Circulation. Arrhythmia and electrophysiology最新文献

{"title":"Magnetic Resonance Imaging in the Assessment of the Risk of Sudden Death in Cardiac Sarcoidosis: What Is Extensive or Significant Late Gadolinium Enhancement?","authors":"Pauli Pöyhönen, Jukka Lehtonen, Suvi Syväranta, Diana Velikanova, Henriikka Mälkönen, Piia Simonen, Hanna-Kaisa Nordenswan, Valtteri Uusitalo, Tapani Vihinen, Kari Kaikkonen, Petri Haataja, Tuomas Kerola, Tuomas T Rissanen, Ville Vepsäläinen, Aleksi Alatalo, Päivi Pietilä-Effati, Markku Kupari","doi":"10.1161/CIRCEP.124.013239","DOIUrl":"10.1161/CIRCEP.124.013239","url":null,"abstract":"<p><strong>Background: </strong>Cardiac sarcoidosis involves a significant but difficult-to-define risk of sudden cardiac death (SCD). Current guidelines recommend consideration of an implantable cardioverter defibrillator for patients with extensive or significant myocardial late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging. However, extensive/significant LGE is not defined.</p><p><strong>Methods: </strong>A nationwide cardiac sarcoidosis registry was screened for patients entered before 2020 with cardiac magnetic resonance imaging done before or <3 months after diagnosis. Available studies were re-analyzed for LGE mass as a percentage of left ventricular (LV) mass and the number of LGE-positive LV segments in a 17-segment model. The occurrence of fatal or aborted SCD and ventricular tachycardia (VT) prompting therapy was recorded until the end of 2020 and subjected to cumulative incidence analyses, including competing events (LV assist device implantations, heart transplantations, and fatalities other than SCD). The predictors of SCD/VT were assessed using Fine and Gray modeling and time-dependent receiver operating characteristic analysis.</p><p><strong>Results: </strong>Altogether, 305 patients (66% women, median age 51) with clinically manifest, definite (45%) or probable cardiac sarcoidosis (55%) were analyzed. On follow-up (median, 4.0 years), 21 SCDs, 60 VTs, and 14 competing events were noted. Both LGE mass and the number of LGE segments predicted the composite of SCD/VT (<i>P</i><0.001), with receiver operating characteristic analyses identifying LGE mass ≥9.9% and ≥6 LGE segments as discriminative thresholds. At presentation, 70 patients were free of class I and class IIa implantable cardioverter defibrillator indications unrelated to LGE. Their 5-year rate of SCD/VT was 6.3% (0.0-14.8%) with LGE mass <9.9% versus 21.5% (6.5-36.6%) with higher LGE mass, and 6.9% (0.0-16.3%) with <6 LGE segments versus 20.5% (5.9-35.2%) with ≥6 segments.</p><p><strong>Conclusions: </strong>In cardiac sarcoidosis, myocardial LGE making up ≥9.9% of LV mass or affecting ≥6 LV segments may suggest prognostically significant LV involvement and a high risk of SCD. However, prospective validation of the thresholds is needed.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013239"},"PeriodicalIF":9.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863544","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":"Preprocedural Screening Tool to Guide Nonpulmonary Vein Trigger Testing in First-Time Atrial Fibrillation Ablation.","authors":"Alireza Oraii, Corentin Chaumont, Oriol Rodriguez-Queralto, Michal Wasiak, Munveer Thind, Carli J Peters, Erica Zado, Balaram Krishna J Hanumanthu, Timothy M Markman, Matthew C Hyman, Cory M Tschabrunn, Gustavo Guandalini, Andres Enriquez, Poojita Shivamurthy, Ramanan Kumareswaran, Michael P Riley, David Lin, Robert D Schaller, Saman Nazarian, David J Callans, Gregory E Supple, Fermin C Garcia, David S Frankel, Sanjay Dixit, Francis E Marchlinski","doi":"10.1161/CIRCEP.124.013351","DOIUrl":"10.1161/CIRCEP.124.013351","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing first-time atrial fibrillation (AF) ablation can benefit from targeting non-pulmonary vein (PV) triggers. Preprocedural identification of high-risk individuals can guide planning of ablation strategy. This study aimed to create a preprocedural screening tool to identify patients at risk of non-PV triggers during first-time AF ablation.</p><p><strong>Methods: </strong>All patients who underwent first-time AF ablation at the Hospital of the University of Pennsylvania between 2018 and 2022 were identified. Those who underwent non-PV trigger provocative maneuvers or had spontaneous non-PV trigger firing were included. Non-PV triggers were defined as non-PV ectopic beats triggering AF or sustained focal atrial tachycardia that occurred spontaneously, after AF cardioversion, or after standard provocative maneuvers. The provocative maneuvers included incremental isoproterenol infusion (3, 6, 12, and 20-30 µg/min) and an atrial burst pacing protocol. Risk factors associated with non-PV triggers in a stepwise multivariable logistic regression model with backward elimination were used to create a risk score.</p><p><strong>Results: </strong>A total of 163 (8.0%) of 2038 patients had non-PV triggers during first-time AF ablation. Based on the multivariable model, we created a risk score using female sex (1 point; odds ratio [OR], 1.90 [95% CI, 1.36-2.67]), sinus node dysfunction (1 point; OR, 1.84 [95% CI, 1.04-3.24]), prior cardiac surgery (1 point; OR, 2.26 [95% CI, 1.45-3.53]), moderate to severe left atrial enlargement (2 points; OR, 3.43 [95% CI, 2.46-4.79]), and cardiac sarcoidosis/amyloidosis (4 points; OR, 7.24 [95% CI, 3.03-17.33]). Internal validation using bootstrap resampling showed an optimism-adjusted C statistic of 0.715 (95% CI, 0.678-0.751). Among all first-time AF ablations, 68.1% of procedures were low-risk for non-PV triggers (scores 0-1, 4.3% risk), 17.8% were intermediate-risk (score 2, 10.5% risk), and 14.1% were high-risk (score ≥3, 22.6% risk).</p><p><strong>Conclusions: </strong>A preprocedural screening tool can classify patients based on their risk of non-PV triggers during first-time AF ablation. This risk score can guide operators to identify patients who would benefit most from adjunctive non-PV trigger testing. However, further validation is needed to confirm these findings.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013351"},"PeriodicalIF":9.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863545","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":"Coronary Involvement With Pulsed Field Ablation and Radiofrequency Ablation: Preclinical Insights.","authors":"Iwanari Kawamura, Rahul Bhardwaj, Assaf Govari, Christopher T Beeckler, Jennifer Maffre, Salman Farshchi-Heydari, Benjamin Manacop, Tushar Sharma, Vivek Y Reddy, Jacob S Koruth","doi":"10.1161/CIRCEP.124.013161","DOIUrl":"10.1161/CIRCEP.124.013161","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013161"},"PeriodicalIF":9.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806314","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":"Cryoballoon Pulmonary Vein Isolation With Versus Without Additional Right Atrial Linear Ablation for Persistent Atrial Fibrillation: The CRALAL Randomized Clinical Trial.","authors":"Daehoon Kim, Hee Tae Yu, Jaemin Shim, Junbeom Park, Yong-Soo Baek, Sang Won Park, Dae-Kyeong Kim, Young-Ah Park, Tae-Hoon Kim, Jae-Sun Uhm, Boyoung Joung, Moon-Hyoung Lee, Hui-Nam Pak","doi":"10.1161/CIRCEP.124.013408","DOIUrl":"10.1161/CIRCEP.124.013408","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary vein isolation (PVI) alone is less effective in patients with persistent atrial fibrillation (AF) compared with those with paroxysmal AF. We investigate whether additional linear ablation from the superior vena cava to the right atrial septum and cavotricuspid isthmus ablation improves the rhythm outcome of patients with persistent AF undergoing cryoballoon PVI (Cryo-PVI).</p><p><strong>Methods: </strong>In this investigator-initiated, multicenter, randomized clinical trial, 289 patients with persistent AF refractory to antiarrhythmic drug therapy were randomized 1:1 to either Cryo-PVI with additional right atrium (RA) linear ablation or Cryo-PVI alone. The primary end point was any documented atrial arrhythmia lasting ≥30 seconds after a 3-month blanking period after ablation. The secondary end points were atrial arrhythmia recurrence or antiarrhythmic drug use after a 3-month blanking period, complications, and total procedure time.</p><p><strong>Results: </strong>During the median follow-up of 24 months (median age, 63 years; 23.9% women), the atrial arrhythmia recurrence was less frequent in the additional RA ablation group (n=50, 37.5%) than in the Cryo-PVI alone group (n=69, 53.1%; absolute difference, -15.6% [95% CI, -27.9% to -3.4%]; hazard ratio, 0.66 [95% CI, 0.46-0.94]). Antiarrhythmic drugs were prescribed after the 3-month period to 72 (49.3%) patients in the additional RA ablation group and 79 (55.2%) patients in the Cryo-PVI alone group. No difference was found in complication rate between the 2 groups. Total procedure time was longer in the additional RA ablation group (median, 88 versus 72 minutes; <i>P</i><0.001).</p><p><strong>Conclusions: </strong>Additional RA linear ablation beyond Cryo-PVI improved the ablation outcome compared with that of PVI alone in persistent AF patients.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013408"},"PeriodicalIF":9.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853252","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":"Performance of ARVC Risk Calculators in (Likely) Pathogenic Plakophilin-2 Variant Carriers Without Definite ARVC Diagnosis.","authors":"Steven A Muller, Babken Asatryan, Brittney Murray, Crystal Tichnell, Moniek G P J Cox, Ahmad S Amin, Sing-Chien Yap, Alessio Gasperetti, Richard T Carrick, Julia Cadrin-Tourigny, Marish I F J Oerlemans, Hugh Calkins, J Peter van Tintelen, Cynthia A James, Anneline S J M Te Riele","doi":"10.1161/CIRCEP.124.013144","DOIUrl":"10.1161/CIRCEP.124.013144","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013144"},"PeriodicalIF":9.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817443","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":"Nurse-Led Multicomponent Behavioral Activation Intervention for Patients With Atrial Fibrillation: A Randomized Controlled Trial.","authors":"Polly W C Li, Doris S F Yu, Bryan P Yan","doi":"10.1161/CIRCEP.124.013236","DOIUrl":"10.1161/CIRCEP.124.013236","url":null,"abstract":"<p><strong>Background: </strong>Patients with atrial fibrillation (AF) are often ill-equipped for shared decision-making. This study investigated the effects of a patient empowerment care model on patient-reported health outcomes and treatment decision-making in patients with AF.</p><p><strong>Methods: </strong>This randomized controlled trial prospectively randomized patients with AF to receive standard care (n=194) or a 13-week nurse-led multicomponent behavioral activation intervention (n=198). The intervention consisted of risk profile assessments, empowered shared decision-making regarding the use of oral anticoagulants (OACs), empowered AF self-management, and increased access to professional advice. The primary outcome was health-related quality of life measured after the completion of the intervention (T1), while the secondary outcomes were patient-physician decision concordance regarding OAC use, actual OAC use, AF knowledge, medication adherence, anxiety, and depression.</p><p><strong>Results: </strong>The intervention group showed significantly greater improvements in health-related quality of life (β, -6.702 [95% CI, -9.556 to -3.847]; <i>P</i><0.001), AF knowledge (β, -1.989 [95% CI, -2.342 to -1.635]; <i>P</i><0.001), and medication adherence (β, 0.340 [95% CI, 0.148-0.532]; <i>P</i><0.001) at immediate post-intervention compared with the control group, and the improvements were sustained at 6 months for all outcomes. A higher proportion of patients in the intervention group were prescribed an OAC compared with the control group at 6 months (odds ratio, 5.870 [95% CI, 1.957-12.331]; <i>P</i>=0.012). No significant between-group differences were detected for patient-physician decision concordance regarding OAC use, anxiety, or depression at both time points.</p><p><strong>Conclusions: </strong>The nurse-led multicomponent behavioral activation intervention improved patient-reported outcomes and increased OAC prescription among patients with AF.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013236"},"PeriodicalIF":9.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853254","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":"Engineering of Generative Artificial Intelligence and Natural Language Processing Models to Accurately Identify Arrhythmia Recurrence.","authors":"Ruibin Feng, Kelly A Brennan, Zahra Azizi, Jatin Goyal, Brototo Deb, Hui Ju Chang, Prasanth Ganesan, Paul Clopton, Maxime Pedron, Samuel Ruipérez-Campillo, Yaanik B Desai, Hugo De Larochellière, Tina Baykaner, Marco V Perez, Miguel Rodrigo, Albert J Rogers, Sanjiv M Narayan","doi":"10.1161/CIRCEP.124.013023","DOIUrl":"10.1161/CIRCEP.124.013023","url":null,"abstract":"<p><strong>Background: </strong>Large language models (LLMs) such as Chat Generative Pre-trained Transformer (ChatGPT) excel at interpreting unstructured data from public sources, yet are limited when responding to queries on private repositories, such as electronic health records (EHRs). We hypothesized that prompt engineering could enhance the accuracy of LLMs for interpreting EHR data without requiring domain knowledge, thus expanding their utility for patients and personalized diagnostics.</p><p><strong>Methods: </strong>We designed and systematically tested prompt engineering techniques to improve the ability of LLMs to interpret EHRs for nuanced diagnostic questions, referenced to a panel of medical experts. In 490 full-text EHR notes from 125 patients with prior life-threatening heart rhythm disorders, we asked GPT-4-turbo to identify recurrent arrhythmias distinct from prior events and tested 220 563 queries. To provide context, results were compared with rule-based natural language processing and Bidirectional Encoder Representations from Transformer-based language models. Experiments were repeated for 2 additional LLMs.</p><p><strong>Results: </strong>In an independent hold-out set of 389 notes, GPT-4-turbo had a balanced accuracy of 64.3%±4.7% out-of-the-box at baseline. This increased when asking GPT-4-turbo to provide a rationale for its answers, a structured data output, and in-context exemplars, to a balanced accuracy of 91.4%±3.8% (<i>P</i><0.05). This surpassed the traditional logic-based natural language processing and BERT-based models (<i>P</i><0.05). Results were consistent for GPT-3.5-turbo and Jurassic-2 LLMs.</p><p><strong>Conclusions: </strong>The use of prompt engineering strategies enables LLMs to identify clinical end points from EHRs with an accuracy that surpassed natural language processing and approximated experts, yet without the need for expert knowledge. These approaches could be applied to LLM queries for other domains, to facilitate automated analysis of nuanced data sets with high accuracy by nonexperts.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013023"},"PeriodicalIF":9.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827497","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":"Empirical Non-Pulmonary Vein Trigger Ablation for Management of Atrial Fibrillation: Is Cryoballoon Isolation of the Superior Vena Cava the Answer?","authors":"Fatima M Ezzeddine, Yong-Mei Cha","doi":"10.1161/CIRCEP.124.013637","DOIUrl":"10.1161/CIRCEP.124.013637","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013637"},"PeriodicalIF":9.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930724","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":"Editors and Editorial Board.","authors":"","doi":"10.1161/HAE.0000000000000092","DOIUrl":"https://doi.org/10.1161/HAE.0000000000000092","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":"18 1","pages":"e000092"},"PeriodicalIF":9.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000740","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":"Association Between <i>ALDH2</i> Genotypes and Atrial Fibrillation Recurrence Following Catheter Ablation: Prospective Multicenter Cohort Study.","authors":"Tadashi Hoshiyama, Keiichi Ashikaga, Kenji Morihisa, Miwa Ito, Kentaro Oniki, Junji Saruwatari, Masanobu Ishii, Hisanori Kanazawa, Hitoshi Sumi, Shozo Kaneko, Takuya Kiyama, Yuichiro Tsuruta, Kohei Matsunaga, Yuta Tsurusaki, Kenichi Tsujita","doi":"10.1161/CIRCEP.124.013433","DOIUrl":"10.1161/CIRCEP.124.013433","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013433"},"PeriodicalIF":9.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806290","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}