Hina Ahmed Siddiqui, Mounika Kotte, Hilana Soliman Omar, Saad Manzoor, Zohaib Qasim, Fnu Abdullah, Sadia Siddique, Muhammad Bari Hassan, Ali Karim, Hansa Devi, Ekta Rani, Aniket Tara, Payal Bai, Sajid Ali, Hina Kumari, Sitara Jabeen, Vikram Kumar, Abida Perveen
Background
Left bundle branch area pacing (LBBAP) is an emerging physiological pacing technique that restores ventricular electrical synchrony by directly engaging the left conduction system. It has been proposed as an alternative to conventional pacing strategies, particularly in heart failure patients with reduced left ventricular ejection fraction (LVEF ≤ 50%).
Methods
A systematic literature search of PubMed, MEDLINE, and Scopus was conducted up to December 2024 in accordance with PRISMA guidelines. Sixteen studies involving 5680 patients were included. Reported outcomes included changes in LVEF, QRS duration (QRSd), hospitalization rates, complications, and mortality. Due to heterogeneity among studies, a qualitative narrative synthesis was performed.
Results
LBBAP was associated with significant improvements in cardiac function, with most studies reporting increased LVEF and marked reductions in QRSd, indicating improved electrical synchrony. Complication rates were low, with rare events such as pneumothorax and lead dislodgement. Heart failure–related hospitalizations were lower with LBBAP compared with biventricular pacing (19.05% vs. 30.00%), while mortality rates remained low across pacing strategies. Overall, LBBAP demonstrated superior electrical resynchronization and favorable clinical outcomes compared with conventional pacing modalities.
Conclusion
LBBAP is a promising pacing strategy that improves electrical synchrony and cardiac function with a favorable short- to mid-term safety profile. Further large-scale randomized studies are needed to establish its long-term efficacy and safety.
{"title":"Outcomes of Left Bundle Branch Area Pacing in Heart Failure Patients: A Systematic Review","authors":"Hina Ahmed Siddiqui, Mounika Kotte, Hilana Soliman Omar, Saad Manzoor, Zohaib Qasim, Fnu Abdullah, Sadia Siddique, Muhammad Bari Hassan, Ali Karim, Hansa Devi, Ekta Rani, Aniket Tara, Payal Bai, Sajid Ali, Hina Kumari, Sitara Jabeen, Vikram Kumar, Abida Perveen","doi":"10.1111/anec.70158","DOIUrl":"10.1111/anec.70158","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Left bundle branch area pacing (LBBAP) is an emerging physiological pacing technique that restores ventricular electrical synchrony by directly engaging the left conduction system. It has been proposed as an alternative to conventional pacing strategies, particularly in heart failure patients with reduced left ventricular ejection fraction (LVEF ≤ 50%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic literature search of PubMed, MEDLINE, and Scopus was conducted up to December 2024 in accordance with PRISMA guidelines. Sixteen studies involving 5680 patients were included. Reported outcomes included changes in LVEF, QRS duration (QRSd), hospitalization rates, complications, and mortality. Due to heterogeneity among studies, a qualitative narrative synthesis was performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>LBBAP was associated with significant improvements in cardiac function, with most studies reporting increased LVEF and marked reductions in QRSd, indicating improved electrical synchrony. Complication rates were low, with rare events such as pneumothorax and lead dislodgement. Heart failure–related hospitalizations were lower with LBBAP compared with biventricular pacing (19.05% vs. 30.00%), while mortality rates remained low across pacing strategies. Overall, LBBAP demonstrated superior electrical resynchronization and favorable clinical outcomes compared with conventional pacing modalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>LBBAP is a promising pacing strategy that improves electrical synchrony and cardiac function with a favorable short- to mid-term safety profile. Further large-scale randomized studies are needed to establish its long-term efficacy and safety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12865226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146103299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stephanie Happ, Satish R. Raj, Derek Chew, Robert Sheldon
Background
Syncope in adults at least 50 years old without structural or electrical heart disease has numerous potential causes, and uncertainty persists in up to 41% of patients. Guideline-directed investigations include implantable cardiac monitoring (ICM) and tilt table testing (TTT). Physician preferences about which to perform first are unknown. We aimed to understand physician opinions on whether to first utilize ICM or TTT to investigate syncope in older patients without electrical or structural heart disease.
Methods
Physicians assessing syncope patients completed an online survey about diagnostic strategy, test availability, and values about test accuracy and clinical consequences.
Results
Seventy-one physicians completed the survey; 77% were cardiac electrophysiologists. Most respondents (62%) felt the optimum first test depended on the clinical scenario, 30% preferred an ICM, and 8% preferred a TTT. Tests were widely available: both tests were present in 76% of sites, TTT alone in 3%, ICM alone in 18%, and neither in 3%. TTT was preferred in Europe (75%) while ICM was preferred in North America (85%; p = 0.024). Concerns about missed diagnoses were expressed about TTT by 61% of physicians and only 19% for ICM. Following a negative first test, physicians were more likely to recommend an ICM (39%) than a TTT (11%), and more likely to watchfully wait after a negative ICM (45%) than a negative TTT (11%; p < 0.001).
Conclusion
International equipoise exists about whether to pursue strategies of first conducting a TTT or implanting an ICM, although opinions differ between physicians practicing in Europe and North America.
Trial Registration
ClinicalTrials.gov identifier: NCT05776810
背景：50岁以上无结构性或电性心脏病的成人晕厥有许多潜在原因，高达41%的患者仍存在不确定性。指导调查包括植入式心脏监测（ICM）和倾斜台试验（TTT）。医生对先做哪一种手术的偏好是未知的。我们的目的是了解医生对是否首先使用ICM或TTT来调查无电性或结构性心脏病的老年患者晕厥的意见。方法：评估晕厥患者的医生完成了一项关于诊断策略、测试可用性、测试准确性和临床后果的在线调查。结果：71名医生完成了调查；77%为心脏电生理学家。大多数受访者（62%）认为最佳的首次测试取决于临床情况，30%的人更喜欢ICM， 8%的人更喜欢TTT。检测方法广泛使用：76%的检测地点有两种检测方法，3%单独有TTT， 18%单独有ICM， 3%两者都没有。欧洲首选TTT(75%)，北美首选ICM （85%; p = 0.024）。61%的医生对TTT的漏诊表示担忧，而ICM的漏诊仅为19%。在首次检测呈阴性后，医生更有可能推荐ICM（39%）而不是TTT(11%)，并且更有可能在ICM阴性后谨慎等待（45%）而不是TTT阴性（11%）。p结论：对于是否采取首先进行TTT或植入ICM的策略存在国际均衡，尽管在欧洲和北美执业的医生之间存在意见分歧。试验注册：ClinicalTrials.gov标识符：NCT05776810。
{"title":"Physician Perspectives on the Initial Diagnostic Strategy of Syncope in Older Patients Without Diagnostic Clues","authors":"Stephanie Happ, Satish R. Raj, Derek Chew, Robert Sheldon","doi":"10.1111/anec.70155","DOIUrl":"10.1111/anec.70155","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Syncope in adults at least 50 years old without structural or electrical heart disease has numerous potential causes, and uncertainty persists in up to 41% of patients. Guideline-directed investigations include implantable cardiac monitoring (ICM) and tilt table testing (TTT). Physician preferences about which to perform first are unknown. We aimed to understand physician opinions on whether to first utilize ICM or TTT to investigate syncope in older patients without electrical or structural heart disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Physicians assessing syncope patients completed an online survey about diagnostic strategy, test availability, and values about test accuracy and clinical consequences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy-one physicians completed the survey; 77% were cardiac electrophysiologists. Most respondents (62%) felt the optimum first test depended on the clinical scenario, 30% preferred an ICM, and 8% preferred a TTT. Tests were widely available: both tests were present in 76% of sites, TTT alone in 3%, ICM alone in 18%, and neither in 3%. TTT was preferred in Europe (75%) while ICM was preferred in North America (85%; <i>p</i> = 0.024). Concerns about missed diagnoses were expressed about TTT by 61% of physicians and only 19% for ICM. Following a negative first test, physicians were more likely to recommend an ICM (39%) than a TTT (11%), and more likely to watchfully wait after a negative ICM (45%) than a negative TTT (11%; <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>International equipoise exists about whether to pursue strategies of first conducting a TTT or implanting an ICM, although opinions differ between physicians practicing in Europe and North America.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: NCT05776810</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146083818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aneliya San, Ilan Goldenberg, Arwa Younis, Kris Cutter, Scott McNitt, Nona Sotoodehnia, Peter J. Kudenchuk, Thomas D. Rea, Dan E. Arking, Bronislava Polonsky, Wojciech Zareba, Mehmet Kemal Aktaş
Background
Women with congenital and acquired long QT syndrome (LQTS) have increased risk of adverse cardiac events after adolescence, mainly due to sex hormones modulating the KCNH2 cardiac potassium channel. We hypothesized that sex hormones may influence ventricular tachyarrhythmia risk during the menstrual cycle in women treated with QT-prolonging drugs.
Objective
To evaluate the association between repolarization dynamics and sex hormone levels during the menstrual cycle in women treated with QT-prolonging drugs.
Methods
We prospectively enrolled 41 women treated with dofetilide or sotalol (N = 20) and healthy controls (N = 21). Participants underwent three 7-day ECG recordings during their menstrual cycles, with concurrent saliva hormone measurements. Primary ECG outcomes were QT-Apex (early repolarization) and QT interval (total repolarization time), adjusted for heart rate.
Results
The mean age was 51 ± 11 years in the treatment group and 42 ± 12 years in controls. In women treated with QT-prolonging drugs, linear mixed-effects models (adjusted for RR interval) showed inverse correlations of QT-Apex with progesterone-to-estradiol ratio (p = 0.018) and testosterone (p = 0.026), and a direct correlation with estradiol (p = 0.004). QT interval inversely correlated with progesterone-to-estradiol ratio (p = 0.012). No significant correlations were observed in controls.
Conclusions
Sex hormones are significantly associated with ventricular repolarization dynamics during the menstrual cycle in women treated with QT-prolonging drugs, suggesting a mechanism for sex-specific arrhythmia susceptibility.
{"title":"Sex Hormones and Repolarization Dynamics During the Menstrual Cycle in Women Treated With QT-Prolonging Drugs","authors":"Aneliya San, Ilan Goldenberg, Arwa Younis, Kris Cutter, Scott McNitt, Nona Sotoodehnia, Peter J. Kudenchuk, Thomas D. Rea, Dan E. Arking, Bronislava Polonsky, Wojciech Zareba, Mehmet Kemal Aktaş","doi":"10.1111/anec.70151","DOIUrl":"10.1111/anec.70151","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Women with congenital and acquired long QT syndrome (LQTS) have increased risk of adverse cardiac events after adolescence, mainly due to sex hormones modulating the KCNH2 cardiac potassium channel. We hypothesized that sex hormones may influence ventricular tachyarrhythmia risk during the menstrual cycle in women treated with QT-prolonging drugs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the association between repolarization dynamics and sex hormone levels during the menstrual cycle in women treated with QT-prolonging drugs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We prospectively enrolled 41 women treated with dofetilide or sotalol (<i>N</i> = 20) and healthy controls (<i>N</i> = 21). Participants underwent three 7-day ECG recordings during their menstrual cycles, with concurrent saliva hormone measurements. Primary ECG outcomes were QT-Apex (early repolarization) and QT interval (total repolarization time), adjusted for heart rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age was 51 ± 11 years in the treatment group and 42 ± 12 years in controls. In women treated with QT-prolonging drugs, linear mixed-effects models (adjusted for RR interval) showed inverse correlations of QT-Apex with progesterone-to-estradiol ratio (<i>p</i> = 0.018) and testosterone (<i>p</i> = 0.026), and a direct correlation with estradiol (<i>p</i> = 0.004). QT interval inversely correlated with progesterone-to-estradiol ratio (<i>p</i> = 0.012). No significant correlations were observed in controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Sex hormones are significantly associated with ventricular repolarization dynamics during the menstrual cycle in women treated with QT-prolonging drugs, suggesting a mechanism for sex-specific arrhythmia susceptibility.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12823772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146016990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Left ventricular non-compaction (LVNC) is a rare cardiomyopathy characterized by prominent trabeculations and deep recesses. Neonatal cases, particularly with severe metabolic disturbances, are uncommon. We report a 2-day-old neonate with LVNC and dilated cardiomyopathy, presenting recurrent heart failure associated with hyperkalemia, metabolic acidosis, hyperlactatemia, and hypoglycemia. Management included mechanical ventilation, metabolic correction, and heart failure therapy, leading to improved cardiac function. Genetic analysis revealed a de novo heterozygous pathogenic ACTN2 deletion spanning exons 2–6. This case broadens the phenotypic spectrum of ACTN2-related LVNC and suggests a potential link between metabolic disturbances and cardiac deterioration.
{"title":"De Novo ACTN2 Variant in a Chinese Neonate With Left Ventricular Non-Compaction and Metabolic Disturbances: A Rare Case Report","authors":"Jinqiu Huang, Ziyue Zhang, Juxian Yang","doi":"10.1111/anec.70117","DOIUrl":"10.1111/anec.70117","url":null,"abstract":"<p>Left ventricular non-compaction (LVNC) is a rare cardiomyopathy characterized by prominent trabeculations and deep recesses. Neonatal cases, particularly with severe metabolic disturbances, are uncommon. We report a 2-day-old neonate with LVNC and dilated cardiomyopathy, presenting recurrent heart failure associated with hyperkalemia, metabolic acidosis, hyperlactatemia, and hypoglycemia. Management included mechanical ventilation, metabolic correction, and heart failure therapy, leading to improved cardiac function. Genetic analysis revealed a de novo heterozygous pathogenic <i>ACTN2</i> deletion spanning exons 2–6. This case broadens the phenotypic spectrum of <i>ACTN2</i>-related LVNC and suggests a potential link between metabolic disturbances and cardiac deterioration.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146008540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
His bundle typically passes through the central fibrous body of the atrioventricular node and then enters the membranous portion of the interventricular septum, where it branches into the left and right bundle branches. The feasibility and safety of left bundle branch area pacing (LBBAP) in patients with perimembranous ventricular septal defect (pmVSD) have not been reported.
{"title":"Is Left Bundle Branch Pacing Feasible in Patients With Ventricular Septal Defect?","authors":"Binbin Luo, Longfu Jiang, Lu Zhang, Jiabo Shen","doi":"10.1111/anec.70150","DOIUrl":"10.1111/anec.70150","url":null,"abstract":"<p>His bundle typically passes through the central fibrous body of the atrioventricular node and then enters the membranous portion of the interventricular septum, where it branches into the left and right bundle branches. The feasibility and safety of left bundle branch area pacing (LBBAP) in patients with perimembranous ventricular septal defect (pmVSD) have not been reported.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12820410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146008563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Saad Manzoor, Mounika Kotte, Jahanzeb Malik, Bhavna Singla, Shivam Singla, Muhammad Subhan, Fnu Sandesh, Pooja Kumari, Abdullah Ashraf, Abida Perveen
Objective
This meta-analysis aimed to evaluate the impact of esophageal temperature monitoring (ETM) on the incidence of esophageal injury during cryoballoon ablation (CBA) for atrial fibrillation (AF).
Methods
A systematic search identified randomized controlled and observational studies comparing CBA procedures performed with versus without ETM. Data on study design, patient characteristics, procedural details, and esophageal outcomes were extracted. The primary endpoint was the incidence of endoscopically detected esophageal lesions (EDEL). Secondary outcomes included severe ulceration, symptomatic esophageal thermal injury (ETI), and atrioesophageal fistula (AEF). Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Risk of bias was assessed according to Cochrane guidelines, and publication bias was evaluated with funnel plots.
Results
Four studies comprising 269 patients were included. ETM significantly reduced the risk of EDEL compared with no ETM (pooled OR 0.57, 95% CI 0.39–0.85), with low to moderate heterogeneity. Subgroup analyses confirmed consistent benefits across randomized and observational designs. Severe esophageal ulceration and symptomatic ETI were infrequent, and no AEF cases were reported. Funnel plot analysis indicated no major publication bias.
Conclusion
ETM significantly lowers the incidence of esophageal injury during CBA and should be considered a routine safety measure to improve procedural outcomes.
目的：本荟萃分析旨在评估食道温度监测（ETM）对房颤（AF）冷冻球囊消融（CBA）期间食道损伤发生率的影响。方法：系统检索了随机对照和观察性研究，比较了有ETM和没有ETM的CBA手术。提取了有关研究设计、患者特征、手术细节和食管结局的数据。主要终点是内镜检查食管病变（EDEL）的发生率。次要结局包括严重溃疡、症状性食管热损伤（ETI）和房-食管瘘（AEF）。比值比（ORs）和95%置信区间（ci）采用随机效应模型进行汇总。根据Cochrane指南评估偏倚风险，用漏斗图评估发表偏倚。结果：纳入4项研究，共269例患者。与未行ETM相比，ETM显著降低了EDEL的风险（合并OR 0.57, 95% CI 0.39-0.85），具有低至中等异质性。亚组分析证实了随机设计和观察设计的一致益处。严重食管溃疡和有症状的ETI少见，无AEF病例报道。漏斗图分析显示无重大发表偏倚。结论：ETM可显著降低CBA术中食管损伤的发生率，应作为一种常规的安全措施，以改善手术结果。
{"title":"Impact of Esophageal Temperature Monitoring on Esophageal Injury in PVI: A Systematic Review and Meta-Analysis","authors":"Saad Manzoor, Mounika Kotte, Jahanzeb Malik, Bhavna Singla, Shivam Singla, Muhammad Subhan, Fnu Sandesh, Pooja Kumari, Abdullah Ashraf, Abida Perveen","doi":"10.1111/anec.70156","DOIUrl":"10.1111/anec.70156","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This meta-analysis aimed to evaluate the impact of esophageal temperature monitoring (ETM) on the incidence of esophageal injury during cryoballoon ablation (CBA) for atrial fibrillation (AF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search identified randomized controlled and observational studies comparing CBA procedures performed with versus without ETM. Data on study design, patient characteristics, procedural details, and esophageal outcomes were extracted. The primary endpoint was the incidence of endoscopically detected esophageal lesions (EDEL). Secondary outcomes included severe ulceration, symptomatic esophageal thermal injury (ETI), and atrioesophageal fistula (AEF). Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Risk of bias was assessed according to Cochrane guidelines, and publication bias was evaluated with funnel plots.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four studies comprising 269 patients were included. ETM significantly reduced the risk of EDEL compared with no ETM (pooled OR 0.57, 95% CI 0.39–0.85), with low to moderate heterogeneity. Subgroup analyses confirmed consistent benefits across randomized and observational designs. Severe esophageal ulceration and symptomatic ETI were infrequent, and no AEF cases were reported. Funnel plot analysis indicated no major publication bias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ETM significantly lowers the incidence of esophageal injury during CBA and should be considered a routine safety measure to improve procedural outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12816882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 30-year-old woman with a history of prior ablation for a concealed left posteroseptal accessory pathway (AP) presented with incessant narrow QRS tachycardia, highlighting a rare complication of incomplete AP ablation.
Methods and Results
Adenosine transiently terminated the tachycardia, which recurred immediately. Electrophysiology study confirmed orthodromic atrioventricular reentry tachycardia (AVRT) due to a slow-conducting AP at the previously ablated site. Three-dimensional mapping localized the AP to the left posteroseptal region, and radiofrequency ablation at the shortest VA interval successfully eliminated the arrhythmia.
Conclusion
This case illustrates incessant AVRT caused by an iatrogenic slow-conducting posteroseptal accessory pathway following incomplete ablation. Recognition of this mechanism is important to guide appropriate repeat ablation and prevent tachycardia-induced cardiomyopathy.
{"title":"Incessant Narrow QRS Complex Tachycardia in a Patient With a Prior Ablation History","authors":"Yi Liu, Yuwei Chen, Xiangbin Xiao, Xiaobo Pu","doi":"10.1111/anec.70154","DOIUrl":"10.1111/anec.70154","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>A 30-year-old woman with a history of prior ablation for a concealed left posteroseptal accessory pathway (AP) presented with incessant narrow QRS tachycardia, highlighting a rare complication of incomplete AP ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>Adenosine transiently terminated the tachycardia, which recurred immediately. Electrophysiology study confirmed orthodromic atrioventricular reentry tachycardia (AVRT) due to a slow-conducting AP at the previously ablated site. Three-dimensional mapping localized the AP to the left posteroseptal region, and radiofrequency ablation at the shortest VA interval successfully eliminated the arrhythmia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case illustrates incessant AVRT caused by an iatrogenic slow-conducting posteroseptal accessory pathway following incomplete ablation. Recognition of this mechanism is important to guide appropriate repeat ablation and prevent tachycardia-induced cardiomyopathy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12811688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145987827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>We read with interest the article by Kazantzi et al. examining the association between established P-wave parameters and left atrial hemodynamics in the context of atrial cardiomyopathy (ACM) (Kazantzi et al. <span>2026</span>). The authors should be acknowledged for addressing a clinically relevant question using a prospective design and comprehensive echocardiographic assessment. Their conclusion that advanced interatrial block (IAB) is the most reliable electrocardiographic marker of impaired left atrial function is clearly presented and supported by internal consistency within the dataset.</p><p>Nevertheless, several methodological aspects warrant closer scrutiny. The study population is heterogeneous, comprising patients with prior atrial fibrillation, embolic stroke of undetermined source, and individuals without manifest cardiovascular disease. While this broad inclusion enhances external validity, it may dilute pathophysiologically specific associations between P-wave indices and atrial remodeling. Current consensus documents emphasize that ACM represents a spectrum with variable electrical, structural, and mechanical manifestations, and pooling such diverse phenotypes may obscure parameter-specific diagnostic performance (Goette et al. <span>2024</span>).</p><p>A further concern relates to the operational definition of pathological P-wave parameters. Thresholds derived from consensus recommendations are largely based on epidemiological associations rather than mechanistic validation against atrial tissue pathology or gold-standard imaging. In particular, the dismissal of P-wave terminal force in lead V1 as a hemodynamic marker may reflect cohort characteristics rather than a true lack of biological relevance, given its previously demonstrated association with atrial fibrosis and stroke risk in population-based studies (Kamel et al. <span>2014</span>).</p><p>Additionally, the reliance on cross-sectional echocardiographic markers limits causal inference. Left atrial strain and PA-TDI are sensitive indicators of atrial function, yet they remain load-dependent and subject to inter-vendor variability. Longitudinal assessment or correlation with advanced imaging modalities such as late gadolinium-enhanced cardiac magnetic resonance imaging could have strengthened the argument that advanced IAB truly captures the substrate of atrial cardiomyopathy rather than representing an epiphenomenon of aging and comorbidity burden (Bisbal et al. <span>2020</span>).</p><p>Finally, the clinical implications of prioritizing advanced IAB over other P-wave parameters deserve cautious interpretation. While advanced IAB appears strongly associated with impaired atrial hemodynamics, its relatively low prevalence may limit utility as a screening tool. A multiparametric approach integrating electrocardiographic, echocardiographic, and biomarker data may better reflect the complex biology of ACM and align with contemporary views of atrial disease as a continuum r
我们饶有兴趣地阅读了Kazantzi等人的文章，该文章研究了心房心肌病（ACM）背景下已建立的p波参数与左房血流动力学之间的关系（Kazantzi et al. 2026）。作者使用前瞻性设计和全面的超声心动图评估来解决临床相关问题，应该得到承认。他们的结论是，晚期房间传导阻滞（IAB）是左房功能受损最可靠的心电图标志物，这一结论得到了数据集内部一致性的清晰呈现和支持。然而，有几个方法方面值得更仔细的审查。研究人群是异质性的，包括既往房颤患者、来源不明的栓塞性卒中患者和无明显心血管疾病的个体。虽然这种广泛的包含增强了外部有效性，但它可能会淡化p波指数与心房重构之间的病理生理特异性关联。目前的共识文件强调，ACM代表了一个具有可变电学、结构和力学表现的光谱，汇集这些不同的表型可能会模糊特定参数的诊断性能（Goette et al. 2024）。进一步的关注涉及病理p波参数的操作定义。从共识建议中得出的阈值主要基于流行病学关联，而不是针对心房组织病理学或金标准成像的机制验证。特别是，考虑到先前在基于人群的研究中证实与心房纤维化和卒中风险相关，V1导联p波末端力作为血流动力学标志物的消失可能反映了队列特征，而不是真正缺乏生物学相关性（Kamel et al. 2014）。此外，对横断面超声心动图标记物的依赖限制了因果推断。左心房应变和PA-TDI是心房功能的敏感指标，但它们仍然依赖于负荷，并受到供应商之间的差异。纵向评估或与晚期钆增强心脏磁共振成像等先进成像方式的相关性可能会加强这样一种观点，即先进的IAB真正捕获了心房心肌病的基底，而不是代表衰老和合并症负担的附带现象（Bisbal et al. 2020）。最后，优先考虑晚期IAB而不是其他p波参数的临床意义值得谨慎解释。虽然晚期IAB似乎与心房血流动力学受损密切相关，但其相对较低的患病率可能限制了其作为筛查工具的效用。综合心电图、超声心动图和生物标志物数据的多参数方法可能更好地反映ACM的复杂生物学，并与当代心房疾病作为一个连续体而不是二元实体的观点保持一致（Kreimer和Gotzmann 2022）。所有的作者都对计划、写作和修订做出了贡献。作者没有什么可报告的。作者声明无利益冲突。数据共享不适用于本文，因为在当前研究中没有生成或分析数据集。
{"title":"Electrocardiographic Markers of Atrial Cardiomyopathy: Strengths and Limits of P-Wave–Based Assessment","authors":"Mehmet Mustafa Yılmaz, Mücahit Aker, Macit Kalçık","doi":"10.1111/anec.70152","DOIUrl":"10.1111/anec.70152","url":null,"abstract":"<p>We read with interest the article by Kazantzi et al. examining the association between established P-wave parameters and left atrial hemodynamics in the context of atrial cardiomyopathy (ACM) (Kazantzi et al. <span>2026</span>). The authors should be acknowledged for addressing a clinically relevant question using a prospective design and comprehensive echocardiographic assessment. Their conclusion that advanced interatrial block (IAB) is the most reliable electrocardiographic marker of impaired left atrial function is clearly presented and supported by internal consistency within the dataset.</p><p>Nevertheless, several methodological aspects warrant closer scrutiny. The study population is heterogeneous, comprising patients with prior atrial fibrillation, embolic stroke of undetermined source, and individuals without manifest cardiovascular disease. While this broad inclusion enhances external validity, it may dilute pathophysiologically specific associations between P-wave indices and atrial remodeling. Current consensus documents emphasize that ACM represents a spectrum with variable electrical, structural, and mechanical manifestations, and pooling such diverse phenotypes may obscure parameter-specific diagnostic performance (Goette et al. <span>2024</span>).</p><p>A further concern relates to the operational definition of pathological P-wave parameters. Thresholds derived from consensus recommendations are largely based on epidemiological associations rather than mechanistic validation against atrial tissue pathology or gold-standard imaging. In particular, the dismissal of P-wave terminal force in lead V1 as a hemodynamic marker may reflect cohort characteristics rather than a true lack of biological relevance, given its previously demonstrated association with atrial fibrosis and stroke risk in population-based studies (Kamel et al. <span>2014</span>).</p><p>Additionally, the reliance on cross-sectional echocardiographic markers limits causal inference. Left atrial strain and PA-TDI are sensitive indicators of atrial function, yet they remain load-dependent and subject to inter-vendor variability. Longitudinal assessment or correlation with advanced imaging modalities such as late gadolinium-enhanced cardiac magnetic resonance imaging could have strengthened the argument that advanced IAB truly captures the substrate of atrial cardiomyopathy rather than representing an epiphenomenon of aging and comorbidity burden (Bisbal et al. <span>2020</span>).</p><p>Finally, the clinical implications of prioritizing advanced IAB over other P-wave parameters deserve cautious interpretation. While advanced IAB appears strongly associated with impaired atrial hemodynamics, its relatively low prevalence may limit utility as a screening tool. A multiparametric approach integrating electrocardiographic, echocardiographic, and biomarker data may better reflect the complex biology of ACM and align with contemporary views of atrial disease as a continuum r","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12784103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Temporary pacing during acute inferior MI or no-reflow can trigger ventricular fibrillation rather than prevent it. Four mechanisms are highlighted: (1) acute ischemia lowers VF threshold and creates repolarization heterogeneity; (2) fragmented electrograms cause undersensing and asynchronous spikes; (3) bradycardia-related long RR cycles position spikes on the T-wave (“R-on-T”); and (4) catheter micro-displacement induces mechanical extrasystoles. We propose a bedside decision framework—three questions before pacing—and a prevention bundle focused on urgent ischemia reversal, continuous electrogram surveillance, and early electrode removal. Bradycardia in this setting is often transient, but the electrophysiological vulnerability is not. Treating ischemia first and avoiding unnecessary pacing are paramount to prevent iatrogenic arrhythmia.
{"title":"Why Temporary Pacing in Acute Inferior Myocardial Infarction or No-Reflow Becomes a Trigger—Not a Remedy—For Ventricular Fibrillation: Undersensing, “R-On-T”, Catheter Trauma and the Ischaemic Substrate","authors":"Zhong-Qun Zhan, Hai-Jun Xu","doi":"10.1111/anec.70149","DOIUrl":"10.1111/anec.70149","url":null,"abstract":"<p>Temporary pacing during acute inferior MI or no-reflow can trigger ventricular fibrillation rather than prevent it. Four mechanisms are highlighted: (1) acute ischemia lowers VF threshold and creates repolarization heterogeneity; (2) fragmented electrograms cause undersensing and asynchronous spikes; (3) bradycardia-related long RR cycles position spikes on the T-wave (“R-on-T”); and (4) catheter micro-displacement induces mechanical extrasystoles. We propose a bedside decision framework—three questions before pacing—and a prevention bundle focused on urgent ischemia reversal, continuous electrogram surveillance, and early electrode removal. Bradycardia in this setting is often transient, but the electrophysiological vulnerability is not. Treating ischemia first and avoiding unnecessary pacing are paramount to prevent iatrogenic arrhythmia.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12784284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aveir, as a newly approved leadless pacemaker (LP), has been increasingly adopted in clinical practice. However, its application in the Chinese population remains limited. This retrospective study aimed to evaluate the safety and efficacy of the Aveir LP in Chinese patients.
Methods
A retrospective analysis was conducted on patients who underwent LP implantation at the First Affiliated Hospital of Xiamen University between June 2024 and October 2024. Implantation sites included the right ventricular septum and the right ventricular free wall. Parameters were collected preoperatively and at 1-month post-implantation.
Results
A total of 16 patients were included, and all cases achieved successful implantation. At the 1-month follow-up, the pacing threshold improved from 0.68 ± 0.42 to 0.59 ± 0.27 V, impedance decreased from 740.00 ± 268.53 to 557.5 ± 129.69 Ω, and R-wave sensing increased from 8.51 ± 3.83 to 11.4 ± 4.22 mV. No complications were observed. There were no significant differences in measurements of the aorta, ascending aorta, left atrium, right atrium, left ventricular end-diastolic diameter, interventricular septal thickness, left ventricular end-systolic diameter, or ejection fraction between preoperative and 1-month post-implantation. Similarly, no significant changes in tricuspid regurgitation were noted between preoperative and 1-month post-implantation.
Conclusion
This study demonstrated the safety and efficacy of Aveir VR implantation in the Chinese population, with no complications or adverse effects on right heart function. Both the right ventricular free wall and septum were shown to be safe implantation sites with satisfactory device performance, highlighting the free wall as a viable alternative.
{"title":"Safety and Efficacy of Aveir Leadless Pacemaker in Chinese Patients","authors":"Wuyang Zheng, Ziguan Zhang, Zuheng Liu, Yuxiao Ma, Changqing Sun, Wangwei He, Yan Ge, Xiongbiao Lin, Yueming Wu, Qiang Xie","doi":"10.1111/anec.70141","DOIUrl":"10.1111/anec.70141","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Aveir, as a newly approved leadless pacemaker (LP), has been increasingly adopted in clinical practice. However, its application in the Chinese population remains limited. This retrospective study aimed to evaluate the safety and efficacy of the Aveir LP in Chinese patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on patients who underwent LP implantation at the First Affiliated Hospital of Xiamen University between June 2024 and October 2024. Implantation sites included the right ventricular septum and the right ventricular free wall. Parameters were collected preoperatively and at 1-month post-implantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 16 patients were included, and all cases achieved successful implantation. At the 1-month follow-up, the pacing threshold improved from 0.68 ± 0.42 to 0.59 ± 0.27 V, impedance decreased from 740.00 ± 268.53 to 557.5 ± 129.69 Ω, and R-wave sensing increased from 8.51 ± 3.83 to 11.4 ± 4.22 mV. No complications were observed. There were no significant differences in measurements of the aorta, ascending aorta, left atrium, right atrium, left ventricular end-diastolic diameter, interventricular septal thickness, left ventricular end-systolic diameter, or ejection fraction between preoperative and 1-month post-implantation. Similarly, no significant changes in tricuspid regurgitation were noted between preoperative and 1-month post-implantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrated the safety and efficacy of Aveir VR implantation in the Chinese population, with no complications or adverse effects on right heart function. Both the right ventricular free wall and septum were shown to be safe implantation sites with satisfactory device performance, highlighting the free wall as a viable alternative.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"31 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12774324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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