Circulation. Arrhythmia and electrophysiology最新文献

{"title":"Electrophysiological Mechanisms of Typical Atrial Flutter After Atrial Switch Operation: Critical Role of the Septal Corridor.","authors":"Geoffroy Ditac, Nicolas Johner, Laurens Verhaeghe, Allan Plant, Francesco Notaristefano, Karim Benali, John L Fitzgerald, Kinan Kneizeh, Konstantinos Vlachos, Cinzia Monaco, Marianne Tétreault-Langlois, Benjamin Sacristan, Jan Charton, Marine Arnaud, Romain Tixier, Mélèze Hocini, Michel Haïssaguerre, Pierre Jaïs, Thomas Pambrun, Josselin Duchateau, Frédéric Sacher, Jean-Benoît Thambo, Xavier Iriart, Nicolas Derval","doi":"10.1161/CIRCEP.125.014777","DOIUrl":"10.1161/CIRCEP.125.014777","url":null,"abstract":"<p><strong>Background: </strong>Peritricuspid, or cavotricuspid isthmus-dependent, atrial flutter is the most common arrhythmia in patients with dextro-transposition of the great arteries treated with atrial switch surgery, but its underlying mechanisms remain poorly understood.</p><p><strong>Methods: </strong>Twenty consecutive patients with prior atrial switch surgery referred for atrial flutter ablation were included. All underwent transbaffle puncture and high-density mapping. Anatomic barriers, activation patterns, conduction velocities, and low-voltage areas were assessed.</p><p><strong>Results: </strong>In all cases of peritricuspid atrial flutter, surgical incisions defined the posterior boundary of the circuit. The narrowest segment of the reentry was consistently located within a septal corridor bounded posteriorly by the baffle incision and anteriorly by the tricuspid annulus. Slow conduction (<30 cm/s) was identified in this septal corridor in 92% of peritricuspid flutters and in 85% of patients during sinus or paced rhythm. Low-voltage areas were limited and frequently colocalized with regions of slow conduction. No patient exhibited slow conduction or low voltage at the cavotricuspid isthmus. The septal corridor was also involved in 60% of nonperitricuspid reentrant atrial tachycardias. Programmed atrial stimulation with S2 mapping accentuated conduction delay in this region, with demonstration of functional block and induction of atrial flutter.</p><p><strong>Conclusions: </strong>In patients with dextro-transposition of the great arteries corrected by atrial switch, surgical incisions define posterior boundaries and create a narrow septal corridor, or baffle-tricuspid isthmus, characterized by slow conduction and a propensity for functional block. These anatomic and electrophysiological features likely underlie the high prevalence of peritricuspid reentry in this population, representing a ubiquitous critical substrate for arrhythmia initiation and maintenance. Systematic cavotricuspid isthmus ablation should, therefore, be considered in these patients.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014777"},"PeriodicalIF":9.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148577220","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":"Effect of Left Atrial Size and Volume Reduction on Pulmonary Vein Isolation Efficacy in Patients With Persistent and Longstanding Persistent Atrial Fibrillation: Subset Analysis From the aMAZE Trial.","authors":"Dhanunjaya Lakkireddy, David J Wilber, Suneet Mittal, David Rene Tschopp, Christopher R Ellis, Abdi Rasekh, Troy Hounshell, Robert Hoyt, Rudolph F Evonich, Sheetal Chandhok, Ronald D Berger, Rodney Horton, Michael Hoskins, Hugh Calkins, Steven J Yakubov, Omar K Khalique, Todd Cory Pulerwitz, Nitish Badhwar, Thomas Dewland, Stanislav Weiner, Smit Valsaiwala, Aashish Katapadi, Pamela Simons, Patrick Walker, Nifi Ndilkintum, Luigi DiBiase, Andrea Natale, Randall J Lee","doi":"10.1161/CIRCEP.125.014755","DOIUrl":"10.1161/CIRCEP.125.014755","url":null,"abstract":"<p><strong>Background: </strong>Large left atrial volume (LAV) is a strong predictor of advanced left atrial substrate and is associated with less successful outcomes following pulmonary vein isolation (PVI) alone. Prespecified variables of the aMAZE trial (Left Atrial Appendage Ligation Adjunctive to PVI for Persistent or Longstanding Persistent Atrial Fibrillation) were evaluated to access for the impact of LAV and left atrial appendage ligation on atrial fibrillation (AF) outcomes.</p><p><strong>Methods: </strong>The aMAZE trial was a multicenter, randomized-controlled study evaluating the effects of LAV on freedom from atrial arrhythmias (AA) following PVI-only compared with LARIAT and PVI (LARIAT+PVI). In total, 610 drug-refractory patients with nonparoxysmal AF were randomized 2:1 to LARIAT versus PVI alone. Freedom from AA was assessed 12 months postprocedure. LAV was independently assessed by a core laboratory from cardiac computed tomography performed before ablation. (REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02513797).</p><p><strong>Results: </strong>There were 404 patients in the LARIAT+PVI group and 206 in the PVI-only group. Logistic regression performed within each subgroup for primary effectiveness with LAV demonstrated that the recurrence of AA after PVI was directly related to increasing LAV. Freedom from recurrence of AA in the LARIAT+PVI arm was independent and preserved irrespective of LAV. Similar results were seen with LAV index. A tercile analysis of early persistent AF (perAF) patients (AF >7 days and <6 months) and LARIAT+PVI in the highest (>148 cm³) LAV tercile showed statistically significant freedom from AA compared with PVI-only (69% versus 49%; <i>P</i>=0.02). Significant differences (<i>P</i><0.04) between groups in the early perAF cohort began at an LAV of 130 cm³ and an LAV index of 65 cm³/m².</p><p><strong>Conclusions: </strong>The correlation of LAV with PVI effectiveness in this study demonstrates that AA recurrence after PVI alone is directly related to increasing LAV. Freedom from AA after left atrial appendage ligation in addition to PVI is independent of increasing LAV, and left atrial appendage ligation may therefore provide an adjunctive benefit in patients with nonparoxysmal AF and enlarged LAV.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014755"},"PeriodicalIF":9.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599647","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":"Effects of Omega-3 Fatty Acid Treatment on Risk for Atrial Fibrillation: An Updated Meta-Analysis of 35 Trials including 114 592 Individuals.","authors":"Nada R Abuknesha, James H O'Keefe, Frank Qian, Nathan L Tintle, Yidie Lin, Yue Sun, Han-Zhu Qian, Paul S Aisen, Christine M Albert, William J Aronson, Abdul Aziz A Asbeutah, Heike A Bischoff-Ferrari, Matthew J Budoff, Nicholas R Burns, Cecilia A Cardenas, Cynthia M Carlsson, Emily Y Chew, Neal J Cohen, Léopold K Fezeu, Amana Liddell, Pilar Galan, Mark A Hull, Tsuo-Hung Lan, Pan-Yen Lin, Alexia Mengelberg, Anne-Marie Minihane, Joseph F Quinn, Thomas A B Sanders, Andrew Scholey, David A Schoenfeld, Kirsty Sprange, Kuan-Pin Su, Christopher H van Dyck, Carol A Van Hulle, David Vauzour, Claire Weber, Francine K Welty, Gary Wittert, William S Harris","doi":"10.1161/CIRCEP.125.014785","DOIUrl":"10.1161/CIRCEP.125.014785","url":null,"abstract":"<p><strong>Background: </strong>Recent meta-analyses of randomized controlled trials have raised concerns that treatment with omega-3 fatty acids may increase the risk of atrial fibrillation (AF). However, these meta-analyses included at most 8 trials. The aim of this current meta-analysis was to expand the search by including other eligible omega-3 randomized controlled trials with AF incidence data, incorporating both published and unpublished data.</p><p><strong>Methods: </strong>Eligible studies were randomized controlled trials investigating daily doses of ≥500 mg/d of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Additional inclusion criteria included ≥12 months of treatment with EPA/DHA, participants ≥50 years of age, and, where possible, the absence of known AF/atrial flutter at baseline. The primary outcome was the occurrence of new-onset AF. Our primary hypothesis was that risk for AF would simultaneously depend on both omega-3 dose (above or below 1500 mg/d) and background cardiovascular disease risk status, and that their combined impact on AF risk would be synergistic.</p><p><strong>Results: </strong>A total of 35 randomized controlled trials (37 data sets; n=114 592) were included in this meta-analysis. Only studies including patients at high-risk for cardiovascular disease who were treated with high-doses of EPA/DHA (>1500 mg/d) showed a statistically significant increase in AF risk with a pooled odds ratio (OR) of 1.43 (95% CI, 1.14-1.79) and an absolute risk difference of 0.8% (0.40%-1.1%). None of the other 3 groups showed statistically significant levels of AF risk (odds ratios, 1.07 [high risk-low dose], 1.06 [low risk-low dose], and 1.03 [low risk-high dose]).</p><p><strong>Conclusions: </strong>This meta-analysis suggests that high-dose EPA/DHA treatment is associated with an increased risk of AF in patients at high cardiovascular disease risk, whereas low-dose EPA/DHA does not appear to increase AF risk, even in high-risk populations. Further prospective studies are needed to evaluate any potential increased risk of higher doses balanced against potential benefits.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014785"},"PeriodicalIF":9.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13489779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599704","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":"Effect of Exercise Training on Myocardial and Residual Scar Electrophysiology in Post-MI Rats.","authors":"Tomas O Stølen, Mathias Nyman, Karin Garten, Francis L Burton, Jan Pål Loennechen, Godfrey L Smith, Anne B Johnsen","doi":"10.1161/CIRCEP.125.014248","DOIUrl":"10.1161/CIRCEP.125.014248","url":null,"abstract":"<p><strong>Background: </strong>Exercise training improves contractile function and can reduce arrhythmia burden after a myocardial infarction (MI). How exercise modifies the proarrhythmic status is uncertain.</p><p><strong>Methods: </strong>In this study, rats 6 weeks post-MI were randomized to an 8-week high-intensity exercise program (MI-EX) or to a sedentary control group (MI-SED) and compared with a sedentary sham group (Sham-SED). After the exercise program, in vivo and ex vivo programmed electrical stimulation was performed on the rat hearts. Subsequently, optical mapping was conducted to electrophysiologically characterize the MI hearts.</p><p><strong>Results: </strong>Exercise significantly improved maximal oxygen uptake (<i>V</i>O_2max; MI-EX, 67 mL·min^-1·kg^-^0.75 versus MI-SED, 47 mL·min^-¹·kg^-^0.75). In vivo cardiac stimulation protocols indicated reduced inducibility of ventricular arrhythmias in MI-EX compared with MI-SED. This anti-arrhythmic effect was retained ex vivo in Langendorff-perfused hearts. Optical mapping of the noninfarcted left ventricle indicated a prolonged average action potential (AP) duration at 4.5 Hz pacing frequency in both MI groups compared with Sham-SED. As pacing frequency increased (6.5 Hz and ≈8 Hz), AP duration remained significantly longer in the MI-SED group but decreased in the MI-EX group, demonstrating a negative frequency dependency. Spatial heterogeneity of AP duration in the noninfarcted left ventricle area was increased post-MI but was significantly reduced following exercise. Optical AP recorded from the remnant myocardium within the scar showed similar AP duration characteristics at low stimulation frequencies, but AP upstroke time was shorter in the MI-EX group compared with MI-SED.</p><p><strong>Conclusions: </strong>Post-MI exercise was associated with electrophysiological changes in both the noninfarcted region and the remnant myocardium within the scar. These changes suggest a mechanism for the anti-arrhythmic effects of exercise following MI.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014248"},"PeriodicalIF":9.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366958","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":"Identifying the Presence and Characteristics of Mid-Myocardial and Epicardial Fibrosis From Intracardiac Electrograms in Patients Undergoing Ventricular Arrhythmia Ablation Using a Transformer-Based Self-Supervised Classifier.","authors":"Xichong Liu, Abdul Qayyum, Sabyasachi Bandyopadhyay, Sulaiman Somani, Prasanth Ganesan, Rayan A Ansari, Hui Ju Chang, Alexander C Perino, Nitish Badhwar, Paul J Wang, Steven Niederer, Sanjiv M Narayan, Albert J Rogers","doi":"10.1161/CIRCEP.125.014765","DOIUrl":"10.1161/CIRCEP.125.014765","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation is an essential tool for ventricular arrhythmia management, yet sustained procedural success is hindered by the limited ability to identify nonendocardial arrhythmogenic substrates during the procedure. Although delayed enhancement cardiac magnetic resonance imaging is the reference standard for detecting myocardial fibrosis, barriers including cost, workflow complexity, and artifacts in patients with implantable devices limit its preprocedural use. We hypothesized that intracardiac electrograms provide sufficient information to infer scar beyond the endocardial surface and that this information can be harnessed by machine learning techniques.</p><p><strong>Methods: </strong>This retrospective study included a total of 131 584 cardiac contact electrogram (EGM) signals collected from 46 patients undergoing ventricular arrhythmia ablation. A stratified patient-wise split was used to create the training/validation set (N=37) and the testing set (N=9), while ensuring a similar distribution of scar types. We developed a novel image-processing workflow to create scar labels using coregistered cardiac magnetic resonance imaging and electroanatomic mapping surface meshes. We developed a transformer-based self-supervised model, EGM2Scar-AI, alongside basic convolutional neural network models using either EGM waveforms or EGM-derived short-time Fourier transform spectrograms.</p><p><strong>Results: </strong>The average task-specific area under the receiver operating characteristic curve of both the basic and short-time Fourier transform-based convolutional neural networks was 0.729 (0.725-0.732) and 0.729 (0.726-0.733), respectively, while EGM2Scar-AI performed significantly better with an average area under the receiver operating characteristic curve of 0.822 (0.819-0.825) across all 3 scar types. All models performed better on endocardial and mid-myocardial fibrosis identification, with a modest reduction in performance for epicardial fibrosis. Sensitivity improved significantly with the transformer-based architecture without appreciable changes in specificity.</p><p><strong>Conclusions: </strong>Our study demonstrates that routine intracardiac electrograms enable the identification of endocardial, mid-myocardial, and epicardial scar using a transformer-based self-supervised deep learning model. Ultimately, our model has the potential to provide magnetic resonance imaging-like fibrosis maps during EP procedures without the need for external imaging and to increase the data set size for patient-specific models in ventricular arrhythmia research.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014765"},"PeriodicalIF":9.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396136","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 of Two-Dimensional Speckle-Tracking Echocardiography for Assessing Ablation Complexity in Left Ventricular Outflow Tract Premature Ventricular Contractions.","authors":"Shinya Yamada, Takashi Kaneshiro, Minoru Nodera, Sadahiro Murota, Hidetomo Onuma, Yukio Yamadera, Masayoshi Oikawa, Takafumi Ishida, Yasuchika Takeishi","doi":"10.1161/CIRCEP.126.014913","DOIUrl":"10.1161/CIRCEP.126.014913","url":null,"abstract":"<p><strong>Background: </strong>The origins of left ventricular outflow tract premature ventricular contractions (PVCs) differ in depth and may involve preferential pathways, potentially requiring complex ablation. However, a noninvasive method to preprocedurally estimate ablation complexity has not been established.</p><p><strong>Methods: </strong>Sixteen patients with idiopathic left ventricular outflow tract PVCs (V2 transition ratio ≥0.6) underwent 2-dimensional speckle-tracking echocardiography during monomorphic PVCs. Endocardial peak systolic strain timing in 18 left ventricular segments was displayed on a bull's-eye map using 8 color-coded intervals (0-800 ms). Patients were classified as localized (n=6) when the earliest interval appeared in 1 segment and nonlocalized (n=10) when it involved ≥2 segments. Ablation outcomes were compared according to whether a simple ablation approach (PVC elimination within 30 s at a single site) was achieved.</p><p><strong>Results: </strong>Baseline electrocardiographic characteristics were comparable between the groups. Ablation-related parameters, including contact force, power output, and impedance drop at the initial ablation site, were also similar. However, the nonlocalized group required statistically significantly greater total radiofrequency energy to eliminate the targeted PVCs (median, 22,206 versus 10,409 J; <i>P</i>=0.031) and demonstrated a statistically significantly lower rate of successful simple ablation approach compared with the localized group (20.0% versus 83.3%; <i>P</i>=0.035). Nonlocalized patterns may reflect conduction from deeper origins with preferential pathways, thereby requiring more complex ablation strategies.</p><p><strong>Conclusions: </strong>A localized earliest-strain pattern was associated with successful PVC elimination using a simple ablation approach, whereas a nonlocalized pattern indicated the need for more complex ablation. This simple, noninvasive metric may aid preprocedural planning for left ventricular outflow tract PVC ablation.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014913"},"PeriodicalIF":9.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148307234","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":"cAMP-Activated EPAC Signaling Is an Integral Component of Cardiac Pacemaker Cell Automaticity.","authors":"Tatiana M Vinogradova, Daniel R Riordon, Dongmei Yang, Kirill V Tarasov, Yelena S Tarasova, Bruce Ziman, Edward G Lakatta","doi":"10.1161/CIRCEP.125.014455","DOIUrl":"10.1161/CIRCEP.125.014455","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous automaticity of sinoatrial node cells (SANCs) is driven by a system that couples ion channels, membrane clock and Ca²⁺clock, the sarcoplasmic reticulum generated LCRs (local subsarcolemmal Ca²⁺releases). Although LCRs are critically dependent on high basal cAMP and both PKA (protein kinase A)- and CaMKII (Ca²⁺/calmodulin dependent protein kinase II)-dependent protein phosphorylation, the link between cAMP and CaMKII remains unclear. Here, we tested a hypothesis that high cAMP activates EPAC (exchange protein directly activated by cAMP) which increases basal CaMKII activity, reinforcing the Coupled clock pacemaker system, to boost LCRs and accelerate spontaneous SANC firing.</p><p><strong>Methods: </strong>Real-time quantitative polymerase chain reaction, Western blot, immunostaining, whole-cell patch clamp, and line-scan confocal microscopy were employed to study EPAC-dependent regulation of rabbit SANC firing.</p><p><strong>Results: </strong>Both EPAC isoforms were expressed and active in SANC. Selective inhibition of EPAC1 (CE3F4) or EPAC2 (HJC0350) similarly suppressed basal CaMKII activity, CaMKII-dependent phosphorylation of Ca²⁺-cycling proteins (PLB [phospholamban] and RyR [ryanodine receptors]) and reduced the amplitude of L-type Ca²⁺current. EPAC1 and EPAC2 inhibitors significantly decreased LCR number, size, and prolonged the LCR period (interval between prior AP-induced Ca²⁺ transient and LCR) reducing spontaneous SANC firing by ≈30%. In contrast, EPAC activator (8-pCPT) increased LCR number and size, shortened the LCR period and accelerated spontaneous firing by≈18%. EPAC-mediated effects were implemented in PKC (protein kinase C)-dependent manner via EPAC-PLC-PKC-CaMKII signaling pathway, since PKC inhibitor reproduced effects of EPAC inhibition on CaMKII activity, CaMKII-dependent phosphorylation of Ca²⁺-cycling proteins, LCR parameters, and spontaneous SANC firing.</p><p><strong>Conclusions: </strong>EPAC is an essential component of basal cardiac pacemaker function, which accelerates spontaneous automaticity of SANC via an increase in basal CaMKII-dependent phosphorylation of Ca²⁺-cycling proteins (PLB, RyR, L-type Ca²⁺channels, and likely others), leading to amplification of LCR parameters, shortening of LCR timing and resultant spontaneous cycle length. Consequently, EPAC might represent a novel therapeutic target to regulate resting heart rate and treat sinoatrial node dysfunction.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014455"},"PeriodicalIF":9.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316084","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":"Discovery of Novel Magnetocardiography Parameters Predicting Future ICD Therapies: Insights From the Magneto-SCD Study.","authors":"Thomas Lachlan, Hejie He, Adam Miller, Nakul Chandan, Shoaib Siddiqui, Roger Beadle, David Wilson, Sanjiv Petkar, Peter K Kimani, G Andre Ng, Faizel Osman","doi":"10.1161/CIRCEP.126.014998","DOIUrl":"10.1161/CIRCEP.126.014998","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014998"},"PeriodicalIF":9.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249300","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":"Tau20-RETROmapping System Identifies Driver-Like Activation Patterns in Real Time During Persistent Atrial Fibrillation.","authors":"Oliver S Jones, Nick Linton, Stewart Bissett, Simos Koutsoftidis, Jamie Kay, Huiyi Wu, Ji-Jian Chow, Norman Qureshi, Tina Baykaner, Junaid Zaman, Thorsten Lewalter, Ali Anil Demircali, Qindong Zheng, Fergus Heaney, Ivin Jose, Louisa C Malcolme-Lawes, Michael Koa-Wing, Boon Lim, Ahran D Arnold, Nicholas S Peters, Daniel Keene, Fu Siong Ng, Zachary I Whinnett, Burak Temelkuran, Emmanuel Drakakis, Prapa Kanagaratnam","doi":"10.1161/CIRCEP.126.015039","DOIUrl":"10.1161/CIRCEP.126.015039","url":null,"abstract":"<p><strong>Background: </strong>Conventional activation mapping of atrial fibrillation (AF) during clinical procedures is limited by low-amplitude, fractionated electrograms and cycle length variability. The Tau20-RETROmapping stimulator-recorder system (TauRhythm Therapies, United Kingdom) is an investigational device used to identify nonpulmonary vein AF drivers by real-time, high-density activation mapping of uniform wavefronts during AF. We validated the accuracy of the system and applied it to left atrial mapping for evidence of AF drivers.</p><p><strong>Methods: </strong>Left atrial geometry was acquired using a 3-dimensional electroanatomic mapping system with high-density mapping catheters (CARTO 3 with Optrell, or EnSite X with HD Grid). Electrograms were recorded for 30 seconds at multiple left atrial sites. The Tau20-RETROmapping system generates activation maps of organized wavefronts. System performance was manually validated against randomly sampled local electrograms using a grid sweep of thresholds to identify Pareto-optimal parameters in sinus rhythm, atrial pacing, atrial tachycardia (AT), and AF. The system was then applied to identify putative driver activation patterns during persistent AF.</p><p><strong>Results: </strong>We studied 24 patients undergoing pulmonary vein isolation for AF. Six patients presented in sinus rhythm or AT, in whom the system demonstrated a sensitivity of 100.0% (95% CI, 80.5%-100.0%) and a specificity of 100.0% (85.2%-100.0%). Eighteen patients were mapped in AF: the system had a sensitivity of 94.4% (86.2%-98.4%) and a specificity of 97.1% (89.9%-99.6%) when identifying organized AF wavefronts, and accurately identified the earliest activation in 89.6% (79.7%-95.7%) of waves. Stable propagation originating from the left atrial appendage (LAA) was observed in 3/18 patients, while 8/18 demonstrated competing propagation toward and away from the LAA. Conduction away from the LAA was detected along the anterior (8/18 patients), lateral (8/18 patients), and posterior (7/18 patients) walls. No propagation near the LAA was observed in 6/18 patients.</p><p><strong>Conclusions: </strong>The Tau20-RETROmapping system enables real-time activation mapping of AF, with the most convincing driver-like areas being identified around the LAA.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e015039"},"PeriodicalIF":9.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366980","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":"Interpretable Multimodal AI to predict the Presence of Late Gadolinium Enhancement on Cardiac Magnetic Resonance Imaging in Cardiac Sarcoidosis Patients.","authors":"Ishan Vatsaraj, Shane Loeffler, Eugene G Kholmovski, Maryam Mojarrad Sani, Nisha A Gilotra, Jonathan Chrispin, Natalia A Trayanova","doi":"10.1161/CIRCEP.125.014627","DOIUrl":"10.1161/CIRCEP.125.014627","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014627"},"PeriodicalIF":9.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13332396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270410","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}