Stereotactic arrhythmia radioablation (STAR) is an emerging treatment for refractory or recurrent arrhythmias. Compared with conventional stereotactic body radiotherapy (SBRT), STAR involves greater complexity in target delineation, motion management, and organs at risk (OARs) protection, yet it lacks established consensus clinical guidelines, and workflow-specific risk analyses remain limited. To develop a C-arm linear accelerator (LINAC)-based STAR workflow and perform a failure modes and effects analysis (FMEA) with fault tree analysis (FTA), supplemented by an exploratory segment-based anatomical proximity analysis. A multidisciplinary team constructed a process map for C-arm LINAC-based STAR and identified potential failure modes across the workflow. Risks were scored using occurrence, severity, and detectability to calculate risk priority numbers (RPNs), and FTA was used to analyze causal pathways. In a predefined exploratory imaging subgroup of eight patients with ventricular tachycardia and simulation-acquired coronary computed tomography angiography (CCTA), we divided the left ventricle according to the 17-segment model and measured the minimum distances from each segment to adjacent OARs as an anatomical surrogate of exposure likelihood. Seventy-nine failure modes were identified, of which 17 were classified as high risk. The highest-risk failure modes were concentrated in target delineation and motion-related steps, including inaccurate multimodal image registration (RPN 432), improper motion evaluation/management (RPN 336), and diagnostic error of arrhythmia substrate definition (RPN 320). In the exploratory imaging subgroup (n = 8), segmental spatial patterns were moderately consistent across patients, with most standard deviations of minimum distance below 2.0 cm, although variability remained for several segment-OAR relationships. Segments 4, 5, and 10 were each located within 2 cm of both the stomach and esophagus, indicating relatively higher anatomical proximity-related risk. In this FMEA of C-arm LINAC-based STAR, the principal high-risk workflow steps were concentrated in substrate definition, image registration, and motion management. The segment-based analysis provides an exploratory anatomical risk-mapping framework for OAR awareness. Further multicenter studies are needed to refine workflow risk prioritization and evaluate the clinical relevance of the segment-based anatomical findings. Not applicable.

BACKGROUND:Pulsed field ablation (PFA) has gained attention in cardiac electrophysiology, but data on its application to paroxysmal supraventricular tachycardia are limited. This study aimed to assess the feasibility and safety of PFA and its combination with radiofrequency ablation for treating paroxysmal supraventricular tachycardia.METHODS:A prospective, multicenter, single-arm study was conducted across 8 centers in China. Patients with atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, or Wolff-Parkinson-White syndrome underwent ablation using a focal point dual-mode PFA/radiofrequency ablation catheter. PFA was used to achieve acute ablation success, with consolidation using PFA for atrioventricular nodal reentrant tachycardia or near-His accessory pathways and radiofrequency ablation for far-His accessory pathways. Primary and secondary end points were acute ablation success and 180-day follow-up success, respectively.RESULTS:A total of 158 patients (77 with atrioventricular nodal reentrant tachycardia, 63 with atrioventricular reentrant tachycardia, 16 with Wolff-Parkinson-White, and 2 with both atrioventricular nodal reentrant tachycardia and atrioventricular reentrant tachycardia) completed the trial. Acute ablation was successful in 157 patients (99.37%). The skin-to-skin procedure time was 89.9 +/- 35.5 min. The median number of PFA discharges was 12 (8-19) with a median effective PFA discharge time of 4.6 (3.2-6.4) ms. Five patients (4 with atrioventricular reentrant tachycardia and 1 with Wolff-Parkinson-White syndrome) experienced paroxysmal supraventricular tachycardia recurrence during the 180-day follow-up period. One patient had a transient first-degree atrioventricular block resolving in 12 hours, and one patient had a transient third-degree atrioventricular block resolving in 24 hours. No permanent atrioventricular block or other adverse events occurred during the ablation procedure or 180-day follow-up period.CONCLUSIONS:PFA demonstrated the feasibility of the treatment of SVT. Reversible first- and third-degree atrioventricular blocks were observed following ablation in one patient each. The preliminary results indicated the safety and feasibility of a combination of PFA and radiofrequency ablation treatment for atrioventricular accessory pathways although it is impossible to determine the relative contribution of PFA.

心房扑动需要依赖功能或解剖的阻滞带来维持其激动的折返传导,外科手术为心房扑动的发生创造了基础条件,手术瘢痕的形成,人为地产生电静止区,使心房扑动形成的概率增加[1].外科瘢痕相关心房扑动、肺静脉触发心房扑动[2]、左房消融后裂隙相关心房扑动[3]为左心房扑动的成因;因心房扑动发作症状严重,严重影响患者生活质量,它已成为一个不容忽视的问题,随着对心房扑动电生理机制的认识及导管消融技术的发展,使根治该类心房扑动成为可能.

目的 评估改良的"大针套小针"干性心包穿刺术用于心外膜消融通路建立的有效性及安全性.方法 回顾性选取2012年8月—2022年1月,因心律失常就诊于四川大学华西医院心内科并采用经剑突下干性心包穿刺术行心外膜标测和消融的患者.根据心包穿刺具体方式,分为Sosa组及"大针套小针"(NIN)组,比较两种心包穿刺方式的安全性和有效性.结果 本研究总计纳入患者86例,其中Sosa组13例(15.12％),NIN组73例(84.88％).NIN法与Sosa法相比,二者在患者年龄、性别、体重指数、缺血性心肌病构成、扩张型心肌病构成、室性心动过速比例、室性期前收缩比例、左室射血分数、纽约心功能分级、β受体阻滞剂使用情况、血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻滞剂/血管紧张素受体内啡肽酶抑制剂使用情况、胺碘酮使用情况、植入型心律转复除颤器/心脏再同步化治疗除颤器植入方面,均无显著统计学差异;穿刺成功率二者相似(100％vs 92.3％,P=0.15);但NIN组心包穿刺总时间更少[(5.73±0.58)min vs(12.38±0.64)min,P<0.001],严重并发症发生率更低(0％vs 15.4％,P=0.02),轻微并发症发生率更低(1.4％vs 23.1％,P=0.01),X射线曝光时间更短[(1.85±0.84)min vs(3.86±1.69)min,P<0.001].结论 "大针套小针"法干性心包穿刺术,穿刺时间短,并发症发生率低,安全性及有效性均较高,有望临床进一步推广及应用.

Replacement of CRT-D battery 2021 3 rd catheter ablation failed 2021 Received stereotactic body radiotherapy After 6-week blanking period Significant improvement of VT After 6-month post-ablation period No recurrences of VT and complications VT, ventricular tachycardia; CRT-D, cardiac resynchronization therapy-defibrillator.

Introduction: Pneumopericardium is a rare complication of epicardial ablation after dry pericardiocentesis to treat ventricular arrhythmia (VA); its exact clinical effects on patients are still unclear. The purpose of this study was to evaluate the clinical effects of pneumopericardium during epicardial ablation on patients with VA. Methods and Results: A total of 86 patients with VA who underwent epicardial catheter ablation under local anesthesia at West China Hospital of Sichuan University from August 2012 to March 2021 were enrolled in this study. 22 cases had pneumopericardium, with an incidence rate of 25.6%. and 12 (54.55%) patients complained of dyspnea during the procedure with an average occurrence time of 5.4±3.2 minutes after pericardiocentesis. The blood pressure (BP) decreased significantly, with the mean BP dropping from 119.8/73.2 mmHg to 103.5/64.9 mmHg (p<0.001). None of the cases progressed to tension pneumopericardium. Postoperative follow-up with a median period of 496 days showed that the incidence rate of major adverse cardiovascular events (MACEs), including the composite endpoints of all-cause death, rehospitalization for heart failure, and tachyarrhythmia events, was 65% (n=13) in the pneumopericardium group and 43.4% (n=23) in the non-pneumopericardium group. The Kaplan-Meier survival analysis showed that there was no statistically significant difference in the incidence of MACEs between the two groups (p=0.80). Conclusion: The incidence of pneumopericardium during epicardial ablation was relatively high. However, it can barely progress to tension pneumopericardium and further lead to serious consequences. The occurrence of pneumoperitoneum during the procedure may not significantly affect the long-term prognosis of patients.

Objectives Echocardiography is routinely recommended to evaluate structural abnormalities in patients with ventricular tachycardia. However, the performance of cardiac magnetic resonance imaging (MRI) in the evaluation of patients with hemodynamic stable ventricular arrhythmia (VA) has not been verified. In the present study, we investigated the diagnostic yield of cardiac MRI in identifying potential cardiac abnormalities in patients referred for ablation of VA. Methods Cardiac MRI (CMR) was performed in 78 consecutive patients (average age 43.6 ± 16.5 years) with premature ventricular contraction or hemodynamic stable paroxysmal ventricular tachycardia referred for transcatheter ablation. Patients with prior known structural heart disease were excluded. All the patients received standard clinical non-CMR evaluation before CMR examination. Results Cardiac MRI findings were abnormal in 48 patients (61.5%), including late gadolinium enhancement (LGE) in 23.1%. The diagnostic yield of cardiac MRI was significantly greater than that of routine non-CMR modalities, with which findings were positive in 28.2% of patients. Cardiac MRI detected 31 cases (55.4%) of abnormalities in 56 patients in whom echocardiography was negative. LGE patterns in patients with VA were variable and LGE in myocardium was associated with worse right and left ventricular function. Conclusions Cardiac MRI was a more effective tool than routine echocardiography in identifying potential structural abnormalities in patients with stable VA before ablation. Comprehensive cardiac MRI should be considered a routine screening examination before VA ablation even in patients without prior known structural heart disease.