Circulation. Arrhythmia and electrophysiology最新文献

{"title":"Multichannel Dysfunction Associated With a Dominant-Negative <i>KCNH2</i> Missense Variant, p.G604S, Results in Action Potential Duration Prolongation and Early Afterdepolarizations in a Patient-Specific, Reengineered Cardiomyocyte Model of Type 2 Long-QT Syndrome.","authors":"Trung Huynh, Dan Ye, Wei Zhou, David J Tester, Ramin Garmany, John R Giudicessi, Michael J Ackerman","doi":"10.1161/CIRCEP.126.014919","DOIUrl":"https://doi.org/10.1161/CIRCEP.126.014919","url":null,"abstract":"<p><strong>Background: </strong>Type 2 long-QT syndrome results from <i>KCNH2</i>-encoded Kv11.1 loss-of-function, but whether secondary inward-current dysfunction amplifies dysfunction remains unclear.</p><p><strong>Methods: </strong>We characterized sodium (<i>SCN5A</i>, I_Na) and L-type calcium channel (<i>CACNA1C</i>, I_Ca) function in KCNH2-G604S and variant-corrected isogenic control induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs). Whole-cell patch-clamp measured action potential duration at 90% repolarization (APD90), and potassium (I_Kr), sodium (I_Na), and calcium (I_{Ca, L}) currents. Fluo-4 imaging quantified calcium transients. A modified Kernik-Clancy iPSC-CM model incorporated experimentally measured persistent I_Na,L and I_Ca,L fractions and simulated isolated and combined current defects.</p><p><strong>Results: </strong>KCNH2-G604S caused severe I_Kr loss-of-function (72.5% reduction). APD90 was prolonged in G604S-iPSC-CMs (765±58 ms) compared with isogenic controls (368±37 ms; <i>P</i><0.005), with early afterdepolarizations in 50% of G604S cells. Nifedipine, verapamil, and mexiletine successfully shortened APD90 and abolished early afterdepolarizations. Compared with isogenic control, I_Na,L (0.60±0.1% versus 0.26±0.06%; <i>P</i><0.01), persistent I_Ca,L (2.88±0.55% versus 1.26±0.35%; <i>P</i><0.05), and calcium transient decay times (<i>P</i><0.0001) were greater in G604S iPSC-CMs. Increased persistent I_Ca,L was phenocopied by E-4031 in isogenic controls and reduced by nifedipine in G604S iPSC-CMs. In silico modeling revealed that the I_Kr defect alone prolonged APD90 to only 620 ms. The addition of the observed I_Na,L defect had a small additive effect (+20 ms); however, incorporating persistent I_Ca,L synergistically extended APD90 to 758 ms, replicating the experimental phenotype. Flux dynamics analysis indicated that this persistent Ca²⁺ entry suppresses the forward-mode sodium-calcium exchanger, forcing a compensatory reliance on sarcoplasmic-endoplasmic reticulum Ca-ATPase that primes for calcium instability.</p><p><strong>Conclusions: </strong>The KCNH2-G604S variant drives a severe multihit phenotype via primary I_Kr loss-of-function and secondary state-dependent gain-of-function in persistent I_Ca,L. These comprehensive validations demonstrate that the remodeled persistent I_Ca,L acts as the essential amplifier driving extreme action potential duration prolongation and Ca²⁺ mishandling.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014919"},"PeriodicalIF":9.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value of Left Ventricular Low Voltage Area and Ejection Fraction in Predicting End-Stage Heart Failure Outcomes After Ventricular Tachycardia Ablation in Patients With Non-Ischemic Cardiomyopathy.","authors":"Arian Afzalian, Alireza Oraii, Corentin Chaumont, Oriol Rodriguez-Queralto, Yuichiro Sagawa, Carli J Peters, Erica Zado, Balaram Krishna J Hanumanthu, Poojita Shivamurthy, Timothy M Markman, Matthew C Hyman, Cory M Tschabrunn, Gustavo Guandalini, Andres Enriquez, Fermin C Garcia, Michael P Riley, David Lin, Robert D Schaller, Saman Nazarian, David J Callans, Gregory E Supple, Ramanan Kumareswaran, Sanjay Dixit, David S Frankel, Francis E Marchlinski","doi":"10.1161/CIRCEP.126.014886","DOIUrl":"https://doi.org/10.1161/CIRCEP.126.014886","url":null,"abstract":"<p><strong>Background: </strong>Patients with nonischemic cardiomyopathy (NICM) and ventricular tachycardia are at increased risk for adverse HF outcomes, and abnormal left ventricular (LV) substrate identified by endocardial unipolar and bipolar low-voltage areas (LVAs) may aid in risk stratification. This study assessed the association of LV unipolar and bipolar LVAs with end-stage HF outcomes in patients with NICM undergoing ventricular tachycardia ablation.</p><p><strong>Methods: </strong>Patients with NICM and LV ejection fraction (EF) <50% undergoing ventricular tachycardia ablation from 2019 to 2023 were included. Endocardial voltage mapping defined confluent (>2 cm²) unipolar LVAs as <8.27 mV and bipolar LVAs as <1.5 mV during sinus or paced rhythm. End-stage HF outcomes included HF death, LV assist device implantation, or heart transplant. Multivariable Cox proportional hazards regression analysis assessed associations between unipolar/bipolar LVAs and end-stage HF outcomes.</p><p><strong>Results: </strong>One hundred eleven patients with NICM (mean age, 64.6±9.8 years; 81.1% male; mean LVEF, 33.8±11.7%) were included. During a median follow-up of 28.1 months (interquartile range, 18-46), 28 (25.2%) patients experienced end-stage HF outcomes. Unipolar LVA (hazard ratio, 1.03 per 1% increase [95% CI, 1.01-1.05]; <i>P</i>=0.002) and LVEF (hazard ratio, 1.04 per 1% decrease [95% CI, 1.00-1.09]; <i>P</i>=0.03) were independently associated with higher end-stage HF risk, while bipolar LVA was not (hazard ratio, 0.98, 1% increase [95% CI, 0.96-1.01]; <i>P</i>=0.25). A 3-point risk score based on the Youden index, unipolar LVA ≥70% (2 points), 35% to 70% (1 point), and LVEF ≤25% (1 point), had 82.1% sensitivity and 77.1% specificity for predicting end-stage HF in scores ≥2.</p><p><strong>Conclusions: </strong>In patients with NICM undergoing ventricular tachycardia ablation, unipolar LVA and LVEF are independent predictors of end-stage HF outcomes. Integrating these predictors yields a prognostic score to identify patients at the highest risk of end-stage HF outcomes.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014886"},"PeriodicalIF":9.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrophysiologist-Led Deep Sedation for Pulsed Field Ablation of Atrial Fibrillation Using a Bipolar Contact Force Focal Catheter: The DEEP-PFA Randomized Controlled Trial.","authors":"Fadong Li, Le Zhou, Yize Zhao, Shaobin Wei, Han Feng, Mengge Zhou, Jue Wang, Xiangyi Kong, Yufang Lv, Xueyuan Guo, Liu He, Shijun Xia, Chao Jiang, Xin Li, Junmeng Zhang, Xiaoxia Liu, Ning Zhou, Songnan Li, Chenxi Jiang, Ribo Tang, Song Zuo, Caihua Sang, Deyong Long, Paul C Zei, Jianzeng Dong, Changsheng Ma","doi":"10.1161/CIRCEP.126.015420","DOIUrl":"https://doi.org/10.1161/CIRCEP.126.015420","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e015420"},"PeriodicalIF":9.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serial Artificial Intelligence ECG-Derived Atrial Fibrillation Probability and Recurrence Risk After Pulsed Field Ablation.","authors":"Mayank Sardana, Juan F Rodriguez-Riascos, Hema S Vemulapalli, James Kim, Zachi I Attia, Julia Wood, Kathryn Mangold, Paul A Friedman, Peter A Noseworthy, Komandoor Srivathsan","doi":"10.1161/CIRCEP.126.015183","DOIUrl":"https://doi.org/10.1161/CIRCEP.126.015183","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation is now widely used for atrial fibrillation (AF) ablation, but atrial tachyarrhythmia recurrence remains common and postablation risk tools are limited. We assessed whether a validated sinus‑rhythm artificial intelligence- enabled ECG AF probability score, and its early postablation change, predicts recurrence after pulsed field ablation.</p><p><strong>Methods: </strong>We studied consecutive patients undergoing index pulsed field ablation across 3 Mayo Clinic sites (February 2024-March 2025) with ≥1 sinus‑rhythm ECG within 180 days preprocedure. Baseline artificial intelligence-enabled ECG AF score (range 0-1) was the mean across baseline ECGs. Recovery indices (RI30/60/90), defined as mean postprocedure artificial intelligence-enabled ECG score within days 1-30/60/90 minus baseline, predicted post‑blanking recurrence using corresponding 30‑, 60‑, and 90‑day blanking windows. The primary outcome was time to first documented AF/atrial flutter/atrial tachycardia episode >30 seconds, ascertained via clinic ECGs, ambulatory monitoring, and device interrogations. Cox regression adjusted for prespecified clinical and echocardiographic covariates assessed associations; Harrell C‑statistic quantified discrimination.</p><p><strong>Results: </strong>Among 1052 patients (67±10 years; 33% women), median baseline score was 0.35; 320 (30%) recurred over 188 days. Higher baseline score independently predicted recurrence (hazard ratio per 0.1 increase, 1.08 [95% CI, 1.03-1.14]). Scores rose on day 0 after ablation, then declined over subsequent weeks, with persistently higher, less‑improving trajectories among patients who recurred (time×recurrence interaction <i>P</i><0.001). Day 0 score was not independently associated with recurrence after adjustment. Attenuated early recovery (higher recovery index) was independently associated with recurrence, most robustly for RI-90 (hazard ratio per 0.1 increase, 1.15 [95% CI, 1.07-1.24]), and improved discrimination beyond baseline and covariates (C‑statistic, 0.63-0.67; ΔC=0.04). Findings were consistent in a historical thermal ablation cohort.</p><p><strong>Conclusions: </strong>Baseline and early postablation dynamics of a sinus‑rhythm artificial intelligence-enabled ECG AF probability score are associated with pulsed field ablation recurrence and may aid multivariable risk stratification; prospective validation is warranted.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e015183"},"PeriodicalIF":9.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NIMA-Related Kinase-7 Activates Atrial Cardiomyocyte NLRP3 Inflammasome and Associates With Occurrence of Postoperative Atrial Fibrillation.","authors":"Issam H Abu-Taha, Theresa Poppenborg, Florian Bruns, Marcel A Tekook, Friederike Lunemann, Lisa Oehlke, Pascal Martsch, Markus Kamler, Payam Akhyari, Anke C Fender, Samuel C Dudley, Na Li, Dobromir Dobrev","doi":"10.1161/CIRCEP.126.015003","DOIUrl":"10.1161/CIRCEP.126.015003","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e015003"},"PeriodicalIF":9.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Lifestyle and Risk Factor Modification Clinics in Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Yan Zhao, Francis J Ha, Adam J Brown, Nitesh Nerlekar","doi":"10.1161/CIRCEP.126.015055","DOIUrl":"https://doi.org/10.1161/CIRCEP.126.015055","url":null,"abstract":"<p><strong>Background: </strong>Incidence and recurrence of atrial fibrillation (AF) are associated with several lifestyle risk factors. Lifestyle and risk factor modification (LRFM) clinics could have a role in comprehensively addressing AF from a holistic, patient-centered approach to improve clinical outcomes.</p><p><strong>Methods: </strong>We performed a systematic review and meta-analysis of randomized controlled trials evaluating the role of LRFM clinics compared with usual care in patients with AF. The primary end point was atrial arrhythmia recurrence. Secondary end points were AF and heart failure-related hospitalization, cardiovascular death, stroke or transient ischemic attack, and quality-of-life.</p><p><strong>Results: </strong>Eleven randomized controlled trials with a total of 3364 patients were included (5 randomized controlled trials performed in the context of AF ablation). Mean age was 58 to 73 years, 30% were female, and 18% had persistent AF. Duration of follow-up ranged from 3 to 24 months. LRFM clinics significantly reduced the primary end point of arrhythmia recurrence compared with usual care after catheter ablation (odds ratio, 0.34 [95% CI, 0.23-0.51]; <i>P</i><0.001, I²=0%). LRFM clinics also reduced AF-related hospitalization (odds ratio, 0.70 [95% CI, 0.51-0.98]; <i>P</i>=0.04, I²=21%) and improved quality-of-life (mean improvement on Short Form 36 Questionnaire, 8.90 [95% CI, 6.91-10.90]; <i>P</i><0.001). There was no detected difference between LRFM clinics and usual care for heart failure-related hospitalization (<i>P</i>=0.16), cardiovascular deaths (<i>P</i>=0.79), or stroke/transient ischemic attack (<i>P</i>=0.83).</p><p><strong>Conclusions: </strong>In this meta-analysis of randomized controlled trials, LRFM clinics reduced AF recurrence after ablation, reduced AF-related hospitalization, and improved quality of life. This study supports a comprehensive multidisciplinary lifestyle risk modification model of care to improve clinical outcomes in patients with AF.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e015055"},"PeriodicalIF":9.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reclassifying Single Lead Sinus Rhythm ECGs for Improved AF Recurrence Detection With Deep Learning.","authors":"Yingshuo Liu, Chanho Lim, Ghassan Bidaoui, Christian Massad, Yunsung Chung, Hadi Younes, Mayana Bsoul, Yishi Jia, Abboud Hassan, Cong Zhao, Amitabh Pandey, Omar Kreidieh, Han Feng, Nassir Marrouche","doi":"10.1161/CIRCEP.125.014659","DOIUrl":"https://doi.org/10.1161/CIRCEP.125.014659","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) remains a common outcome after catheter ablation, with recurrence observed in up to 50% of patients within 5 years. Despite extensive research, challenges remain in optimizing observation and prediction windows for AF recurrence assessment. Therefore, we developed and validated a novel deep learning model that reclassifies sinus rhythm based on past and future AF events using single-lead ECG strips from handheld devices.</p><p><strong>Methods: </strong>Of the 558 participants, 308 with no documented recurrence during study follow-up contributed Benign Sinus strips, while 250 with documented recurrence contributed sinus rhythm strips recorded within ±3 days of an AF event, defined as Severe Sinus strips. Both clinical feature-based models and a deep learning model were used to classify these ECGs according to their proximity to AF recurrence events. Performance was evaluated using area under the receiver operating characteristic curve, accuracy, sensitivity, specificity, and F1-score.</p><p><strong>Results: </strong>The strip-level pretrained deep learning model achieved an area under the receiver operating characteristic curve of 0.86, with sensitivity of 0.79, and specificity of 0.76. The complementary participant-level clinical feature-based Random Forest benchmark achieved an area under the receiver operating characteristic curve of 0.71, sensitivity of 0.58, and specificity of 0.69. Feature-based analyses identified associations involving heart-rate variability, mean R-R interval, female sex, left atrial volume, and mean P-wave duration.</p><p><strong>Conclusions: </strong>Our dynamic deep learning model reclassifies 30-second single-lead sinus rhythm ECGs based on AF events within ±3 days, transforming a brief ECG snapshot into a summarized indicator of short-term AF risk.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014659"},"PeriodicalIF":9.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardized Spark-Pattern Cut-Mode Electrosurgical Bailout Workflow for Difficult Left Bundle Branch Area Pacing Lead Advancement: Procedural and Follow-Up Outcomes From a 15-Patient Case Series.","authors":"Binbin Luo, Longfu Jiang, Xianfeng Du, Hengdong Li, Di Lu, Ding Yuan, Lu Zhang, Nan Zheng, Zixuan Hu","doi":"10.1161/CIRCEP.126.015435","DOIUrl":"https://doi.org/10.1161/CIRCEP.126.015435","url":null,"abstract":"<p><strong>Background: </strong>Electrosurgical facilitation can aid difficult left bundle branch area pacing lead advancement, but standardized delivery patterns, reassessment logic, and follow-up lead performance remain insufficiently defined.</p><p><strong>Methods: </strong>We retrospectively analyzed 15 consecutive patients undergoing standardized spark-pattern cut-mode electrosurgical bailout after conventional mechanical left bundle branch area pacing lead advancement failed. The generator was operated in unipolar cut-mode at 20 W; spark-pattern delivery denoted brief sliding contact to the exposed cathode segment followed by immediate mechanical readvancement and ECG/electrogram reassessment. A prestandardization sustain-mode polymorphic ventricular tachycardia/ventricular fibrillation event outside the 15-patient cohort informed the safety workflow.</p><p><strong>Results: </strong>Conventional advancement failed in all included patients. Across 50 target-site advancement attempts, spark-pattern cut-mode assistance was activated at 15 final target sites, requiring 1.5±0.6 cycles per patient. Procedural success of left bundle branch area pacing lead deployment was achieved in 15/15. V1 terminal rightward progression occurred in 14/15, jump in 14/15, and split/discrete components in 12/15. Spark-associated premature ventricular complexes occurred in 15/15 but were isolated and self-limited; no nonsustained ventricular tachycardia, sustained ventricular tachycardia, polymorphic ventricular tachycardia/ventricular fibrillation, defibrillation, or hemodynamic instability occurred during the standardized workflow. Mean follow-up was 400±170 days; no clinically documented lead malfunction, dislodgement, microdislodgement, loss requiring revision, septal perforation, ventricular septal defect, pericardial effusion, or reintervention occurred.</p><p><strong>Conclusions: </strong>A standardized spark-pattern cut-mode bailout workflow provides a reproducible framework for difficult left bundle branch area pacing lead deployment. Progression markers should be distinguished from procedural success, and follow-up surveillance remains essential. Larger studies with longer follow-up and dedicated lead-integrity testing are required before general adoption.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e015435"},"PeriodicalIF":9.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventricular Arrhythmias in Marfan Syndrome: Prevalence and Clinical Correlates in a Multicenter Cohort.","authors":"Luke Dreher, Hussein Abdul Nabi, Christopher Kanaan, Chadi Ayoub, Dan Sorajja, Fadi E Shamoun, Hicham El Masry","doi":"10.1161/CIRCEP.126.014967","DOIUrl":"https://doi.org/10.1161/CIRCEP.126.014967","url":null,"abstract":"<p><strong>Background: </strong>Ventricular arrhythmias are increasingly recognized in Marfan syndrome, but associated clinical and structural features remain incompletely defined.</p><p><strong>Methods: </strong>We performed a retrospective multicenter cohort study of 783 adults with confirmed Marfan syndrome at 3 Mayo Clinic sites. Clinical, arrhythmic, echocardiographic, cardiac magnetic resonance, surgical, and implantable cardioverter defibrillator data were obtained by manual chart review. Associations with sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) were evaluated using univariable logistic regression, a primary multivariable model in the full cohort, and a prespecified exploratory cardiac magnetic resonance sensitivity model.</p><p><strong>Results: </strong>Sustained VT/VF occurred in 74 patients (9.5%) over 12.7±7.6 years. On univariable analysis, sustained VT/VF clustered with an adverse structural-electrical phenotype including atrial arrhythmias, ventricular remodeling, mitral valve disease, cardiac surgery history, and late gadolinium enhancement. In the primary multivariable model, nonsustained VT (odds ratio, 12.11 [95% CI, 6.43-22.79]; <i>P</i><0.001), lower left ventricular ejection fraction (odds ratio, 0.95 per 1% increase [95% CI, 0.93-0.97]; <i>P</i><0.001), history of at least 1 cardiac surgery (odds ratio, 3.59 [95% CI, 1.65-7.84]; <i>P</i>=0.001), and moderate-severe mitral regurgitation (odds ratio, 2.00 [95% CI, 1.07-3.75]; <i>P</i>=0.030) were independently associated with sustained VT/VF. In the cardiac magnetic resonance sensitivity model, nonsustained VT, lower left ventricular ejection fraction, and late gadolinium enhancement remained associated with sustained VT/VF.</p><p><strong>Conclusions: </strong>In adults with Marfan syndrome, sustained VT/VF occurs in nearly 1 in 10 patients and is associated with a broader structural-electrical phenotype. Late gadolinium enhancement provided additional risk signal among patients undergoing cardiac magnetic resonance.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014967"},"PeriodicalIF":9.3,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial Fibrillation Ablation Effectiveness End Points, Safety End Points, and Trial Design: Academic Research Consortium Initiative Endorsed by the Heart Rhythm Society.","authors":"Paul J Wang, Edward P Gerstenfeld, Jonathan P Piccini, Atul Verma, T Jared Bunch, Carina Blomstrom-Lundqvist, Stylianos Tzeis, Jason G Andrade, A John Camm, Lin Yee Chen, Rod Passman, Matthew R Reynolds, Hugh Calkins, Andrea M Russo, Pierre Jais, Mina Chung, Boris Schmidt, Marco Perez, Elaine Y Wan, Kevin L Thomas, Eileen Mihas, Mellanie True Hills, J Peter Weiss","doi":"10.1161/CIRCEP.126.015082","DOIUrl":"https://doi.org/10.1161/CIRCEP.126.015082","url":null,"abstract":"<p><p>The aim of the AFA-ARC (Atrial Fibrillation Ablation Academic Research Consortium) initiative is to reexamine trial design and the safety and effectiveness end points for pivotal clinical trials evaluating catheter ablation for the treatment of symptomatic atrial fibrillation to provide meaningful and interpretable data to support regulatory decision-making. Beginning in July 2024, a group of international experts began meeting regularly both virtually together and separately in working groups (group 1 effectiveness end points; group 2 safety end points; and group 3 trial design and report forms), with one in-person meeting held in April 2025, and revisions of draft proposals from January 2025 to February 2026. The Food and Drug Administration Office of Cardiovascular Devices at the Center for Devices and Radiological Health provided input throughout the revision and proposal process. A patient advocate participated in the in-person meeting and during the revision phase. Heart Rhythm Society leadership was involved throughout the process and in the revision phase. Industry representatives were sent drafts of the proposed manuscripts during the revision phase before submission. The result of this process was the creation of a combined document to reexamine trial design and the safety and effectiveness end points for pivotal clinical trials evaluating catheter ablation of atrial fibrillation. This document represents contributions from each of the 3 Working Groups. The Heart Rhythm Society endorsed this document. This AFA-ARC document proposes revised effectiveness and safety end points, study design, and report forms for studies evaluating AF ablation in patients with symptomatic paroxysmal, persistent, or longstanding persistent AF.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e015082"},"PeriodicalIF":9.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}