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.

INTRODUCTION:Left bundle branch area pacing (LBBAP) represents an essential physiological pacing technique, and conduction system (CS) capture can be achieved even in the absence of detectable CS potential. We aimed to measure the distance between the electrode tip and the left ventricular conduction system (LVCS) during LBBAP. METHODS AND RESULTS:Sixteen canines are evenly divided into two groups: (1) conduction system pacing (CSP) group, including left bundle branch pacing (LBBP) and left fascicular pacing (LFP); (2) left ventricular septal pacing (LVSP) group. A three-dimensional electroanatomical mapping (EAM) system used to visualize the LVCS and guide electrode implantation. Pathological specimens are used to measure the distances between the electrode tip and LVCS, as well as the depth and angle of electrode implantation. Group 1 showed electrode tip-to-LVCS distance ≤ 2 mm versus > 2 mm in Group 2. Significant differences existed in pacing and pathological parameters between groups: stimulus to left ventricular activation time (Stim-LVAT) (48.75 ± 2.38 ms vs. 59.75 ± 2.05 ms, p < 0.01), Stim-Retro-His interval (21.00 ± 2.27 ms vs. 44.50 ± 2.83 ms, p < 0.01), QRS duration (89.50 ± 4.34 ms vs. 109.88 ± 5.96 ms, p < 0.01), the depth of electrode implantation (10.38 ± 0.53 mm vs. 9.35 ± 0.76 mm, p < 0.01), the angle of electrode implantation (76.88° ± 11.32° vs. 55.63° ± 12.66°, p < 0.01), and the distance between the electrode tip and the LVCS (0.69 ± 0.66 mm vs. 3.06 ± 0.28 mm, p < 0.01). CONCLUSION:When the distance between the electrode tip and LVCS is ≤ 2 mm, the CS could be captured at outputs of ≤ 1.5 V/0.5 ms.

In some arrhythmia centers, intraprocedural guidance using fluoroscopy alone remains the mainstream approach for left atrial appendage closure (LAAC). This study aims to synthesize recent literature and assess the feasibility of fluoroscopy‑guided LAAC performed without echocardiography. A computer-based search was conducted in PubMed, Embase, and the Cochrane Library for studies comparing fluoroscopy alone versus fluoroscopy combined with echocardiography for LAAC, from the inception of each database to September 13, 2025. Summary analysis was conducted using Review Manager 5.4. This meta-analysis included 7 studies with 2,472 patients, 1,358 in the Fluoroscopy group and 1,114 in the combined fluoroscopy‑echocardiography group (Standard group). Both groups achieved high immediate procedural success rates, with a higher rate in the Standard group (RR 0.98, 95

Background:The impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on post-ablation atrial fibrillation (AF) recurrence is still unclear. Accordingly, we investigated whether exposure to SGLT2i reduces post-ablation AF recurrence among individuals with heart failure (HF) or type 2 diabetes mellitus (T2DM). Methods:We carried out a structured search of PubMed, Embase, and the Cochrane Library from database launch through August 17, 2025. Pooled analyses were generated with RevMan 5.4 and Stata 18. Results:11 studies were included, comprising 2 randomized controlled trials (RCTs) and 9 retrospective cohort studies, with a total of 7,664 individuals. Among them, 3,390 received SGLT2i therapy, and 4,274 received non-SGLT2i therapy. Compared with the non-SGLT2i, SGLT2i was linked to decreased post-ablation AF recurrence (RR: 0.61, 95% CI: 0.52-0.71, p < 0.001). Subgroup analyses showed consistent reductions in recurrence risk in individuals with AF and T2DM (RR: 0.74, 95% CI: 0.68-0.80, p < 0.001) as well as those with AF and HF (RR: 0.61, 95% CI: 0.50-0.74, p < 0.001). Furthermore, SGLT2i corresponded to reduced all-cause mortality (RR: 0.66, 95% CI: 0.48-0.91, p = 0.010), fewer rehospitalization (RR: 0.79, 95% CI: 0.72-0.88, p < 0.001), and a lower incidence of thromboembolic events (RR: 0.56, 95% CI: 0.36-0.86, p = 0.009). Conclusions:Use of SGLT2i was linked to reduced post-ablation AF recurrence, and this association was consistent in AF individuals with T2DM as well as those with HF. Additionally, SGLT2i therapy correlated with reduced risks of all-cause mortality, rehospitalization, and thromboembolic events. Systematic Review Registration:identifier CRD420251125971.

Heart failure (HF) is a complex clinical syndrome associated with significant morbidity and mortality. Dysregulation of long non-coding RNA (lncRNA) has been implicated in the pathogenesis of HF. The present study aims to investigate the role of lncRNA HOX transcript antisense RNA (HOTAIR) in cardiomyocyte pyroptosis in a murine HF model. A murine HF model was established through transverse aortic contraction surgery, and an in vitro HF cell model was developed by treating HL-1 cells with H2O2. HOTAIR was overexpressed in TAC mice and HL-1 cells via pcDNA3.1-HOTAIR transfection. Cardiac function was assessed in TAC mice, and myocardial changes were evaluated using HE staining. The expression of NLRP3 was examined by immunohistochemistry. Myocardial injury markers and pyroptosis-related inflammatory cytokines were quantified using ELISA. Protein levels of NLRP3, cleaved-caspase-1, and GSDMD-N were analyzed by Western blot. Dual-luciferase assays and RNA immunoprecipitation were employed to confirm the binding interactions between HOTAIR and miR-17-5p, miR-17-5p and RORA. Functional rescue experiments were conducted by overexpressing miR-17-5p or silencing RORA in HL-1 cells. HOTAIR exhibited reduced expression in TAC mice and H2O2-induced cardiomyocytes. Overexpression of HOTAIR ameliorated cardiac dysfunction, reduced myocardial pathological injury, enhanced cardiomyocyte viability, and decreased myocardial injury and pyroptosis. HOTAIR interacted with miR-17-5p to repress RORA transcription. Overexpression of miR-17-5p or silencing of RORA abolished the inhibitory effect of HOTAIR overexpression on cardiomyocyte pyroptosis. In conclusion, HOTAIR competitively bound to miR-17-5p, relieving its inhibition of RORA transcription and leading to increased RORA expression and suppressed cardiomyocyte pyroptosis in HF models.

Background Atrial fibrillation (AF) has been a worldwide health issue with increasing prevalence and mortality. Recently, increasing attention has been gained to the relationship between heart rate variability (HRV) and the clinical prognosis of AF catheter ablation. We aimed to evaluate the prognostic value of HRV in AF recurrence. Methods We systematically searched Web of Science, PubMed, and Embase from inception until 17 August 2022 to conduct the systematic review and meta-analysis. We included the studies reporting the predictive value of HRV parameters for AF recurrence or in which HRV parameters in AF recurrence and non-recurrence groups were individually reported. Results Finally, we enrolled 16 studies, including 2,352 patients. Higher rMSSD could independently predict AF recurrence following catheter ablation (OR: 1.02, 95% CI: 1.00–1.04; p = 0.03). Higher HF (OR: 1.55, 95% CI: 1.05–2.28; p = 0.03) and lower LF/HF (OR: 1.12, 95% CI: 1.03–1.20; p = 0.004) could independently predict AF recurrence within 1 year. Higher SDNN (OR: 1.02, 95% CI: 101–1.02; p = 0.0006) could independently predict AF recurrence among patients with paroxysmal AF. Almost all HRV parameters within 3 days after catheter ablation and lnHF, lnLF, and rMSSD at 3 months after catheter ablation performed significant differences in AF recurrence and non-recurrence groups. Conclusion Heart rate variability, especially higher rMSSD (within short-term and long-term periods), was closely related to recurrent AF following catheter ablation, highlighting the clinical importance of HRV in the prognosis of AF following catheter ablation.

BackgroundThe development of pulsed field ablation (PFA) as a new technique for pulmonary vein isolation (PVI) has been advancing rapidly in recent years. My team's previous work has shown the safety and long-term efficacy of bipolar asymmetric pulses in animal experiments. However, in ongoing clinical trials, we have observed that atrial fibrillation (AF) recurs in some patients after surgery, but the rhythm returns to normal without surgical intervention after seven days, and there is no recurrence in the follow-up.Based on this observation, we have proposed the hypothesis that myocardial cell apoptosis may play a role in AF recurrence after PFA. Our team has designed animal experiments to verify this hypothesis and further investigate the process of PFA-induced cardiomyocyte apoptosis.MethodsPulse field ablation was performed on 15 dogs and the animals were dissected at various time points after the operation (immediately, 3 days, 7 days, 30 days, and 150 days). To obtain ablation voltage maps, electroanatomic mapping was performed before and after ablation and before dissection. The ablation area was also subjected to HE and TUNEL staining to analyze apoptosis and pathological results.ResultsThe edge area of the ablation in the pulmonary vein (PV) demonstrated continuous dynamic changes from 0 to 2 h after the operation and a slight expansion of the ablation range was observed in the long-term follow-up. Myocardial intima hyperplasia was observed from 0 to 7 days. Local apoptosis was detected from 0 to 2 h and massive, concentrated apoptosis was observed at 3 days. No recurrence of apoptosis was seen at 7 days, 30 days, and 150 days.ConclusionsThe results of this study showed that after pulse field ablation (PFA), the central ablation area of the canine heart experienced immediate cardiomyocyte death. Meanwhile, cardiomyocytes in the edge ablation area underwent apoptosis, which began from 0 to 2 h post-operation and ended between 3 and 7 days. This process occurred simultaneously with intimal thickening.In the long-term follow-up group, there was no recovery of isolation and no recurrence of cardiomyocyte apoptosis, and no change was observed in the endomyocardial intima.

INTRODUCTION:The anatomical substrate for idiopathic left ventricular tachycardia (ILVT) remains speculative. Purkinje networks surrounding false tendons (FTs) might be involved in the reentrant circuit of ILVT. The objective was to evaluate the anatomical and electrophysiological features of false tendons FTs in relation to ILVT.METHODS:Intracardiac echocardiography (ICE) was conducted on patients with ILVT. The relationship of the FTs with ILVT was determined using electro-anatomical mapping.RESULTS:Electrophysiological evaluation and radiofrequency ablation were conducted in 23 consecutive patients with ILVT. FTs were identified in 19/23 cases (82.6%) with P1 potentials during VT recorded at the FT in 14 of these patients (73.7%). Three FT types were identified. In type 1, the FT attached the septum to the base of the posteromedial papillary muscle (PPM) (4/19); type 2 FTs ran between the septum and the PPM apex (3/19), while in type 3, the connection occurred between the septum and apex (11/19) or between the septum and the LV free wall (1/19). The effective ILVT ablation sites were situated at the FT-PPM (3/19) and the FT-septum (16/19) attachment sites.CONCLUSIONS:This series demonstrates the association between Purkinje fibers and FTs during catheter ablation of ILVT and verifies that left ventricular FTs are an important substrate in this type of tachycardia.

Objectives: The objective was to evaluate the anatomical and electrophysiological features of false tendons (FTs) in relation to idiopathic left ventricular tachycardia (ILVT). Background: The anatomical substrate for the ILVT remains speculative. Purkinje network surrounding the FTs might be involved in the reentrant circuit of ILVT.Methods: Intracardiac echocardiography (ICE) was conducted on patients with ILVT. The relationship of the FTs with ILVT was determined using electro-anatomical mapping.Results: Electrophysiological evaluation and radiofrequency ablation were conducted on 21 consecutive ILVT patients with ILVT. FTs were identified in 15/21 cases (71.4%) with P1 potentials during VT recorded at the FT in four of these patients (26.7%). Three FT types were identified. In type 1, the FT attached the septum to the base of the posteromedial papillary muscle (PPM) (4/21); type 2 FTs ran between the septum and the PPM apex (3/21), while in type 3, the connection occurred between the septum and apex (7/21) or between the septum and the LV free wall (1/21). The effective ILVT ablation sites were situated at the FT-PPM (3/15) and the FT-septum (12/15) attachment sites.Conclusions: This is the first case series to demonstrate the association between Purkinje fibers and FTs during catheter ablation of ILVT and to verify that the left ventricle FT association is responsible for this type of tachycardia.

Objective:To evaluate the association between the duration of atrial fibrillation(AF)or atrial flutter(AFL)and stroke events recorded in cardiovascular implantable electronic devices(CIED)and stroke events as well as the intervention effect of anticoagulant therapy.Methods:The study included 2 342 patients with sinus rhythm who received dual CIED in Department of Cardiology Tianjin Chest Hospital between January 2015 to December 2019.Atrial high-rate episodes(AHRE)(electro-cardiogram documented AF/AFL or intracavitary electrogram confirmed AF/AFL, AHRE>6 min and≥250 beats/min)were recorded.Anticoagulant therapy and stroke events were obtained during follow up period.The effects of the longest AHRE duration and CHA 2DS 2-VASc score on subsequent risk of ischemic stroke were evaluated with time dependent covariate Cox models. Results:Among 2 136 patients[mean age(68.9±9.6)years, 868 male]during mean follow-up of 42 months, the longest single episode of AHRE lasted<1.0 h in 79/2 136 patients(3.7%), 1.0-5.9 h in 93(4.4%), 6.0-23.9 h in 135(6.3%) and ≥24.0 h in 211(9.9%). AHRE duration≥6 h was associated with an increased risk of subsequent stroke(adjusted hazard ratio[ HR]=3.8, P<0.05), and the stroke risk was higher when AHREs were longer than 24 hours( HR=17.3, P<0.01). Anticoagulation therapy was associated with reduced stroke risk in those patient who had anticoagulant indication(male patients with CHA 2DS 2-VASc score≥1 or in female patients with CHA 2DS 2-VASc score≥2). Conclusion:Patients with AF≥6 h had an increased risk of ischemic stroke.Regular anticoagulant therapy could reduce the risk of stroke The use of anticoagulant was reasonable in patients with AF≥6 h.

目的:本研究旨在评价心脏不同起搏部位对心室电及机械同步性的影响.方法:选择2019年1月-2019年10月于天津市胸科医院因房室传导阻滞或心房颤动(房颤)伴缓慢心室率行永久起搏器安置术、左室射血分数(LVEF)＞40％的患者53例.根据心室电极植入位置分为希浦系统起搏24例,其中包括希氏束起搏(HBP)组14例,左束支起搏(LBBP)组10例;右室间隔起搏(RVSP)组15例;深部室间隔起搏(DVSP)组14例.测量术后QRS宽度及左室激动达峰时间(LVAT).术后1年起搏器程控评价心室电极参数并行心脏彩超检查及临床不良事件随访.应用二维斑点追踪技术测量并计算胸骨旁短轴水平左室18节段收缩期径向应变达峰时间平均值(Trs-AVG)、标准差(Trs-SD)及最大差(Trs-Dif),评价左室收缩同步性情况.结果:患者术后QRS时限、LVAT、Trs-AVG、Trs-SD、Trs-Dif相比,HBP与LBBP起搏组无明显差异;DSVP组较希浦系统起搏组上述时限均延长并出现统计学差异.DVSP组较RVSP组患者上述时限均显著缩短,两组术后QRS时限:(120.7±7.4)ms∶(152.1±7.4)ms,LVAT:(80.6±6.6)ms∶(108.1±3.4)ms,Trs-AVG:(366.5±32.3)ms∶(422.3±43.9)ms,Trs-SD:(43.5±8.4)ms∶(67.6±9.7)ms,Trs-Dif:(146.6±35.3)ms∶(257.6±47.2)ms,P＜0.01.起搏术后QRS宽度与Trs-SD强相关(r=0.895).与LBBP、DVSP、RVSP组相比,HBP组导线起搏阈值高(2.4±0.9 V/0.4 ms),R波振幅低(4.6±1.1)mV,P＜0.01.RVSP组患者术后LVEF较其余3组相比略减低(P=0.023),4组患者术后左室舒张末期内径未见统计学差异.结论:希浦系统起搏及DVSP的左室电及机械收缩同步性均优于RVSP.

Objective:To evaluate the relationship between the atrial high rate episodes (AHRE) and atrial fibrillation (AF) or atrial flutter (AFL) in contemporary pacemakers.Methods:The study included 2 109 patients implanted pacemakers which could supply intracavitary electrogram during follow-up period in Tianjin Chest Hospital from January 2015 to December 2020. All AHRE recorded with available electrograms were reviewed to determine whether they represented true AF/AFL. The distribution, different rates and durations of AHRE were analyzed.Results:Of 2 440 AHRE ≥30 s and ≥160 beats/min, 86.5% (2 111/2 440) were true AF/AFL. Other false positives included atrial tachycardia (9.7%, 237/2 440) , noise (2.6%, 64/2 440) , cross sensing (0.9%, 21/2 440) , repetitive non-reentrant ventricular atrial synchrony rhythm (0.2%, 5/2 440) , uncertainty (0.1%, 2/2 440) . By using a cutoff of ≥250 beats/min and > 6 h, the positive predictive value of AHRE was 99.9%.Conclusion:AHRE combined with time and frequency analysis is a reliable tool for the diagnosis of AF/AFL.

目的 评价导管消融心脏外科联合迷宫术后复发房性心动过速(简称房速)的电解剖基质及射频消融.方法 回顾性分析本院2016年1月至2019年1月心脏外科联合迷宫术后复发房速消融病例,所有房速应用三维标测于双房电解剖标测,结合拖带标测,明确房速机制后进行线性及基质消融.结果 共入选27例,诱发出33种心动过速.右房起源房速7例,所有右房起源房速均与切口和/或三尖瓣环大折返相关;左房房速26例,大折返机制15例,微折返机制11例.首次消融手术成功率93.9％(31/33).平均随访(31±18)个月,有5例患者复发.2例进行二次消融,总体手术成功率81.5％(22/27).结论 心脏外科联合迷宫术后房速患者行导管消融治疗安全、有效.

晕厥指突然发作的短暂的意识丧失,同时伴有肌张力的降低或消失,持续几秒至几分钟自行恢复,其实质是脑血流量的暂时减少. 晕厥可由心血管疾病、神经系统疾病及代谢性疾病等引起.血管迷走神经性晕厥,是指各种刺激通过迷走神经介导反射导致心跳忽然减慢、周边血管扩张,血压降低、脑部缺氧,表现为动脉低血压伴有短暂的意识丧失,能自行恢复.血管迷走神经性晕厥非常普遍的,尤其是当情绪受到相当压力,极度疲劳、疼痛、恐慌,或置身于拥挤人群、闷热房间里更容易发作.

目的 探讨氯沙坦对冠心病冠状动脉介入诊疗患者肾功能的保护作用及机制.方法 221例接受冠状动脉造影(CAG)或经皮冠状动脉介入术治疗(PCI)的冠心病患者随机分为三组.对照组(72例)术前不服用氯沙坦;低剂量组(74例)及高剂量组(75例)术前1d开始分别晨服氯沙坦50、100 mg,1次/d.分别于术前和术后24h检测各组血尿酸(SUA)、肌酐(Scr)、尿素氮(BUN)、肾素活性、血管紧张素Ⅱ(AngⅡ)及醛固酮水平,采用MDRD方法估算肾小球滤过率(eGFR);采用ELISA法检测血清和尿液中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和半胱氨酸蛋白酶抑制物C(CysC)水平.记录对比剂急性肾损伤(CIAKI)发生率.随访90d观察用药依从性并记录临床事件.结果 三组共发生CIAKI8例,其中对照组、高剂量组各2例,低剂量组4例.与对照组相比,低剂量组和高剂量组术后血SUA和BUN均降低(P均＜0.01),呈剂量依赖性;对照组术后血Scr、血NGAL和血Cysc升高、eGFR降低(P均＜0.05),低剂量组术后血CysC升高(P＜0.05).结论 氯沙坦可降低冠心病患者介入诊疗术后血尿酸水平,改善肾功能,其机制可能与阻断肾素—血管紧张素系统、降低围手术期血尿酸水平有关.

Objective:To investigate the selection of different revascularization treatment in patients with coronary ar tery disease and type 2 diabetes.Methods:Four hundred and fifty-six patients with coronary artery disease and type 2 diabe tes were divided into percutaneous coronary intervention(PCI) group(n =288) and coronary artery bypass grafting(CABG)group(n =168).According to the SYNTAX score,each group was divided into high,medium and low score subgroups.The primary endpoints were major adverse cardiac events(MACE,including all-cause deaths,myocardial infarction and stroke)within 12 months,and the second endpoint was target vessel revascularization within 12 months.Results:The rate of myocardial re-in farction was higher within 12 months in PCI group than that of CABG group(P 0.05).There were no significant differences in total adverse cardiac events,fatality and other MACE between two groups(all P 0.05).The incidence of adverse cardiac events was higher in high score-SYNTAX PCI group than that of CABG group(P 0.05),while there was no difference be tween low score subgroup and medium score subgroup(all P 0.05).Conclusion:It could not come to the conclusion that CABG was much better than PCI in patients with coronary artery disease and type 2 diabetes,but it might have lower inci dence of adverse cardiac events in high score-SYNTAX subgroup.