Circulation. Arrhythmia and electrophysiology最新文献

{"title":"Pace and Ablate or Pace Then Ablate: Defining the Risk of Concomitant AV Node Ablation and Pacemaker Implantation Using a Probability Based Approach.","authors":"Anthony J Preston, Justin Blackman, Andrew D Krahn, Darrel P Francis, Matthew T Bennett, James P Howard, Lyndon J Rebello, Martin van Zyl, Michael J Thibert, Laura Arbour, Markus B Sikkel","doi":"10.1161/CIRCEP.125.014790","DOIUrl":"https://doi.org/10.1161/CIRCEP.125.014790","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014790"},"PeriodicalIF":9.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811915","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":"Screening Smarter: A Quantitative Approach to Reduce Inappropriate Shocks From Subcutaneous ICDs.","authors":"Oliver Monfredi, Pamela K Mason","doi":"10.1161/CIRCEP.126.015114","DOIUrl":"https://doi.org/10.1161/CIRCEP.126.015114","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e015114"},"PeriodicalIF":9.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811935","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":"First-in-Human Clinical Experience with Focal Pulsed Field and Radiofrequency Dual-Modality Ablation for Treatment Refractory Left Ventricular Summit PVCs.","authors":"Shivaraj Patil, Xiaoke Liu, Konstantinos C Siontis, Narut Prasitlumkum, Samuel J Asirvatham, Yong-Mei Cha, Freddy Del-Carpio, Abhishek J Deshmukh, Christopher V DeSimone, Fatima M Ezzeddine, Paul A Friedman, Gurukripa N Kowlgi, Malini Madhavan, Siva K Mulpuru, Thomas Munger, Duy Nguyen, Peter Noseworthy, Nicholas Y Tan, Alan Sugrue, Suraj Kapa, Ammar M Killu","doi":"10.1161/CIRCEP.126.014942","DOIUrl":"https://doi.org/10.1161/CIRCEP.126.014942","url":null,"abstract":"<p><p><b>Background:</b> Radiofrequency (RF) ablation of premature ventricular complexes (PVCs) originating from the left ventricular summit (LVS) may be unsuccessful, highlighting the need for alternative approaches. We aimed to assess the efficacy and safety of a novel dual-modality focal catheter in treating LVS PVCs in patients who failed previous RF ablation. <b>Methods:</b> Patients were prospectively enrolled and underwent a redo-ablation procedure using an irrigated, contact-force sensing, dual-modality focal catheter (TactiFlex™ Duo, Abbott) under compassionate use indication. The ablation strategy, including the choice of energy modality (monopolar pulsed field [PF], RF or both), was left to the operator's discretion. Safety assessments included serial biomarkers, renal function, and cardiac MRI within 36 hours. Efficacy was defined as ≥80% reduction in PVC burden with symptom resolution at 3-month follow-up. <b>Results:</b> Six consecutive patients (4 male, mean age 53.8±15 years) with symptomatic LVS PVCs and a prior failed RF ablation (range 1-2) were prospectively enrolled. All PVCs had an inferior axis, with a left bundle V1 morphology observed in 4 out of 6 cases (mean burden: 30.1±5.3%). Acute suppression of PVCs was achieved in all cases. Acute suppression with a single PF application in the GCV-AIV occurred in 2 patients, while 3 patients required additional RF, PF, or combined RF+PF applications at adjacent sites. One patient with an inaccessible GCV-AIV was successfully treated in the LVOT with RF+PF application. Transient, reversible LAD vasospasm was observed during PF delivery in 2 of 5 cases who underwent PF application adjacent to a coronary artery, despite pre-treatment with intracoronary (IC) nitroglycerin without ECG or hemodynamic sequalae. All patients had durable suppression of PVCs at follow-up. <b>Conclusions:</b> In its first human application, dual-modality ablation was feasible and effective for refractory LV summit PVCs. Transient coronary vasospasm occurred, though it was reversible and without acute clinical consequence.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764197","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":"Maximizing Lesion Depth With the Lattice-Tip Catheter: A Preclinical Comparison of Single, Double, and Mixed Pulsed-Field and Radiofrequency Applications.","authors":"Keita Watanabe, Masaya Shinohara, Fengyuan Yu, Vivek Y Reddy, Jacob S Koruth","doi":"10.1161/CIRCEP.125.014799","DOIUrl":"https://doi.org/10.1161/CIRCEP.125.014799","url":null,"abstract":"<p><strong>Background: </strong>Combining radiofrequency (RF) and pulsed-field (PF) applications in various combinations, or repeating PF applications, has been reported to augment lesion size and depth. We compared lesion dimensions using single, double, and combined applications of PF and RF for the large-footprint lattice-tip catheter.</p><p><strong>Methods: </strong>Sixteen swine underwent endocardial ablation using the lattice-tip catheter. Four-second PF and 5-second, saline-irrigated, temperature-controlled RF energy were delivered in the ventricles using 1 of 5 different settings: single applications of PF (PF¹-only), single RF (RF¹-only), and 3 sequential settings: PF¹-PF² (2 consecutive PF applications at the same location), PF¹-RF¹ (PF followed by RF), and RF¹-PF¹ (RF followed by PF).</p><p><strong>Results: </strong>A total of 102 lesions (69 left and 33 right ventricles) were analyzed. Mean lesion depths were 6.8±0.3 mm (PF¹-PF²), 6.6±0.3 mm (RF¹-PF¹), 5.7±0.2 mm (PF¹-only), 5.0±0.3 mm (PF¹-RF¹), and 5.1±0.2 mm (RF¹-only). Mean lesion depths did not differ significantly between PF¹-PF² and either PF¹-only or RF¹-PF¹ (<i>P</i>=0.114 and <i>P</i>=0.986, respectively). However, the variability in depth was significantly smaller in the PF¹-PF² group compared with both PF¹-only and RF¹-PF¹ (<i>P</i>=0.017 and <i>P</i>=0.013, respectively). Only the PF¹-PF² setting produced significantly deeper lesions compared with the RF¹-only and PF¹-RF¹ settings (<i>P</i>=0.015 and <i>P</i>=0.012, respectively). RF lesions exhibited a prominent dark hemorrhagic core and a thin pale rim; PF lesions appeared uniformly pale; and combination lesions demonstrated a central dark zone surrounded by a pale rim of variable thickness.</p><p><strong>Conclusions: </strong>Repeating PF twice created the optimal combination of greatest depth and least variation compared with all other strategies. RF¹-PF¹ resulted in similar depth, but required toggling between settings and risked thermal adverse events.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014799"},"PeriodicalIF":9.8,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764241","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":"Initial Experience Using a Variable Loop Circular Pulsed Field Ablation Catheter to Treat Atrial Arrhythmias in Complex Congenital Heart Disease Patients.","authors":"Pierre-Olivier Veillette, Zachariah Hale, Elizabeth DeWitt, Douglas Mah, Thomas Tadros, Edward O'Leary","doi":"10.1161/CIRCEP.125.014619","DOIUrl":"https://doi.org/10.1161/CIRCEP.125.014619","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014619"},"PeriodicalIF":9.8,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764176","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":"2026 ACC/AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology (Revision of the 2015 ACC/AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology): A Report of the ACC Competency Management Committee.","authors":"José A Joglar, Julia H Indik, Nadeen N Faza, Sana M Al-Khatib, Sumeet S Chugh, Edmond Cronin, James P Daubert, Jasneet Devgun, Mehak Dhande, David S Frankel, Zachary D Goldberger, Jodie L Hurwitz, Fred M Kusumoto, Dhanunjaya R Lakkireddy, Amgad N Makaryus, Joseph E Marine, Jeremy P Moore, Kristen K Patton, Dawn R Phoubandith, Andrea M Russo, Rachel Schreier, Stacy Westerman","doi":"10.1161/HAE.0000000000000094","DOIUrl":"https://doi.org/10.1161/HAE.0000000000000094","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e000094"},"PeriodicalIF":9.8,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764246","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":"Variability in Tissue Interface Temperature During Pulse Field Atrial Ablation: Implications for Real-Time Contact Assessment.","authors":"John R Power, Keita Watanabe, Masaya Shinohara, Fengyuan Yu, Srinivas Dukkipati, Daniel R Musikantow, William Whang, Joshua Lampert, Abhishek Maan, Maryam Saleem, Ariel Banai, Connor P Oates, Sai Krishna Reddy Seemala, Vivek Y Reddy, Jacob S Koruth","doi":"10.1161/CIRCEP.125.014310","DOIUrl":"https://doi.org/10.1161/CIRCEP.125.014310","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) can generate low-intensity catheter-tissue interface heating. Recently, a large-focal PFA catheter able to measure the tip-tissue interface temperature has become available. Accordingly, we aimed to characterize the electrode tip-tissue interface temperature dynamics during PFA.</p><p><strong>Methods: </strong>A retrospective single-center study evaluated PFA lesions in 41 consecutive patients undergoing atrial fibrillation ablation using the lattice-tip catheter. Lesions were grouped by anatomic location with interface temperatures measured via catheter tip thermocouples. The association of predictors with lesion temperatures was evaluated with a mixed-effects model. An analysis of lesion dimensions and interface temperatures was also performed in swine.</p><p><strong>Results: </strong>Among 41 patients, 2779 pulse field lesions were analyzed. Mean peak temperature was 41.7±2.2 °C (range, 37.2 °C-52.8 °C) and average temperature was 39.5±1.4 °C (range, 36.4 °C-46.9 °C). Temperatures exceeded 50 °C in 10 of 2779 (0.4%) lesions, most often in the anterosuperior left superior pulmonary vein (5/10). Univariate analysis showed peak temperature was positively associated with previous lesion temperature (<i>r</i>=0.65 [95% CI, 0.63-0.67]; <i>P</i><0.001) and had weak associations with time between lesions (<i>r</i>=-0.15 [-0.19 to -0.11]; <i>P</i><0.001) and percentage impedance drop (<i>r</i>=0.20 [95% CI, 0.16-0.23]; <i>P</i><0.001). Even after multivariable analysis, the peak temperature remained significantly lowest at the right carina (39.7 °C), anterosuperior right superior pulmonary vein (40.9 °C), and right superior pulmonary vein roof (40.5 °C) locations. Swine demonstrated a moderately strong association between lesion depth with peak temperature (<i>R</i>=0.53 [95% CI, 0.20-0.75]; <i>P</i>=0.003) and average temperature (<i>R</i>=0.49 [95% CI, 0.16-0.73]; <i>P</i>=0.007).</p><p><strong>Conclusions: </strong>Lattice-tip temperatures during PFA vary substantially, with right superior pulmonary vein sites often demonstrating a blunted temperature response compared with other sites. Peak and average temperatures correlated with lesion depth.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014310"},"PeriodicalIF":9.8,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147722017","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":"Quantitative Vector Screening to Improve Sensing and Reduce Inappropriate Shocks With the Subcutaneous Implantable Cardioverter Defibrillator.","authors":"Thomas A Boyle, David C Callans, Rajat Deo, Sanjay Dixit, Andres Enriquez, Andrew E Epstein, Fermin Garcia, Gustavo Guandalini, Balaram K Hanumanthu, Matthew C Hyman, Ramanan Kumareswaran, David Lin, Francis E Marchlinski, Timothy M Markman, Maiwand Mirwais, Saman Nazarian, Michael Riley, Vincent See, Poojita Shivamurthy, Gregory E Supple, Robert Schaller, David S Frankel","doi":"10.1161/CIRCEP.125.014581","DOIUrl":"https://doi.org/10.1161/CIRCEP.125.014581","url":null,"abstract":"<p><strong>Background: </strong>The subcutaneous Implantable Cardioverter Defibrillator (S-ICD) offers protection from sudden cardiac death without transvenous leads. Although contemporary techniques and programming have reduced inappropriate shocks, high rates persist in certain populations. The objective of this study was to evaluate the impact of a novel quantitative vector screening (QVS) protocol on the incidence of sensing-related complications and inappropriate shocks in patients undergoing S-ICD implantation.</p><p><strong>Methods: </strong>We analyzed 223 consecutive patients who underwent S-ICD implantation at the Hospital of the University of Pennsylvania from December 2018 to July 2025. Traditional vector screening was used before 2023. In 2023, we implemented QVS, which incorporated quantitative sensing scores for each candidate and raised the threshold for S-ICD implantation. The primary end point was time to first inappropriate shock or under-sensed ventricular arrhythmia. Secondary outcomes included SMART Pass deactivation and need for device revision. Outcomes were reported as survival analyses.</p><p><strong>Results: </strong>During preimplant screening, the QVS protocol reduced patient eligibility from 96% to 83%. The median follow-up after implant was 42 months (interquartile range, 48) in the traditional vector screening arm and 18 months (interquartile range, 15) in the QVS arm. The primary end point of time to first inappropriate shock or under-sensed ventricular arrhythmia was longer in the QVS arm (log-rank, <i>P</i>=0.02). There were 23 primary end point events among 145 patients in the traditional vector screening arm (5.2 per 100 patient-years [95% CI, 3.1-7.4]) and 2 primary end point events among 78 patients in the QVS arm (1.8 per 100 patient-years [95% CI, 0.01-4.38]).</p><p><strong>Conclusions: </strong>Implementation of a novel S-ICD screening protocol with stricter eligibility thresholds reduced sensing-related complications, particularly inappropriate shocks.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014581"},"PeriodicalIF":9.8,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147722011","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":"Automated Cardiac Arrest Detection Using Wrist-Worn Photoplethysmography: External Validation in Patients With Induced Shockable Cardiac Arrest (DETECT-1b).","authors":"Roos Edgar, Niels T B Scholte, Kambiz Ebrahimkheil, Catharina E Jansen, Rypko J Beukema, Marc A Brouwer, Sing-Chien Yap, Masih Mafi-Rad, Reinoud E Knops, Eelko Ronner, Aysun Cetinyurek-Yavuz, Kevin Vernooy, Eric Boersma, Peter C Stas, Niels van Royen, Judith L Bonnes","doi":"10.1161/CIRCEP.125.014708","DOIUrl":"https://doi.org/10.1161/CIRCEP.125.014708","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014708"},"PeriodicalIF":9.8,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147671038","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":"Experimental Platform for Screening and Validation of BacNa_v Gene Therapy Candidates.","authors":"Tianyu Wu, Hung X Nguyen, Yiu Yan Siu, Yongwu Li, Nenad Bursac","doi":"10.1161/CIRCEP.125.014425","DOIUrl":"https://doi.org/10.1161/CIRCEP.125.014425","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014425"},"PeriodicalIF":9.8,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13082454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688486","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}