Circulation. Arrhythmia and electrophysiology最新文献

{"title":"Pulsed Field Ablation Therapy Parameters: Enhancing Lesion Depth While Reducing Musculoskeletal Stimulation and Thermal Response in an Irrigated Tip Catheter: A Comprehensive Study Using In Silico, In Vitro, and In Vivo Models.","authors":"Atul Verma, Chirag Barbhaiya, Daniel J Friedman, Jonathan P Piccini","doi":"10.1161/CIRCEP.126.014955","DOIUrl":"10.1161/CIRCEP.126.014955","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation therapies need to be optimized to maximize lesion depth while mitigating heat and musculoskeletal stimulation. We describe the adjustment of biphasic pulsed field ablation parameters for an irrigated tip catheter.</p><p><strong>Methods: </strong>Experimental models all used an 8F, flexible-tip, irrigated ablation catheter. Computer simulation models were designed to assess the effects of bipolar versus monopolar applications. A vegetal (potato) model was used to assess the effects of voltage, pulse width, and number of pulses per burst on lesion depth. In-vitro testing on bovine cardiac muscle was performed with temperature sensors at the surface and 3 and 7 mm beneath the surface to measure temperature rises. Finally, an in vivo canine model was used to assess for musculoskeletal stimulation caused by the pulsed field ablation therapies established with the vegetal/in vitro testing.</p><p><strong>Results: </strong>Monopolar delivery consistently delivered more tissue depth than bipolar configurations. Adjustments from n to n+1.0 µs and increasing pulses per burst from 50 to 250 increased lesion depth but also increased musculoskeletal stimulation. The optimized burst count was 5 R-wave-gated bursts over 4 to 9 seconds. The optimized therapy had a minimal observed depth of >5 mm and minimized musculoskeletal stimulation. Final selected therapies did create temperature rises, which were completely offset by irrigation rates of 7 to 13 mL/min.</p><p><strong>Conclusions: </strong>Pulse width and number of pulses per burst are important contributors to lesion depth, musculoskeletal stimulation, and incident heating. Even small adjustments in these parameters can alter lesion depth, muscle stimulation, and thermal effects, which will differentiate optimal from suboptimal pulsed field ablation.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014955"},"PeriodicalIF":9.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788474","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":"Skin Sympathetic Nerve Activity After Pulsed Field Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation: The NEU-PFA Study.","authors":"Lo-Chieh Ling, Li-Wei Lo, Fa-Po Chung, Shih-Lin Chang, Yu-Feng Hu, Chin-Yun Lin, Ting-Yung Chang, Ling Kuo, Chih-Min Liu, Shin-Huei Liu, Cheng-I Wu, Yenn-Jiang Lin, Yu-Cheng Hsieh, Cheng-Hung Li, Ming-Jen Kuo, Shang-Ju Wu, Guan-Yi Lee, Yu-Shan Huang, Yu-Shan Chien, Cheng-Han Chan, Yuen Hoong Phang, Quoc-Hoang Nguyen, Xuan-Hoang Le, Naomi Ong, Da-Wei Chang, Shih-Ann Chen","doi":"10.1161/CIRCEP.126.015148","DOIUrl":"10.1161/CIRCEP.126.015148","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":"19 9","pages":"e015148"},"PeriodicalIF":9.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13581291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976026","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":"Isochronal Versus Electrogram-Based Conduction Velocity Estimation to Predict Inducible Monomorphic Ventricular Tachycardia in Repaired Tetralogy of Fallot.","authors":"Edward T O'Leary, Victor Waldmann, Francis Bessière, Reina B Tan, Elisabetta Mariucci, Philip M Chang, Ronald J Kanter, Mitchell I Cohen, Paul Khairy, Jeremy P Moore","doi":"10.1161/CIRCEP.125.014548","DOIUrl":"10.1161/CIRCEP.125.014548","url":null,"abstract":"<p><strong>Background: </strong>Isthmus conduction velocity (CV) predicts ventricular tachycardia risk in tetralogy of Fallot and traditionally is calculated using electrogram-based methods (electrogram CV index [EGM-CVi]). Isochronal activation mapping approximates CV in adults with ischemic and nonischemic cardiomyopathy but has never been tested in congenital heart disease populations. Our objectives were to (1) investigate the diagnostic performance of isochronal CV index (ISO-CVi) in predicting inducible ventricular tachycardia and (2) compare it to traditional EGM-CVi in a population of patients with repaired tetralogy of Fallot undergoing electrophysiology study before transcatheter pulmonary valve replacement.</p><p><strong>Methods: </strong>Retrospective cohort subanalysis of the CATAPULT-TOF registry (Catheter Ablation of Ventricular Tachycardia Before Transcatheter Pulmonary Valve Replacement in Repaired Tetralogy of Fallot). The primary outcome was inducible monomorphic ventricular tachycardia (MMVT) at electrophysiology study. Predictor variables were ISO-CVi and EGM-CVi. Electroanatomic activation maps profiling anatomic isthmus 3 were centrally adjudicated to measure anatomic isthmus 3 ISO-CVi; real-world anatomic isthmus 3 EGM-CVi values reported by contributing centers per the parent registry protocol were used as the comparator. Multivariable logistic regression and receiver operating characteristic analyses quantified associations between predictors and outcomes.</p><p><strong>Results: </strong>Seventy patients with tetralogy of Fallot underwent pretranscatheter pulmonary valve replacement electrophysiology study at a median age of 40 (interquartile range, 24.8-51) years. Inducible MMVT was observed in 24 (34%). Median ISO-CVi was lower in those with versus without MMVT (0.17 versus 0.30 m/s; <i>P</i><0.001). Median EGM-CVi did not differ between groups (0.43 versus 0.70 m/s; <i>P</i>=0.055). Coefficients of variation were higher for EGM-CVi (79%) than ISO-CVi (46%). On multivariable analysis, ISO-CVi was associated with MMVT (odds ratio, 0.31 per 0.1 m/s increase, [95% CI, 0.13-0.63]; <i>P</i>=0.004) with a sensitivity and specificity of 88% and 70%, respectively, at a threshold of 0.22 m/s.</p><p><strong>Conclusions: </strong>ISO-CVi was independently associated with inducible MMVT and is measured with less variability than legacy EGM-CVi methods in a real-world sample. If external validity is confirmed, ISO-CVi may represent a more standardized method of isthmus CV estimation that could be broadly implemented across centers.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014548"},"PeriodicalIF":9.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677286","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":"When Science Is Sidelined: Implications of US Vaccine Policy Rollbacks for Electrophysiology and Cardiovascular Health.","authors":"Jiaqi Mi, Aashish Katapadi, Daniel P Morin, Kenneth A Ellenbogen, Jodie L Hurwitz, Sana M Al-Khatib, Jagmeet P Singh, David S Frankel, Bradley P Knight, Henry D Huang, Thomas F Deering, Sanjeev Saksena, Andrea M Russo, Sami Viskin, Mina K Chung, Dhanunjaya Lakkireddy","doi":"10.1161/CIRCEP.126.015006","DOIUrl":"https://doi.org/10.1161/CIRCEP.126.015006","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":"19 9","pages":"e015006"},"PeriodicalIF":9.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976013","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":"Left Atrial Appendage Closure Versus Oral Anticoagulation in Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Adishwar Rao, Venkatesh Ravi, Mukunthan Murthi, Rahul Chikatimalla, Vennela Talla, Nihal Nagaraj, Gaurav Dhar, Neeraj Jolly, Aviral Vij","doi":"10.1161/CIRCEP.126.015245","DOIUrl":"10.1161/CIRCEP.126.015245","url":null,"abstract":"<p><strong>Background: </strong>Left atrial appendage closure (LAAC) is an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation, but randomized controlled trials have primarily focused on composite end points, potentially obscuring differences in individual clinical outcomes. We compared the efficacy and safety of LAAC versus OAC with an emphasis on individual clinical outcomes.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of randomized controlled trials comparing LAAC with OAC in adults with atrial fibrillation was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases were searched from January 2000 to March 2026. The primary efficacy end point was any stroke, and the primary safety end point was major bleeding. Risk ratios (RRs) with 95% CIs were pooled using a random-effects model.</p><p><strong>Results: </strong>Six randomized controlled trials comprising 7004 patients (3681 LAAC; 3323 OAC) were included. LAAC was associated with a higher risk of ischemic stroke (RR, 1.41 [95% CI, 1.04-1.91]; <i>P</i>=0.03; 3.2% versus 2.1%), without a significant difference in any stroke (RR, 1.08 [95% CI, 0.82-1.42]; <i>P</i>=0.60) or the composite of stroke, systemic embolism, or death (RR, 0.99 [95% CI, 0.77-1.29]; <i>P</i>=0.96). Cardiovascular mortality (RR, 0.88; <i>P</i>=0.40) and all-cause mortality (RR, 0.92; <i>P</i>=0.36) were similar between groups. Major bleeding, including procedural events, did not differ significantly (RR, 0.93; <i>P</i>=0.40), although LAAC was associated with a significantly lower risk of nonprocedural major bleeding (RR, 0.57 [95% CI, 0.43-0.77]; <i>P</i><0.01; 6.2% versus 10.7%).</p><p><strong>Conclusions: </strong>In patients with atrial fibrillation, LAAC is associated with a higher risk of ischemic stroke, but lower risk of nonprocedural major bleeding compared with OAC, with no significant differences in composite thromboembolic outcomes or mortality, underscoring the importance of individualized risk-benefit assessment in stroke prevention strategies.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e015245"},"PeriodicalIF":9.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789025","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":"Genotype-Specific Electrophysiological Remodeling in PLN R14del Cardiomyopathy: Implications for Precision Antiarrhythmic Therapy.","authors":"Mena Fawzy Abdelsayed, Efthimios Tim Gianitsos, Alice Yu, Mark Mercola","doi":"10.1161/CIRCEP.125.014684","DOIUrl":"10.1161/CIRCEP.125.014684","url":null,"abstract":"<p><strong>Background: </strong>Inherited PLN (phospholamban) R14del variants cause dilated cardiomyopathy with a high burden of malignant ventricular arrhythmias. However, the single-cell electrophysiological substrate underlying arrhythmogenicity is incompletely characterized, and it is unclear whether antiarrhythmic agents validated in wild-type (WT) or long QT models retain efficacy in this genotype. We sought to define the genotype-specific electrophysiological phenotype of PLN R14del cardiomyocytes and evaluate how modulation of the transient outward potassium current and late sodium current alters arrhythmic risk.</p><p><strong>Methods: </strong>Isogenic WT (HD.15S1) and CRISPR (clustered regularly interspaced short palindromic repeats)-edited PLN R14del human induced pluripotent stem cell-derived cardiomyocytes were studied using high-throughput optical action potential (AP) recordings. A deep learning framework classified AP morphology to quantify normal versus aberrant AP types, AP duration, and early afterdepolarization incidence at baseline and under graded concentrations of the transient outward potassium current activator NS-5806, the transient outward potassium current inhibitor acacetin, and the selective late sodium current blocker GS-967 (eleclazine).</p><p><strong>Results: </strong>At baseline, PLN R14del human induced pluripotent stem cell-derived cardiomyocytes exhibited a subtle but significant arrhythmogenic phenotype, with a reduced proportion of normal APs, prolonged AP duration, and increased early afterdepolarizations compared with isogenic WT, consistent with impaired calcium handling and diminished repolarization reserve. In WT cells, NS-5806 produced a biphasic, dose-dependent response, transiently destabilizing and then restoring normal AP morphology; in PLN R14del cells, NS-5806 induced marked proarrhythmic remodeling and near-complete loss of normal APs at higher doses. GS-967 paradoxically exacerbated arrhythmic features in the mutant line, including AP duration prolongation and suppression of normal APs. Acacetin preserved stability in WT cells but failed to rescue normal AP morphology in PLN R14del cardiomyocytes.</p><p><strong>Conclusions: </strong>PLN R14del cardiomyopathy creates a distinct electrophysiological substrate that fundamentally alters antiarrhythmic drug responsiveness, such that agents beneficial in WT contexts may be ineffective or proarrhythmic in this genotype. Preclinical antiarrhythmic evaluation should incorporate genotype-specific, patient-derived human induced pluripotent stem cell models to enable precision medicine strategies in inherited cardiomyopathies.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014684"},"PeriodicalIF":9.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403893","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":"Yield of Family Screening in Arrhythmogenic Right Ventricular Cardiomyopathy Without a Validated Genetic Cause.","authors":"Steven A Muller, Brittney Murray, Crystal Tichnell, Arman Salavati, Peter Loh, Richard T Carrick, Moniek G P J Cox, Pim van der Harst, Maarten J Cramer, Marish I F J Oerlemans, Alessio Gasperetti, Babken Asatryan, Stefan L Zimmerman, J Peter van Tintelen, Hugh Calkins, Cynthia A James, Anneline S J M Te Riele","doi":"10.1161/CIRCEP.125.014420","DOIUrl":"10.1161/CIRCEP.125.014420","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend regular screening for first-degree relatives of gene-elusive arrhythmogenic right ventricular cardiomyopathy (ARVC) patients using a similar regimen as for genotype-positive/phenotype-negative relatives. However, the multifactorial nature of gene-elusive ARVC may necessitate a different approach. This study aimed to determine the yield of cardiac screening in first-degree relatives of ARVC probands without a validated genetic cause.</p><p><strong>Methods: </strong>We included all first-degree relatives of probands who (1) met the 2010 Task Force Criteria, (2) underwent next-generation sequencing that included all genes with at least moderate evidence for ARVC causation per Clinical Genome Resource appraisal (validated ARVC genes), and (3) had no pathogenic/likely pathogenic (P/LP) variants identified in these genes. The primary and secondary end points were definite ARVC by the 2010 Task Force Criteria and ventricular arrhythmia, respectively.</p><p><strong>Results: </strong>We included 44 relatives (39.0 [22.3-45.8] years; 36% male) from 24 families. In 4 (17%) families, a P/LP variant was identified in a different cardiomyopathy/arrhythmia gene (<i>SCN5A</i>, <i>LMNA</i>, <i>CDH2</i>, <i>FLNC</i>). Overall, 10 (23%) relatives had definite ARVC at baseline evaluation. Of the 20 relatives without definite ARVC who had follow-up available, 8/20 (40%) relatives progressed to definite ARVC during 9.0 (5.8-14.4) years of follow-up. No statistical difference in the yield of baseline screening or serial evaluation between relatives from families with a P/LP variant and relatives from families without a P/LP variant was observed. Of the 27 relatives who had follow-up available, ventricular arrhythmia was observed in 2/27 (7%) relatives and occurred 6.3 and 13.8 years after definite ARVC diagnosis. Both of those relatives were from families without a P/LP variant.</p><p><strong>Conclusions: </strong>These findings highlight the importance of managing first-degree relatives of ARVC probands without a validated genetic cause similarly to genotype-positive ARVC relatives. Furthermore, using a broad cardiomyopathy and arrhythmia gene panel in ARVC probands, rather than limiting testing to validated ARVC genes alone, is warranted.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014420"},"PeriodicalIF":9.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367008","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":"Cardiac Implantable Electronic Devices Remote Programming.","authors":"Sylvain Ploux, Marc Strik, Niraj Varma, Anand Thiyagarajah, Michel Haïssaguerre, Karim Benali, Pierre Bordachar","doi":"10.1161/CIRCEP.125.014786","DOIUrl":"10.1161/CIRCEP.125.014786","url":null,"abstract":"<p><p>Remote monitoring has revolutionized the follow-up of cardiac implantable electronic device recipients, leading to both organizational benefits and improved patient survival. To fully realize the potential of a remote cardiac implantable electronic device management strategy, a 2-way communication system enabling remote programming capabilities is essential. In recent years, several initiatives have emerged to develop and evaluate indirect remote programming solutions based on the remote control of a device programmer. This hybrid approach, which mitigates cybersecurity risks, has been successfully applied in various clinical settings, from magnetic resonance imaging procedures to medically underserved regions, and has consistently demonstrated high safety and patient satisfaction. Indirect remote programming reduces the need for both patient and healthcare professional travel, thereby lowering associated costs and the carbon footprint, while shortening delays and enhancing patient safety. It provides a clear preview of the enormous potential of direct remote programming, particularly regarding equity in access to care and patient outcomes. Direct remote programming of cardiac implantable electronic devices is no longer technical a barrier and is already available for implantable cardiac monitors. In the near future, extending direct programming to therapeutic cardiac implantable electronic devices is expected to further remove geographic and logistical barriers, reduce time to intervention, and improve patient safety. This promising evolution will, however, require not only addressing cybersecurity challenges but also embracing a paradigm shift within the cardiology community.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014786"},"PeriodicalIF":9.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403940","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":"Innervation of the Human Atrioventricular Node via the Inferior Pyramidal Space: Characterization Using Intersectional Strategies.","authors":"Takanori Sato, Shumpei Mori, Peter Hanna, Joseph E Hadaya, Yuichiro Miyazaki, Logan G Kirkland, Donald B Hoover, Olujimi A Ajijola, Kalyanam Shivkumar","doi":"10.1161/CIRCEP.126.014978","DOIUrl":"10.1161/CIRCEP.126.014978","url":null,"abstract":"<p><strong>Background: </strong>The inferior pyramidal space (IPS), the epicardial adipose tissue extending from the inferior crux of the heart, contains the atrioventricular node (AVN) at its apex. However, innervation of the human AVN via the IPS remains unknown.</p><p><strong>Methods: </strong>Seven whole-mount samples of the human IPS involving the AVN were obtained from hearts rejected for transplantation (85.7% male, 49.4±12.8 years old). The IPS was further divided into the anterior (behind the floor of the triangle of Koch) and posterior (within the Eustachian ridge) fat pads relative to the coronary sinus. A whole-mount tissue-clearing method with immunohistochemical staining was applied to each fat pad to count and characterize the nerve fascicles ≥10 µm and ganglia ≥6000 µm².</p><p><strong>Results: </strong>Within the anterior fat pad, sympathetic nerve fascicles ascended towards the AVN along the AVN artery, whereas nonsympathetic nerve fascicles approached the AVN from the superior and posterior aspects without a consistent relationship to the AVN artery. Within the IPS, sympathetic nerve fascicles were thicker than nonsympathetic nerve fascicles (51.7±32.8 versus 22.1±10.6 µm; <i>P</i><0.001). The ganglia, which were mainly nonsympathetic, were found predominantly within the posterior fat pad compared with the anterior fat pad (63.2±40.3 versus 5.8±5.0; <i>P</i><0.01). The compact AVN regions were devoid of thick nerve fascicles and ganglionated plexuses but filled with a fine meshwork of both sympathetic and nonsympathetic nerve fibers.</p><p><strong>Conclusions: </strong>The human IPS exhibits a distinct pattern of autonomic innervation and distribution of ganglia. These neural structures are likely to contribute to the physiological control of the human AVN and could be a novel target for neuromodulation to restore normal AVN function.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014978"},"PeriodicalIF":9.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599677","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":"Clinical Triage of Individuals With Warning Symptoms of Imminent Cardiac Arrest.","authors":"Kyndaron Reinier, Harpriya Chugh, Vishnu Kadiyala, Arayik Sargsyan, Audrey Uy-Evanado, Kotoka Nakamura, Elizabeth Heckard, Marco Mathias, Tristan Grogan, David Elashoff, Angelo Salvucci, Jonathan Jui, Sumeet S Chugh","doi":"10.1161/CIRCEP.125.014647","DOIUrl":"10.1161/CIRCEP.125.014647","url":null,"abstract":"<p><strong>Background: </strong>At least 50% of individuals who suffer sudden cardiac arrest (SCA) have warning symptoms before their SCA, but these are not sufficient to predict imminent SCA (ISCA). We hypothesized that combining symptoms with clinical profile could effectively predict ISCA.</p><p><strong>Methods: </strong>In 2 community-based studies of SCA in Oregon and California, survivors of SCA who had experienced warning symptoms and called 911 (n=364) were compared with control subjects (n=313) who also called 911 for similar symptoms but did not have SCA. Symptom information was obtained directly from interviews as well as prehospital emergency records. We used machine learning to identify predictive combinations of symptoms and clinical features in this case-control study. The area under the receiver operating characteristic curve (AUC) and 5-fold cross-validation were used to assess model performance and stability.</p><p><strong>Results: </strong>Warning symptom-clinical profile combinations were successfully identified. The combination of chest pain and known heart failure predicted ISCA among men, while chest pain and known coronary artery disease predicted ISCA among women (AUC=0.788). With dyspnea, both history of coronary artery disease and heart failure were predictors (AUC=0.745). In the absence of chest pain or dyspnea, seizure-like symptoms, coronary artery disease, and heart failure were predictors (AUC, 0.775). 5-fold cross-validation produced consistent results.</p><p><strong>Conclusions: </strong>Combinations of warning symptoms and clinical features distinguished individuals with SCA from individuals without SCA with good accuracy (AUCs, 0.745-0.788). These findings have implications for clinical triage of ISCA warning symptoms in emergency settings and warrant investigation in larger studies.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014647"},"PeriodicalIF":9.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403954","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}