BACKGROUND:The prognostic significance of blanking period arrhythmic events following extensive substrate modification ablation, such as the STABLE-SR procedure, remains inadequately defined. METHODS:In this single-center retrospective study, we analyzed data from 411 consecutive patients with non-paroxysmal atrial fibrillation (AF) undergoing first-time catheter ablation using the STABLE-SR technique. The incidence and characteristics of blanking period events (within 3 months post-ablation) were assessed. All patients were followed for 1 year to determine AF recurrence. Univariable and multivariable Logistic regression analyses were performed to identify predictors of recurrence. RESULTS:Among the 373 patients who completed follow-up, blanking period events occurred in 106 patients (28.4%). The 1-year recurrence rate was significantly higher in patients with blanking period events compared to those without (46.2% vs. 16.9%, p < 0.001). Multivariable analysis identified the presence of any blanking period event (odds ratio [OR] 2.73, 95% confidence interval [CI] 1.22-6.11, p = 0.014), adjunctive cavotricuspid isthmus ablation (OR 1.91, 95% CI 1.01-3.36, p = 0.047), and the need for end-procedural electrical cardioversion (OR 3.10, 95% CI 1.01-9.48, p = 0.047) as independent predictors of long-term recurrence. CONCLUSIONS:In patients undergoing STABLE-SR ablation for non-paroxysmal AF, arrhythmias during the blanking period are common and constitute the strongest independent predictor of 1-year recurrence. Specific procedural characteristics further stratify recurrence risk.

BACKGROUND:Previous studies have demonstrated electrical connections between ipsilateral pulmonary veins (PVs). This study aimed to characterize the electrophysiological features of right middle pulmonary vein (RMPV) originating from right superior pulmonary vein (RSPV). METHODS:We prospectively enrolled patients with atrial fibrillation (AF) with an identifiable RMPV on pre-procedural cardiac computed tomography angiography (CTA) and in whom a multipolar mapping catheter could be advanced into the RMPV. Cardiac CTA was used to assess left atrial and PV anatomy, including ostial diameter, area and ovality index. The RMPV was defined as an inferiorly directed branch arising from the ostium-proximal segment of the RSPV, within 1 cm from the ostium RESULTS: A total of 118 patients were included (mean age 63.9 years, 63.6% male). The mean RMPV ostial area was 0.69 ± 0.41 cm2, with maximum and minimum diameters of 0.83 ± 0.21 cm and 0.63 ± 0.17 cm, respectively. The mean ovality index was 1.35 ± 0.27 for RMPV. AF triggers originating from the RMPV were identified in 3 patients (2.5%). During circumferential pulmonary vein isolation (CPVI), RMPV potentials were eliminated in 99 patients (83.9%), concurrently with disappearance of RSPV potentials. In the remaining 19 patients, RMPV potentials persisted after CPVI and required additional carina ablation to achieve isolation. After a mean follow-up of 41 months, 96 patients remained free from atrial tachyarrhythmia recurrence after the index procedure. CONCLUSIONS:RMPV potentials predominantly originate from the RSPV and can usually be eliminated during CPVI. However, additional carina ablation is required in a subset of patients to achieve RMPV isolation.

BACKGROUND:Bundle branch reentry ventricular tachycardia (BBRT) in patients without structural heart disease (SHD) has been well-documented. However, the occurrence of concomitant atrial tachycardia (AT) in this cohort remain poorly characterized. The study aimed to investigate the prevalence, clinical characteristics, and electrophysiological properties of concomitant AT in patients with BBRT. METHODS:Eighteen patients without SHD were enrolled. Detailed electrophysiological studies were performed to identify and characterize concomitant ATs. Catheter ablation was performed for both BBRT and atrial ATs. RESULTS:Among 18 patients with BBRT, 6 patients (33.3%; mean age 26.3 years) presented with a total of 7 ATs. Three patients had a history of AT ablation, two exhibited BBRT concomitant with AT during the index procedure, and two developed AT following BBRT ablation. All ATs originated from the right atrium, with the following distribution: coronary sinus ostium (CSO) (n = 4), typical atrial flutter (AFL) (n = 2) and mid-crista terminalis (MCT) (n = 1). The mean tachycardia cycle length (TCL) was 337±61 ms. Acute procedural success was achieved in all cases. During a mean follow-up of 54.1±26.0 months, all patients remained free from AT and BBRT recurrence. However, progressive deterioration of left ventricular function requiring cardiac resynchronization therapy occurred in one patient, and two patients developed ventricular enlargement. CONCLUSIONS:Concomitant AT was observed in one-third of patients with BBRT without SHD. Catheter ablation proved effective in treating both arrhythmias. Intensive long-term monitoring of cardiac function is recommended in this population.

INTRODUCTION:Prolonged sinus pause (PSP) after atrial fibrillation (AF) termination shortly after catheter ablation seems to be a reversible phenomenon without further need for pacemaker implantation (PMI). However, no mature management strategy has been established. METHODS:In this prospective observational study, we included consecutive patients who developed PSP ≥ 3 s upon AF termination during hospitalization following AF ablation at our center between October 2020 and October 2022. Regular follow-up was conducted. RESULTS:Twelve patients (mean age 66.3 ± 8.5 years; 7 females) were included. PSP ≥ 3 s upon AF termination initiated at a median of 2.0 days (IQR: 1.3-3.8) post-ablation and resolved by 5.0 days (IQR: 3.5-7.5). Three patients received temporary PMI, all of which were removed before discharge without further pacing. One patient underwent permanent PMI during hospitalization due to Adams-Stokes syndrome. After discharge, one patient received permanent pacing for symptomatic sinus arrest at 3 months, and another underwent atrioventricular node ablation followed by permanent pacing due to recurrent arrhythmia. The remaining patients had no related symptoms or need for pacing during follow-up. CONCLUSION:PSP ≥ 3 s upon AF termination shortly after catheter ablation appears to be reversible. A watch-and-wait strategy was practical. Management may involve discontinuation of antiarrhythmic drugs or temporary pacing support. A small proportion of patients may ultimately require permanent PMI.

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 cm2, 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:Transition zone (TZ) may serve as a potential substrate for atrial fibrillation (AF). This study aims to investigate the relationship of TZ burden with left atrial conduction velocity (LACV) and recurrence after circumferential pulmonary vein isolation (CPVI) in elderly patients with paroxysmal AF without low-voltage areas (LVA). METHODS:Patients with paroxysmal AF without LVA were categorized into three groups based on the TZ burden (< 5%, 5%-15% and > 15%). TZs were defined as regions with bipolar voltage between 0.5 and 1 mV in more than 3 adjacent points. TZ burden was calculated as the proportion of TZ on the entire left atrium surface. LACV were calculated as conduction distance divided by conduction time. Recurrence was defined as any episode of atrial tachyarrhythmia (ATA) lasting ≥ 30 s after a 3-month blanking period. RESULTS:Among the 158 enrolled patients (mean age 69.7 ± 3.8 years), 48 (30.4%) had a TZ < 5%, 66 (41.8%) had a TZ of 5%-15%, and 44 (27.8%) had a TZ > 15%. Patients with higher TZ burden exhibited significantly decreased anterior LACV (1.52 ± 0.36 vs. 1.21 ± 0.27 vs. 1.02 ± 0.25 m/s, p < 0.0001). After a mean follow-up of 24.9 months, 40 (25.3%) patients experienced recurrence. Patients with recurrence had higher TZ burden (15.4 [7.2-22.4] vs. 8.2 [3.5-14.3], p < 0.0001). TZ burden remained significantly associated with recurrence in a multivariable Cox regression model (adjusted HR 1.065 [95% CI 1.034-1.098], p < 0.0001). CONCLUSIONS:TZ burden is correlated with slow LACV and independently predicts ATA recurrence following CPVI.

Patients undergoing maintenance hemodialysis (HD) face a substantially elevated risk of all-cause mortality, yet robust tools for individualized risk stratification remain limited. This multicenter study developed a predictive model integrating dynamic autonomic nervous system (ANS) markers - heart rate variability (HRV) and skin sympathetic nerve activity (SKNA) - with clinical factors to assess mortality risk. We enrolled 198 HD patients from two Chinese centers between 2021 and 2023, recording HRV/SKNA parameters at baseline, 30 min, and 240 min into dialysis. Over a median follow-up of 34 months, the all-cause mortality rate was 17.7%. Ninety-one baseline features were included in the LASSO-regression model. The final multivariable logistic regression model incorporated six variables (diabetes mellitus, DBP2h, RMSSD240, ΔNnmean30, ΔApEn30 and ΔaSKNA240) into the nomogram. The AUC of the nomogram for predicting one-year, two-year, and three-year survival rates was 0.764, 0.749, and 0.805, respectively. The Kaplan-Meier curves for overall survival stratified by nomogram model showed a significant difference between high- and low- risk groups. Internal validation via bootstrap resampling confirmed model robustness, with optimism-corrected AUCs of 0.758, 0.736, and 0.788 for one-, two-, and three-year mortality, respectively. The model demonstrated superior predictive accuracy for cardiovascular mortality (C-index = 0.881) and consistent performance across age and sex subgroups. The proposed model has the potential to predict all-cause mortality in HD patients and may enable earlier intervention and personalized management.

BACKGROUND:Cryoballoon ablation (CBA) has been shown as an effective alternative strategy to radiofrequency ablation (RFA) for the treatment of paroxysmal atrial fibrillation (PAF), with comparable efficacy and safety. However, the electrophysiological properties in pulmonary veins (PVs) after CBA and RFA are not well understood. This study compares these characteristics in PAF patients. METHODS:Consecutive patients with PAF undergoing initial catheter ablation were prospectively randomized to CBA (N = 50) or RFA (N = 50) for PV isolation (PVI). Each PV's automaticity and excitability were assessed. Follow-up for atrial tachyarrhythmia recurrence at 3, 6, and 12 months was monitored via electrocardiogram/Holter. RESULTS:A total of 100 patients were randomized (mean age of 62 ± 10 years). After initial PVI, 33 (66%) patients in the RFA group retained PV automaticity, compared to 17 (34%) patients in the CBA group (p = 0.027). The number of PVs exhibiting stable automaticity was significantly higher in the RFA group compared with the CBA group (51/198 vs. 19/197, p < 0.0001). Ipsilateral PV crosstalk was more common in the RFA group (7/17 vs. 0/2, p = 0.5088). Moreover, low-frequency pacing revealed local capture in 46% of the RFA group versus 2% of the CBA group (p < 0.0001). Fluoroscopy time was shorter with RFA (p = 0.0003), but ablation time was longer (p < 0.0001). Over an average of 13-month follow-up, atrial tachyarrhythmia recurrence rates were similar between groups. CONCLUSIONS:Automaticity and excitability within PVs were more prevalent in the RFA group than the CBA group after AF ablation.

Atrial fibrillation (AF) and atrial flutter (AFL) are common arrhythmias, with incidence increasing with age. Catheter ablation and left atrial appendage closure (LAAC) are guideline-recommended treatments for patient with AF and high thromboembolic risk of stroke. We report the case of a patient with paroxysmal AF/AFL at high thromboembolic risk who developed paroxysmal rapid AF with sinus arrest following combined pulmonary vein isolation (PVI) and LAAC. Notably, both the arrhythmia and sinus node dysfunction gradually resolved over three months without pacemaker implantation. We propose that a watchful waiting strategy may be appropriate in similar clinical scenarios.

BACKGROUND AND AIMS:The optimal long-term antithrombotic strategy after left atrial appendage occlusion (LAAO) remains undetermined. The present study aimed to investigate whether half-dose rivaroxaban (10 mg daily) could better reduce silent cerebral embolic lesions (SCEs) and preserve cognitive function compared to antiplatelet therapy after successful LAAO. METHODS:In this investigator-initiated, prospective, multicenter, randomized controlled trial, patients with successful LAAO confirmed 45 days post-procedure were assigned 1:1 to half-dose rivaroxaban or antiplatelet therapy group. Diffusion-weighted magnetic resonance imaging and cognitive assessments were repeated at 90, 180 and 365 days after LAAO. The primary outcome was the patient-level incidence of any newly detected SCE during follow-up. Secondary outcomes included cognitive trajectories, SCE burden, and a composite of all-cause mortality, clinical thromboembolic events and major bleeding. RESULTS:Between December 2022 and February 2025, 164 patients were randomized. The patient-level incidence of new SCEs was significantly lower in the half-dose rivaroxaban group than in the antiplatelet therapy group (10/82 [12.2%] vs. 26/82 [31.7%]; P = 0.005). At 365 days, model-derived between-group differences favored the half-dose rivaroxaban group for both Mini-Mental State Examination (2.56; 95% confidence interval [CI] 1.11-4.01; P < 0.001) and Montreal Cognitive Assessment (2.67; 95% CI 1.07-4.26; P = 0.001) scores. The composite clinical outcome occurred in 2.4% of the half-dose rivaroxaban group vs. 11.0% of the antiplatelet therapy group (P = 0.057). CONCLUSIONS:In patients eligible for oral anticoagulation after successful LAAO, rivaroxaban 10 mg daily significantly reduced SCEs and better maintained cognitive function compared with antiplatelet therapy, with numerically fewer composite clinical events.

Atrial cardiomyopathy, which often comes with underlying genetic defects, has been recognized as a possible substrate of atrial fibrillation. MYH6 encodes α-myosin heavy chain (α-MHC), predominantly expressed in the atria and pivotal in sarcomere organization and muscle contraction. Genetic investigation in patients with a family history of atrial cardiomyopathy identified three probands carrying MYH6 variants (D629N, V893M, A1327T). However, the role of MYH6 in atrial diseases has not been fully elucidated, and the genetic cause of atrial cardiomyopathy needs further investigation. Here, we employed CRISPR/Cas9 to generate myh6 knockout zebrafish, assessing cardiac abnormalities in structural, electrical, and gene expression levels through diverse methodologies. Our findings revealed that myh6 defects in zebrafish impaired atrial and ventricular function and disordered sarcomere, which underscores the pivotal role of MYH6 in maintaining atrial function and development. Transcriptomic sequencing also identified 1318 differentially expressed genes enriched in muscle development, calcium ion homeostasis, and sarcomere pathways. The association between MYH6 dysfunction and atrial cardiomyopathy highlights the role of sarcomeric abnormalities in atrial remodeling, a process implicated in atrial fibrillation.

ABSTRACT Background Discrete prepotentials (DPPs) mapped inside aortic sinuses of Valsalva (ASVs) are deemed as reliable targets for ablation of premature ventricular contractions (PVCs). Nevertheless, ablation may still fail, necessitating further investigation. This study aimed to investigate the electrophysiological features and ablation approaches for PVCs with failed ablation inside ASVs, despite identified DPPs. Methods and Results Patients undergoing PVCs ablation requiring left ventricular outflow tract mapping were consecutively enrolled at six centers. Inclusion criteria comprised the presence of reproducible DPPs in ASVs and the earliest activation inside ASVs preceding the left ventricle. Patients were divided into ASV and non‐ASV groups based on ablation outcomes within ASVs. Of 780 assessed patients, 40 (age 47.5 ± 19.4; 17 males) were included in the final analysis, with 10 in the non‐ASV group. The interval from DPPs to QRS onset (DPP‐QRS) in the ASV group significantly exceeded that in the non‐ASV group (44.3 ± 6.7 ms vs. 15.0 ± 5.0 ms, p < 0.001). A DPP‐QRS interval < 25 ms perfectly differentiated non‐ASV from ASV cases. Successful ablation beneath ASVs was achieved in all non‐ASV patients, despite the local potential preceding the QRS onset by only 2.3 ± 8.0 ms. In the non‐ASV group, the distance between locations of targets and DPPs was 13.3 ± 4.2 mm, negatively correlated with the DPP‐QRS interval ( R 2 = 0.618, p = 0.007). Over a 22‐month follow‐up, one patient in the non‐ASV group had recurrence. Conclusion DPPs mapped inside ASVs, despite being the earliest sites, do not necessarily represent PVCs targets. An infra‐valvular approach is suggested with a DPP‐QRS interval < 25 ms.

INTRODUCTION:Trans-thoracoscopic atrial fibrillation (AF) ablation combined with left atrial appendage excision (LAAE) is an alternative treatment approach for nonvalvular AF patients with a history of thromboembolic events. The primary objective of this research was to investigate the electrophysiological characteristics of recurrent atrial tachyarrhythmias and rhythm outcome in patients receiving repeat catheter ablation after surgical AF ablation plus LAAE. METHODS:Nonvalvular AF patients with previous thromboembolic events who underwent trans-thoracoscopic AF ablation plus LAAE and then received radiofrequency catheter ablation were enrolled. During the procedure, the reconnection of the left atrium (LA) and pulmonary veins (PVs) was investigated, and three-dimensional activation mapping of the LA and/or right atrium during atrial tachyarrhythmias was performed. RESULTS:From January 2014 to December 2021, 173 patients without a history of prior ablation underwent concurrent trans-thoracoscopic AF ablation and LAAE. A total of 74 patients experienced recurrent atrial tachyarrhythmias during a median follow-up period of 3.5 years (interquartile range [IQR]: 2.0 to 5.0 years) after the surgical procedure. A total of 22 patients with atrial tachyarrhythmias recurrence (11 males, aged 60 ± 9 years) underwent radiofrequency catheter ablation. Among them, 10 patients with recurrent AF were identified, and in two of them, non-PV triggers originated from the interatrial septum and the superior vena cava. Reconnected LA-PV conduction was detected in 12 patients, with a total of 27 PV gaps. Eighteen of these PV gaps were located at the roof or the bottom. Thirteen sustained atrial tachycardias (ATs) were mapped in 12 patients, including peri-mitral AT (n = 7), cavotricuspid isthmus-dependent AT (n = 3), remnant LAA-related micro-reentrant AT (n = 1), roof-dependent reentry AT (n = 1), and focal AT (n = 1). At a median follow-up of 9 months (IQR: 3-20 months) after the ablation procedure, the freedom rate from atrial tachyarrhythmias was 77%. CONCLUSION:Reconnection of LA-PVs and macro-reentry ATs are common in repeat catheter ablation after surgical treatment for AF, with peri-mitral AT being the most frequently observed AT. PV gaps are most often located at the roof or bottom. Additionally, LAAE may contribute to arrhythmogenesis in certain patients. Catheter ablation targeting these mechanisms resulted in a favorable short- to mid-term rhythm outcome.

BACKGROUND:The occurrence of a left free-wall (LFW) accessory pathway (AP) with concentric activation sequences in the coronary sinus (CS) during orthodromic atrioventricular reentrant tachycardia (OAVRT) is an uncommon phenomenon. METHODS:Using three-dimensional (3D) mapping system in eight patients with LFW-AP (mean age 44±9.9 years), we systematically analyzed mitral annular (MA) activation during OAVRT. RESULTS:The primary location of the APs was in the left lateral region in seven patients. The tachycardia, characterized by varying CS sequences, remained sustainable in three patients and was inducible in four patients following the initial ablation at the earliest retrograde atrial insertions. The tachycardia cycle length (TCL) was comparable to the baseline TCL (345.4±94.2  vs. 345.6±93.4 ms; p = 0.99). Moreover, the tachycardia was terminated by ablating the earliest retrograde atrial activation region adjacent to the initial ablation site. One patient with a history of left lateral AP ablation exhibited mitral isthmus (MI) block, and the left anterior AP was successfully ablated. Following a mean follow-up of 50.5 months, no recurrence of tachycardia was reported by any patient. CONCLUSION:LFW-AP with concentric CS activation sequences represents a distinctive electrophysiological entity, our study demonstrates detailed mapping in the vicinity of the MA is imperative to localize the secondary atrial insertion site of the AP or to identify multiple APs in close proximity to the initial ablation site. CLINICAL TRIAL REGISTRATION:This retrospective study does not require clinical trial registration.

To investigate the prevalence, distribution and ablation of non-pulmonary vein (PV) triggers in older patients with paroxysmal atrial fibrillation (AF). A total of 694 patients aged 65–80 receiving index ablation for paroxysmal AF were included. These patients were divided as follows: patients without low-voltage areas (LVA) (n = 437), LVA patients with modification (n = 175), and LVA patients without modification (n = 82). Following propensity score matching (PSM) analysis, two sets of matched groups emerged: LVA patients without modification (Group A, n = 77) and patients without LVA (Group B, n = 77), and patients without LVA (Group C, n = 168) and LVA patients with modification (Group D, n = 168). The clinical endpoint was defined as the detection of ATA lasting longer than 30 s through ECG documentation or Holter recordings following the index ablation. Fifty-seven (8.2

BACKGROUND:Pre-implantation screening is a crucial step in preventing inappropriate sensing in patients with subcutaneous implantable cardioverter defibrillators (S-ICDs). Paced QRS-T morphology may influence screening outcomes. We aimed to explore the impact of pacing rhythm and different pacing sites on pre-implantation screening of S-ICD. METHODS AND RESULTS:This prospective, single-center study enrolled patients referred for radiofrequency ablation, with both left and right-heart access. A contact-force ablation catheter was used to mimic ventricular pacing at different sites. Automatic screening tests for S-ICD eligibility were performed during pacing and sinus rhythm. The impact of pacing sites on S-ICD eligibility was assessed. Thirty patients (age 54.0 ± 15.0 years, 73.3% male) were enrolled. The overall passing rate during intrinsic sinus rhythm was 86.7%. Compared with sinus rhythm, conduction system pacing from His bundle or left bundle branch demonstrated comparable pass rates and the number of passed vectors, whereas right ventricular septum (RVS) pacing exhibited significantly lower pass rates and less pass vectors. Among all RVS pacing sites, the lowest pass rate was observed at the apical portion, followed by middle and basal portion (p < 0.001 for all comparisons). CONCLUSION:Conduction system pacing preserves patient eligibility for S-ICD comparable to sinus rhythm, while RVS pacing significantly impairs sensing performance, with the greatest deterioration observed in apical pacing. These findings underscore the advantages of conduction system pacing in optimizing sensing function for patients eligible for both S-ICDs and pacemakers.

BACKGROUND:Pulsed-field ablation (PFA) emerges as an innovative nonthermal energy modality for catheter ablation of atrial fibrillation (AF). This study aimed to assess the safety and effectiveness of a novel PFA system that uses a multichannel, circular ablation catheter with adjustable diameters in treating paroxysmal AF. METHODS:This clinical trial (PF-Beat-AF) was a prospective, multicenter, single-arm study. Patients with paroxysmal AF underwent pulmonary vein isolation (PVI) using the PFA system, and were followed at discharge, 7-day, 1-, 3-, 6- and 12-month post-procedure. Primary safety endpoint was the incidence of primary adverse events (PAEs). While primary effectiveness endpoint was freedom from documented atrial arrhythmia recurrence lasting >30 s during the 3-12 months evaluation period. RESULTS:A total of 161 patients were enrolled and 159 patients were treated in eight centers. Conscious sedation was used in 68.6 % of cases, and 40.9 % of procedures were completed without fluoroscopy. The mean total procedure time was 132.3 ± 40.4 min, and fluoroscopy time averaged 6.4 ± 6.8 min. Acute PVI was achieved in 100 % of patients. One PAE (0.6 %) occurred (pericardial tamponade, resolved). At 12 months, 87.7 % (95 % CI: 82.5 %-92.9 %) of patients remained free from atrial arrhythmia after the blanking period. No significant differences in effectiveness were observed between conscious sedation and general anesthesia/deep sedation, or fluoroscopy and zero-fluoroscopy cases. CONCLUSION:The results of clinical trial demonstrated the safety and effectiveness of the PFA system in treating paroxysmal AF, including successful use with conscious sedation and zero-fluoroscopy.

Predicting recurrence after radiofrequency catheter ablation (RFCA) in persistent atrial fibrillation (PeAF) remains challenging. This study evaluated the predictive value of F‐wave amplitude (FWA), F‐wave duration (FWD) in inferior ECG leads (II, III, aVF), and AF duration for post‐ablation recurrence. In this dual‐center retrospective study, 763 persistent atrial fibrillation (PeAF) patients undergoing first RFCA (2017–2022) were analyzed. Pre‐procedural FWA and FWD were measured across 12‐lead ECGs using MATLAB. Clinical data and 12‐month follow‐up outcomes were collected. Independent predictors were identified via binary logistic regression, and a gradient boosting machine (GBM) model was developed. Model performance was assessed using ROC curves, calibration plots, and decision curve analysis (DCA), with internal (random split) and external (between‐center) validation. At 12 months, 198 patients (26%) experienced recurrence. Recurrence patients exhibited significantly lower inferior lead FWA (0.108 [0.076–0.157] vs. 0.126 [0.087–0.173] mV, p = 0.003), narrower FWD (54.96 [40.26–71.31] vs. 61.46 [42.7–76] ms, p = 0.038), and longer AF duration (13.8 [4–38] vs. 6.5 [3–21] months, p < 0.001). Multivariate analysis identified inferior lead FWA (OR = 0.788, 95%CI 0.662–0.937, p = 0.007) and AF duration (OR = 1.014, 95%CI 1.007–1.021, p < 0.001) as independent predictors. The model combining AF duration and FWA achieved an AUC of 0.692 (95%CI 0.648–0.737), improving to 0.746 (0.701–0.787) with FWD inclusion. Validation demonstrated stable discrimination (internal AUC = 0.722, 95%CI 0.680–0.762; external AUC = 0.703, 0.659–0.747). Inferior lead FWA and AF duration are independent predictors of post‐RFCA recurrence in persistent AF. The combined model integrating these parameters with FWD shows robust discriminative ability and clinical utility, supporting personalized treatment strategies.

BACKGROUND:Intradialytic hypotension (IDH) is a prevalent complication during hemodialysis (HD). However, conventional predictive models are imperfect due to multifaceted etiologies underlying IDH. METHODS:This study enrolled 201 patients undergoing maintenance HD across two centers. Seventy percent of the patient cohort was randomly allocated to the training cohort (n = 136), while the remaining 30% formed the validation cohort (n = 65). IDH was defined as a reduction in systolic blood pressure (SBP) ≥20 mmHg or mean arterial pressure (MAP) ≥10 mmHg. Clinical data and autonomic nervous parameters, including skin sympathetic nerve activity (SKNA) and heart rate variability (HRV) during the initial 30 min of HD, were employed to construct the model. The least absolute shrinkage and selection operator (LASSO) regression facilitated variable selection associated with IDH. Subsequently, a multivariable logistic regression model was formulated to predict the risk of IDH and establish the nomogram. RESULTS:Sixty-six baseline features were included in the LASSO-regression model. In the final multivariable logistic regression model, 5 variables (SBP0, aSKNA0, △aSKNA0-30, SDNN0, △SDNN0-30) were incorporated into the nomogram. The AUC was 0.920 (95% CI, 0.878-0.962) in the training cohort and 0.855 (95% CI, 0.763-0.947) in the validation cohort, indicating concordance between the nomogram prediction and actual observation of IDH. CONCLUSION:The LASSO-enabled model, based on clinical characteristics and autonomic nervous system parameters from the first 30 min of HD, shows promise in accurately predicting IDH.

Background Left atrial appendage occlusion (LAAO) was associated with a high incidence of procedure‐related silent cerebral embolism (SCE). There are limited data regarding the long‐term cognitive trajectory of patients undergoing LAAO. The aim of our study was to comprehensively assess the acute and long‐term impact of SCE during and after LAAO. Methods Consecutive patients with atrial fibrillation referred for LAAO from the First Affiliated Hospital with Nanjing Medical University between February 2021 and February 2023 were included. All patients underwent magnetic resonance imaging and cognitive assessments before and within 48 hours after the procedure. These evaluations were also repeated at 45‐day, 3‐month, 6‐month, and 1‐year follow up. Results Out of 75 patients included in the final analysis, 29 (38.7%) patients suffered from new SCE during LAAO. Patients with SCE exhibited a significant decline in cognitive function (Mini‐Mental State Examination) immediately after the procedure (P<0.001), which was not reversible during 1‐year follow‐up (P<0.001). Additionally, with time going on, the gap in cognitive function between patients with and without SCE became wider (SCE × 1 year: B=−4.81 [95% CI, −5.58 to −4.05]; P<0.001). New‐onset SCE was detected in 11 (14.7%) patients during the follow‐up magnetic resonance imaging, which also showed a decline in cognitive function (P=0.004). The results in Montreal Cognitive Assessment scores were consistent with Mini‐Mental State Examination. Conclusions LAAO‐related SCE is associated with a marked impairment in cognitive function immediately after the procedure and is irreversible over a 1‐year follow‐up. New magnetic resonance‐detected SCE during follow‐up after LAAO would also be associated with a decline in cognitive function.