Heart Rhythm

BackgroundThe ventricular tachycardia (VT) substrate map is influenced by the rhythm during mapping. This study aimed to elucidate the effects of different pacing sites on substrate mapping using decrement-evoked potential (DEEP) mapping in patients with scar-related VT. MethodsPatients with ischemic cardiomyopathy (ICM) or nonischemic cardiomyopathy (NICM) who underwent substrate mapping and ablation for scar-related VT were included. DEEP mapping was performed during right ventricular apex (R...

BackgroundDuring atypical atrioventricular nodal reentrant tachycardia (AVNRT), the earliest atrial activation site following retrograde slow pathway (SP) conduction is at the atrial exit of the left inferior extension of the compact node (LIE) in the coronary sinus (CS) or the right inferior extension (RIE) on the tricuspid annulus (TA). We tested the validity of conventional electrode placement-based mapping of the atrial ends of these extensions. MethodsWe retrospectively evaluated the effic...

BackgroundEsophageal thermal injury is a risk of ablation of the posterior left atrium despite various devices utilized to date. ObjectiveEvaluate the potential of a commercially-available esophageal cooling device to provide esophageal protection during left atrial catheter ablation. MethodsIn this pilot study, we randomized 6 patients undergoing catheter ablation for atrial fibrillation. Three patients received standard of care for our site (use of a single-sensor temperature probe, with adj...

Background and AimsLeft bundle branch pacing (LBBP) is a novel pacing strategy that improves ventricular synchrony by utilizing the native conduction system. However, the current standard practices limit continuous monitoring of paced electrocardiogram (ECG) and intracardiac electrogram (EGM) transition, which may result in overlooked or misinterpreted subtle transitions. This study aimed to explore the electrophysiological characteristics of the lead-position-dependent EGM continuous transition...

BackgroundHuman induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) represent a highly promising approach for cell-based replacement therapy in heart failure. However, the development of graft-related ventricular arrhythmias immediately following transplantation impedes its clinical translation. To date, there have been no reports worldwide characterizing the features of engraftment arrhythmias after hiPSC-CMs transplantation in human. Consequently, this study aims to analyze the ch...

ObjectiveCardioneuroablation (CNA) is effective for cardiac inhibitory and mixed vasovagal syncope (VVS) but not vasodepressor VVS. This study aimed to assess the therapeutic benefits of CNA in vasodepressor VVS. MethodsVVS patients hospitalized in the Department of Cardiology of Jiangxi Provincial Peoples Hospital were retrospectively reviewed. Holter monitoring was performed before, during, and 3 months after CNA. Changes in heart rate and Wenckebach point of atrioventricular conduction befor...

BackgroundLeft bundle branch pacing (LBBP) had been proven to be feasible and safe in patients with a pacemaker indication. In this study, we assessed the feasibility and safety of LBBP procedure using simplified ECG monitoring and LBBP criteria in comparison with that by using the conventional EP system and currently adopted LBBP criteria. MethodsThe single-center study included 143 consecutive patients from March 2021 to January 2022. The operator was single-blind to the electrophysiology rec...

BackgroundWhile various reports described the characteristics and catheter ablation strategies for para-Hisian premature ventricular contraction (PVC), the patient population were limited in previous literatures and optimal approach remain unknown. This study sought to comprehensively assess the safety and outcomes of catheter ablation for para-Hisian PVC, with a particular focus on the safety and efficacy of ablation from aortic coronary cusps. MethodsA total of 122 para-Hisian PVC cases were ...

BackgroundThermal damage to the esophagus is a risk from radiofrequency (RF) ablation of the left atrium for the treatment of atrial fibrillation (AF), with the most extreme type of thermal injury resulting in atrio-esophageal fistula (AEF), with a correspondingly high mortality rate. Various approaches have been developed to reduce esophageal injury, including power reduction, avoidance of greater contact-force, esophageal deviation, and esophageal cooling. One method of esophageal cooling invo...

BackgroundPulmonary vein isolation (PVI) constitutes the established strategy for atrial fibrillation (AF) ablation. With the advent of PV stenosis risk-free pulsed field ablation (PFA), we explored the feasibility and safety of additional ablation within PV sleeves (PVA). Moreover, we assessed the durability of PVI through PFA in a deep sedation setting, comparing a 3D Electroanatomical Mapping (3D-EAM)-based navigation approach with the standard fluoroscopy-based one. MethodsIn this single-ce...

BackgroundRadiofrequency catheter ablation (RFCA) for long-standing persistent atrial fibrillation (LSP-AF) remains challenging, especially in patients with very long atrial fibrillation (AF) duration. ObjectiveTo evaluate the long-term outcomes of RFCA in patients with LSP-AF lasting [≥] 3 years, and to identify predictors for AF recurrence. MethodsThis retrospective study included 151 patients with LSP-AF undergoing first-time RFCA. Procedure was performed with wide antral pulmonary vein ...

BackgroundThe cryoballoon (CB) has recently been used for performing pulmonary vein isolation (PVI) with concomitant left atrial posterior wall isolation (LAPWI). However, successful LAPWI using only the CB is technically challenging. This study aimed to evaluate the feasibility, safety, and efficacy of the cross-over technique, wherein an overlapped ablation is performed by placing the CB from both left and right directions in contact with the roof and bottom of the left atrium (LA). MethodsTh...

ObjectiveThe characteristics of discrete intracardiac electrograms in selective left bundle branch (SLBB) pacing (SLBBP) have not been described in detail previously. This study aimed to examine the effect of different high-pass filter (HPF) settings on discrete ventricular components in an intracardiac electrogram (EGM) and to analyze its possible mechanisms. MethodsThis study included 95 patients with indications of permanent cardiac pacing. EGMs were collected at four different HPF settings ...

IntroductionAtypical atrial flutter is a supraventricular arrhythmia that can be treated with catheter ablation. However, the best approach is still to be defined and this strategy has suboptimal results. The Carto(R) electroanatomical mapping (EAM) system can display a histogram of the local activation times (LAT) of the tachycardia cycle length (TCL). This study aimed to assess the ability of this new tool to identify the critical isthmus of this arrhythmia. MethodsRetrospective analysis of a...

ObjectivesThe effectiveness and safety of STAR in patients with refractory ventricular tachycardia (VT) to catheter ablation are limited to small series. We performed a meta-analysis of observational studies to summarize existing data about efficacy and toxicity following START for VT. Methods: Eligible studies were identified on Medline, Embase, the Cochrane Library, and the proceedings of annual meetings through March 2020. We followed the PRISMA and MOOSE guidelines. An estimative of % VT bur...

BackgroundCurrently, splitting of electrogram (EGM) or electrocardiogram (ECG) under threshold test are used as the gold standard to assess Left bundle branch (LBB) capture in LBB area pacing. However, discrete intracardiac ventricular EGM has not been reported until now. This study aims to explore the clinical significance and possible mechanism of different pacing ventricular EGM morphologies in selective LBB pacing. MethodsOnly patients with evidence of selective LBB pacing (splitting of EGM...

BACKGROUNDAlthough clinical prediction models have been proposed to predict thrombosis risk in non-valvular atrial fibrillation (NVAF), machine learning (ML) based models to predict thrombotic risk were limited. This study aimed to develop a robust ML-based predictive model that integrates multimodal echocardiographic data and clinical risk factors to evaluate the risk of thrombosis in patients with NVAF. METHODS AND RESULTSA total of 402 NVAF patients scheduled for AF radiofrequency ablation a...

BackgroundCardiac computed tomography (CCT) is an emerging non-invasive modality for assessing left atrial appendage (LAA) thrombus, but the results were conflicting. Our study aims to evaluate the accuracy of CCT for detecting LAA thrombus in patients undergoing catheter ablation of atrial fibrillation (AF), using transesophageal echocardiography (TEE) as the reference standard. MethodsFrom May 2017 to December 2022, 726 patients (male: 60.2%, age: 61{+/-}11 years) who had both TEE and CCT bef...

BackgroundPatients with repaired tetralogy of Fallot (rTOF) remain at risk of sustained monomorphic ventricular tachycardia (SMVT) related to slow-conducting anatomical isthmuses (SCAI). Invasive electroanatomical mapping (EAM) is the only available method to identify SCAI (SCAIEAM). We aimed to determine rTOF-specific high signal intensity threshold values (HSIt) to identify abnormal myocardium by 3D late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) and assess the performance of ...

BackgroundAtrial myocardial degeneration predisposes to atrial fibrillation (AF), ischemic stroke, and heart failure. Studies suggest the presence of sex differences in atrial myocardial degeneration. This study aimed to delineate sex differences in the prevalence, predictors, and prognostic impact of left atrial low-voltage areas (LVAs). MethodsThis observational study included 1,488 consecutive patients undergoing initial ablation for AF. Voltage mapping was performed after pulmonary vein iso...