No difference was found between the PVI and PVI + groups.

Conclusions

Cryoballoon ablation demonstrated efficiency, safety, and effectiveness in treating patients with paroxysmal and persistent AF. 12-month atrial arrhythmia-free survival rates were significantly higher in patients with PAF compared to those with PsAF. Pre-procedural atrial arrhythmias and post-procedural atrial arrhythmias requiring cardioversion are associated with a higher risk of recurrence. Major procedural adverse effects were comparable to those reported in global standards.

背景：虽然冷冻消融手术的安全性和有效性在西方人群中已经得到证实，但在次大陆地区，关于这些结果的数据仍然有限。方法：本回顾性观察研究纳入阵发性心房颤动（PAF）或持续性心房颤动（PsAF）患者，根据标准临床实践采用冷冻球囊导管消融治疗。主要疗效终点（平均随访15.3个月）是房颤/心房扑动(AFL)/房性心动过速（AT）持续≥30秒。主要安全终点是手术后30天内发生的严重手术相关不良事件。结果：研究人群包括66例连续的复发性症状性心房颤动患者，尽管接受了药物治疗，并接受了冷冻消融手术以控制心律。该队列的平均年龄为55±14岁，男性占77%，CHA2DS2-VASc评分为1.63±1.53，在冷冻消融前诊断为房颤的平均时间为2.93±3.25年。PAF患者占总队列的75.8%。PsAF亚组平均左房直径明显增大（42mm对36mm， p < 0.01）， LVEF明显降低（57%对63%，p = 0.016），晕厥前发作较少（6%对30%，p = 0.048），近一年内胺碘酮的使用率较高（69%对22%，p < 0.01）。发生2例严重手术相关事件（膈神经损伤）（3.03%），均在随访3个月内消退。12个月房性心律失常复发率为71% (95% CI 55-81%), PAF 84% （95% CI 68-92%）和PsAF 34% （95% CI 10-60%）组之间存在显著差异。在研究开始时存在心房心律失常（87%对51%），并且在消融手术完成后未能终止心房心律失常，需要电复律，会增加复发的风险（83%对28%）。PVI组与PVI+组间无差异。结论：低温球囊消融治疗阵发性和持续性房颤的有效性、安全性和有效性。与PsAF患者相比，PAF患者12个月无房性心律失常生存率显著高于PsAF患者。术前心房心律失常和术后需要复律的心房心律失常与较高的复发风险相关。主要程序性不良反应与全球标准报告的不良反应相当。

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ICD-associated R-wave double counting in ARVC: A mechanistic approach to troubleshooting inappropriate shocks 在ARVC中与icd相关的r波重复计数：一种排除不适当冲击的机制方法。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2025-11-01 Epub Date: 2025-11-22 DOI: 10.1016/j.ipej.2025.11.002

Anubhav Das , Anup Khetan , Debabrata Bera , Kingshuk Bag

引用次数: 0

The power of the flower – how to facilitate pentaspline navigation to the right inferior pulmonary vein 花的力量-如何方便五行导航到右下肺静脉。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2025-11-01 Epub Date: 2025-12-01 DOI: 10.1016/j.ipej.2025.12.001

Boris Schmidt MD, FHRS, K.R. Julian Chun MD

引用次数: 0

Unusual electrophysiological features of fasciculoventricular accessory pathway 束状室副通路异常电生理特征

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2025-11-01 Epub Date: 2025-12-22 DOI: 10.1016/j.ipej.2025.12.004

R. Velayutham, R.J. Selvaraj

引用次数: 0

Sudden cardiac death and the role of postmortem genetic testing in unexplained cases 心源性猝死和死后基因检测在不明原因病例中的作用

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2025-11-01 Epub Date: 2025-11-21 DOI: 10.1016/j.ipej.2025.11.005

Deepthi Rajan , Tobias Skjelbred , Thomas Hadberg Lynge , Jacob Tfelt-Hansen

Sudden cardiac death (SCD) is accountable for 10–20 % of deaths in Europe. While inherited and acquired structural heart disease underlie a considerable proportion, many SCDs remain unexplained after conventional autopsy. Lack of structural cardiac abnormalities in sudden death points towards the possibility of inherited heart disease, yet to manifest in observable changes. In fact, 70 % of SCDs in the young are potentially inherited, and causes may be familial hypercholesterolemia, cardiomyopathies, and primary arrhythmias syndromes. Early diagnosis of occult hereditary conditions and initiation of tailored prevention is key in risk reduction of SCD in relatives of deceased individuals. Postmortem genetic testing is recommended in potential inherited causes of SCD, with novel data showing the technique enables detection of concealed cardiomyopathies and channelopathies. Yet widespread implementation is impeded by a number of challenges, including lack of awareness among clinicians of the value of postmortem genetics. Current guidelines from the European Society of Cardiology (ESC) and the American Heart Association (AHA) advise both post-mortem genetic testing of the SCD victim with a potential inherited cause of death and testing of first-degree relatives to prevent future SCDs. Furthermore, it is recommended that specialists interpret findings, and that family evaluation takes place in multidisciplinary collaboration between cardiologists, pathologists, geneticists, and counsellors. This review provides a summary of contemporary knowledge on SCD, outlines guidelines for general forensic management and use of post-mortem genetic testing – including its interpretation, advantages, and challenges - and finally describes standard procedures for investigations of relatives to the deceased individual.

心脏性猝死（SCD）占欧洲死亡人数的10-20%。虽然遗传性和获得性结构性心脏病占相当大的比例，但许多scd在常规尸检后仍无法解释。猝死中缺乏结构性心脏异常指向遗传性心脏病的可能性，但尚未表现为可观察到的变化。事实上，年轻人中70%的SCDs可能是遗传性的，其原因可能是家族性高胆固醇血症、心肌病和原发性心律失常综合征。早期诊断隐性遗传疾病和开始有针对性的预防是降低死亡个体亲属SCD风险的关键。死后基因检测被推荐用于潜在的SCD遗传原因，新数据显示该技术可以检测隐蔽性心肌病和通道病变。然而，广泛实施受到一些挑战的阻碍，包括临床医生对死后遗传学的价值缺乏认识。目前来自欧洲心脏病学会（ESC）和美国心脏协会（AHA）的指南建议对有潜在遗传死亡原因的SCD患者进行死后基因检测，并对一级亲属进行检测，以预防未来的SCD。此外，建议专家解释研究结果，家庭评估应在心脏病专家、病理学家、遗传学家和咨询师之间的多学科合作中进行。这篇综述概述了SCD的当代知识，概述了一般法医管理和使用尸检基因检测的指导方针-包括其解释，优点和挑战-最后描述了死者亲属调查的标准程序。

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引用次数: 0

Spontaneous Pacemaker Lead Screw Retraction: A Single-Center Case Series and Clinical Analysis 自发起搏器螺旋回缩：单中心病例系列和临床分析

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2025-11-01 Epub Date: 2025-12-22 DOI: 10.1016/j.ipej.2025.12.007

S. Sharma , S. Bohora , Raghav Bansal

引用次数: 0

Cavotricuspid Isthmus Anatomy: Clinical Implications for Cardiac Ablation 三尖瓣峡解剖：心脏消融的临床意义

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2025-11-01 Epub Date: 2025-12-22 DOI: 10.1016/j.ipej.2025.12.005

A. Patel, H. Oza, B. Doshi

引用次数: 0

Parameters predicting symptoms related to ventricular premature complexes. 预测室性过早复合体相关症状的参数。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2025-11-01 Epub Date: 2025-12-22 DOI: 10.1016/j.ipej.2025.12.008

V. Mishra, A.H. Ansari, A. Jain, A. Gupta

引用次数: 0

Clinical utility of cardiac MRI at initial evaluation in the diagnosis and management of non-ischemic cardiomyopathies: A prospective cohort study 心脏MRI在非缺血性心肌病诊断和治疗的初步评估中的临床应用：一项前瞻性队列研究

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2025-11-01 Epub Date: 2025-12-22 DOI: 10.1016/j.ipej.2025.12.009

M.H. Nimisha , N.K. Ramya Das MD , A. Anoop , V. Jineesh , Rehna C. Mohamed , Jyothi Vijay , Sai Kiran Karkala , Arun Gopalakrishnan , S.P. Abhilash , Narayanan Namboodiri

引用次数: 0

Retracting PetAls againST the sEptum (Re-PASTE) technique for right inferior pulmonary vein pentaspline pulsed field ablation: A case report 右下肺静脉五顺线脉冲场消融术中瓣瓣对鼻中隔收缩术1例报告。

Q3 Medicine

Indian Pacing and Electrophysiology Journal

Pub Date : 2025-11-01 Epub Date: 2025-10-15 DOI: 10.1016/j.ipej.2025.10.005

Yuhei Kasai , Takayuki Kitai , Junji Morita , Kazuhiro Satomi

Pulsed field ablation is a nonthermal ablation modality with favorable safety and efficacy profiles for pulmonary vein isolation in patients with atrial fibrillation. However, isolating the right inferior pulmonary vein can be technically challenging because of anatomical limitations and restricted catheter maneuverability. We report the case of a 47-year-old man with symptomatic, drug-refractory paroxysmal atrial fibrillation who underwent successful pulsed field ablation under general anesthesia using the FARAPULSE system. The Retracting the PetAls (in the flower configuration) againST the sEptum (Re-PASTE) technique was used in combination with radiopaque markers on the pentaspline FARAWAVE catheter and FARADRIVE sheath to facilitate accurate right inferior pulmonary vein access using fluoroscopic guidance alone. The Re-PASTE technique benefits from the design features of the pentaspline PFA catheter and sheath, such as their widths and lengths and their radiopaque markers, thereby enabling clear identification of the right–left atrial boundary and stable catheter positioning without spline deformation. The technique is simple, reproducible, and effective in addressing right inferior pulmonary vein anatomical challenges. The Re-PASTE technique may enhance procedural safety and efficiency, particularly in cases with difficult right inferior pulmonary vein anatomy, offering a practical solution to a common technical limitation in pulsed field ablation procedures.

脉冲场消融是一种用于心房颤动患者肺静脉隔离的非热消融方式，具有良好的安全性和有效性。然而，由于解剖结构的限制和导管可操作性的限制，隔离右下肺静脉在技术上具有挑战性。我们报告一例47岁男性有症状，药物难治性阵发性心房颤动，他在全身麻醉下使用FARAPULSE系统进行了成功的脉冲场消融。将花瓣（花朵形）对隔膜（Re-PASTE）技术与pentaspline FARAWAVE导管和FARADRIVE鞘上的透射线标记结合使用，以方便仅使用透视引导准确进入右下肺静脉。Re-PASTE技术得益于pentaspline PFA导管和护套的设计特点，如其宽度和长度以及不透射线标记，从而能够清晰地识别左右心房边界，稳定地定位导管，而不会发生样条变形。该技术简单，可重复性好，在解决右下肺静脉解剖难题方面效果显著。Re-PASTE技术可以提高手术安全性和效率，特别是在右下肺静脉解剖困难的情况下，为脉冲场消融手术中常见的技术限制提供了实用的解决方案。

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