Circulation. Arrhythmia and electrophysiology最新文献

{"title":"Left Atrial Thrombus Occurring in Sinus Rhythm: Role of Variants of the Atrial Septum.","authors":"Ratnasari Padang, Lawrence J Sinak, Subramaniam C Krishnan","doi":"10.1161/CIRCEP.125.014050","DOIUrl":"https://doi.org/10.1161/CIRCEP.125.014050","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":"18 10","pages":"e014050"},"PeriodicalIF":9.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343965","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":"Vagal Influence on Atrial Electrograms: Differentiating Functional and Structural Fragmentation in Ganglionated Plexi Regions.","authors":"Andrea Giomi, Andrea Bernardini, Alessandro Paoletti Perini, Margherita Padeletti, Cristiano Salvatore Zaccaria, Davide Ciliberti, Federica Michelotti, Umberto Signorini, Massimo Milli","doi":"10.1161/CIRCEP.125.014122","DOIUrl":"10.1161/CIRCEP.125.014122","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014122"},"PeriodicalIF":9.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136684","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":"Prediction of Atrial Fibrillation From the ECG in the Community Using Deep Learning: A Multinational Study.","authors":"Luisa C C Brant, Antônio H Ribeiro, Oseiwe B Eromosele, Marcelo M Pinto-Filho, Sandhi M Barreto, Bruce B Duncan, Martin G Larson, Emelia J Benjamin, Antonio L P Ribeiro, Honghuang Lin","doi":"10.1161/CIRCEP.125.013734","DOIUrl":"10.1161/CIRCEP.125.013734","url":null,"abstract":"<p><strong>Background: </strong>We aimed to refine and validate a deep neural network model from the ECG to predict atrial fibrillation (AF) risk, using samples from diverse backgrounds: the Framingham Heart Study (FHS), UK Biobank, and Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil). We compared the model's performance to the clinical Cohorts for Heart and Aging Research in Genomic Epidemiology consortium (CHARGE-AF) risk score and evaluated the association with other cardiovascular outcomes.</p><p><strong>Methods: </strong>The ECG-derived deep-learning prediction of AF (ECG-AF) model was refined using 60% of FHS samples free of AF. Its performance was then tested in the remaining FHS samples, UK Biobank, and ELSA-Brasil, with discrimination assessed by the area under the receiver operating characteristic curve. The association of ECG-AF with cardiovascular outcomes was assessed using Cox proportional hazards models.</p><p><strong>Results: </strong>The study sample included 10 097 FHS participants (mean age 53±12 years; 54.9% women), 49 280 participants from the UK Biobank (mean age 64±8 years, 47.9% women), and 12 284 participants from ELSA-Brasil (mean age 53±8 years, 54.7% women). The ECG-AF model showed moderate discrimination for incident AF (area under the curve, 0.82 [95% CI, 0.80-0.84]) in the FHS, comparable to the CHARGE-AF score (area under the curve, 0.83 [95% CI, 0.81-0.85]), and incremental when combined (area under the curve, 0.85 [95% CI, 0.83-0.87]). In UK Biobank and ELSA-Brasil, combining ECG-AF and CHARGE also improved prediction. Higher ECG-AF scores were associated with increased risks of heart failure, myocardial infarction, stroke, and all-cause mortality in all 3 cohorts.</p><p><strong>Conclusions: </strong>In multinational cohort studies, the single-input ECG-AF deep neural network model demonstrated good performance in predicting AF and other cardiovascular outcomes, comparable to a multivariable clinical risk score, with improved performance when combined.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013734"},"PeriodicalIF":9.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12569998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191315","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":"Prevalence and Clinical Impact of Postural Orthostatic Tachycardia Syndrome in Highly Symptomatic Long COVID.","authors":"Mikael Björnson, Klara Wijnbladh, Anna Törnberg, Anna Svensson-Raskh, Annie Svensson, Marcus Ståhlberg, Michael Runold, Artur Fedorowski, Malin Nygren-Bonnier, Judith Bruchfeld","doi":"10.1161/CIRCEP.124.013629","DOIUrl":"10.1161/CIRCEP.124.013629","url":null,"abstract":"<p><strong>Background: </strong>The incidence of postural orthostatic tachycardia syndrome (POTS) in long COVID has been a growing concern since the first cases were reported in 2021. The aim of this study was to assess the prevalence and clinical impact of POTS in a series of well-characterized patients with long COVID.</p><p><strong>Methods: </strong>We prospectively analyzed 467 nonhospitalized, highly symptomatic (sick leave ≥50%) patients with long COVID, and studied differences in demographics and clinical assessment outcomes between those diagnosed with POTS and the remaining long COVID patients. Examinations were performed at a median of 12 months after acute COVID-19, followed by a cardiologist evaluation with 48-hour ECG, head-up tilt test, and Active Stand Test for those with clinically suspected POTS.</p><p><strong>Results: </strong>Of all long COVID patients, 143 (31%) were diagnosed with POTS, 128 (27%) did not fulfill POTS criteria, while 196 (42%) had no clinical signs of POTS. Patients with POTS were younger (mean age, 40.0 versus 44.0 versus 47.0 years, respectively; <i>P</i>≤0.001) and predominantly female (91%). They had significantly lower physical activity compared with the other 2 groups, as measured with the Frändin-Grimby scale (<i>P</i>=0.001). Heart rates during the 6-minute walk test were significantly higher in the POTS group, both during walking and at rest afterward, with a significantly shorter walking distance (448 m versus 472 m versus 509 m, respectively; <i>P</i>≤0.001). However, the distribution of symptoms showed no significant differences between the groups.</p><p><strong>Conclusions: </strong>In this cohort of predominantly younger women with highly symptomatic long COVID, POTS is common and presents with overlapping symptoms between POTS and non-POTS patients. Long COVID POTS confers lower physical activity and capacity compared with non-POTS long COVID and should be systematically assessed in this condition.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013629"},"PeriodicalIF":9.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191367","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":"Mexiletine as Adjunctive Therapy in Atrial Fibrillation Following Dofetilide Treatment Failure.","authors":"Carlos Ceron, Raj Dalsania, Farid Farkouh, Jianzeng Dong, Gan-Xin Yan","doi":"10.1161/CIRCEP.125.014055","DOIUrl":"10.1161/CIRCEP.125.014055","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014055"},"PeriodicalIF":9.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136614","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":"Modified Unipolar Return Pulsed Field Ablation in Ventricular Myocardium.","authors":"Maria Terricabras, Peter Lombergar, Terenz Escartin, Bor Kos, Philippa Krahn, Jennifer Barry, Graham Wright, Tomaž Jarm, Jernej Štublar, Matej Kranjc, Nicolas Coulombe, Lars Mattison, Daniel C Sigg, Damijan Miklavčič, Atul Verma","doi":"10.1161/CIRCEP.125.014006","DOIUrl":"10.1161/CIRCEP.125.014006","url":null,"abstract":"<p><strong>Background: </strong>Various pulsed field ablation (PFA) parameters have been proposed to improve lesion depth. This study evaluated a modified unipolar return PFA system to create deep lesions in healthy and infarcted ventricular myocardia.</p><p><strong>Methods: </strong>Numerical modeling was used to compare a modified unipolar return PFA system configuration with a conventional unipolar return (skin patch). We then performed ablation in 14 swine (5 with chronic myocardial infarction and 9 healthy). PFA lesions were created in the left ventricle using a focal catheter (4-mm tip) with a return electrode positioned in the inferior vena cava (biphasic, microsecond pulses of 1300 and 1500 V, 1-16 trains). Electroanatomical mapping guided ablation and lesion localization on magnetic resonance imaging were performed 48 hours post-ablation in the infarcted group and at 1 day, 7 days, and 6 weeks post-ablation in the healthy group.</p><p><strong>Results: </strong>Numerical modeling demonstrated that the modified unipolar return PFA system produced deeper lesions with reduced variability compared with the skin patch. In healthy pigs (n=35 lesions), depths of 6.8±1.8 mm and widths of 11.5±4.7 mm were achieved with 8 pulse trains. Depths of 8.2±2.8 mm and widths of 14.0±4.7 mm were achieved with 16 trains. The maximum lesion depths were 8.8 and 11.6 mm for 8 and 16 trains, respectively. In the infarcted cohort (n=22 lesions), all lesions applied to scar tissue penetrated through fibrotic regions, with epicardial involvement observed in 57% of lesions.</p><p><strong>Conclusions: </strong>The modified unipolar return PFA system effectively creates large lesions and can achieve transmurality in healthy and infarcted animals. Compared with conventional unipolar, it may offer greater lesion depth, width, and consistency.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014006"},"PeriodicalIF":9.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12529984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198363","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":"Intellectual and Neurodevelopmental Delays in Pediatric Catecholaminergic Polymorphic Ventricular Tachycardia: Distinct Characteristics and a More Malignant Neurocardiac Phenotype.","authors":"Christina Y Miyake, Dania Kallas, Sara B Stephens, Oliver M Moore, Xander H T Wehrens, Peter S Fischbach, Martin J LaPage, Andrew P Landstrom, Ian H Law, Allison C Hill, Prince J Kannankeril, Frank A Fish, Taylor S Howard, Santiago O Valdes, Tam Dan N Pham, Jeffrey J Kim, Santokh S Dhillon, Christopher L Johnsrude, Ulrich Krause, Georgia Sarquella-Brugada, Peter Kubuš, Terezia Tavacova, Sit-Yee Kwok, Susan P Etheridge, Svjetlana Tisma-Dupanovic, Adam C Kean, Andrew D Krahn, Mohammed A Ebrahim, Joseph Atallah, Anne Fournier, Anjan S Batra, Ming-Lon Young, James Perry, Joshua R Kovach, Anna N Kamp, Bradley C Clark, Erick Jimenez, Fatme Charafeddine, Robert M Hamilton, Seshadri Balaji, Shubhayan Sanatani","doi":"10.1161/CIRCEP.124.013437","DOIUrl":"10.1161/CIRCEP.124.013437","url":null,"abstract":"<p><strong>Background: </strong>Marked intellectual and neurodevelopmental delay (INDD) was noted in 6 unrelated patients diagnosed with <i>RYR2</i>-related catecholaminergic polymorphic ventricular tachycardia (CPVT) from a single center. Patients exhibited similar distinct phenotypic features not previously described. We aimed to determine the prevalence of INDD in CPVT, compare clinical characteristics between patients with CPVT with and without INDD, and investigate the possibility of a unique neurocardiac CPVT phenotype.</p><p><strong>Methods: </strong>Retrospective combined review of patients with <i>RYR2</i>-related CPVT diagnosed ≤18 years with and without INDD from a single center and the International Pediatric CPVT Registry. Patients with hypoxic ischemic insult were excluded unless INDD preceded injury.</p><p><strong>Results: </strong>Among a total of 168 patients, INDD was reported in 19 (11.3% [95% CI, 7.0%-17.1%]). When compared with cases without INDD, patients with INDD exhibited distinct features including (1) younger age at onset of symptoms (median 7.0 versus 10.0 years; <i>P</i>=0.04); (2) higher frequency of atrial tachyarrhythmias (84.2% versus 16.3%, <i>P</i><0.001); (3) atrial or ventricular tachycardia without adrenergic stimulation (81.3% versus 2.2%, <i>P</i><0.001, 31.6% versus 4.5%, <i>P</i>=0.001 respectively); (4) cardiac structural changes or systolic dysfunction (36.8% versus 1.3%, <i>P</i><0.001); and (5) higher incidence of cardiac arrest or sudden death after diagnosis (26.3% versus 2.7%, <i>P</i>=0.001). INDD-related <i>RYR2</i> genetic variants clustered within the central and channel domains and may be specific to certain variants.</p><p><strong>Conclusions: </strong>This study demonstrates a wider spectrum of <i>RYR2</i>-related disease, with a subset associated with extracardiac manifestations. Certain <i>RYR2</i> variants may lead to a neurocardiac phenotype with distinct features that are important to recognize, as these patients may be at higher risk.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013437"},"PeriodicalIF":9.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148149","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":"Characteristics of Different Ventricular Electrogram Morphologies in Selective Left Bundle Branch Pacing.","authors":"Dongjuan Wang, Longfu Jiang, Jiabo Shen, Hengdong Li","doi":"10.1161/CIRCEP.125.013879","DOIUrl":"10.1161/CIRCEP.125.013879","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013879"},"PeriodicalIF":9.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12442774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944689","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":"Cryoballoon Roof Line and Pulmonary Vein Isolation for Persistent Atrial Fibrillation: A Randomized Trial.","authors":"Changjin Li, Yao Zhao, Ruihan Ju, Chao Liu, Shaohua Dong, Jingwen Song, Aihong Qin, Jiang Cao, Manli Yu, Xinmiao Huang, Zhifu Guo, Songqun Huang","doi":"10.1161/CIRCEP.125.013826","DOIUrl":"10.1161/CIRCEP.125.013826","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013826"},"PeriodicalIF":9.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12442777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944889","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":"Feasibility and Safety of Pulsed Field Ablation for Coronary Sinus and Left Atrial Appendage Isolation and Mitral Isthmus Ablation: Acute and Chronic Findings.","authors":"Vincenzo Mirco La Fazia, Sanghamitra Mohanty, Carola Gianni, Elio Zito, Nicola Pierucci, Giuseppe Stifano, Preem Geeta Torlapati, Domenico G Della Rocca, Weeranun Dechyapirom Bode, J David Burkhardt, Rodney Horton, Amin Al-Ahmad, Luigi Di Biase, Andrea Natale","doi":"10.1161/CIRCEP.125.014026","DOIUrl":"10.1161/CIRCEP.125.014026","url":null,"abstract":"<p><strong>Background: </strong>The safety and efficacy of pulsed field ablation for pulmonary vein and posterior wall isolation in atrial fibrillation ablation are well established; however, evidence regarding its use in extra-pulmonary vein areas remains limited. The aim of this study was to assess the feasibility and durability of pulsed field ablation for coronary sinus (CS) and left atrial appendage (LAA) isolation and mitral isthmus (MI) ablation.</p><p><strong>Methods: </strong>We analyzed data from consecutive patients who underwent repeat atrial fibrillation ablation with pulsed field ablation between February and October 2024. MI ablation, CS isolation, and LAA isolation were attempted in all patients using the Farapulse (Boston Scientific) ablation system. Acute isolation was assessed after a 20-minute waiting period and an adenosine challenge, while chronic durability was evaluated during a repeat procedure for LAA closure at 3 months.</p><p><strong>Results: </strong>A total of 236 patients (145, 61.4% men) were included in our analysis. Acute CS isolation was achieved in 147 (62.2%) patients for the CS and in all patients for the LAA. Acute MI block was obtained in all patients. After a 20-minute waiting time, the adenosine challenge revealed dormant conduction in 52 (26.4%) cases for the CS, in 4 (1.7%) for the LAA, and MI block regression in 35 (14.8%). All patients underwent remapping at the time of left atrial appendage occlusion, which showed CS and LAA isolation in only 3 (1.3%) and 10 (4.6%) patients, respectively, and MI block in 13 (5.5%) cases.</p><p><strong>Conclusions: </strong>Pulsed field ablation is a feasible and acutely effective method for CS and LAA isolation and MI block; however, lesion durability remains a significant limitation.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014026"},"PeriodicalIF":9.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944947","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}