Circulation. Arrhythmia and electrophysiology最新文献

{"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}

{"title":"Patient Empowerment in the Management of Atrial Fibrillation: The Missing Link for Improved Outcomes.","authors":"Ratika Parkash","doi":"10.1161/CIRCEP.124.013638","DOIUrl":"10.1161/CIRCEP.124.013638","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013638"},"PeriodicalIF":9.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930725","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":"Impact of Age on Smartphone-Based Screening for Atrial Fibrillation: A Prespecified Subgroup Analysis of the eBRAVE-AF Trial.","authors":"Luisa Freyer, Peter Spielbichler, Lukas von Stülpnagel, Aresa Krasniqi, Maximilian Wörndl, Lukas Tenbrink, Laura Elisa Villegas Sierra, Maria F Vogl, Lauren E Sams, Ann-Kathrin Mayer, Michael Schreinlechner, Elodie Eiffener, Annika Schneidewind, Mathias Klemm, Steffen Massberg, Axel Bauer, Konstantinos D Rizas","doi":"10.1161/CIRCEP.124.013293","DOIUrl":"10.1161/CIRCEP.124.013293","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013293"},"PeriodicalIF":9.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806332","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":"Pulsed Field Ablation Using Focal Contact Force-Sensing Catheters for Treatment of Atrial Fibrillation: 1-Year Outcomes of the ECLIPSE AF Study.","authors":"Ante Anić, Thomas Phlips, Toni Brešković, Vikramaditya Mediratta, Steven Girouard, Zrinka Jurišić, Ivan Sikirić, Lucija Lisica, Pieter Koopman, Nathalie Antole, Johan Vijgen","doi":"10.1161/CIRCEP.124.012794","DOIUrl":"10.1161/CIRCEP.124.012794","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) is a promising treatment for atrial fibrillation. We report 1-year freedom from atrial arrhythmia outcomes using monopolar PFA delivered through 3 commercial, contact force-sensing focal catheters.</p><p><strong>Methods: </strong>ECLIPSE AF (Safety & Clinical Performance Study of Catheter Ablation With the Centauri System for Patients With Atrial Fibrillation; NCT04523545) was a prospective, single-arm, multicenter study evaluating acute and chronic safety and performance using the CENTAURI system to deliver focal PFA with TactiCath SE, StablePoint, and ThermoCool ST. Patients with paroxysmal or persistent atrial fibrillation underwent pulmonary vein (PV) isolation under deep sedation or general anesthesia and returned for remapping at 90 days to evaluate chronic durability. Freedom from atrial arrhythmia was evaluated continuously through 12 months using standard rhythm monitoring for symptomatic episodes and 24-hour Holter at 6 and 12 months.</p><p><strong>Results: </strong>Eighty-two patients (74% male, 51.2% paroxysmal, and 58.5% deep sedation) were treated. PV isolation was achieved in 100% of targeted veins (322/322) with first-pass isolation in 92.2% (297/322). There were 4 primary safety events in 4 patients (4.9%, 4/82); 1 nonembolic stroke due to exacerbated cardiac tamponade secondary to catheter perforation and 3 hemorrhagic vascular access complications. There were no incidences of adverse event fistula, diaphragmatic paralysis, myocardial infarction, pericarditis, thromboembolism, PV stenosis, transient ischemic attack, or death. Eighty patients (98%) underwent remapping. Optimized PFA cohorts 3, 4, and 5 showed per-patient isolation rates of 60%, 73%, and 81% and per-PV isolation rates of 84%, 90%, and 92%, respectively. One-year freedom from atrial arrhythmia was 80.2% (95% CI, 69.7%-87.4%) for the entire patient sample, including 41 patients who underwent repeat focal PFA with the CENTAURI system at remapping.</p><p><strong>Conclusions: </strong>This study demonstrated that optimization of focal PFA with 3 contact force-sensing, solid-tip ablation catheters resulted in the progressive improvement of PV isolation durability at 3-month remapping and high freedom from atrial arrhythmia survival rates, providing a promising focal PFA treatment option integrated with current ablation workflows.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e012794"},"PeriodicalIF":9.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853256","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":"Approach to the Diagnosis and Management of Complex Fascicular Ventricular Tachycardias.","authors":"Christopher X Wong, Henry H Hsia, Adam C Lee, Robert M Hayward, Colleen J Johnson, Edgar Antezana-Chavez, Pichmanil Khmao, Melvin M Scheinman","doi":"10.1161/CIRCEP.124.013450","DOIUrl":"10.1161/CIRCEP.124.013450","url":null,"abstract":"<p><p>Complex ventricular tachycardias involving the fascicular system (fascicular ventricular tachycardias [FVTs]) can be challenging. In this review, we describe our approach to the diagnosis and ablation of these arrhythmias with 10 illustrative cases that involve (1) differentiation from supraventricular tachycardia; (2) assessment for atypical bundle branch reentry and other interfascicular FVTs; (3) examination of P1/P2 activation sequences in sinus rhythm, pacing, and tachycardia; and (4) entrainment techniques to establish the tachycardia mechanism and aid circuit localization. To summarize, 5 cases had prior ablation with 2 previously misdiagnosed as supraventricular tachycardia. A short His-ventricular interval supported ventricular tachycardia. Atrial stimulation could initiate and entrain 4 FVTs. P1 potentials were recorded in all cases of left posterior FVT. Entrainment at P1 and P1 to P2 connection sites at the mid-septal region, and the postablation emergence of a late P1 with decremental properties, is consistent with the left septal fascicle being the slowly conducting, retrograde limb of the left posterior FVT circuit. Ablation targeting the mid-septal left septal fascicle and P1 to P2 connection sites successfully eliminated left posterior FVT. Right ventricular apical pacing was useful in differentiating bundle branch reentry and focal FVTs from reentrant FVTs. Two cases exhibited bundle branch reentry and other interfascicular FVTs. Three cases were postinfarct FVTs involving the LPF, where pacing and entrainment at sites of conduction system potentials were able to localize sites critical for ablation, in contrast to previously unsuccessful substrate modification. In conclusion, several ventricular tachycardia mechanisms involving the fascicular system can occur in both structurally normal and abnormal hearts. A high index of suspicion is required given their rarity and potential for misdiagnosis. Once identified, we emphasize a structured approach to the diagnosis and management of FVTs to confirm the mechanism and localize suitable ablation targets involving careful recording of conduction system potentials and pacing/entrainment maneuvers.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013450"},"PeriodicalIF":9.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827372","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":"In Vivo Mapping of Human Ventricular Fibrillation in Brugada Syndrome: The Role of Repolarization Heterogeneity.","authors":"Luigi Pannone, Domenico Giovanni Della Rocca, Pasquale Vergara, Antonio Sorgente, Alvise Del Monte, Giampaolo Vetta, Maria Cespon Fernandez, Giacomo Talevi, Ivan Eltsov, Paul-Adrian Calburean, Ingrid Overeinder, Gezim Bala, Alexandre Almorad, Erwin Ströker, Gudrun Pappaert, Juan Sieira, Thomy de Ravel, Sonia Van Dooren, Ali Gharaviri, Mark La Meir, Pedro Brugada, Gian Battista Chierchia, Andrea Sarkozy, Carlo de Asmundis","doi":"10.1161/CIRCEP.124.013290","DOIUrl":"10.1161/CIRCEP.124.013290","url":null,"abstract":"<p><strong>Background: </strong>Brugada syndrome (BrS) is associated with ventricular fibrillation (VF). Different VF mechanisms have been described, and repolarization gradients were associated with VF in a BrS model. The aim of this study is to map VF in BrS with ECG imaging. Furthermore, spatial correlation between sinus rhythm maps and VF maps was evaluated.</p><p><strong>Methods: </strong>Inclusion criteria were (1) BrS diagnosis and (2) VF mapped with ECG imaging during right ventricle outflow tract ablation. VF mechanism was classified into (1) rotational, (2) focal, and (3) irregular. For comparison, 6 controls were enrolled. The following sinus rhythm maps were performed: activation, recovery time, and activation-recovery interval time. Spatial overlap between steep repolarization gradients (cliffs) at recovery time and activation-recovery interval time maps and initiating VF rotational activity was evaluated with photogrammetry.</p><p><strong>Results: </strong>A total of 28 VF maps in 21 patients with BrS were analyzed. In the first ≈7 seconds of VF, rotational, focal, and irregular mechanisms were found. In 19 patients with BrS (90.5%) and none of the controls, a right ventricle outflow tract repolarization cliff only was found. In all these patients, the singularity point of the first initiating rotational VF activity spatially overlapped with the right ventricle outflow tract cliff. Abolition of right ventricle outflow tract repolarization cliffs was confirmed in all but 2 patients (94.3%). In one patient with recurrence, VF was mapped on the anterior right ventricle over a cliff that was not targeted at the first ablation procedure.</p><p><strong>Conclusions: </strong>In patients with BrS, repolarization heterogeneity has a critical role in VF. Repolarization cliffs might be a therapeutic target in VF ablation.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013290"},"PeriodicalIF":9.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766740","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}