Chylothorax is a rare complication of thoracic procedures caused by leakage of chyle into the pleural space secondary to thoracic duct injury or obstruction. Although uncommon, it can lead to significant respiratory compromise and requires prompt recognition and management. We report the case of a patient who developed progressive respiratory distress 2 days after undergoing pulmonary vein isolation with radiofrequency ablation. Imaging demonstrated large bilateral pleural effusions, which were identified as bilateral chylothoraces. The patient was managed conservatively with placement of bilateral thoracostomy tubes and initiation of a low-fat diet, resulting in successful resolution of symptoms and chyle leakage. This case represents an unprecedented presentation of bilateral chylothoraces following pulmonary vein isolation with radiofrequency ablation. Clinicians should maintain awareness of this rare but potentially serious complication in patients presenting with respiratory symptoms after ablation procedures, as early diagnosis and conservative management may result in favorable outcomes.
To evaluate changes in persistence to basal insulin following the implementation of the $35 monthly out-of-pocket cost cap for insulin for Medicare beneficiaries. We completed a retrospective cohort analysis of a nationally representative Medicare Advantage sample from 2022 to 2023. We compared precap rates of persistence to basal insulin in 2022 with postcap rates in 2023 using Persistence to Basal Insulin, a health plan performance measure used in Medicare Part D quality programs, among the study population and multiple subgroups. A statistically significant increase (+1.3 percentage points; P < .001) was seen in overall patient persistence to basal insulin in the first year of the implementation of the insulin cost cap. Subgroup analyses showed greater increases in persistence in several subpopulations, including patients aged 45 to 54 and 65 to 74 years, male patients, non-Hispanic Black patients, and patients residing in certain census divisions, especially those with a high prevalence of type 2 diabetes. In addition to providing financial relief to Medicare patients, the implementation of the insulin cost cap was associated with an improvement in patients' treatment persistence to basal insulin therapy, a measure associated with positive health and economic outcomes. These results lend useful insight into future policy evaluations and proposals that seek to improve treatment access and address disparities in appropriate medication use.
Several states have amended their laws relating to a minor's ability to consent to medical forensic exams after sexual assault. To identify state-by-state legal differences of who may provide informed consent for forensic medical exams with adolescent patients following sexual assault. A search of all 50 states using the legal database Westlaw for state statutes pertaining to who may provide consent for sexual assault medical forensic exams on minors. Unless stated as an exception, parental consent remains a prerequisite for minors to undergo medical forensic exams and medical treatment following a sexual assault. Fourteen states have an exception that allows minors to obtain sexual assault medical forensic exams without parental consent, while twenty-eight states do not have an exception (require parental consent). Legislative divergence across states highlights the importance of health care providers to remain current on their state's requirements.
This study investigated the effectiveness of biofilm removal using individually customized cleaning splints (CS) as an aid for interdental brushes (IDBs). In a randomized clinical crossover study, the effect of IDBs in combination with CS on plaque reduction and periodontal parameters was examined. Periodontitis patients received an intraoral scan to produce a 3D-printed CS. Following a 2-week interdental hygiene pause, they were divided into two groups: Group A: CS+IDBs, Group B: IDBs. Participants performed daily interdental cleaning at home for 2 weeks following standardized professional instruction. After another 2-week interdental hygiene pause, the groups switched methods. Additionally, motor skills, stress levels, and nutritional quality were assessed. Thirty participants (age range 21-82 years) completed the study. CS+IDBs led to a significantly greater plaque reduction (change in Quigley-Hein plaque index, ∆QHI) compared to IDBs alone (ΔQHI = -1.38 vs. -0.23, p < 0.001). The impact on reducing gingival inflammation (GI) was limited to younger participants with no effect on bleeding on probing (BOP). Random effects ANCOVA confirmed the significant effect of CS on ∆QHI (p < 0.001). An interaction between perceived stress and CS use on BOP indicated that stress may influence the effectiveness of CS supported plaque removal. Cleaning splints are a promising approach to enhance the effectiveness of IDBs in reducing interdental biofilm.
To evaluate healing rates observed on second-look arthroscopy (SLA) in patients with medial meniscus posterior root tears treated with isolated high tibial osteotomy (HTO) or HTO combined with root repair (MMPRR) in varus knees. Osteoarthritis (OA) progression, medial meniscus extrusion (ME), and clinical outcomes were assessed as secondary objectives. A comprehensive literature search was conducted following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies assessing postoperative healing and failure rates on SLA, radiographic progression of knee OA, ME, and clinical outcomes following HTO with or without MMPRR in varus knee were included. Ten articles met the final inclusion criteria, comprising 459 patients: 148 underwent isolated HTO, and 311 underwent concomitant HTO with MMPRR. SLA was performed in all included patients. The proportion of successfully healed root repairs ranged from 5.9% to 50.0% in the isolated HTO group and 12.5% to 64.9% in the combined HTO + MMPRR group. Partially healed repairs occurred in 25.0% to 40.9% of isolated cases and 0% to 75% of combined cases, whereas failure rates ranged from 20.0% to 59.4% and 0% to 45.5%, respectively. Postoperatively, ME remained largely unchanged, ranging from 4.2 to 4.5 mm in the isolated HTO group and 3.1 to 5.5 mm in the combined HTO + MMPRR group. Improvement in OA grade was observed in 15% to 20.6% of isolated HTO patients and 4% to 20% of combined group patients, whereas OA progression occurred in 4.5% to 10% and 3.7% to 40.9%, respectively. Arthroscopic evaluation showed cartilage improvement in 17.6% to 40.0% of the isolated group and 3.9% to 53.8% of the combined group, with cartilage deterioration reported in 0% to 9.1% and 0% to 12.0%, respectively. Healing outcomes following MMPRR varied widely across studies, with outcome ranges showing higher healing rates and lower failure rates in the combined HTO + MMPRR group compared with isolated HTO. Postoperative ME remained largely unchanged in both treatment groups. Although modest improvements in OA grade and cartilage condition were observed, degenerative changes continued to progress in both groups. Level IV, systematic review of Level II to IV studies.
Postoperative urinary tract infection (UTI) following pyeloplasty remains a significant complication and continues to pose challenges in pediatric urological care. This study aimed to develop a simplified predictive model to identify risk factors for postoperative UTI after unilateral pyeloplasty and to support clinicians in implementing preventive strategies targeting modifiable risk factors. Clinical data from children who underwent unilateral pyeloplasty at the Children's Hospital of Capital Institute of Pediatrics (Beijing, China) between January 2012 and January 2022 were retrospectively analyzed. Variables including sex, age, body mass index (BMI), surgical modality, drainage tube type, and parameters from blood and urine tests were evaluated. Statistical analyses, including least absolute shrinkage and selection operator (LASSO) regression, logistic regression, and random forest modeling, were performed to identify significant predictive factors. Variables with the greatest predictive importance were used to develop a nomogram, and its clinical utility was evaluated using decision curve analysis (DCA). Among 764 patients, 265 (35%) developed postoperative UTI. Key risk factors included surgical modality, laterality of ureteropelvic junction obstruction (UPJO), drainage tube type, blood urea nitrogen (BUN) level, and patient height. LASSO regression identified 14 predictive variables, while logistic regression determined independent risk and protective factors. Ultimately, 8 variables (e.g., sex, operative time, drainage tube type, history of infection, history of fistula, age, BUN level, and renal cortical thickness) were selected for development of the nomogram predicting postoperative UTI risk after unilateral pyeloplasty. This study identified 8 factors associated with postoperative UTI following unilateral pyeloplasty in children. The developed predictive model may assist clinicians in identifying high-risk patients, thereby supporting improved perioperative planning and postoperative management.
Travel burden has been identified as a source of care disparities in other malignancies, but its impact on gastric cancer care is poorly understood. Therefore, we investigated the impact of travel burden on treatment administration for stage II/III patients and its association with survival. This was a retrospective cohort study among patients diagnosed with stage II/III gastric cancer from 2004 to 2021 in the National Cancer Database. Travel burden was measured as distance from treatment facility to patient's ZIP code (great circle distance [GCD]). We analyzed differences in treatment administration across GCD categories and the impact of GCD on overall survival (OS). We identified 16,826 patients with stage II/III gastric cancer in the following GCD categories: 0-25 miles (n = 11,301 [67.2%]), 25-50 miles (n = 2,566 [15.3%]), 50-100 miles (n = 1,746 [10.4%]), and 100-300 miles (n = 1,213 [7.2%]). Patients in high GCD categories experienced increased rates of delays in care initiation (0-25 miles: 13.7%, 100-300 miles: 17.1%, P < .001), fragmented care (0-25 miles: 57.6%, 100-300 miles: 72.6%, P < .001), and delay between chemotherapy and surgery (0-25 miles: 23.0%, 100-300 miles: 27.3%, P < .001). Median OS decreased with increasing GCD categories (0-25 miles: 41.0 mo, 100-300 miles: 34.9 mo, P = .003) and persisted after adjusting for clinical, demographic, and socioeconomic variables (100-300 miles hazard ratio, 1.12 [1.03-1.21], P = .008). Care fragmentation was associated with reduced OS, even if patients received care at academic (fragmented: 39.9 mo [37.8-42.8], nonfragmented: 50.4 mo [45.7-54.6]), or high-volume centers (fragmented: 38.8 mo [36.9-41.2], nonfragmented: 47.4 mo [44.2-50.7]). Increased travel burden was associated with delayed treatment administration and increased care fragmentation and was independently associated with increased mortality, particularly in patients traveling 100-300 miles. Understanding the impact of travel burden on gastric cancer care and outcomes can help guide future resource allocation for patients.
Alcohol use disorder (AUD) is marked by sensitivity to alcohol cues and stress, increasing craving and stress. Stress typically lowers heart rate variability (HRV), whereas alcohol cues may increase or decrease HRV; however, their combined effects remain unclear. We examined (1) subjective craving, stress, and HRV responses to alcohol cue exposure and stress exposure, and (2) whether exposure order (stress-alcohol vs alcohol-stress) influenced these responses. Additional exploratory analyses examined associations between subjective and physiological reactivity. Fifty-six young adult who engaged in hazardous drinking (37 women; median age = 20 years, IQR = 3) with AUDIT scores ≥ 8 (median = 14, IQR = 6) and minimal other substance use were randomized to two conditions: stress-alcohol or alcohol-stress exposure. Alcohol cues included visual, olfactory, and tactile stimuli, and stress was induced using a computerized mental arithmetic task (MAT). Craving and stress were rated on Likert scales, and HRV was continuously recorded via a portable electroencephalograph (ECG) device. Alcohol cues increased craving. While stress exposure followed by alcohol cues reduced subjective stress. Alcohol cues increased HRV, while stress-exposure raised stress without affecting craving. In an exploratory subgroup analysis, HRV reactivity during MAT was observed only in participants whose craving remained unchanged change following MAT, suggesting an inverse association between craving and autonomic responsiveness. These findings highlight linked effects of stress exposure and alcohol cues on autonomic regulation in hazardous drinking and may offer preliminary insights into mechanisms that could be relevant for relapse prevention.
Limited health literacy among individuals with epilepsy is associated with poor health outcomes, highlighting the importance of accessible, evidence-based self-care resources. Mobile health applications represent a promising avenue for supporting epilepsy self-management; however, the quality and reliability of app content may significantly affect patient trust, clinical interactions, and health outcomes. Therefore, this study aims to evaluate the quality of available Persian-language epilepsy-related mobile applications. Persian-language apps related to epilepsy and seizures were systematically identified from Google Play, Café Bazaar, and IranApps using relevant keywords. After excluding non-Persian and duplicate apps, the eligible applications were independently evaluated using the user version of the Mobile Application Rating Scale (uMARS) and DISCERN tools. Of 659 identified applications, 78 were epilepsy-related; following exclusions, 11 apps met the inclusion criteria for full evaluation. The mean overall uMARS score was 2.8 ± 0.5 out of 5, with six of the 11 apps (54%) scoring above 3. The section-specific mean scores were as follows: engagement, 2.2 ± 0.5; functionality, 4.0 ± 0.4; esthetics, 3.3 ± 0.9; and information, 2.3 ± 0.4, out of 5. DISCERN total scores ranged from 26 to 40 out of 80 (mean 34.5 ± 4.2), and the mean reliability score was 18.2 ± 3.9. The results showed that Persian-language epilepsy-related apps demonstrated high functionality but limited support for behavior change, engagement, and esthetics. Information quality was generally poor, and none of the evaluated apps were free of charge. These findings highlight the urgent need for developing high-quality, evidence-based epilepsy apps that support comprehensive self-care and behavioral change strategies for Persian-speaking users.
Long-term survival of lung transplant recipients remains limited by chronic lung allograft dysfunction (CLAD). CLAD is only diagnosed following a persistent and substantial decline in lung function, after which irreversible damage to the lungs has occurred, limiting opportunities to effectively intervene at an early stage. There is a critical need for earlier detection prior to its clinical manifestation. The immunological drivers of CLAD remain unclear, limiting the development of predictive biomarkers and new therapies. In this hypothesis-generating, prospective cohort study, we profiled the microbial, metabolic, lipidomic, and gene expression dynamics of longitudinally collected broncho-alveolar lavages (BALs) from 56 CLAD-free lung transplant recipients up to 30 months post-transplant, and compared BALs from 13 CLAD-free patients to BALs from 13 patients who developed CLAD. In CLAD-free patients, the first 6 months post-transplant were hallmarked by diminished microbial diversity and increased abundance of Staphylococcus and Candida, coupled with upregulated innate and adaptive immune responses, and elevated nitric oxide metabolism (FDR < 0.05). This was superseded by homeostatic tissue repair and by the reactivation of T-cell genes such as CD3, GZMA, IL2RB, CD28, CD40LG, and LCK, after tapering of maintenance immunosuppression (FDR < 0.05). In patients who developed CLAD, disease onset was preceded by the increased abundance of sphingolipids and the upregulation of glycocalyx and immune cell recruitment genes such as HAPLN3, HS3ST3B1, SULF2, CHST2, CSGALNACT1, CXCR1, CSF3R, SELL, CXCL2, and CEACAM1 (FDR < 0.05), suggesting increased vascular dysfunction and immune cell graft infiltration prior to CLAD onset. Scoring against a publicly available lung single-cell dataset showed our bulk gene transcriptomics signature to be expressed by monocytes, endothelial, and T cells. In contrast to CLAD-free patients, this signature persisted after 1.5 months post-transplant and increased in intensity upon the start of lung function decline. Multi-omics integration highlighted sphingolipid molecules and genes involved in immune cell recruitment and endothelial function as candidate biomarkers associated with the onset of CLAD. This study is limited by its small sample size. We have identified immunological processes, metabolites, lipids, and genes associated with the onset of CLAD. Our findings are to be considered associative and not aimed at establishing causality. Future studies employing a targeted approach in independent validation cohorts, using, for example, quantitative polymerase chain reaction (PCR) and targeted mass-spectrometry, will be required to confirm these findings.
Cytomegalovirus (CMV) reactivation reshapes immune reconstitution and remains a significant cause of morbidity and mortality following allogeneic hematopoietic stem cell transplantation (HSCT). To understand the impact of asymptomatic CMV viremia on immune reconstitution, we profiled longitudinal blood samples (n=32) from donor-recipient pairs pre- and post-HSCT with single-cell RNA and TCR sequencing for three months after transplantation. To analyze the development of antigen-specific T-cell responses in detail, we sorted and TCR-sequenced T cells specific to the immunodominant CMV epitope pp65. After HSCT, an early increase in CD14+ monocytes was observed, followed by expansion of T and NK cells. Persisting patient cell-chimerism was observed in the CD4+ T cell fraction. CMV-specific T cells and CMV-associated adaptive NK cells matured slower in grafts from seronegative donors compared to seropositive donors. The early maturation of adaptive NK cells was markedly more rapid in patients with CMV seropositive donors with enhanced recall-function; however, adaptive NK cell cytotoxicity was higher in patients with CMV seronegative donors. Large oligoclonal CD8+ T cell expansions against the immunodominant CMV pp65NLV epitope comprised up to 63.6% of the CD8+ T cell repertoire, showing terminal maturation with upregulation of canonical NK cell receptors. Our study presents the first comprehensive single-cell transcriptomic characterization of adaptive immune recovery following allogeneic HSCT, with a particular focus on CMV reactivation. Our findings highlight the impact of donor CMV serostatus on immune maturation in recipients with CMV reactivation, which may help predict the timing of immune reconstitution and inform strategies for management of post-transplant complications.
Nurse practitioners (NPs) often lead interprofessional healthcare teams, yet many receive little or no formal leadership training. As healthcare systems grow in complexity and demand greater accountability, the need for strong and effective NP leadership has intensified. However, leadership development within NP education remains poorly defined and often lacks theoretical grounding. This systematic review explores interventions designed to build NP leadership skills. Following PRISMA and BEME Guide No. 13 guidelines, a search (July 2022, updated April 2024) identified peer-reviewed English-language articles from 1980 onward. Studies involving NPs at any training or practice stage were included if they described a leadership intervention. Of 3,058 articles, eight met inclusion criteria. Most studies originated in the U.S., featured isolated leadership interventions, and lacked NP clinical faculty involvement. Experiential learning and mentorship were common. Leadership domains emphasized cognitive and emotional intelligence, with little focus on leader character development. Evaluation of leadership interventions were limited. Overall, few theoretically informed, robust NP leadership interventions exist. Future efforts should prioritize comprehensive, longitudinal, and theory-based approaches to strengthen leadership capacity within NP education and practice.
In the article cited above, funding information was inadvertently omitted. The following text has been added: "This research was supported in part by National Institutes of Health grant P30 DK036836, which supports the Joslin Diabetes Center's Clinical Research Center." The authors apologize for the omission. The online version of the article (https://doi.org/10.2337/dc24-1599) has been updated with the correct funding information.
Fasting enhances small intestinal regeneration after radiation, but the contribution of the gut microbiome to this process remains uncharacterized. We identify Akkermansia muciniphila (AKK) as a key mediator of this response. AKK was enriched in fasted mice and its antibiotic depletion abrogated radioprotection, whereas reintroduction restored both organismal survival and intestinal integrity. Fasting elevated propionic acid, consistent with AKK's metabolic output. AKK-conditioned medium and propionate induced histone H3 acetylation in intestinal stem cell cultures while in vivo fasting induced AKK-dependent H3K27ac and H3K9ac, remodeling promoter-enhancer landscapes in crypt epithelial cells. Epigenetic profiling revealed a rewired core regulatory program enriched for pioneer transcription factors (Foxa, Gata, Klf), architectural organizers (Ctcf, Boris), and lineage-defining and metabolic regulators (Cdx2, Hnf4). This program supports expansion of a population of primed persister cells characterized by open chromatin accessibility at key stem and regenerative-associated loci including Clu, Olfm4, Lgr5, Ascl2, Lrig1, Sox9, Rnf43, and Axin2. These findings define a fasting-induced microbiome-metabolite-chromatin axis that epigenetically primes highly plastic persister cells for rapid regeneration of the intestinal epithelium following radiation-induced injury.
Solving tasks with others is fundamental in our daily life and requires coordinating actions with other agents in time and space. To manage such real-time interactions, humans must deal with uncertainty caused by noise and delays in sensory and motor signals. One mechanism the sensorimotor system may employ to reduce uncertainty is exploiting information from multiple sensory systems. Here, we review empirical studies examining how visual, auditory, and haptic information contribute to joint actions. A systematic search following PRISMA guidelines yielded 24 eligible studies, which we classified according to the taxonomies by Knoblich et al. (2011) - emergent vs planned coordination - and Jarrassé et al. (2012) - co-activity, cooperation, and collaboration. Across emergent and planned coordination, access to multiple sensory channels generally enhanced interpersonal coordination. The review provides indications that the weighting of sensory signals depends on their reliability and task relevance. However, studies directly testing integration principles are rare, and learning in the context of multisensory integration in joint action remains unexplored. We argue that experimentally testing multisensory integration mechanisms in joint actions and investigating training-related changes offers valuable avenues for further research, advancing theoretical understanding and practical applications across domains such as sports, rehabilitation, and human-robot interaction.
Tissue engineering can be accomplished in a plethora of ways, ranging from direct deposition of cells onto scaffolds and chips to contactless volumetric printing of 3D structures. Recent studies have examined the feasibility of using acoustic manipulation of cells in vitro and in situ, although these studies have not yet identified the critical quality requirements to create complex tissues. To this end, we present a methodology for generating and evaluating acoustically patterned 3D vascular tissue for biomedical studies. Over a period of 7 days, tissues were able to generate self-assembling vasculature, deposit a self-secreted extracellular matrix network, and demonstrate changes in angiogenic gene expression in response to acoustic patterning. These behaviors demonstrated a positive correlation between the quality of alignment and associated vascular structure following acoustic manipulation, suggesting a relationship between patterning and tissue development. These findings identify necessary requirements for creating self-assembling vasculature in vitro, accounting for biological and physical parameters.
Provide an overview of medical traumatic stress in pediatric critical care and highlight pediatric psychology as a central mechanism for translating evidence into trauma-informed screening, prevention, and intervention practices within pediatric intensive care units (PICUs). Current literature is synthesized to characterize medical traumatic stress, identify trauma-informed practice guidelines, and propose recommendations for improved integration of pediatric psychology into critical care settings. High rates of medical traumatic stress and posttraumatic stress disorder (PTSD) are reported among critically ill children, caregivers, and PICU staff, with identifiable risk factors. Current and emerging standards of care reviewed include traumatic stress and delirium screening, early mobility initiatives, PICU follow-up programs, trauma-focused interventions, and staff debriefing efforts. Medical traumatic stress is a common outcome of PICU hospitalization. Earlier integration of pediatric psychology services during and following PICU admission offers promise for improving outcomes, advancing trauma-informed care, and informing future research across the PICU continuum.
To compare echocardiographic hemodynamic parameters between pregnant women with and without preeclampsia evaluated at high altitude. We conducted an observational cross-sectional study including pregnant women evaluated at a tertiary referral center located at 2640 m above sea level. Participants were classified according to the presence or absence of preeclampsia, diagnosed using International Society for the Study of Hypertension in Pregnancy criteria. All participants underwent standardized transthoracic echocardiography following international guidelines. Conditions known to significantly affect maternal hemodynamics were excluded. A total of 105 pregnant women were included (35 with preeclampsia and 70 controls). Women with preeclampsia had higher cardiac output (median 5.18 L/min (IQR 3.90-6.04) vs. 4.52 L/min (IQR 3.67-5.15); p = 0.045) and higher left ventricular stroke volume (median 62.80 mL (IQR 53.04-71.41) vs. 55.65 mL (IQR 50.24-62.80); p = 0.019) compared with controls. Systemic vascular resistance was lower in the preeclampsia group, although the difference was not statistically significant (median 1243.36 dyn·s·cm-5 (IQR 1057.32-1594.65) vs. 1418.58 dyn·s·cm-5 (IQR 1234.44-1717.41); p = 0.06). Left ventricular systolic function and indexed chamber volumes were similar between groups. Among pregnant women evaluated at high altitude, preeclampsia was associated with higher cardiac output and stroke volume, accompanied by mild alterations in diastolic filling, without significant differences in ventricular structure or systolic function. These findings underscore the heterogeneity of maternal hemodynamic presentation in preeclampsia and support further investigation of maternal cardiovascular adaptation in high-altitude settings.
This scoping review describes the characteristics of studies that were designed to address two research questions: 1) What is the nature of patient-provider communication about weight or weight management among adults, including antecedents and consequences of this communication?; and 2) What are the communication strategies or intervention approaches to improve patient-provider communication about weight or key weight-related behaviors? Following the PRISMA-ScR, we searched five databases for peer-reviewed empirical studies published in English between January 1, 1970 (marking the emergence of obesity research in response to rising obesity rates), and June 25, 2024. A total of 101 studies met the inclusion criteria. The number of studies that examine the nature of communication (first research question) or strategies to improve it (second research question) has significantly increased since 2013-the year in which the American Medical Association declared obesity a chronic disease. Despite its growth, the overwhelming majority of studies (98.0%) were conducted in Western countries. Additionally, most studies (90.1%) focused on describing the nature of communication, while only 10 studies addressed interventions. Notably, all intervention studies were still in early research phases. Finally, while nearly all studies (98.9%) assessed verbal behaviors, only 15 (16.5%) and 16 (17.6%) studies examined paraverbal and nonverbal behaviors, respectively, reflecting a predominant reliance on qualitative methods. These gaps identified in this scoping review underscore the need for more diverse, methodologically rigorous, and culturally inclusive research that reflects the full complexity of patient-provider communication to support the development of evidence-informed interventions for improving patient-provider communication about weight and weight management. Findings from this scoping review highlight several important directions for future research to advance the literature on patient-provider communication about weight and weight management. These include using mixed methods designs, assessing all behavioral communication channels, and developing and testing interventions.
Recurrent atrial tachyarrhythmia (AT) remains a major challenge following catheter ablation for atrial fibrillation (AF). While pulmonary vein (PV) reconnection is a well-recognized mechanism, the contribution of lesion heterogeneity to iatrogenic AT is not clearly defined. To analyze the clinical characteristics of recurrent AT caused by ablation-induced focal potentials. We retrospectively analyzed 113 patients who underwent repeat ablation for recurrent AT. Mechanisms of AT recurrence were identified using high-resolution electroanatomic mapping and categorized into five types. Nonuniform ablation-related AT-considered iatrogenic-was defined as focal or localized reentrant ATs arising from regions of prior ablation. Gap conduction was the most common mechanism of recurrence (51.3%), followed by other mechanisms (27.4%) and nonuniform ablation-related AT (14.2%). The number of reconnected PVs was not significantly associated with the timing of all-mechanism recurrence. Nonuniform ablation-related ATs frequently presented as a combination of AF and atrial flutter (AFL), whereas gap-related recurrence typically manifested as AF. Lesion homogeneity plays a critical role in minimizing iatrogenic ATs, highlighting the importance of ablation strategies that optimize both electrical isolation and lesion quality. These findings offer insights for the refinement of ablation techniques and the development of improved catheter technologies.