Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology

BACKGROUND: This study aimed to investigate the effectiveness of closed-loop stimulation (CLS) pacing compared to the traditional DDD mode in patients with chronotropic incompetence (CI) using bicycle-based cardiopulmonary exercise testing (CPET). METHODS: This single-center, randomized crossover trial involved 40 patients with CI. Patients were randomized to receive either DDD-CLS or DDD mode pacing for 2 months, followed by a crossover to the alternative mode for an additional 2 months...

BACKGROUND AND AIMS: Autothreshold algorithms enable remote monitoring of patients with conventional pacing, but there is limited information on their performance in left bundle branch pacing (LBBP). Our objective was to analyze the behavior of the autothreshold algorithm in LBBP and compare it with conventional pacing and manual thresholds during initial device programming (acute phase), after 1-7 days (subacute) and 1-3 months later (chronic). METHODS: A prospective, non-randomized, single-center comparative study was conducted...

BACKGROUND: Pulsed-field ablation (PFA) has emerged as a novel treatment technology for patients with atrial fibrillation (AF). Cryoballoon (CB) is the most frequently used single shot technology. A direct comparison to a novel CB system is lacking. OBJECTIVE: To compare pulmonary vein isolation (PVI) using PFA versus a novel CB system regarding efficiency, safety, myocardial injury, and outcomes. METHODS: 181 consecutive patients underwent PVI and were included (age 64 ± 9...

BACKGROUND AND AIMS: The compatibility of cardiac pacing with the presence of a subcutaneous implantable cardioverter-defibrillator (S-ICD) has been investigated, but S-ICD screening test results have not been compared among different pacing sites. The objective was to compare S-ICD screening results among different cardiac pacing sites and to assess the electrocardiographic predictors of success. METHODS: This prospective single-center study conducted automated S-ICD screening in 102 carriers of cardiac pacing devices in conduction system (CSP), biventricular (BVP), right ventricular outflow tract (RVOT), or right ventricular apex (RVA) pacing sites...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: Studies on objectively measured physical activity (PA) have investigated acute cardiovascular outcomes but not cardiac arrest (CA). Our study aimed to investigate the dose-response relationship between accelerometer-measured PA and CA by intensity of PA. METHODS: This prospective cohort study included 98,893 UK Biobank participants whose PA data were measured using wrist-worn accelerometers. Total PA volume was measured using the average overall acceleration...

BACKGROUND: Epicardial adipose tissue might promote atrial fibrillation (AF) in several ways, including infiltrating the underlying atrial myocardium. However, the role of this potential mechanism has been poorly investigated. AIM: Aim of the present study is to evaluate the presence of left atrial (LA) infiltrated adipose tissue (inFAT) by analyzing multidetector computer tomography (MDCT)-derived three-dimensional (3D) fat infiltration maps and to compare the extent of LA inFAT between patients without AF history, with paroxysmal, and with persistent AF...

BACKGROUND AND AIMS: This study was performed to compare the usability, efficiency, and safety of a modified angioplasty guidewire-assisted transseptal puncture (TSP) technique versus the conventional approach in facilitating access to the left atrium during left atrial appendage occlusion (LAAO) procedures for treatment of atrial fibrillation. METHODS: The ADVANCE-LAAO trial (Angioplasty Guidewire-Assisted Versus Conventional Transseptal Puncture for Left Atrial Appendage Occlusion) was an investigator-initiated, prospective, multicenter, randomized controlled trial (NCT05125159)...

BACKGROUND: The mechanisms of transition from regular rhythms to ventricular fibrillation (VF) are poorly understood. The concordant to discordant repolarization alternans pathway is extensively studied; however, despite its theoretical centrality, cannot guide ablation. We hypothesize that complex repolarization dynamics, i.e., oscillations in the repolarization phase of action potentials with periods over two of classic alternans, is a marker of electrically unstable substrate, and ablation of these areas has a stabilizing effect and may reduce the risk of VF...

BACKGROUND AND AIMS: Single-connector (DF4) defibrillator leads have become the predominantly implanted trans-venous ICD lead. However, data on their long-term performance are derived predominantly from manufacturer product performance reports. METHODS: We reviewed medical records in 5289 patients with DF4 leads between 2011 and 2023 to determine the frequency of lead-related abnormalities. We defined malfunction as any single or combination of electrical abnormalities requiring revision including a sudden increase (≥2X) in stimulation threshold, a discrete jump in high-voltage impedance, or sensing of non-physiologic intervals or noise...

AIMS: Transvenous lead extraction (TLE) of implantable cardioverter-defibrillator (ICD) leads is considered challenging. The structure of each ICD leads is variable between manufacturer and model families. The net impact of lead family on the safety and effectiveness of TLE is poorly characterized. We assessed the safety and efficacy of ICD TLE and the impact of manufacturer ICD model family on the outcomes. METHODS: The study cohort included all consecutive patients with ICD who underwent TLE between 2013-2022 and are enrolled in the Cleveland Clinic Prospective TLE Registry...

BACKGROUND AND AIMS: Stereotactic arrhythmia radioablation (STAR) is a novel therapeutic approach for cardiac arrhythmias. The aim of this trial is to investigate the feasibility of STAR for the treatment of paroxysmal atrial fibrillation (AF) in elderly patients. METHOD: inclusion criteria were: age > 70 years, symptomatic AF, antiarrhythmic drugs failure or intolerance. All patients underwent to 4D cardiac Computed Tomography simulation. The clinical target volume was identified in the area around pulmonary veins (PV)...

BACKGROUND AND AIMS: Atrial fibrillation (AF) is associated with high risk of comorbidities and mortality. Our aim was to examine causal and predictive relationships between 4,137 serum proteins and incident AF in the prospective population-based AGES/Reykjavik study. METHODS: The study included 4,765 participants, of whom 1,172 developed AF. Cox proportional hazards regression models were fitted for 4,137 baseline protein measurements adjusting for known risk factors...

BACKGROUND AND AIMS: During the diagnostic work-up of patients with idiopathic ventricular fibrillation (VF), next-generation sequencing panels can be considered to identify genotypes associated with arrhythmias. However, consensus for gene panel testing is still lacking, and variants of uncertain significance (VUS) are often identified. METHODS: We investigated 419 patients with available medical records from the Dutch Idiopathic VF Registry, focussing on genetic testing...

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BACKGROUND AND AIMS: The first-generation radiofrequency HotBalloon (RHB) is a size-adjustable single-shot device used in atrial fibrillation. The energy output is determined by its central temperature, not balloon surface temperature (BST), limiting its efficacy and safety. The second-generation RHB was developed to monitor BST and enable BST-controlled ablation. This animal study aimed to evaluate the accuracy of a newly developed BST monitoring system and validate the optimal BST for ablation...

No abstract text is available yet for this article.

BACKGROUND AND AIMS: Brugada syndrome (BrS) is an inherited disease associated with an increased risk of ventricular arrhythmias. Recent studies have reported the presence of an altered atrial phenotype characterized by abnormal P-wave parameters. The aim of this study was to identify BrS based exclusively on P waves features through an artificial intelligence (AI)-based model. METHODS: Continuous 5-minute 12-lead ECG recordings were obtained in sinus rhythm from a) patients with spontaneous or ajmaline-induced BrS and no history of AF and b) subjects with suspected BrS and negative ajmaline challenge...

BACKGROUND AND AIMS: Dapagliflozin has been widely used for the treatment of type 2 diabetes mellitus (T2DM) and heart failure (HF). However, data concerning the association between dapagliflozin and the recurrence of atrial fibrillation (AF), especially in patients following Cox Maze IV (CMIV), are rare. We aim to explore the effect of dapagliflozin on the recurrence of AF after CMIV with and without T2DM or HF. METHODS: The study of dapagliflozin evaluation in atrial fibrillation patients followed by Cox-Maze IV (DETAIL-CMIV) is a prospective, double-blind, randomized, placebo-controlled trial...