INTRODUCTION: Natriuretic peptides have shown to predict atrial fibrillation (AF) ablation success using thermal energies. Pulsed-field ablation (PFA) is a novel AF ablation technology. This study investigates the predic...INTRODUCTION: Natriuretic peptides have shown to predict atrial fibrillation (AF) ablation success using thermal energies. Pulsed-field ablation (PFA) is a novel AF ablation technology. This study investigates the predictive value of NT-proBNP and clinical parameters for pulmonary vein isolation (PVI) success using PFA, cryoballoon ablation (CBA), and radiofrequency ablation (RFA). METHODS: We included all patients undergoing primary PVI between May 2019 and December 2023 from our prospective registry, excluding those in randomized trials or without NT-proBNP measured ≤1 day before the procedure. Follow-up included 7-day Holter-ECGs at 3, 6, and 12 months. The primary endpoint was atrial arrhythmia recurrence between days 90-365. NT-proBNP was dichotomized using the age- and sex-adjusted 95th percentile in healthy adults. RESULTS: Among 1,391 patients (median age 67 years; 29% female) undergoing primary PVI with RFA (n = 302), CBA (n = 399), or PFA (n = 690), elevated NT-proBNP levels were observed in 55%, with no significant differences between ablation modalities. NT-proBNP correlated with age and left atrial volume and was higher in patients with persistent AF. Overall, 1-year arrhythmia recurrence rate was 32.1%, without differences between ablation technologies. Elevated NT-proBNP was associated with recurrence across all subgroups. In multivariate Cox regression, NT-proBNP and persistent AF were the strongest independent predictors of recurrence. A simplified model including only NT-proBNP and AF type yielded a concordance index of 0.62. CONCLUSIONS: NT-proBNP is a robust predictor of atrial arrhythmia recurrence after PVI, independent of the ablation technology, and may support shared, evidence-based decision-making with patients regarding ablation success probability. TRIAL REGISTRATION: The Swiss-AF-PVI registry is registered with ClinicalTrials.gov (NCT03718364).
BACKGROUND: Cardiac implantable electronic device (CIED) related complications occur frequently. Given the uncertainties, a comprehensive investigation of predictive factors is crucial. This study aimed to identify the d...BACKGROUND: Cardiac implantable electronic device (CIED) related complications occur frequently. Given the uncertainties, a comprehensive investigation of predictive factors is crucial. This study aimed to identify the determinants influencing the occurrence of CIED-related complications and to evaluate their predictive capability for the onset of CIED-related complications. METHODS: This retrospective cohort study recruited 870 patients who underwent CIED implantation. The primary outcome was overall complications, and the secondary was pocket hematomas (PH). Logistic regression model was used to estimate the odds ratio (OR) with the 95% confidence interval (CI), and to establish the prediction models for all complications and PH. RESULTS: 43 cases (4.95%) developed complications during follow-up, including 24 (2.8%) PH and 19 others. After adjusted for potential confounders, body mass index (BMI), having diabetes and chronic kidney disease (CKD), usage of anticoagulants and antiplatelets, device type, device replacement, and device electrode quantities were all associated with the risk of both the complications and PH. The prediction model with these variables displayed a good performance in predicting the complications occurrence, with AUC and C-statistic being 0.886 and 0.886 in training dataset, and 0.780 and 0.761 in the test dataset. Similar good performance in predicting PH onset were also observed. CONCLUSION: The results indicate that BMI, diabetes, CKD, anticoagulants, antiplatelets, device types, device replacement, and device electrode quantities are critical risk factors, which can help predict the onset of the complications and PH.
BACKGROUND: QT interval measurement in the presence of right ventricular pacing (RVP) represents a clinical challenge. We therefore aimed to derive and validate a formula for QT estimation during RVP in a large cohort of...BACKGROUND: QT interval measurement in the presence of right ventricular pacing (RVP) represents a clinical challenge. We therefore aimed to derive and validate a formula for QT estimation during RVP in a large cohort of pacemaker patients. METHODS AND RESULTS: We prospectively enrolled 100 patients in a derivation cohort and 487 in a validation cohort. Eligible patients had implanted pacemakers or implantable cardioverter-defibrillators, preserved atrioventricular conduction, and a narrow native QRS. Standardized 12-lead ECGs were recorded during intrinsic rhythm, atrial pacing (AP), and RVP at matched heart rates. Linear regression of QT during non-paced rhythm against paced QT yielded the equation: QT_non-paced = 139.23 + 0.55 × QT_paced. In the validation cohort (mean age 71 ± 13 years, 72% male), application of the formula showed a significant correlation between predicted and observed QT values (r = 0.50, p < 0.001). Bland-Altman analysis demonstrated a modest mean overestimation of 15 ms, with consistent accuracy across subgroups defined by sex, device type, and lead position. Compared directly with the Bogossian method, our formula showed superior performance, with a lower mean absolute deviation (26.2 vs. 39.9). CONCLUSION: This novel, heart rate-independent formula provides a reliable method for estimating the intrinsic QT interval from paced measurements. It represents a practical tool to improve QT assessment and arrhythmic risk evaluation in patients with RVP, with potential implications for clinical decision-making and drug safety monitoring.
Atrial tachycardia originating from the right atrial appendage was first reported more than a decade ago, which had been observed to occur more frequently in younger populations. Radiofrequency catheter ablation of this...Atrial tachycardia originating from the right atrial appendage was first reported more than a decade ago, which had been observed to occur more frequently in younger populations. Radiofrequency catheter ablation of this type of tachycardia often yielded suboptimal success rates, largely attributable to the complex anatomical structure of the right atrial appendage. In this report, we presented a successful case of bipolar radiofrequency ablation for atrial tachycardia arising from the right atrial appendage, which might offer a promising approach for the treatment of similar cases in the future.
Pulsed field ablation (PFA) is being adopted into widespread use worldwide for the treatment of a wide range of arrhythmias, with attractive tissue selectivity and safety profiles. While single-shot PFA remains the mains...Pulsed field ablation (PFA) is being adopted into widespread use worldwide for the treatment of a wide range of arrhythmias, with attractive tissue selectivity and safety profiles. While single-shot PFA remains the mainstay of atrial ablation at present, focal applications of PFA are emerging as a highly effective means of delivering effective ablation. The present case illustrates transient atrioventricular block following PFA, highlighting potential for conduction system damage with PFA and supporting a cautious approach in close proximity to conduction system structures.
INTRODUCTION: Preprocedural imaging can improve the success rate of ventricular tachycardia (VT) ablation. Left ventricular wall thickness (LVWT) measured by cardiac computed tomography (CT) can be used to identify infar...INTRODUCTION: Preprocedural imaging can improve the success rate of ventricular tachycardia (VT) ablation. Left ventricular wall thickness (LVWT) measured by cardiac computed tomography (CT) can be used to identify infarct regions. We sought to determine whether an association exists between left ventricular wall thickness (LVWT) as obtained from CT imaging and the presence of decrement evoked potentials (DeEPs) as obtained from electroanatomic mapping. METHODS: In this single-center, retrospective analysis, 14 patients with ischemic heart disease who underwent a VT ablation in the University Medical Center Groningen (UMCG) between January 2021 and March 2023 were included. CT images as well as electroanatomic maps were obtained and processed, after which a 3D model of the left ventricle was obtained and segmented in 17 segments. The primary outcome was the presence of DeEPs, defined as late potentials exhibiting a decremental delay response longer than 20 ms after S2 extrastimulus delivery (with the extrastimulus delivered at 50 ms above the ventricular effective refractory period [VERP]), in each of the left ventricular segments. The mean segment LVWT and coefficient of variation of LVWT, defined as the standard deviation of the LVWT of each segment divided by the mean segment LVWT, were analyzed as determinants of the primary outcome. RESULTS: The mean age was 69 ± seven years and 13 (92.9%) patients were male. The mean LVWT was significantly associated with the presence of DeEPs in left ventricular segments [odds ratio (OR) 0.65 (95% confidence interval (CI) 0.55 - 0.78); p < 0.001], as was the coefficient of variation of LVWT [OR 1.10 (95% CI 1.06 - 1.15); p < 0.001]. CONCLUSIONS: The mean and coefficient of variation of LVWT were significantly associated with the presence of DeEPs. This may possibly allow for the preprocedural identification of arrhythmogenic regions as potential targets for VT ablation.
BACKGROUND: Cryoballoon (CB) ablation is widely used for pulmonary vein isolation (PVI). A novel CB (POLARx-FIT) that can be expanded from 28 to 31 mm has recently been introduced. However, its impact on pulmonary vein (...BACKGROUND: Cryoballoon (CB) ablation is widely used for pulmonary vein isolation (PVI). A novel CB (POLARx-FIT) that can be expanded from 28 to 31 mm has recently been introduced. However, its impact on pulmonary vein (PV) morphology, acute lesion characteristics, and treatment selection remains unclear. METHODS: Among 416 consecutive patients undergoing PVI for atrial fibrillation, after excluding radiofrequency catheter ablation (RFCA) cases and CB ablation with Arctic Front Advance, 190 patients were included: a 28 mm CB group (POLARx, N = 122) and a 31 mm CB group (POLARx-FIT, N = 68). PV morphology was assessed on preoperative computed tomography. Lesion size of the CB was evaluated using post-ablation voltage mapping. RESULTS: After introduction of 31 mm CB, the proportion of patients selecting RFCA due to large PV size decreased from 30.7% to 8.3% (p < 0.01). Left and right superior PV were significantly larger and both left and right PV distance were significantly longer in the 31 mm CB group. The actual PVI lesion area was significantly larger in the 31 mm CB group (28 mm CB: 14.1 ± 3.4 cm, 31 mm CB: 17.5 ± 3.7 cm, p < 0.01). One-year atrial tachyarrhythmia recurrence was not significantly different between groups (p = 0.62) CONCLUSION: Despite inclusion of patients with larger PVs, the 31 mm CB was associated with a larger PVI lesion, with similar 1-year recurrence. The introduction of a 31 mm CB expanded CB eligibility and reduced the need for RFCA in the real-world practice.
Helix-fixed leadless pacemaker delivery can be challenging after tricuspid annuloplasty with a rigid ring. An 80-year-old woman with prior mitral valve repair, tricuspid annuloplasty (26-mm MC ring), and Maze III surgery...Helix-fixed leadless pacemaker delivery can be challenging after tricuspid annuloplasty with a rigid ring. An 80-year-old woman with prior mitral valve repair, tricuspid annuloplasty (26-mm MC ring), and Maze III surgery presented with syncope due to atrial fibrillation with a slow ventricular response. Standard maneuvers failed to advance the Aveir VR delivery system across the repaired annulus, and simple distal snare traction crossed the ring but could not secure a stable septal trajectory. A three-step segmental snare traction technique enabled controlled annular crossing and inferior septal fixation with preserved tricuspid valve function at 1 year.
BACKGROUND: Pulsed field ablation (PFA) is an emerging nonthermal ablation modality that can penetrate scar tissue more deeply. However, the evidence supporting its application in ventricular arrhythmias (VAs) is limited...BACKGROUND: Pulsed field ablation (PFA) is an emerging nonthermal ablation modality that can penetrate scar tissue more deeply. However, the evidence supporting its application in ventricular arrhythmias (VAs) is limited. This study summarizes relevant research and aims to evaluate the safety and efficacy of PFA in the treatment of premature ventricular contractions (PVCs) or ventricular tachycardia (VT). METHODS: A computer-based search of PubMed, Embase, and the Cochrane Library identified studies evaluating PFA for VAs from database inception to December 31, 2025. Primary outcomes included acute procedural success rate, short- to mid-term success rate, and perioperative complication rate. A meta-analysis of single-arm studies was performed using a random-effects model with StataMP18. RESULTS: Six studies were included, comprising 149 patients (84 with PVCs, 65 with VT). The overall acute success rate was 88% (95% CI: 82%-93%), with PVCs at 88% (95% CI: 79%-95%) and VT at 90% (95% CI: 80%-97%). The short-to-mid-term success rate was 73% (95% CI: 65%-80%) overall, with 80% (95% CI: 70%-89%) for PVCs and 63% (95% CI: 46%-80%) for VT. The overall perioperative complication rate was 15% (95% CI: 6%-26%). PFA for VT ablation had longer procedure and fluoroscopy times, as well as a greater number of PFA applications, compared to PVCs, but with considerable heterogeneity. CONCLUSIONS: PFA demonstrates a good acute success rate and an acceptable perioperative complication rate in the treatment of VAs. While it shows a higher short-to-mid-term success rate in PVCs patients, its efficacy in VT patients remains limited.
BACKGROUND: Atrial substrate progression is common among patients with atrial fibrillation (AF). Unipolar voltage mapping more comprehensively characterizes the atrial substrate compared with bipolar mapping. OBJECTIVE:...BACKGROUND: Atrial substrate progression is common among patients with atrial fibrillation (AF). Unipolar voltage mapping more comprehensively characterizes the atrial substrate compared with bipolar mapping. OBJECTIVE: This study aimed to characterize atrial substrate progression in patients with recurrent AF using unipolar mapping after pulmonary vein isolation. METHODS: In this single-center retrospective study, consecutive AF patients undergoing index and redo ablations were enrolled. Electroanatomic maps from both ablations were compared and assessed by unipolar and bipolar voltage. Low-voltage zone (LVZ) was defined as bipolar voltage <0.5 mV or unipolar voltage <1.6 mV. Patients were categorized into progression (n = 35) and nonprogression (n = 15) groups. RESULTS: A total of 50 patients (mean age 59.5 ± 12.6 years; 40 males) were enrolled. Compared with index ablation, redo ablation demonstrated significantly larger bipolar LVZ (Bi-LVZ) total area (21.25 vs. 15.86 cm, p = 0.007) and LVZ burden (0.20 vs. 0.14, p = 0.002). The progression group showed a higher LVZ burden (unipolar: 0.27 vs. 0.12, p = 0.007; bipolar: 0.16 vs. 0.09, p = 0.019) and a greater ratio of total unipolar to bipolar LVZ area (Uni/Bi) (1.75 vs. 1.34, p = 0.042) during index ablation compared with the nonprogression group. Linear regression revealed a positive correlation between index-ablation Uni/Bi ratio and the degree of Bi-LVZ area expansion at redo ablation (β = 7.20, p < 0.001). CONCLUSION: Uni-LVZ characterizes the atrial substrate progression, with the higher Uni/Bi ratio during index ablation indicates greater Bi-LVZ expansion at redo ablation.
BACKGROUND: Predicting atrial fibrillation (AF) recurrence after electrical cardioversion (ECV) is challenging. The SLAC score predicts 6-month recurrence but lacked robust external validation. We aimed to externally val...BACKGROUND: Predicting atrial fibrillation (AF) recurrence after electrical cardioversion (ECV) is challenging. The SLAC score predicts 6-month recurrence but lacked robust external validation. We aimed to externally validate the SLAC score and develop an improved predictive model. METHODS: We conducted a single-center retrospective study of patients who underwent successful ECV for AF between 2015 and 2020. Patients with atrial flutter, complex congenital heart disease or early AF ablation were excluded. The primary outcome was AF recurrence at 6 months. SLAC score performance was tested, and multivariable logistic regression was used to develop the SLASH score. Discrimination was assessed with the area under the curve (AUC), calibration with Hosmer-Lemeshow testing, and internal validation with bootstrapping. RESULTS: Of 361 patients (mean age 66 ± 12 years, 61% male), 53.7% experienced AF recurrence in 6 months. Median SLAC scores were higher in recurrence patients (7 vs. 2). The SLAC score demonstrated moderate discrimination (AUC 0.70), improved with a cutoff ≥ 6 (AUC 0.72). Independent predictors of recurrence included left atrial volume index ≥ 40 mL/m, prior stroke/TIA, heart rate > 70 bpm, smoking history, and absence of post-ECV antiarrhythmic therapy. These were incorporated into the SLASH score (0-8 points), which demonstrated improved discrimination (AUC 0.78). Recurrence rates were 16.1%, 65.4%, and 78.5% in low-, moderate-, and high-risk groups, respectively, with acceptable calibration (Hosmer-Lemeshow p = 0.18). CONCLUSION: The SLAC score provides moderate prediction of 6-month AF recurrence after ECV. The SLASH score showed superior performance and may improve risk stratification and rhythm management. Prospective validation is warranted.
BACKGROUND: Current guidelines recommend the use of combined oral anticoagulants and antiplatelet agents in patients with acute myocardial infarction (AMI) and atrial fibrillation (AF), especially for those at high risk....BACKGROUND: Current guidelines recommend the use of combined oral anticoagulants and antiplatelet agents in patients with acute myocardial infarction (AMI) and atrial fibrillation (AF), especially for those at high risk. In real-world clinical practice, adherence to anticoagulant therapy is often suboptimal, and some patients do not routinely receive it. METHODS: Patients diagnosed with AMI and AF who were prescribed dual antiplatelet drugs in Tianjin, China, from August 2016 to June 2023 were enrolled. The primary outcomes were stroke, ischemic stroke, and hemorrhagic stroke. RESULTS: A total of 1,026 patients were identified (mean age: 73.7, standard deviation: 9.12; 39% female), which included 132 rivaroxaban users and 894 non-users. Over a median follow-up of 922 days, 298 patients died and 367 patients suffered from stroke. After adjusting for multiple variables, rivaroxaban users had a lower risk of any stroke (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.43-0.90) and ischemic stroke (HR, 0.63; 95% CI, 0.43-0.92), compared to non-users. In the propensity matched cohort, rivaroxaban users had a lower risk of stroke and ischemic stroke with no significant difference in bleeding or major bleeding. Multivariable competing risk models were consistent with the above results. No statistically significant association was found for rivaroxaban use and bleeding, major bleeding, all-cause mortality, or cardiovascular mortality. CONCLUSIONS: Concomitant rivaroxaban use is associated with lower risks of stroke, especially ischemic stroke, but with no significant increase in the risks of bleeding and major bleeding in patients with AMI and preexisting AF taking dual antiplatelet drugs. TRIAL REGISTRATION: Registration number: ChiCTR2400094021.
BACKGROUND: Leadless pacemakers (LPMs) have been shown to reduce complications compared with conventional transvenous pacing. Transfemoral venous access (FA) is the standard implantation approach; however, the transjugul...BACKGROUND: Leadless pacemakers (LPMs) have been shown to reduce complications compared with conventional transvenous pacing. Transfemoral venous access (FA) is the standard implantation approach; however, the transjugular approach (JA) has recently emerged as an alternative strategy, but comparative evidence remains limited. Therefore, we perform a systematic review and meta-analysis comparing JA and FA for LPMs implantation in terms of electrical performance, procedural efficiency, and complications. METHODS: All studies comparing JA and FA for LPMs were systematically identified. Pooled analyses were performed for pacing threshold, sensed R-wave amplitude, impedance, total procedural time, fluoroscopy duration, and procedural complications. RESULTS: Three observational studies were included. No significant differences were observed between FA and JA in mean pacing threshold (MD 0.05 ms; 95% CI -0.03 to 0.12), mean sensed R-wave amplitude (MD 0.31 mV; 95% CI -0.51 to 1.14), or impedance (MD 45.79 Ω; 95% CI -27.03 to 118.61). Total procedural time was comparable between approaches (MD -0.44 min; 95% CI -8.47 to 7.60). JA was associated with a significant reduction in fluoroscopy time compared with FA (MD 2.73 min; 95% CI 0.66 to 4.81). JA also significantly reduced overall procedural complications (1.8% vs. 15%; OR 0.12, 95% CI 0.04 to 0.39) and wound care-related adverse events (0% vs. 14%; OR 0.07, 95% CI 0.01 to 0.36). No differences were observed in device dislodgement, pericardial effusion, or emergent device removal. CONCLUSIONS: JA provides comparable electrical performance to FA while reducing fluoroscopy exposure and access-related complications, supporting its use as a safe alternative for LPMs implantation.
INTRODUCTION: Leadless pacemakers are typically implanted in the mid-septum of the right ventricle (RV) to mitigate the risk of perforation. However, reports on the precise location of these implants are limited. This st...INTRODUCTION: Leadless pacemakers are typically implanted in the mid-septum of the right ventricle (RV) to mitigate the risk of perforation. However, reports on the precise location of these implants are limited. This study aimed to elucidate tine-based leadless pacemaker position and presence of subclinical RV perforation through computed tomography (CT) imaging, along with the associated prognosis. METHODS: Patients who underwent heart, chest or abdomen CT after leadless pacemaker implantation were consecutively included. Two cardiologists and one radiologist reviewed the CT images to assess the position of tines and to detect RV perforation. The implantation position was categorized as the septum, RV free wall, junction of septum and RV free wall, moderator band, and RV apex. Subclinical perforation was defined as the tines of a leadless pacemaker beyond the outer myocardial contour without symptoms, pericardial effusion, hemodynamic instability, or pacemaker malfunction. RESULTS: A total of 88 patients (age, 72.9 ± 12.1 years; 42 males) were included. The interval between procedure and CT scanning was 8.6 ± 9.2 months. In 68 patients (77.3%), the leadless pacemaker was implanted at the junction of the septum and the RV free wall. Subclinical RV perforation occurred in 15 patients (17.0%). Among patients with RV perforation, the most common implantation site was the junction of the septum and the RV free wall. None of the patients with RV perforation experienced any adverse events for 12.4 ± 12.3 months. CONCLUSIONS: The most common leadless pacemaker implantation site is the junction of the septum and the RV free wall. Subclinical RV perforation is not uncommon and not associated with overt adverse outcomes.
BACKGROUND: Straight Back Syndrome (SBS) is a congenital condition characterized by loss of normal thoracic kyphosis and chest narrowing, which can cause cardiac compression. Although linked to cardiovascular abnormaliti...BACKGROUND: Straight Back Syndrome (SBS) is a congenital condition characterized by loss of normal thoracic kyphosis and chest narrowing, which can cause cardiac compression. Although linked to cardiovascular abnormalities, its relationship with atrial arrhythmia remains unclear. This study aimed to investigate the association between SBS and non-pulmonary vein (PV)-related atrial tachyarrhythmias (ATAs) in patients with atrial fibrillation (AF). METHODS: We retrospectively analyzed 222 consecutive patients (mean age, 65.8 ± 11.3 years) who underwent initial AF ablation. Following PV isolation, ATAs were induced and assessed using intracardiac electrocardiography. SBS was diagnosed by chest radiography and thoracic computed tomography. Twenty-seven patients were classified into the SBS group, and 195 into the control group. RESULTS: Compared with controls, the SBS group had a lower body mass index, smaller left atrial diameter, and lower prevalence of hypertension and diabetes. Non-PV-related ATAs were more frequently induced in the SBS group (18/27 vs. 50/195, p < 0.01), including non-PV-triggered AF (7/27 vs. 16/195, p < 0.01), cavotricuspid isthmus-dependent flutter (8/27 vs. 17/195, p < 0.01), and other atrial tachycardias (15/27 vs. 33/195, p < 0.01). The SBS group also showed a higher incidence of ATAs requiring more complex treatment (10/27 vs. 14/195, p < 0.01). CONCLUSION: SBS is associated with a higher incidence of non-PV-related ATAs, highlighting the need to consider this condition when planning procedural strategies for AF ablation.
BACKGROUND: Implantable cardioverter-defibrillators (ICDs) are essential for preventing sudden cardiac death in patients with ischemic cardiomyopathy (ICM). Noninvasive programmed stimulation (NIPS) is a potential tool f...BACKGROUND: Implantable cardioverter-defibrillators (ICDs) are essential for preventing sudden cardiac death in patients with ischemic cardiomyopathy (ICM). Noninvasive programmed stimulation (NIPS) is a potential tool for predicting ventricle tachycardia (VT) or ventricle fibrillation (VF) and helps to select patients with higher arrhythmic risk. This study aimed to evaluate the predictive value of NIPS in identifying ICM patients at risk for VT/VF episodes and mortality after ICD implantation for primary prevention. METHODS: This prospective, single-center study included 50 patients with ICM who underwent ICD or CRT-D implantation for primary prevention. NIPS was performed between 1- and 3-months following implantation and patients were followed for VT/VF recurrence and mortality. RESULTS: Positive NIPS was observed in 20% of patients. During a median follow-up of 5.67 years, VT/VF occurred in 16% of patients. Kaplan-Meier analysis demonstrated a significantly increased risk of VT/VF episodes in the positive NIPS group (log-rank test, p = 0.047), with a considerably shorter time to VT/VF incidence (0.58 vs. 4.75 years). NIPS was not positively associated with an increased mortality rate (p = 0.45). However, elevated levels of creatinine and NT-pro BNP were significantly associated with higher mortality. CONCLUSIONS: NIPS positivity predicts an increased risk of VT/VF episodes, supporting its role in predicting arrhythmic episodes but not mortality after ICD implantation for primary prevention with ICM. Creatinine and NT-proBNP levels were significantly associated with patient survival. TRIAL REGISTRATION: This prospective study was not registered in a public clinical trials registry, as registration was not required at the time of study initiation.
BACKGROUND: Transseptal puncture (TSP) is essential for various structural and electrophysiological cardiac procedures. However, the conventional mechanical needle can be challenging in complex anatomies. Radiofrequency...BACKGROUND: Transseptal puncture (TSP) is essential for various structural and electrophysiological cardiac procedures. However, the conventional mechanical needle can be challenging in complex anatomies. Radiofrequency (RF)-assisted puncture systems offer an alternative to facilitate septal crossing and potentially reduce complications. This study aimed to evaluate the efficacy and safety of RF needle TSP compared with the conventional mechanical approach. MATERIALS AND METHODS: A systematic review and meta-analysis was conducted following PRISMA guidelines (PROSPERO: CRD420251272470). Primary efficacy outcomes included unassisted success, crossover, and TSP and fluoroscopy time, failure to obtain left atrial access, while safety outcomes included pericardial effusion or cardiac tamponade. Statistical analyses were conducted in R software (version 4.5.1) risk ratios (RR) and differences (MD), and heterogeneity was assessed by I statistics. RESULTS: This review included nine studies, amongst them randomized and nonrandomized. The RF needle demonstrated statistically significant superiority in several efficacy outcomes: increased unassisted success (RR: 1.05; 95% CI: 1.01-1.10), marked reduction risk in crossover rate (RR: 0.11; 95% CI: 0.03-0.38), and failure to obtain transseptal access (RR: 0.11; 95% CI: 0.04-0.33). Furthermore, the RF technique significantly reduced TSP time (MD: -154.7 s) and fluoroscopy time (MD: -84.5 s). Successful TSP rates (RR: 1.03; 95% CI: 0.99-1.06) and pericardial effusion or cardiac tamponade (RR: 0.55; 95% CI: 0.12-2.57) were comparable between groups. CONCLUSION: RF-assisted TSP demonstrated superior performance compared with the conventional mechanical technique, offering higher unassisted primary efficacy, reducing access failures, and improving procedural efficiency. Although major complication rates are similar, RF may be considered a preferred strategy, especially in complex anatomies, due to its predictability and potential benefit in neurological safety.
BACKGROUND: Functional substrate mapping (FSM) enables the identification of slow conduction zones, which may represent critical atrial sites in atrial fibrillation (AF). This study aimed to evaluate the efficacy of FSM-...BACKGROUND: Functional substrate mapping (FSM) enables the identification of slow conduction zones, which may represent critical atrial sites in atrial fibrillation (AF). This study aimed to evaluate the efficacy of FSM-guided ablation as an adjunct to pulmonary vein isolation (PVI) and to identify clinical predictors of arrhythmia recurrence in patients with AF. METHODS: A total of 206 patients [mean age 61 ± 10, 105 (%51) males] with AF who underwent voltage and isochronal late activation mapping (ILAM) during sinus/paced rhythm were retrospectively included. Patients were divided into two groups based on the presence of deceleration zone (DZ) during ILAM: DZ (-) and DZ (+). While patients in the DZ (-) group underwent PVI alone, those in the DZ (+) group received additional ablation lesions targeting the DZs in addition to PVI. RESULTS: The mean number of DZs per left atrium was 1.45 ± 0.6. In the DZ (+) patients, 43 ATs were inducible in 35 patients, with 81.4% (35/43) of CIs colocalized with the DZs identified during ILAM. At a median follow-up of 12.5 (8-23) months, atrial arrhythmia-free survival was significantly higher in the DZ (-) group compared to the DZ (+) group (p = 0.004). Multivariate Cox regression analysis revealed that the presence of DZ (HR: 2.152, 95%CI 1.051-4.404; p = 0.036) was the only significant predictor associated with atrial arrhythmia recurrence. CONCLUSIONS: DZs identified by ILAM may serve as a critical substrate for AF and targeting these regions as an adjunct to PVI could improve procedural success especially in PAF.
PURPOSE: Evaluate the comparative risk of hemolysis and acute kidney injury (AKI) with pulsed field ablation (PFA) versus thermal ablation (TA) for atrial fibrillation. METHODS: Databases were searched through June 2025...PURPOSE: Evaluate the comparative risk of hemolysis and acute kidney injury (AKI) with pulsed field ablation (PFA) versus thermal ablation (TA) for atrial fibrillation. METHODS: Databases were searched through June 2025 for comparative studies reporting hemolysis markers or renal outcomes. Random-effects models estimated risk ratios (RRs) and mean differences (MDs). RESULTS: Eight studies (n = 4307) were included. Compared with TA, PFA was not associated with a statistically significant increase in AKI (RR 2.00, 95% CI 0.5-7.9) or change in creatinine (MD 0.02 mg/dL, p = 0.10). PFA was associated with higher LDH (MD +72 U/L p < 0.001) and lower haptoglobin (MD -0.60 g/L p < 0.001). CONCLUSIONS: PFA may be associated with greater biochemical hemolysis than TA; however, no statistically significant difference in AKI or post-procedural creatinine was observed in pooled analyses.
INTRODUCTION: Cryoablation is widely used for septal paroxysmal supraventricular tachycardia because of its lower risk of atrioventricular block; however, real-time quantitative assessment of catheter-tissue contact is l...INTRODUCTION: Cryoablation is widely used for septal paroxysmal supraventricular tachycardia because of its lower risk of atrioventricular block; however, real-time quantitative assessment of catheter-tissue contact is limited. METHODS AND RESULTS: We describe a modified configuration enabling visualization of the contact index (CI) during cryoablation with the Freezor Xtra catheter, supported by in vitro validation and two clinical cases. In vitro testing demonstrated progressive CI elevation with decreasing catheter-tissue distance. Successful lesions were achieved at CI values of approximately 20%-25%. CI increased despite minimal electrogram changes and correlated with tissue proximity. CONCLUSION: CI-guided cryoablation is feasible and may improve contact assessment during septal ablation.