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BACKGROUND: High-power short-duration (HPSD) ablation has emerged as an alternative to conventional standard-power long-duration (SPLD) ablation. We aim to assess the efficacy and safety of HPSD versus SPLD for atrial fibrillation (AF) ablation. METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) retrieved from PubMed, WOS, SCOPUS, EMBASE, and CENTRAL were performed through August 2023. We used RevMan V. 5.4 to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD) with a 95% confidence interval (CI). PROSPERO ID: CRD42023471797. RESULTS: We included six RCTs with a total of 694 patients. HPSD was significantly associated with a decreased total procedure time (MD: -22.88 with 95% CI [-36.13, -9.63], P = 0.0007), pulmonary vein isolation (PVI) time (MD: -19.73 with 95% CI [-23.93, -15.53], P

BACKGROUND: Pulsed field ablation (PFA) induces cell death through electroporation using ultrarapid electrical pulses. We sought to compare the procedural efficiency characteristics, safety, and efficacy of ablation of atrial fibrillation (AF) using PFA compared with thermal energy ablation. METHODS: We performed an extensive literature search and systematic review of studies that compared ablation of AF with PFA versus thermal energy sources. Risk ratio (RR) 95% confidence intervals (CI) were measured for dichotomous variables and mean difference (MD) 95% CI were measured for continuous variables, where RR

Introduction: The novel cryoballoon with 28 mm or 31 mm adjustable diameters, aims to achieve a wide antral pulmonary vein isolation (PVI). However, the distribution of antral lesions and their variations based on left atrial (LA) remodeling require further clarification. Methods: We evaluated 22 patients (67 [59.5–74.8] years, 19 males) who underwent PVI of atrial fibrillation (AF) (13 paroxysmal AF [PAF] and 9 non‐PAF) using size‐adjustable cryoballoons. LA electro‐anatomical mapping was performed post‐PVI with three‐dimensional mapping systems. We assessed the shapes of the LA and pulmonary veins (PVs) and the distribution of isolated areas (IAs), comparing the results between PAF and non‐PAF patients. Results: In the left PVs (LPVs), the distance between the PV orifice and IA edge (PVos‐IA) was larger on the roof and posterior segments (~15 mm) but relatively smaller on the anterior segment near the PV ridge (<10 mm). For the right PVs (RPVs), it was more extensive in the posterior segment (10–15 mm). Comparing PAF and non‐PAF, there were no significant differences in the PVos‐IA except for the right posterior‐carina segment, antrum IA (LPVs: 5.9 ± 1.6 vs. 5.8 ± 0.8 cm², p =.81; RPVs: 4.8 ± 2.3 vs. 4.8 ± 1.2 cm², p =.81), distances between the right and left IAs on the LA posterior wall (LAPW), and un‐isolated LAPW area (9.0 ± 4.9 vs. 9.9 ± 2.5 cm², p =.62). No individual PVIs were observed in either group. Two patients exhibited overlapping IAs on the roof, and one patient who underwent 31 mm balloon applications for all PVs exhibited an LAPW isolation. Conclusion: The size‐adjustable cryoballoon achieved a wide antral PVI even in non‐PAF patients. [ABSTRACT FROM AUTHOR]

Background: Safety data of the latest radiofrequency (RF) technologies during atrial fibrillation (AF) ablation in real‐world clinical practice are limited. Objectives: We sought to evaluate the acute procedural safety of the four latest ablation catheters commonly used for AF ablation. Methods: A total of 3957 AF ablation procedures performed between January 2022 and December 2023 at 20 centers with either the THERMOCOOL SMARTTOUCH SF (STSF), TactiCath (TC), QDOT Micro (QDM), or TactiFlex (TF) were retrospectively analyzed. Results: In total, QDM, STSF, TF, and TC were used in 343 (8.7%), 1793 (45.3%), 1121 (28.4%), and 700(17.7%) procedures. Among 2406 index procedures, electrical pulmonary vein isolations were successfully achieved in 99.5%. Despite similar total procedure times in the four groups, the total fluoroscopic time was significantly shorter for QDM/STSF with CARTO than TF/TC with EnSite (18.7 ± 14 vs. 27.6 ± 20.6 min, p <.001) and longest in the TF group. The incidence of cardiac tamponade was 0.7% (0.5% and 0.9% during index and redo procedures, 0.8% and 0.3% for paroxysmal and non‐paroxysmal AF) and was significantly lower for QDM/STSF than TF/TC (0.2% vs. 1.1%, p =.008) and highest in the TF group. The incidence of cardiac tamponade was higher for TF than TC and STSF than QDM. In the multivariate analysis, TF/TC with EnSite was a significant independent predictor of cardiac tamponade during both the index (odds ratio [OR] = 4.8, 95% confidence interval [CI] = 1.3–17.5, p =.02) and all procedures (OR = 3.0, 95% CI = 1.3–7.2, p =.01). Conclusions: The incidence of cardiac tamponade and the fluoroscopic time during AF ablation significantly differed among the latest RF catheters and mapping systems in real‐world clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: Surgical manipulation of the lungs increases the number of circulating tumor cells and the subsequent risk of metastasis in patients with lung cancer. This study investigated whether or not ligating the tumor-draining pulmonary vein first during lobectomy could improve the prognosis of these patients. Methods: We retrospectively evaluated patients who underwent curative lobectomy for solitary nonsmall-cell lung carcinoma between January 2012 and December 2016. We divided the patients into the vein-first group, in which all associated pulmonary veins were dissected and severed before cutting the pulmonary artery, bronchus, or pulmonary fissure, and the other procedure group. Results: Overall, we included 177 and 413 patients in the vein-first and other procedure groups, respectively. Propensity score matching yielded 67 pairs of patients. The 5-year overall survival (85.6% [95% confidence interval, 77.3–94.8%] vs. 69.4% [58.7–81.9%], P = 0.03%) and recurrence-free survival (73.4% [63.3–85.1%] vs. 53.5% [42.5–67.3%], P = 0.02) were significantly better in the vein-first group than in the other procedure group. The cumulative recurrence rate at 5 years post-surgery was significantly lower in the vein-first group than in the other procedure group (21.7% vs. 38.3%, P = 0.04). Conclusion: Our study suggests that ligating the pulmonary vein first during lobectomy for lung cancer can improve the overall survival, recurrence-free survival, and cumulative recurrence rate. [ABSTRACT FROM AUTHOR]

Background: Ablation techniques have evolved greatly with advances in high-density 3D mapping systems over the last few years. Some patients develop atypical atrial flutter (AAFL) after pulmonary vein isolation (PVI). The data regarding follow-up after AAFL ablation as well as predictors of arrhythmia recurrence are lacking. This analysis aims to report procedure success rates and establish predictors of long-term success. Methods and Results: This retrospective cohort study included 45 patients (median age: 69 years; 40% female) who qualified for their first AAFL after PVI. The procedures were performed with the use of conventional ablation-index-guided ThermoCool Smarttouch SF and QDOT MICRO catheters. Freedom from arrhythmia recurrence was used as a primary end point. After 52 weeks of follow-up, 60% of patients suffered from arrhythmia recurrence, but over 70% of the studied cohort reported symptom improvement. In multivariate analysis, class I antiarrhythmics prescription (HR = 0.24 [95% CI 0.06–0.94], p = 0.04) was associated with the lack of arrhythmia recurrence during the follow-up, while cardioversion during procedure was associated with increased risk of arrhythmia recurrence (HR = 7.05 [95% CI 2.09–23.72], p = 0.002). Conclusions: Long-term success of AAFL ablation procedures is not satisfactory despite improvement in symptoms. Class I antiarrhythmics prescription at the discharge contributes to higher chances of sinus rhythm maintenance, whereas cardioversion during the procedure is related to increased risk of arrhythmia recurrence. [ABSTRACT FROM AUTHOR]

The use of stereotactic body radiation therapy for tumors in close proximity to the central mediastinal structures has been associated with a high risk of toxicity. This study (NCT03306680) aimed to determine the maximally tolerated dose of stereotactic body radiation therapy for ultracentral non-small cell lung carcinoma, using a time-to-event continual reassessment methodology. Patients with T1-3N0M0 (≤6 cm) non-small cell lung carcinoma were eligible. The maximally tolerated dose was defined as the dose of radiation therapy associated with a ≤30% rate of grade (G) 3 to 5 prespecified treatment-related toxicity occurring within 2 years of treatment. The starting dose level was 60 Gy in 8 daily fractions. The dose-maximum hotspot was limited to 120% and within the planning tumor volume; tumors with endobronchial invasion were excluded. This primary analysis occurred 2 years after completion of accrual. Between March 2018 and April 2021, 30 patients were enrolled at 5 institutions. The median age was 73 years (range, 65-87) and 17 (57%) were female. Planning tumor volume was abutting proximal bronchial tree in 19 (63%), esophagus 5 (17%), pulmonary vein 1 (3.3%), and pulmonary artery 14 (47%). All patients received 60 Gy in 8 fractions. The median follow-up was 37 months (range, 8.9-51). Two patients (6.7%) experienced G3-5 adverse events related to treatment: 1 patient with G3 dyspnea and 1 G5 pneumonia. The latter had computed tomography findings consistent with a background of interstitial lung disease. Three-year overall survival was 72.5% (95% CI, 52.3%-85.3%), progression-free survival 66.1% (95% CI, 46.1%-80.2%), local control 89.6% (95% CI, 71.2%-96.5%), regional control 96.4% (95% CI, 77.2%-99.5%), and distant control 85.9% (95% CI, 66.7%-94.5%). Quality-of-life scores declined numerically over time, but the decreases were not clinically or statistically significant. : Sixty Gy in 8 fractions, planned and delivered with only a moderate hotspot, has a favorable adverse event rate within the prespecified acceptability criteria and results in excellent control for ultracentral tumors. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion The impact of combining ablation index (AI)‐guided and very high‐power short‐duration (vHPSD) ablation on procedural factors at the posterior wall near the esophagus is unclear.Atrial fibrillation patients who underwent initial ablation using three‐dimensional mapping were enrolled. Patients were classified into two groups: those who underwent only AI‐guided pulmonary vein isolation (PVI) (AI group) and those who underwent vHPSD ablation at the posterior wall adjacent to the esophagus in addition to AI‐guided PVI (AI + vHPSD group). Differences in myocardial injury, inflammation, procedural characteristics, and pulmonary vein (PV) reconnection patterns were assessed between the two groups.This study included 167 patients (AI group, 83 patients; AI+vHPSD group, 84 patients). No significant differences in high‐sensitive troponin I or changes in inflammatory markers between pre‐ and Postablation were observed in either group. Total application time and total application energy were significantly lower in the AI+vHPSD group than in the AI group (p < 0.001 for both) despite no significant difference in the total number of applications between the groups. The incidence of esophagus temperature ≥40 degrees was significantly lower in the AI+vHPSD group than in the AI group (p = 0.036). However, the incidence of PV reconnections near the esophagus was significantly higher in the AI+vHPSD group than in the AI group (11.9% vs 3.6%, p = 0.046), despite no significant difference in the incidence of PV reconnections overall.The combination of AI‐guided PVI and vHPSD adjacent to the esophagus demonstrated reduced application energy requirements and maintained safety and effectiveness during the perioperative period. [ABSTRACT FROM AUTHOR]

The question of optimal timing for catheter ablation of atrial fibrillation (AF) to achieve best outcomes remains a crucial clinical issue. As AF occurs less frequently in younger patients, data regarding Diagnosis-to-Ablation Time (DAT) is especially limited in patients under the age of 55 years with persistent AF. We therefore analyzed the temporal relationship between initial AF presentation and timing of catheter ablation in this cohort. We conducted a retrospective single-centre study of patients ≤ 55 years with persistent AF who underwent first-time catheter ablation at our center. The cohort was divided into patients that underwent catheter ablation after diagnosis of persistent AF within a DAT of ≤ 12 months and patients with a DAT of > 12 months. A total of 101 patients (median age 51 years; female n = 19 (18.8%)) with persistent AF were included. Ablation was performed within 12 months ("early DAT") in 51 patients and > 12 months ("late DAT") in 50 patients. Pulmonary vein isolation was performed using high-power short-duration (HPSD) radiofrequency ablation. Median DAT was 5 months (1–12 months) in the early ablation group and 36 months (13–240 months) in the late ablation group. The median follow-up was 11.3 months (0.03–37.1 months). The rate of any atrial arrhythmia recurrence after a 30-day blanking period was significantly lower in the early DAT group (13/51 patients; 25.5%) as compared to the late DAT group (26/50 patients; 52.0%) (log rank test; p = 0.003). Catheter ablation performed > 12 months after the initial AF diagnosis was an independent predictor for the occurrence of any atrial arrythmia (OR: 2.58; (95%-CI: 1.32–5.07). Early first-time catheter ablation (DAT ≤ 12 months) in patients ≤ 55 years with persistent AF is associated with a significantly lower rate of arrhythmia recurrence. [ABSTRACT FROM AUTHOR]

Background: To clarify the fat attenuation index (FAI) change trend of peri-saphenous vein graft (SVG) and determine the association between FAI and graft disease progression based on CCTA images. Methods: Patients with venous coronary artery bypass grafts (CABGs) were consecutively enrolled in this retrospective study. In study 1, 72 patients who had undergone 1, 3, and 5 years of CCTA examinations without graft occlusion were recruited, and generalized estimation equation was used to analyze the peri-SVG FAI change trend over time. In study 2, 42 patients with graft disease progression and 84 patients as controls were propensity score-matched. Generalized linear mixed model and continuous net reclassification improvement (NRI) were used for assessing the associations with graft disease progression. Multivariable Cox regression analysis was used for assessing risk factors predicting cardiac events. Results: In study 1, both the FAI of proximal right coronary artery and SVG decreased over time. In study 2, the 1-year CTA-derived FAI of grafts and graft anastomosis were independent indicators of graft disease progression at the 3-year CCTA follow-up (graft: odds ratio [OR] = 1.106; 95% confidence interval [CI] = 1.030–1.188, P = 0.006; graft anastomosis: OR = 1.170, 95% CI = 1.091–1.254, P < 0.001). Inclusion of the graft anastomosis FAI significantly improved reclassification compared with graft FAI (continuous NRI = 0.638, 95% CI: 0.345–0.931, P < 0.001). Moreover, The graft anastomosis FAI was found to be a risk factor for cardiac events after CABG and no statistically significant difference was found in the graft FAI (graft anastomosis: HR = 1.158, 95% CI = 1.034–1.297, P = 0.011; graft: HR = 1.116, 95% CI = 0.995–1.251, P = 0.061). Conclusions: A synchronism was found in the FAI change trend between native coronary artery and venous graft, which both decreased over time. The CCTA-derived FAI of venous grafts showed the potential of demonstrating SVG disease progression and graft anastomosis served as the optimal measured location. [ABSTRACT FROM AUTHOR]

Introduction Methods and Results Conclusion Catheter ablation for atrial fibrillation (AF) reduces heart failure (HF) hospitalization in patients with HF with preserved ejection fraction (HFpEF). However, the long‐term outcomes and subclinical HF after nonparoxysmal AF ablation in HFpEF patients have not been fully evaluated.One‐hundred‐ninety nonparoxysmal AF patients with left ventricular ejection fraction ≥50% who underwent first‐time AF ablation were studied. HFpEF was diagnosed from a history of congestive HF and/or combined criteria of N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) concentration and transthoracic echocardiogram parameters, including average septal‐lateral E/e' and tricuspid regurgitation peak velocity. Ninety‐five patients with HFpEF (HFpEF group) were compared with 95 patients without HF (CNT group). Low voltage area (LVA) was defined as an area with a bipolar electrogram of <0.5 mV covering >5% of the total left atrial surface. The primary endpoint was a composite of death from any cause or hospitalization for worsening HF. The secondary endpoint was subclinical HFpEF defined from NT‐proBNP concentration and average septal‐lateral E/e' or tricuspid regurgitation peak velocity at 6–12 months after the procedure irrespective of the rhythm. Kaplan–Meier curves showed that the primary composite endpoint did not differ between the two groups (mean follow‐up period 707 ± 75 days, log‐rank p = 0.5330). However, significantly more patients in the HFpEF group reached the secondary endpoint (42 [44%] vs. 13 [14%], p < 0.0001). Multivariate analysis revealed that a high preablation NT‐proBNP (odds ratio [OR] 1.001, 95% confidence interval [CI] 1.001–1.002, p = 0.0040) and the existence of LVA (OR 5.983, 95% CI 1.463–31.768, p = 0.0194) independently predicted the secondary endpoint in HFpEF patients.After nonparoxysmal AF ablation, mortality of HFpEF patients was not inferior compared to patients without coexisting HF. However, subclinical HF occasionally persisted especially in HFpEF patients with a high preprocedure NT‐proBNP concentration and LVA. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusions In addition to the pulmonary vein, the superior vena cava (SVC) is an important focus of atrial fibrillation (AF). However, SVC isolation may cause serious complications, and appropriate settings and techniques for SVC isolation are lacking.This study enrolled 86 consecutive patients with AF who underwent SVC isolation. Voltage mapping using a multi‐electrode catheter and ablation were performed under the guidance of an electro‐anatomical mapping system. The lines encircling the SVC were divided into eight anatomic segments on the SVC geometry, and each segment was subjected to voltage‐guided (VG) ablation in decreasing order of voltage (starting from the segment with the highest voltage). Non‐VG (NVG) ablation was performed anatomically from the anterior wall toward the septum with one‐round cautery.A total of 86 cases (66 males, mean age 69 [60, 74], mean CHA2DS2 VASc score 2 [1, 3], 58 paroxysmal AF) with AF were included for ablation. Electrical SVC isolation was successfully achieved in all patients. The length of the myocardial sleeves, as measured from the SVC‐RA junction to the end of the local signal, was 37 [28, 45] mm. Major axis of the RA‐SVC junction was 15 [13, 17] and minor axis of the RA‐SVC junction was 11 [9, 13]. The number of ablation points with VG SVC isolation was fewer than that for NVG SVC isolation (8 [5, 11.5] vs. 11.5 [8.8, 13.3]; p = 0.001). The procedure time of VG SVC isolation was greater than that of NVG SVC isolation (259 s [154, 379] vs. 167 s [115, 222]; p = 0.012). There were no significant differences in the complication rates.VG SVC isolation reduced the number of ablation points compared with NVG SVC isolation. [ABSTRACT FROM AUTHOR]

Background: Lung transplantation is a vital option for patients with end-stage lung disease. However, it faces a significant challenge due to the shortage of compatible donors, which particularly affects individuals with small chest cavities and pediatric patients. The novel approach of cadaveric lobar lung transplantation is a promising solution to alleviate the donor shortage crisis. Both the mid-term and long-term outcomes of lobar lung transplantation are comparable to those of standard lung transplantation. However, patients undergoing lobar lung transplantation reported a significantly higher rate of primary graft dysfunction compared to patients undergoing standard lung transplantation. Therefore, careful donor selection is critical to improve outcomes after lobar transplantation. However, no established method exists to evaluate each lung lobar graft of deceased donors. This case report describes a case of cadaveric lobar lung transplantation to overcome size mismatch and donor shortage, with particular emphasis on lobar graft evaluation. Case presentation: A 39-year-old woman with scleroderma-related respiratory failure was listed for deceased donor lung transplantation due to a rapidly progressing disease. Faced with a long waiting list and impending mortality, she underwent bilateral living-donor lobar lung transplantation donated by her relatives. Post-transplant complications included progressive pulmonary vein obstruction and pleural effusion, which ultimately required retransplantation. An oversized donor with pneumonia in the bilateral lower lobes was allocated. Lung ultrasound was used to evaluate each lung lobar graft during procurement. The right upper and middle lobes and left upper lobe were confirmed to be transplantable, and lobar lung redo transplantation was performed. The patient's post-transplant course was uneventful, and she was discharged home and returned to her daily activities. Conclusions: This case highlights the clinical impact of cadaveric lobar lung transplantation as a feasible and effective strategy to overcome the shortage of donor lungs, especially in patients with small thoracic cavities. By establishing donor lung evaluation techniques and overcoming anatomical and logistical challenges, cadaveric lobar lung transplantation can significantly expand the donor pool and offer hope to those previously considered ineligible for transplantation. [ABSTRACT FROM AUTHOR]

Background: Data comparing the outcomes of loose versus rigorous validation strategies for pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (PAF) are limited. We aimed to prospectively assess the effectiveness of loose versus rigorous validation for PVI in patients with PAF with a maintained sinus rhythm. Methods: Patients (n = 117) with PAF were randomized to receive either loose validation (n = 59) or rigorous validation (n = 58) after PVI. The presence of dormant conduction in loose validation was assessed only by adenosine administration followed by isoproterenol infusion. The complete absence of pulmonary vein (PV) potentials in rigorous validation was confirmed by the combination of the Lasso catheter with isoproterenol plus adenosine. Dormant conduction, revealed by validation after PVI, was ablated until all reconnections were eliminated. Results: The procedure time in the rigorous validation group was greater than that in the loose validation group (161.3 ± 52.7 min vs. 142.5 ± 37.6 min, p = 0.03, respectively). After successful PVI, the detection of dormant PV reconnections in the rigorous validation group was significantly greater than that in the loose validation group (69.0% vs. 37.3%, p = 0.001). However, after reisolation of the sites of dormant PV conduction, the postablation recurrence rates in 1.3 years were similar between the groups (79.2% vs. 83.6%, p = 0.67). Conclusion: Rigorous validation can reveal dormant conduction in more than two‐thirds of patients with PAF undergoing PVI. However, rigorous validation and additional ablation of the resulting connections do not improve long‐term outcomes when a protocol that includes electrophysiological confirmation and pharmacological validation is used. [ABSTRACT FROM AUTHOR]

Background: Fibrosing mediastinitis (FM) is a rare yet fatal condition, caused by different triggers and frequently culminating in the obstruction of the pulmonary vasculature and airways, often leading to pulmonary hypertension and right heart failure. Percutaneous transluminal pulmonary venoplasty (PTPV) is an emerging treatment for pulmonary vein stenosis (PVS) caused by FM. Our previous study showed as high as 24% of in-stent restenosis (ISR) in FM. However, the predictors of ISR are elusive. Objectives: We sought to identify the predictors of ISR in patients with PVS caused by extraluminal compression due to FM. Methods: We retrospectively enrolled patients with PVS-FM who underwent PTPV between July 1, 2018, and December 31, 2022. According to ISR status, patients were divided into two groups: the ISR group and the non-ISR group. Baseline characteristics (demographics and lesions) and procedure-related information were abstracted from patient records and analyzed. Univariate and multivariate analyses were performed to determine the predictors of ISR. Results: A total of 142 stents were implanted in 134 PVs of 65 patients with PVS-FM. Over a median follow-up of 6.6 (3.4–15.7) months, 61 of 134 PVs suffered from ISR. Multivariate analysis demonstrated a significantly lower risk of ISR in PVs with a larger reference vessel diameter (RVD) (odds ratio (OR): 0.79; 95% confidence interval [CI]: 0.64 to 0.98; P = 0.032), and stenosis of the corresponding pulmonary artery (Cor-PA) independently increased the risk of restenosis (OR: 3.41; 95% CI: 1.31 to 8.86; P = 0.012). The cumulative ISR was 6.3%, 21.4%, and 39.2% at the 3-, 6-, and 12-month follow-up, respectively. Conclusion: ISR is very high in PVS-FM, which is independently associated with RVD and Cor-PA stenosis. Trail Registration: Chinese Clinical Trials Register; No.: ChiCTR2000033153. URL: http://www.chictr.org.cn. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion Trail Registration Atrial fibrillation (AF) inducibility with burst pacing (BP) after radiofrequency ablation (RFA) has been reported to be associated with AF recurrence. In contrast, the relevance of inducibility and recurrence after cryoablation (CRA) is unclear.We investigated 367 patients undergoing initial ablation for paroxysmal AF (RFA: 174, CRA: 193). Propensity score matching was conducted, retaining 134 patients in each group. Following pulmonary vein isolation (PVI), the inducibility by BP was tested. Inductions at 250 ppm were defined as low‐frequency burst pacing (LFBP) positive, and those at 300 ppm were classified as medium‐frequency burst pacing (MFBP) positive. They were followed for 600 days.Forty‐eight patients (18%) had AF recurrence. There was no significant difference in the recurrence rate between RFA and CRA (17% vs. 19%, Log‐rank p = 0.79). In RFA, significant differences were observed for both LFBP (Log‐rank p < 0.001) and MFBP (Log‐rank p < 0.001). In contrast, in CRA, there were no significant differences for either LFBP (Log‐rank p = 0.39) or MFBP (Log‐rank p = 0.19). Multivariable analysis revealed that LFBP‐positive (hazards ratio [HR] = 5.75, 95% confidence interval [CI] 2.41–13.7, p < 0.001) was an independent predictor for recurrence with RFA. Acute reconnection (HR = 2.73, 95% CI 1.13–6.56, p = 0.025) was an independent predictor for recurrence with CRA.The inducibility by BP after RFA predicted recurrence at both low and medium frequencies. LFBP‐positive was an independent predictor of recurrence in multivariable analysis. In contrast, the inducibility by BP after CRA was not a predictor of recurrence.This study did not require clinical trial registration. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Pulsed electric field (PEF) has emerged as a promising energy source for catheter ablation of atrial fibrillation (AF). However, data regarding the in‐vivo effect of PEF energy on erythrocytes during AF ablation procedures are scarce. This study aimed to quantify the impact of PEF energy on erythrocyte damage during AF ablation by assessing specific hemolytic biomarkers.A total of 60 patients (age: 68 years, males: 72%, serum creatinine: 91 µmol/L) with AF underwent catheter ablation of AF using PEF energy delivered by a multipolar pentaspline Farawave catheter (Farapulse, Boston Scientific, Inc.). Ablation beyond pulmonary vein isolation was performed at the operator's discretion. Peripheral venous blood was sampled for assessing the plasma levels of free hemoglobin (fHb), direct (conjugated) bilirubin, lactate dehydrogenase (LDH), and creatinine before, immediately after the ablation, and on the next day.Following the PEF ablation with duration of [median (interquartile range)] 75 (58, 95) min, with 74 (52, 92) applications and PVI only in 27% of patients, fHb, LDH, and direct bilirubin significantly increased, from 40 (18, 65) to 493 (327, 848) mg/L, from 3.1 (2.6, 3.6) to 6.8 (5.0, 7.9) µkat/L, and from 12 (9, 17) to 28 (16, 44) µmol/L, respectively (all p < .0001). A strong linear correlation was found between the peak fHb and the number of PEF applications (R = 0.81, p < .001). The major hemolysis (defined as fHb >500 mg/L) was predicted by the number of PEF applications with the corresponding area under the receiver operating characteristic curve of 0.934. The optimum cut‐off value of >74 PEF applications predicted the major hemolysis with 89% sensitivity and 87% specificity.Catheter ablation of AF using PEF energy delivered from a pentaspline catheter is associated with significant intravascular hemolysis. More than 74 PEF applications frequently resulted in major hemolysis. However, the critical amount of PEF energy that may cause kidney injury in susceptible patients remains to be investigated. [ABSTRACT FROM AUTHOR]

Background Material and Methods Results Conclusion Atrial fibrillation (AF) is usually triggered by frequent atrial premature complexes (APC) and atrial tachycardias originated in the pulmonary veins. The aim of the current study is to clarify the relationship between AF and APCs observed during treadmill exercise testing through long‐term patient follow‐up.Our study only examined the data of patients who did not have any obstructive coronary artery disease and had an exercise test. In total, 1559 patients were included in this research. The study data were divided into two groups according to the development of AF during follow‐up. The patients who developed any type of AF during the follow‐up period were classified as AF (+). Mean follow‐up time for AF (+) and (−) groups were 48 and 47 months, respectively.In the univariable analysis, age, LAAP, and the presence of APCs (HR: 3.906, 95% CI: 2.848–5.365, p < 0.001) during the treadmill exercise test were significantly associated with the development of AF. In the multivariable analysis, age (adjusted HR: 1.063, 95% CI: 1.043–1.083, p < 0.001) and the presence of APCs during the treadmill exercise test (adjusted HR: 2.504, 95% CI: 1.759–3.565, p < 0.001) emerged as independent risk factors for the development of AF. The AF‐free survival was significantly lower in the APCs (+) patients compared with the APCs (−) patients (log rank p < 0.001).Our study revealed that individuals without obstructive CAD who exhibited frequent APCs during treadmill exercise tests were more likely to develop AF. [ABSTRACT FROM AUTHOR]

Background: The occurrence of suspended cords of the left atrium (SCLA) is rare and has seldom been described. The purpose of this study was to summarize the cases of SCLA accidentally detected by coronary CT angiography (CCTA), describe their imaging features, conduct a preliminary analysis of their clinical significance, and review relevant literature. Methods: A total of 10,796 patients who underwent CCTA examinations from July 2020 to November 2021 were consecutively selected. The original and three-dimensional reconstruction images were reviewed to identify patients with SCLA. A control group was selected in a 1:2 ratio based on age, BMI, sex, and education level. The imaging characteristics and clinical data of the two groups were collected and compared. The case group was divided into two subgroups based on the starting and ending positions of the SCLA: Group 1 with the SCLA between the free wall and free wall, and Group 2 with the SCLA between the septum wall and free wall. The clinical features of these subgroups were compared. Furthermore, a review of literature on SCLA published in the past fifteen years that includes its clinical and imaging features was conducted. Results: In this study, a total of 35 patients were found to have SCLA, resulting in an incidence rate of approximately 0.32%. After excluding 1 patient for whom clinical features could not be obtained, the case group included a total of 18 males and 16 females, with a male-to-female ratio of 1:1 and a median age of 57.00 (52.00–64.00) years. It was found that 19 (55.88%) cases of SCLA were located near the right superior pulmonary vein ostia, while no SCLA was found near the left lower pulmonary vein orifice. A significant difference in the incidence of atrial arrhythmia between the two groups was observed (p = 0.009). Additionally, 3 patients (8.82%) in the SCLA group had a history of transient cerebral ischemic attack (TIA), which was significantly different from that in the control group (p = 0.035). The anteroposterior and transverse diameters of the left atrium were longer in the case group than in the control group (p < 0.05), but there was no significant change in left atrial volume. Subgroup analyses found no significant difference in the incidence of cerebral infarction, atrial arrhythmia, or other intracardiac structural malformations, although there was a significant difference in cord length (p = 0.013), with the length of SCLA in Group 1 and Group 2 being 2.64 ± 0.99 cm and 3.39 ± 0.68 cm, respectively. Notably, only 1 of these 34 patients was diagnosed based on echocardiography, whereas all cases were perfectly visualized using CCTA. Conclusion: SCLA is rare. CCTA can accurately detect and depict this abnormal structure as compared to echocardiography. SCLA may be linked to a higher incidence of atrial arrhythmias or transient ischemic attacks. It is important for radiologists and cardiovascular experts to recognize this structure, and further investigation is necessary to determine its clinical significance. [ABSTRACT FROM AUTHOR]

Background: Pulmonary arteriovenous malformation (PAVM) is abnormal arteriovenous shunts between pulmonary artery (PA) and pulmonary vein, and rarely has congenital direct communications with systemic arteries. Case Presentation: A 33-year-old male presented to our hospital with intermittent bloody sputum with no evidence of pulmonary infection, trauma or surgery. Chest computed tomography angiography (CTA) indicated the congenital inferior phrenic artery (IPA)-to-PAVM surrounded by diffuse alveolar hemorrhage located in the lower lobe of right lung. Both the afferent PA and IPA were successfully embolized with coils. Recurrent hemoptysis did not occur during one-year follow up. Conclusions: The congenital communication between IPA and PAVM is rare, and the abnormal direct shunt would induce hemodynamically unstable condition within PAVM. Endovascular embolization of the afferent PA and IPA is a safe and effective method for this abnormal congenital shunt in lung. [ABSTRACT FROM AUTHOR]

Background: Innovative attempt to explore the feasibility and accuracy of using indocyanine green fluorescence (ICGF) to identify the intersegmental plane by the target segmental veins preferential ligation during thoracoscopic segmentectomy. Methods: A retrospective analysis was conducted on clinical data of 32 consecutive patients who underwent thoracoscopic segmentectomy with intersegmental plane identification using both ICGF and inflation-deflation method after target segmental veins prioritized blocking at Nanjing Chest Hospital from December 2022 to June 2023. Preoperative three-dimensional reconstruction was used to identify the target segment and the anatomical structure of the arteries, veins, and bronchi. After ligating the target segmental veins during surgery, the first intersegmental plane was immediately identified and marked with an electrocoagulation device using an inflation-deflation method. Subsequently, the second intersegmental plane was determined using the ICGF method. Finally, the consistency of the two intersegmental planes was evaluated. Results: All the 32 patients successfully completed thoracoscopic segmentectomy without ICG-related complications and perioperative death. The average operation time was (98.59 ± 20.72) min, the average intraoperative blood loss was (45.31 ± 35.65) ml, and the average postoperative chest tube removal time was (3.5 ± 1.16) days. The average postoperative hospital stay was (4.66 ± 1.29) days, and the average tumor margin width was (26.96 ± 5.86) mm. The intersegmental plane determined by ICGF method was basically consistent with inflation-deflation method in all patients. Conclusion: The ICGF can safely and accurately identify the intersegmental plane by target segmental veins preferential ligation during thoracoscopic segmentectomy, which is a beneficial exploration and important supplement to the simplified thoracoscopic anatomical segmentectomy. [ABSTRACT FROM AUTHOR]

Key Points: Question: Does pulmonary vein isolation have a placebo effect in treatment of atrial fibrillation? Findings: In this double-blind randomized trial of 126 patients with symptomatic atrial fibrillation, pulmonary vein isolation resulted in a significant and clinically important decrease in atrial fibrillation burden, with substantial improvements in symptoms and quality of life, compared with a sham procedure. Meaning: Pulmonary vein isolation significantly reduced atrial fibrillation burden compared with a sham control, providing evidence that the benefit of pulmonary vein isolation in symptomatic atrial fibrillation is not because of a placebo effect. Importance: There are concerns that pulmonary vein isolation for atrial fibrillation may have a profound placebo effect, but no double-blind randomized clinical trials have been conducted. Objective: To determine whether pulmonary vein isolation is more effective than a sham procedure for improving outcomes in atrial fibrillation. Design, Setting, and Participants: Double-blind randomized clinical trial conducted at 2 tertiary centers in the UK between January 2020 and March 2024 among patients with symptomatic paroxysmal or persistent atrial fibrillation. Major exclusion criteria included long-standing persistent atrial fibrillation, prior left atrium ablation, other arrhythmias requiring ablative therapy, a left atrium of 5.5 cm or larger, and ejection fraction of less than 35%. Intervention: Participants were randomly assigned to receive pulmonary vein isolation with cryoablation (n = 64) or a sham procedure with phrenic nerve pacing (n = 62). Main Outcomes and Measures: The primary end point was atrial fibrillation burden at 6 months, excluding a 3-month blanking period. Secondary outcomes included quality-of-life measures, time to events, and safety. Atrial fibrillation burden was measured by an implantable loop recorder. Results: A total of 126 participants were randomized (mean age, 66.8 years; 89 men [70.63%]; 20.63% with paroxysmal atrial fibrillation). The absolute mean atrial fibrillation burden change from baseline to 6 months was 60.31% in the ablation group and 35.0% in the sham group (geometric mean difference, 0.25; 95% CI, 0.15-0.42; P <.001). The estimated difference in the overall Atrial Fibrillation Effect on Quality of Life score at 6 months, favoring catheter ablation, was 18.39 points (95% CI, 11.48-25.30 points). The Short Form 36 general health score also improved substantially more with ablation, with an estimated difference of 9.27 points at 6 months (95% CI, 3.78-14.76 points). Conclusions and Relevance: Pulmonary vein isolation resulted in a statistically significant and clinically important decrease in atrial fibrillation burden at 6 months, with substantial improvements in symptoms and quality of life, compared with a sham procedure. Trial Registration: ClinicalTrials.gov Identifier: NCT04272762 This randomized clinical trial assesses the effect of pulmonary vein isolation vs a sham procedure on atrial fibrillation burden at 6 months in patients with symptomatic paroxysmal or persistent atrial fibrillation. [ABSTRACT FROM AUTHOR]

Scimitar syndrome is a congenital heart anomaly characterized by the drainage of one or more accessory veins, usually from the right pulmonary veins, into the right atrium. We present here the case of a 44-year-old patient who was followed up with a diagnosis of asthma but whose dyspnea continued despite treatment and who was subsequently diagnosed by thoracic tomography. It is important to perform additional investigations during the differential diagnosis of patients with respiratory symptoms. [ABSTRACT FROM AUTHOR]

Currently, pulmonary vein isolation (PVI) is the gold standard in catheter ablation for atrial fibrillation (AF). However, PVI alone may be insufficient in the management of persistent AF, and complementary methods are being explored. One such method takes an anatomical approach—improving both its success rate and lesion durability may lead to improved treatment outcomes. An additional approach complementary to the anatomical one is also attracting attention, one that focuses on epicardial conduction. This involves ethanol ablation of the vein of Marshall (VOM) and can be very effective in blocking epicardial conduction related to Marshall structure; it is becoming incorporated into standard treatment. However, the pitfall of this "Marshall-PLAN", a method that combines an anatomical approach with ethanol infusion within the VOM (Et-VOM), is that Et-VOM and other line creations are not always successfully completed. This has led to cases of AF and/or atrial tachycardia (AT) recurrence even after completing this lesion set. Investigating effective adjunctive methods will enable us to complete the lesion set with the aim to lower the rates of recurrence of AF and/or AT in the future. [ABSTRACT FROM AUTHOR]

Background: Catheter ablation (CA) is a well-established treatment for atrial fibrillation (AF). However, its effects on autonomic function and underlying mechanisms remain poorly understood. This study investigated autonomic and haemodynamic changes following CA and explored their potential implications for patient outcomes. Methods: Seventy-eight patients with AF underwent CA and were followed up at one, three, and six months. Autonomic function was assessed using a combination of head-up tilt (HUT), handgrip (HG), and deep breathing (DB) manoeuvres along with baroreflex sensitivity (BRS) and baroreflex effectiveness index (BEI) evaluation. Heart rate (HR), blood pressure (BP), and their variability were measured at each time point. Results: Significant autonomic alterations were observed after ablation, particularly at one month, with reductions in parasympathetic tone and baroreflex function. These changes gradually normalised by six months. Both pulmonary vein isolation (PVI) and cryoablation (CryO) had similar effects on autonomic regulation. Improvements in quality of life, measured by the AFEQT scores, were consistent with these physiological changes. Conclusions: CA for AF induces significant time-dependent autonomic and haemodynamic changes with recovery over six months. These findings underscore the need for ongoing monitoring and personalised post-ablation management. Further research is required to explore the mechanisms driving these alterations and their long-term impacts on patient outcomes. [ABSTRACT FROM AUTHOR]

Simple Summary: The prevalence of indeterminate pulmonary nodule (IPN) findings in early lung cancer screening settings highlights the need for novel imaging biomarkers to assist clinicians in making informed therapeutic decisions. The surrounding vasculature of pulmonary nodules, termed "macro-vasculature", has been identified as a potential biomarker for evaluating nodule malignancy. However, the relationship between the macro-vasculature's arteries and veins surrounding an IPN and its malignancy remains unclear. This study aimed to investigate this association. Our findings indicate that arterial characteristics significantly outweigh venous characteristics in distinguishing malignant from benign nodules. Additionally, incorporating arterial information surrounding a nodule enhances the performance in differentiating malignant from benign nodules. Clarifying the relationship between macro-vasculature arteries and nodule malignancy may facilitate clinical follow-up procedures for screen-detected pulmonary nodules. Objective: This study aims to investigate the association between the arteries and veins surrounding a pulmonary nodule and its malignancy. Methods: A dataset of 146 subjects from a LDCT lung cancer screening program was used in this study. AI algorithms were used to automatically segment and quantify nodules and their surrounding macro-vasculature. The macro-vasculature was differentiated into arteries and veins. Vessel branch count, volume, and tortuosity were quantified for arteries and veins at different distances from the nodule surface. Univariate and multivariate logistic regression (LR) analyses were performed, with a special emphasis on the nodules with diameters ranging from 8 to 20 mm. ROC-AUC was used to assess the performance based on the k-fold cross-validation method. Average feature importance was evaluated in several machine learning models. Results: The LR models using macro-vasculature features achieved an AUC of 0.78 (95% CI: 0.71–0.86) for all nodules and an AUC of 0.67 (95% CI: 0.54–0.80) for nodules between 8–20 mm. Models including macro-vasculature features, demographics, and CT-derived nodule features yielded an AUC of 0.91 (95% CI: 0.87–0.96) for all nodules and an AUC of 0.82 (95% CI: 0.71–0.92) for nodules between 8–20 mm. In terms of feature importance, arteries within 5.0 mm from the nodule surface were the highest-ranked among macro-vasculature features and retained their significance even with the inclusion of demographics and CT-derived nodule features. Conclusions: Arteries within 5.0 mm from the nodule surface emerged as a potential biomarker for effectively discriminating between malignant and benign nodules. [ABSTRACT FROM AUTHOR]

Introduction: Thermal atrial fibrillation (AF) ablation exerts an additive treatment effect on the cardiac autonomic nervous system (CANS). This effect is mainly reported during ablation of the right superior pulmonary vein (RSPV), modulating the right anterior ganglionated plexus (RAGP), which contains parasympathetic innervation to the sinoatrial node in the epicardial fat pad between RSPV and superior vena cava (SVC). However, a variable response to neuromodulation after ablation is observed, with little to no effect in some patients. Our objective was to assess clinical and anatomic predictors of thermal ablation‐induced CANS changes, as assessed via variations in heart rate (HR) postablation. Methods: Consecutive paroxysmal AF patients undergoing first‐time PV isolation by the cryoballoon (CB) or radiofrequency balloon (RFB) within a 12‐month time frame and with preprocedural cardiac computed tomography (CT), were evaluated. Preablation and 24‐h postablation electrocardiograms in sinus rhythm were collected and analyzed to assess HR. Anatomic evaluation by CT included the measurement of the shortest distance between the SVC and RSPV ostium (RSPV‐SVC distance). Results: A total of 97 patients (CB, n = 50 vs. RFB, n = 47) were included, with similar baseline characteristics between both groups. A significant HR increase postablation (ΔHR ≥ 15 bpm) occurred in a total of 37 patients (38.1%), without difference in number of patients between both thermal ablation technologies (CB, 19 [51%]), RFB, 18 [49%]). Independent predictors for increased HR were RSPV‐SVC distance (odds ratio [OR]: 0.49, CI: 0.34–0.71, p value <.001), and age (OR: 0.94, CI: 0.89–0.98, p value =.003). Conclusions: Thermal balloon‐based PV isolation influences the CANS through its effect on the RAGP, especially in younger patients and patients with shorter RSPV‐SVC distance. [ABSTRACT FROM AUTHOR]

Introduction: Strategies beyond pulmonary vein isolation (PVI) in persistent atrial fibrillation (persAF) are debated. A novel mapping tool provides algorithmic detection of ablation targets based on electrogram (EGM) properties specific to stable localized rotational activations. Methods: The mapping tool was used on 31 patients (20 de novo). The algorithm was used to optimize PVI line placement and guide additional ablations. Targets were detected by calculating local cycle length (L‐CL) and local spread of activation within that L‐CL (Duty Cycle; DC) for EGMs with consistent morphology and activation. At least two left atrial (LA) maps (pre‐PVI and post‐PVI) were acquired in atrial fibrillation (AF) in all patients (except those with AF termination during PVI). Extra‐pulmonary vein (PV) targets were compared between the two LA maps in each patient. Follow‐up included Holter monitoring every 3 months. Results: Patients had a median of 3 extra‐PV drivers/targets. The majority (81%) were localized in the same areas between the two LA maps. All patients had progressive AF organization demonstrated by global activation slowing: histogram peak L‐CL increased from 162 to 171 ms (post‐PVI; p =.0003) than to 175 ms (posttarget ablation; p =.04). Moreover, L‐CL dispersion was reduced by ablation; in 50% their values tended to cluster around two dominant cycles. In de novo patients AF terminated to sinus rhythm or atrial tachycardia (AT) within 48 h postprocedure in 88% of cases, and at 18 months mean follow‐up recurrence occurred in only five (25%) patients (three persAF, two AT). There were no complications. Conclusion: The algorithmic detection of EGMs consistent with localized reentry during sequential mapping of persAF provided reproducible targets for ablation. This allowed personalized PVI and limited, highly‐selective, extra‐PV ablation. Results of this initial experience included progressive organization of AF with ablation and a low recurrence rate after a single procedure. [ABSTRACT FROM AUTHOR]

Introduction: High‐frequency low‐tidal‐volume (HFLTV) ventilation during radiofrequency catheter ablation (RFCA) for paroxysmal atrial fibrillation (PAF) has been shown to be superior to standard ventilation (SV) in terms of procedural efficiency, acute and long‐term clinical outcomes. Our study aimed to compare ablation lesions characteristics utilizing HFLTV ventilation versus SV during RFCA of PAF. Methods: A retrospective analysis was conducted on patients who underwent pulmonary vein isolation (PVI) for PAF between August 2022 and March 2023, using high‐power short‐duration ablation. Thirty‐five patients underwent RFCA with HFLTV ventilation and were matched with another cohort of 35 patients who underwent RFCA with SV. Parameters including ablation duration, contact force (CF), impedance drop, and ablation index were extracted from the CARTONET database for each ablation lesion. Results: A total of 70 patients were included (HFLTV = 35/2484 lesions, SV = 35/2830 lesions) in the analysis. There were no differences in baseline characteristics between the groups. While targeting the same ablation index, the HFLTV ventilation group demonstrated shorter average ablation duration per lesion (12.3 ± 5.0 vs. 15.4 ± 8.4 s, p <.001), higher average CF (17.0 ± 8.5 vs. 10.5 ± 4.6 g, p <.001), and greater impedance reduction (9.5 ± 4.6 vs. 7.7 ± 4.1 ohms, p <.001). HFLTV ventilation group also demonstrated shorter total procedural time (61.3 ± 25.5 vs. 90.8 ± 22.8 min, p <.001), ablation time (40.5 ± 18.6 vs. 65.8 ± 22.5 min, p <.001), and RF time (15.3 ± 4.8 vs. 22.9 ± 9.7 min, p <.001). Conclusion: HFLTV ventilation during PVI for PAF was associated with improved ablation lesion parameters and procedural efficiency compared to SV. [ABSTRACT FROM AUTHOR]

Deep vein thrombosis and pulmonary embolism can result in serious complications when diagnosis is delayed or missed. Definitive diagnosis often relies on consultative imaging, which may not be readily accessible in rural settings. Point-of-care ultrasound has been emerging as an accurate and reliable method of rapidly diagnosing deep vein thrombosis. We present a case report in which a patient presented to a rural emergency department with a chief complaint of dyspnea and was found on point-of-care ultrasound to have a right deep vein thrombosis, which resulted in the prompt recognition of a possible diagnosis of pulmonary embolism versus an asthma exacerbation. Anticoagulation was appropriately initiated prior to obtaining consultative imaging, which confirmed a right deep vein thrombosis and bilateral pulmonary emboli. This case report highlights the utility and reliability of using point-of-care ultrasound for diagnosing deep vein thrombosis in settings with limited access to immediate consultative imaging. The major barriers in improving the use of point-of-care ultrasound in rural British Columbia are a lack of integrated training and concerns about funding and availability of training courses, which highlights the need to implement formal training in medical school and family medicine residency. [ABSTRACT FROM AUTHOR]

Objectives: The influence of lung resection on cardiac function has been reported, and previous studies have mainly focused on right ventricular (RV) dysfunction. As few studies have analyzed changes in left ventricular hemodynamic variables caused by lung resection, we aimed to investigate the perioperative changes in left ventricular stroke volume (LVSV) caused by anatomical lung resection. Methods: We enrolled 61 patients who underwent anatomical lung resection and perioperative LVSV monitoring. The Flo Trac system was used for dynamic monitoring. We investigated changes in LVSV after lung resection and the factors that affected these changes. The operative procedures that contributed to these changes were also investigated. Results: LVSV decreased after anatomical lung resection in the majority of patients (n = 38, 62.2%). Operative procedures affecting this change were (a) taping the superior pulmonary vein (SPV; right: V1‐3) before dorsal part procedure (e.g., major fissure division of right upper lobectomy, A1 + 2c, and A4 + 5 division of left upper lobectomy); (b) division of the SPV (right: V1‐3, V4 + 5); (c) division of A6‐10 (in lower lobectomy); and (d) finish division of all vessels. Conclusions: LVSV decrease was caused by anatomical lung resection in the majority of patients owing to the intraoperative procedures described above. [ABSTRACT FROM AUTHOR]

The Japanese Catheter Ablation (J‐AB) registry, started in August 2017, is a voluntary, nationwide, multicenter, prospective, observational registry, performed by the Japanese Heart Rhythm Society (JHRS) in collaboration with the National Cerebral and Cardiovascular Center. From January 2022, the data registration system was changed from Research Electronic Data Capture (REDCap) system to Fountayn system. The purpose of this registry was to collect the details of target arrhythmias, the ablation procedures, including the type of target arrhythmias, outcomes, and acute complications in the real‐world settings. During the year of 2022, we have collected a total of 90,042 procedures (mean age of 66.7 years and 65.9% male) from 614 participant hospitals. Detailed data were shown in Figures and Tables. [ABSTRACT FROM AUTHOR]

Background: CARTONET® enables automatic ablation site classification and reconnection site prediction using machine learning. However, the accuracy of the site classification model and trends of the site prediction model for potential reconnection sites are uncertain. Methods: We studied a total of 396 cases. About 313 patients underwent pulmonary vein isolation (PVI), including a cavotricuspid isthmus (CTI) ablation (PVI group) and 83 underwent PVI and additional ablation (i.e., box isolation) (PVI+ group). We investigated the sensitivity and positive predictive value (PPV) for automatic site classification in the total cohort and compared these metrics for PV lesions versus non‐PV lesions. The distribution of potential reconnection sites and confidence level for each site was also investigated. Results: A total of 29,422 points were analyzed (PV lesions [n = 22 418], non‐PV lesions [n = 7004]). The sensitivity and PPV of the total cohort were 71.4% and 84.6%, respectively. The sensitivity and PPV of PV lesions were significantly higher than those of non‐PV lesions (PV lesions vs. non‐PV lesions, %; sensitivity, 75.3 vs. 67.5, p <.05; PPV, 91.2 vs. 67.9, p <.05). CTI and superior vena cava could not be recognized or analyzed. In the potential reconnection prediction model, the incidence of potential reconnections was highest in the posterior, while the confidence was the highest in the roof. Conclusion: The automatic site classification of the CARTONET®R12.1 model demonstrates relatively high accuracy in pulmonary veins excluding the carina. The prediction of potential reconnection sites feature tends to anticipate areas with poor catheter stability as reconnection sites. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF), the most common arrhythmia, is associated with increased morbidity, mortality, and healthcare costs. Evidence indicates that rhythm control offers superior cardiovascular outcomes compared to rate control, especially when initiated early after the diagnosis of AF. Catheter ablation remains the single best therapy for AF; however, it is not free from severe complications and only a small percentage of AF patients in the Western world ultimately receive ablation. Ensuring that AF ablation is safe, effective, and efficient is essential to make it accessible to all patients. With the limitations of traditional thermal ablative energies, pulsed field ablation (PFA) has emerged as a novel non-thermal energy source. PFA targets irreversible electroporation of cardiomyocytes to achieve cell death without damaging adjacent structures. Through its capability to create rapid, selective lesions in myocytes, PFA presents a promising alternative, offering enhanced safety, reduced procedural times, and comparable, if not superior, efficacy to thermal energies. The surge of new evidence makes it challenging to stay updated and understand the possibilities and challenges of PFA. This review aims to summarize the most significant advantages of PFA and how this has translated to the clinical arena, where four different catheters have received CE-market approval for AF ablation. Further research is needed to explore whether adding new ablation targets, previously avoided due to risks associated with thermal energies, to pulmonary vein isolation can improve the efficacy of AF ablation. It also remains to see whether a class effect exists or if different PFA technologies can yield distinct clinical outcomes given that the optimization of PFA parameters has largely been empirical. [ABSTRACT FROM AUTHOR]

Background and Objectives: Atrial fibrillation (AF) significantly impacts the quality of life (QoL) of affected individuals. Pulmonary vein isolation (PVI) has emerged as a therapeutic approach to manage AF and improve QoL. This study aimed to assess the QoL in patients with AF undergoing PVI. Methods and Materials: A total of 97 AF patients undergoing PVI (radiofrequency 52.6% (n = 51) and cryoablation 47.4% (n = 46)) at Pauls Stradins Clinical University Hospital were included in this study. QoL was measured using the 36-Item Short-Form Survey (SF-36) before PVI and during a follow-up period of 5.98 ± 1.97 months. Results: This study consisted of 60.8% (n = 59) males, with a mean age of 60.06 ± 11.61 years. A total of 67.0% (n = 65) of patients had paroxysmal AF, and 33.0% (n = 32) had persistent AF. The SF-36 questionnaire revealed major improvements across multiple QoL domains post-PVI, reaching a statistical significance of p < 0.01. Patient factors, such as female gender ([estimate 21.26, 95% CI (7.18, 35.35)], p < 0.01), persistent AF ([estimate 15.49, 95% CI (2.83, 28.15)], p = 0.02), and restored sinus rhythm ([estimate 14.35, 95% CI (1.65, 27.06)], p = 0.03), were associated with significantly improved QoL. Conclusions: PVI in patients with AF positively influences various dimensions of QoL, as evidenced by significant improvement across multiple SF-36 domains. These findings emphasize worsened QoL in patients with AF and the potential benefits of PVI enhancing the overall wellbeing of individuals with AF. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of pulmonary vein antrum enlargement combined with left atrial roof cryoballoon ablation in patients with persistent atrial fibrillation (PeAF) by analyzing the relationship between left atrial isolation area surface area (ISA) and early postoperative recurrence. Methods: 93 patients with PeAF were classified into recurrence and non-recurrence groups according to the results of the 1-year follow-up. Three-dimensional electroanatomical labeling map was constructed and merged with that of the left atrial pulmonary vein CTA, and the ISA and the left atrial surface area (LASA) were measured and analyzed to determine the relationship between ISA/LASA in relation to early postoperative recurrence. Results: 93 patients were included and followed up for 1 year with AF-free recurrence rate of 75.3%. The ISA of the recurrence group was lower than that of the non-recurrence group. Left atrial internal diameter (LAD), left common pulmonary vein, the ISA, the ISA/LASA and early-term recurrence had statistical significance in both groups. The factors that significantly predicted early-term recurrence were left common pulmonary vein and the ISA/LASA. ISA/LASA (HR 0, 95% CI 0–0.005, P = 0.008) and left common pulmonary vein trunk (HR 7.754, 95% CI 2.256–25.651, P = 0.001) were the independent risk factors for early recurrence. ROC curve analysis showed that ISA/LASA predicted the best early recurrence after operation with a cut-off value of 15.2%. Conclusion: A greater ISA/LASA reduces early recurrence after cryoablation in patients with PeAF. An ISA/LASA of 15.2% may be the best cut-off value for predicting early recurrence after cryoablation for PeAF. [ABSTRACT FROM AUTHOR]

Background: Pulmonary vein isolation (PVI) using cryoballoon (CB) ablation has comparable efficacy and safety to the gold standard of radiofrequency ablation in the treatment of symptomatic atrial fibrillation (AF). Initial randomized control trials were performed using Arctic Front Advance Pro™ (AFr) (Medtronic, Dublin, Ireland) CB system. Novel CB systems have recently become available, including the POLARx™ (Px) (Boston Scientific, Marlborough, Massachusetts, USA) system. We aimed to compare PVI using the Px and the AFr CB systems in our patient population in terms of efficacy, safety and procedure characteristics in a routine clinical setting. Methods: We performed a retrospective analysis of our internal AF ablation registry, containing 452 consecutive patients (pts) that underwent first procedure cryo-PVI for symptomatic AF. Primary endpoints were AF recurrence after 3 and 12 months, complication rate, procedure duration, fluoroscopy time and fluoroscopy dose. Secondary endpoints were minimal freeze temperature, time to isolation (TTI) and temperature at TTI for each of the pulmonary veins as well as minimal esophageal temperature during the procedure. Results: The primary efficacy endpoints of AF recurrence after 3 and 12 months were similar between the AFr and the Px systems (25.5% vs 21.3%, p = 0.416 and 22.2% vs 20.6%, p = 0.794, respectively). Complication rates were similar (3.9% vs 6.8%, p = 0.18) between groups and consisted mostly of mild vascular complications. The AFr group showed a significantly shorter procedural duration (68 (55–77) vs 73 (60–80) min, p = 0.002), and lower fluoroscopy dose compared to the Px system. Fluoroscopy times remained similar, however. Minimal freeze temperatures and temperatures at time of isolation were significantly lower in the Px group. However, the time to isolation and minimal procedural esophageal temperature were similar in both groups. Conclusion: PVI using the AFr and the Px systems showed comparable safety and efficacy. Procedural times were longer for the Px system. The Px system showed lower freeze temperature measurements but seemed to have a comparable biological effect. [ABSTRACT FROM AUTHOR]

Background: Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors are powerful molecular targeted therapeutic agents for lung cancer. We recently developed an original immunocytology and glass slide-based circulating tumor cell (CTC) detection platform for both CTC enumeration and EGFR mutation analysis with DNA extracted from CTCs. Methods: Using this platform, we conducted a pilot clinical study for CTC enumeration in peripheral blood (PB), pulmonary arterial blood (PA), and pulmonary venous blood (PV) from 33 patients with lung cancer (Stage I–III) who underwent surgery, followed by digital PCR-based EGFR mutation analysis of CTCs in PV from 12 patients. Results: The results showed that CTC levels were significantly higher in PV and PA than in PB (p < 0.05, p < 0.01. respectively), with a notably greater number of small and large CTC clusters (p < 0.01). Genetic analysis of EGFR mutations of CTCs from PV (n = 12) revealed six mutations, including three Exon19del and three L856R, in CTCs and eight EGFR mutations, including five Exon19del and three L856R, in lung tumor tissue. CTC mutation status matched that of tissue samples in nine patients, was unmatched in two patients, and controversial in one patient, indicating a sensitivity of 0.75 (6/8) and specificity of 1.0 (4/4) with some false-negative results for the mutation analysis of CTCs. Conclusions: This immunocytology-based CTC detection platform is a convenient method for detecting both CTC number and EGFR mutation status under microscopy, suggesting its potential as a liquid biopsy tool in the hospital for patients with lung cancer in some clinical settings. [ABSTRACT FROM AUTHOR]

ABSTRACT The importance of treating non‐pulmonary vein (PV) foci is increasing with improvements in the durability of PV isolation. We describe two cases wherein non‐PV foci were induced by mechanical irritation and conventional induction in the same area, which was impossible to induce after ablation, suggesting a relationship between mechanical irritation and induction of non‐PV foci. In a recurrent case of non‐PV foci, atrial fibrillation (AF) was induced only by mechanical irritation. No recurrence has been observed since the ablation of the area. Thus, treatment of the AF induction site with mechanical irritation could be considered an effective therapy for non‐PV foci. [ABSTRACT FROM AUTHOR]

The effect of gravity on the lungs has been evaluated using computed tomography (CT) in the supine and prone positions but not the standing position. However, as humans spend most of the daytime in the standing position, we aimed to compare lung attenuation gradients between the supine and standing positions, and to assess the correlations between the lung attenuation gradients and participant characteristics, including pulmonary function test results. Overall, 100 healthy participants underwent conventional/supine and upright CT, and lung attenuation gradients were measured. Lung attenuation gradients in anteroposterior direction were greater in the supine position than in standing position (all p values < 0.0001) in both upper lobes at the level of the aortic arch (right: standing/supine, -0.02 ± 0.19/0.53 ± 0.21; left: standing/supine, -0.06 ± 0.20/0.51 ± 0.21); in the right middle (standing/supine, -0.26 ± 0.41/0.53 ± 0.39), left upper (standing/supine, -0.35 ± 0.50/0.66 ± 0.54), and lower lobes at the level of the inferior pulmonary vein (right: standing/supine, -0.22 ± 0.30/0.65 ± 0.41; left: standing/supine, -0.16 ± 0.25/0.73 ± 0.54); and in both lower lobes just above the diaphragm (right: standing/supine, -0.13 ± 0.22/0.52 ± 0.32; left: standing/supine, -0.30 ± 0.57/0.55 ± 0.37). Craniocaudal gradients were greater in the standing position (right: standing/supine, 0.41 ± 0.30/0.00 ± 0.16; left: standing/supine, 0.35 ± 0.30/-0.02 ± 0.16, all p values < 0.0001). No moderate to very high correlations were observed between age, sex, height, weight, body index mass, or pulmonary function test results and each lung attenuation gradient. Lung attenuation gradients in anteroposterior direction, which was observed in the supine position, disappeared in the standing position. However, the craniocaudal lung attenuation gradient, which was not present in the supine position, appeared in the standing position. [ABSTRACT FROM AUTHOR]

Background: There has been no consensus on what power of radiofrequency energy can be used to produce the best surgical results in patients with atrial fibrillation. In addition, patients undergoing local anesthesia and fentanyl analgesia may experience pain when radiofrequency ablation is performed. This study investigated the effect of different power radiofrequency ablations in treatment and postoperative pain in patients with atrial fibrillation. Methods: A retrospective study was performed with 60 patients who underwent radiofrequency ablation for atrial fibrillation between January and June 2023. Patients were divided into 2 groups according to the power of the radiofrequency ablation catheter used, with 30 patients in the conventional power group (35 W) and 30 patients in the high-power group (50 W). The cardiac electrophysiological indexes and postoperative pain of the 2 groups were compared. Results: Most of the procedural key parameters between the 2 groups had no significant differences. However, the total application time during radiofrequency ablation and pulmonary vein isolation time in the high-power group were significantly shorter than those in the conventional power group (p < 0.001). Patients in the high-power group reported significantly less pain than those in the conventional power group in the immediate postoperative period and the late postoperative period (p < 0.001). Conclusions: High-power radiofrequency ablation showed a shorter treatment time, and could reduce postoperative pain compared to conventional power ablation. [ABSTRACT FROM AUTHOR]

Objectives: To assess the impact of the diagnosis-to-ablation time (DAT) on atrial fibrillation (AF) recurrence in search of lower and upper DAT thresholds. Background: DAT strongly predicts AF recurrence after ablation. Whether this association holds any lower and/or upper limits is unknown. Methods: A total of 2000 AF patients from two cohorts of 1000 patients each (69% males, age 62 ± 10 years) undergoing pulmonary vein isolation (PVI) between 2005–2014 and 2017–2019, followed for 3 years. Results: Clinical success was achieved in 61.7% of the patients. Median DAT decreased over time from 36 (Q1–Q3: 12–72) in the first cohort to 12 months (Q1–Q3: 5–48) in the second (p <.001). A multivariable Cox proportional hazards fitted model of AF recurrence rate in relation to DAT (range 0–288 months) demonstrated a steep rise in AF recurrence from 27% to 40% in the first 36 months (d%/dt = 0.36), with a first hinge point at 36 months and a less steep rise to 45% until 90 months (d%/dt = 0.09), with flattening beyond 90 months (d%/dt = 0.026). Rise in AF recurrence rate in the first 36 months was higher in persistent AF patients (from 40% to 54%, d%/dt = 0.39) than in paroxysmal AF (19%–29%, d%/dt = 0.28). Conclusions: The association between DAT and AF recurrence has no lower limit ('the shorter the better') while little gain is to be expected beyond 36 months ('the longer the more irrelevant'). Our data advocate for performing PVI as early as possible, certainly within 3 years of AF diagnosis, and even more so in persistent AF. [ABSTRACT FROM AUTHOR]

Myocardial sleeves of the pulmonary veins (PV) extending from the left atrium (LA) are the major source of ectopic activity causing atrial arrhythmias. The structural and electrophysiological characteristics of the PV myocardium differ from those of the LA. The mechanical activity of cardiomyocytes (CM) impacts cardiac excitation-contraction coupling, however, the mechanical function of PV CM has not been studied yet. We compared the characteristics of the actin-myosin interaction and sarcomere length (SL) dynamics in mechanically non-loaded single CM between the PV and LA in the guinea pig heart. We found that the functional properties of myosin from the PV and LA are not different, while the phosphorylation levels of sarcomeric proteins in the PV and LA are different. End-diastolic SL, sarcomere shortening amplitude, and velocities of sarcomere shortening and relengthening of PV and LA CM do not differ, while PV CM are longer and thinner than LA CM. The amplitude of sarcomere shortening increased with an increase in CM length in the LA but not in the PV. We assume that an absence of correlation between the morphometric parameters of CM and the amplitude of sarcomere shortening together with the electrophysiological features of the PV myocardium may contribute to the occurrence and development of atrial fibrillation. [ABSTRACT FROM AUTHOR]

Introduction: Total anomalous pulmonary venous connection (TAPVC) has a low prenatal diagnostic rate. Therefore, we investigated whether Doppler waveforms with a low pulsatility in the pulmonary veins can indicate fetal TAPVC. Methods: This retrospective study included 16 fetuses with TAPVC, including 10 with complex congenital heart disease and 104 healthy fetuses that underwent fetal echocardiography. Pulmonary venous S and D wave flow velocities and the valley (representing the lowest velocity between the S and D waves) were measured. Valley indices I and II were then calculated as (velocity of valley/greater of the S and D wave velocities) and (velocity of valley/lesser of the S and D wave velocities), respectively. Results: Supra/infracardiac TAPVC cases exhibited significantly greater valley indices than that of the healthy group. After adjusting for gestational age at fetal echocardiography, valley indices I (odds ratio [OR] 7.26, p < 0.01) and II (OR: 9.23, p < 0.01) were significant predictors of supra/infracardiac TAPVC. Furthermore, valley indices I and II exhibited a high area under the curve for detecting supra/infracardiac TAPVC, regardless of the presence of pulmonary venous obstruction. Conclusion: The valley index may be a useful tool for the detection of fetal TAPVC. Plain Language Summary: Total anomalous pulmonary venous connection (TAPVC) requires urgent intervention after birth. Furthermore, prenatal diagnosis is essential to improve the postnatal clinical course. However, fetuses with TAPVC show no identifying characteristics of the disease in echocardiographic images, producing a low prenatal diagnostic rate. Our research proposes a "valley index" to objectively quantify the low pulsatility of pulmonary venous waveforms in fetuses and serve as an indicator of fetal TAPVC. The study sample consisted of 16 fetuses with TAPVC, including 10 with complex congenital heart disease and 104 healthy fetuses. The valley index was calculated using velocities of the S wave, D wave, and valley between the waves. The valley indices were significantly higher in the groups with supracardiac and infracardiac TAPVC than in the healthy control group; indicating that it was a significant predictor of the two types of TAPVC. The optimal cutoff value of the valley index was calculated, showing high sensitivity and specificity for the detection of fetal TAPVC. Therefore, the valley index may be a useful tool for the prenatal detection of TAPVC. [ABSTRACT FROM AUTHOR]

Background: Improved characterization of arrhythmias is based on minimally invasive catheterizations. However, these catheterizations have been poorly explored in horses because apart from 3‐dimensional (3D) mapping systems, continuous guidance of the catheter's position with adequate detail is difficult using current imaging modalities. Hypothesis: Position multiple electrophysiology catheters simultaneously at predetermined strategical positions in the heart using transthoracic echocardiographic guidance. Animals: Eight adult healthy horses. Methods: Observational study. Two electrophysiological studies were performed: 1 procedure with catheters positioned in the right heart in the standing sedated horse and 1 procedure under general anesthesia with catheters positioned in the left heart. Except for the coronary sinus catheter, each catheter positioning was simultaneously guided by right‐parasternal transthoracic echocardiography and 3D electro‐anatomical mapping. Results: For each catheter position, a central imaging plane was taken as the starting point, after which the imaging probe was shifted, rotated, and angulated to visualize the catheter over its entire length, including its distal electrode. Catheter positionings in the right heart and left ventricle were successfully guided in the majority of the horses whereas catheter positionings in the left atrium, and especially the pulmonary veins, were challenging to guide echocardiographically. Conclusions and Clinical Importance: Ultrasound guidance of catheters to specific positions useful for electrophysiological mapping was feasible in the right heart and left ventricle but challenging for the left atrium. This approach creates a perspective for minimally invasive arrhythmia diagnosis without the need for a 3D mapping system. Left parasternal views and intracardiac echocardiography might provide better guidance for left atrial positions. [ABSTRACT FROM AUTHOR]

Objective: The balance between free oxygen and nitrogen species and physiological antioxidant mechanisms is crucial for maintaining vital tissue functions. Notably, oxidative stress affects the pathophysiology of many diseases, including atrial fibrillation (AF). We investigated the role of oxidative stress in AF and the effects of ablation procedures on oxidative stress. Methods: A total of 40 patients who underwent cryoballoon or radiofrequency ablation for pulmonary vein isolation were enrolled in the study. Patients with well-known diseases associated with increased oxidative stress were excluded. The total antioxidative capacity and total oxidative status (TOS) values before and six months after the procedure were examined and evaluated according to rhythm status. Results: After six months, there was a statistically significant difference in TOS compared with the preprocedure values (1880.05±1016.19 vs. 1418.32±1075.11, p=0.001). The postprocedural TOS value was significantly lower in the sinus rhythm group than in the patient group with AF (1237.48±1036.34 vs. 2270.88±870.20, p=0.013). However, there were significant differences between the paroxysmal and persistent AF groups according to preprocedural rhythm status (4.87±5.77 vs. 20.43±23.23, p=0.009). We did not find any association between C-reactive protein levels and the presence of arrhythmia after the procedure (11.29±16.19 vs. 13.70±25.47, p=0.662). Conclusion: Oxidative stress, as evaluated by TOS values, can be a prognostic parameter for AF recurrence after ablation. [ABSTRACT FROM AUTHOR]

Atrial fibrillation and heart failure are two common cardiovascular conditions that frequently coexist, and it has been widely demonstrated that in patients with chronic heart failure, atrial fibrillation is associated with a significant increase in the risk of all-cause death and all-cause hospitalization. Nevertheless, there is no unanimous consensus in the literature on how to approach this category of patients and which therapeutic strategy (rhythm control or frequency control) is the most favorable in terms of prognosis; moreover, there is still a lack of data comparing the different ablative techniques of atrial fibrillation in terms of efficacy, and many of the current trials do not consider current ablative techniques such as high-power short-duration ablation index protocol for radiofrequency pulmonary vein isolation. Eventually, while several RCTs have widely proved that in patients with heart failure with reduced ejection fraction, ablation of atrial fibrillation is superior to medical therapy alone, there is no consensus regarding those with preserved ejection fraction. For these reasons, in this review, we aim to summarize the main updated evidence guiding clinical decision in this complex scenario, with a special focus on the most recent trials and the latest meta-analyses that examined the role of catheter ablation (CA) in rhythm control in patients with AF and HF. [ABSTRACT FROM AUTHOR]

Despite advances in ablative therapies, outcomes remain less favorable for persistent atrial fibrillation often due to presence of non-pulmonary vein triggers and abnormal atrial substrates. This review highlights advances in ablation technologies and notable scientific literature on clinical outcomes associated with pursuing adjunctive ablation targets and substrate modification during persistent atrial fibrillation ablation, while also highlighting notable future directions. [ABSTRACT FROM AUTHOR]

Bronchial varices, characterized by dilated and tortuous vessels within the bronchial tree, are a rare entity often presenting as massive or recurrent haemoptysis. Multiple aetiologies have been described in the literature including congenital or acquired pulmonary vein stenosis secondary to surgical or radiofrequency ablation or other cardiac interventions. We present a case of a 60-year-old female with a history of systemic hypertension, hypothyroidism and sick sinus syndrome, who presented with intermittent episodes of dry cough and haemoptysis. A diagnostic workup revealed circumferential bronchial thickening and pulmonary vein stenosis on contrast-enhanced chest computed tomography (CT). Bronchoscopic findings confirmed the presence of bronchial varices, which was secondary to the Radiofrequency ablation she underwent 7 years ago. This case highlights the diagnostic challenge posed by bronchial varices and underscores the importance of a comprehensive approach in managing such rare presentations. [ABSTRACT FROM AUTHOR]

Background: Superior vena cava (SVC) is atrial fibrillation (AF)’s most common non-pulmonary vein (PV) foci. Studies reported conflictory results when SVC isolation (SVCi) was combined with PVi and long-term outcomes were lacking. Therefore, we aimed to evaluate the long-term efficacy and safety of empirical SVCi as an adjunct to cryoballoonbased PV isolation (PVi) in persistent AF ablation. Methods: A total of 40 consecutive persistent AF patients (60.6 ± 8.2 years, 52.5% females) who underwent SVCi in addition to PVi compared with a propensity score matched cohort of 40 persistent AF patients (58.6 ± 8.7 years, 50% female) in whom PVionly was performed. Second-generation cryoballoon (CB2) was used in all procedures. Atrial tachyarrhythmia (ATa) recurrence was defined as the detection of AF, atrial flutter, or atrial tachycardia (≥30 s) after a 3-month blanking period. Results: Pulmonary veins and SVC were successfully isolated in all patients. At a mean of 46.7 ± 7.8 months follow-up, 22 (55%) patients in the PVi-only group, and 27 (67.5%) patients in the PVi+SVCi group were free of ATa after the index procedure (P = .359). Phrenic nerve injury (PNI) was detected in 2 (5%) patients in the PVi-only group (during right PVi) and 2 (5%) patients in the PVi+SVCi group (during SVCi) (P = 1.00). Cox regression analysis revealed that early recurrence was the only predictor of recurrence (hazard ratio 4.88, 95% confidence interval 1.59-14.96; P = .005). Conclusion: Long-term results of our small sample-sized study revealed that CB-based PVi+SVCi was associated with outcomes similar to the PVi-only strategy in patients with persistent AF. Although complication rates were similar between the groups, close follow-up of diaphragmatic movement is crucial to prevent PNI during SVCi. [ABSTRACT FROM AUTHOR]