With the rapid development of transcatheter aortic valve replacement, a large number of new studies, new technologies, and new devices have been proposed and applied both domestically and internationally in 2025. This article intends to start from both international and domestic perspectives, summarize and review the updated guidelines, application status, research progress and new device development in 2025, in order to make predictions and suggestions for the development direction of this field and the trend of clinical research in 2026.

Cardiac physiologic pacing aims to restore or approximate the cardiac native conduction and activation pattern. Among these strategies, conduction system pacing (CSP), represented by His bundle pacing and left bundle branch pacing (LBBP), has developed rapidly in recent years. In 2025, several randomized controlled trials and real-world studies further strengthened the evidence base for CSP. In patients with bradycardia, CSP has shown potential advantages over right ventricular pacing in preserving left ventricular function and reducing the incidence of pacing-induced cardiomyopathy. In patients with heart failure and those indicated for cardiac resynchronization therapy, comparative data between CSP and biventricular pacing continue to accumulate, and the potential value of combined strategies such as LBBP-optimized CRT is being further explored. Meanwhile, technological and device innovations are advancing in areas such as lead reliability, the use of defibrillation leads for LBBP, leadless CSP systems, and physiological atrial pacing. Overall, CSP is progressively driving pacing therapy toward a more physiological and precision-oriented approach. However, its long-term outcomes and optimal indications still require further confirmation through high-quality studies.

Significant progress has been made in the management of ventricular arrhythmias in 2025, characterized by three paradigm shifts: earlier therapeutic intervention, expanded management dimensions, and continuous technological innovation. The European Heart Rhythm Association, in collaboration with multiple societies, released the first international consensus statement on epicardial ventricular arrhythmia ablation, establishing standardized protocols encompassing anatomical considerations, substrate identification, access techniques, and complication prevention. The European Heart Rhythm Association, in collaboration with the Heart Rhythm Society, has released the first-ever consensus document on patient selection, target definition, and data transfer for stereotactic radiotherapy in ventricular tachycardia. This document represents the first comprehensive technical summary of stereotactic radiotherapy for the treatment of ventricular tachycardia in the field. Three landmark clinical trials have reshaped clinical practice, VANISH2 demonstrated that catheter ablation as first-line therapy was superior to antiarrhythmic drugs in reducing composite endpoints in ischemic cardiomyopathy patients with ventricular tachycardia. POTCAST pioneered a metabolic intervention approach by showing that actively maintaining serum potassium in the high-normal range (4.5-5.0 mmol/L) significantly reduced ventricular tachycardia events and hospitalizations in implantable cardioverter defibrillator recipients. VCAS validated the feasibility of high-voltage pulsed field ablation for structural ventricular tachycardia, achieving transmural lesions via endocardial-only approach in humans and dramatically reducing arrhythmia burden. Collectively, these advances, spanning from treatment strategies and clinical concepts, to ablation technologies, are shaping a more comprehensive and proactive paradigm for ventricular arrhythmia management, offering evidence-based guidance for clinical decision-making.

Atrial fibrillation (AF) is one of the more prevalent arrhythmias in clinical practice. Its initiation and maintenance are closely associated with the dysregulation of the cardiac autonomic nervous system. The imbalance between sympathetic and parasympathetic regulation, combined with the abnormal firing of ganglionated plexi (GP) promotes atrial electrical and structural remodeling. These pathological processes exacerbate atrial ectopic triggering and reentrant activities, shorten the atrial effective refractory period, and increase myocardial spatial heterogeneity, thereby serving as critical mechanisms underlying the genesis and perpetuation of AF. Consequently, cardiac autonomic modulation techniques, which aim to suppress sympathetic activity and enhance parasympathetic tone, have emerged as promising therapeutic strategies. These interventions primarily include GP ablation, epicardial botulinum toxin injection, low-level vagus nerve stimulation, renal denervation, and stellate ganglion ablation. This article reviews the roles and strategies of cardiac autonomic modulation in the management of AF.

Atrial fibrillation (AF) is one of the most common clinical arrhythmias and is closely associated with adverse events such as reduced quality of life, stroke, heart failure, cognitive impairment, and death. It is a significant contributor to cardiovascular-related mortality and disability. Although AF is more prevalent in older adults with underlying medical conditions, recent lifestyle changes have led to a trend of increasing incidence among younger individuals. Simultaneously, the widespread adoption of smart wearable devices and the growing public awareness of health have facilitated early detection among younger patients. However, research focusing on this specific group remains relatively limited, posing numerous challenges in clinical practice. This article summarizes domestic and international studies on the epidemiology, risk factors, and treatment of young AF patients, highlighting the advantages of early rhythm control (particularly catheter ablation) in this group, in order to provide insights and reference for improving the management and prognosis of this population.

To investigate the relationship between serum albumin (ALB) levels on the first day of intensive care unit (ICU) admission and in-hospital mortality risk in patients with sepsis complicated by chronic heart failure (CHF), and to evaluate for a potential non-linear association.

This was a retrospective cohort study using data from the medical information mart for intensive care Ⅳ (MIMIC-Ⅳ) database. The patients with sepsis and CHF who met the study criteria were included. Demographic data, such as age and gender, as well as disease severity scores (simplified acute physiology score Ⅱ, sequential organ failure assessment), vital signs (e.g., body temperature, heart rate), laboratory indicators (e.g., serum albumin, white blood cell count), and comorbidities (e.g., hypertension, diabetes) were collected. Multivariable Logistic regression analysis was used to assess the independent association between ALB and in-hospital mortality. Generalized additive models and two-piecewise regression models were employed to analyze the non-linear relationship between ALB and in-hospital mortality risk and to identify the inflection point.

A total of 1 093 patients with sepsis complicated by CHF were included. The mean age was (74.2±12.5) years, and 57.5% (628/1 093) were male. The in-hospital mortality rate was 25.3% (276/1 093). After adjusting for confounding factors using multivariable Logistic regression, for every 1 g/L increase in ALB, the in-hospital mortality risk decreased by 5% (OR = 0.95, 95%CI 0.92-0.98, P = 0.002). Smooth curve fitting and two-piecewise regression analysis further revealed a significant non-linear relationship between ALB and in-hospital mortality risk, with an inflection point at 28 g/L. Specifically, when ALB levels were below 28 g/L, every 1 g/L increase in ALB was associated with a 12% reduction in mortality risk (OR = 0.88, 95%CI 0.83-0.95, P < 0.001). However, when ALB levels were above 28 g/L, ALB had no statistically significant impact on mortality risk (OR = 1.01, 95%CI 0.95-1.07, P = 0.826).

Low ALB levels on the first day of ICU admission in patients with sepsis complicated by CHF are independently associated with an increased risk of in-hospital mortality, and there is a non-linear relationship between them. When ALB levels are below 28 g/L, higher ALB levels have a significant protective effect on reducing in-hospital mortality.

Abnormal neuroregulation of coronary microcirculation is one of the important mechanisms leading to myocardial ischemia symptoms, but coronary angiography shows no obstructive lesions. Studies have shown that sympathetic and parasympathetic nerves dynamically regulate microvascular tension through α/β adrenergic receptors, cholinergic receptors and various neurotransmitters (such as neuropeptide Y and calcitonin gene-related peptide). And their dysfunction is closely related to non-obstructive coronary artery ischemia. Based on the anatomical and functional characteristics of coronary microcirculation innervation, this paper systematically summarizes its regulation mechanism, which provides theoretical basis for clinical diagnosis and optimization of treatment strategy.

Heat stroke represents the most severe manifestation of heat-related illnesses, characterized by a core body temperature exceeding 40 ℃, accompanied by central nervous system dysfunction and multiple organ dysfunction syndrome. This condition is highly fatal, and results from exposure to high-temperature environments or strenuous physical activity, which leads to excessive heat production and an imbalance between heat generation and dissipation, culminating in multi-system damage. As global temperatures continue to rise, the incidence of heat stroke is anticipated to increase, with a concomitant rise in mortality rates. The cardiovascular system plays a pivotal role in thermoregulation, and the primary pathological features of myocardial tissue injury in heat stroke include systemic inflammatory responses, endothelial cell damage, ferroptosis, myocardial metabolic disorders, and dysregulation of heat shock proteins. This article provides a comprehensive review of the pathophysiological effects of heat stroke on the cardiovascular system, with the aim of informing future research on the mechanisms underlying cardiac damage induced by heat stroke.

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a high-risk inherited cardiac channelopathy. In recent years,CPVT complicated by atrial arrhythmias has become a research hotspot. However, CPVT presenting with atrial tachycardia (AT) as the initial manifestation is rarely reported. This article reports a case of a pediatric patient in whom premature ventricular complexes (PVC) and ventricular tachycardia (VT) were only detected more than two years after recurrent syncope, and these ventricular arrhythmias were detected in almost all subsequent re-examinations. Prior to that, only AT was detected on monitoring, without any PVC or VT. A definitive diagnosis of CPVT with AT as the initial manifestation in a child was established. The combination therapy of beta-blockers and propafenone to CPVT was administered. During follow-up, this regimen effectively suppressed PVC, VT and AT simultaneously, and no further syncopal episodes occurred.

One case of a 62-year-old female patient with right ventricular malformation complicated by sick sinus syndrome was reported. Due to the high risk of pacemaker infection associated with long-term glucocorticoid use, an active-fixation leadless pacemaker was implanted via the internal jugular vein approach under general anesthesia with transesophageal echocardiography guidance. The procedure was successfully completed. Postoperatively, the patient's recurrent palpitations and dizziness resolved completely. Electrocardiography revealed a pacing rate of 60 bpm with normal pacing and sensing functions. This case indicates that implantation of an active-fixation leadless pacemaker via the internal jugular vein approach is safe and feasible for patients with right ventricular malformation, complicated by sick sinus syndrome. Preoperative multimodal imaging assessment and meticulous intraoperative manipulation are the key factors for successful outcomes.