Circulation. Arrhythmia and electrophysiology最新文献

{"title":"Experimental Platform for Screening and Validation of BacNa_v Gene Therapy Candidates.","authors":"Tianyu Wu, Hung X Nguyen, Yiu Yan Siu, Yongwu Li, Nenad Bursac","doi":"10.1161/CIRCEP.125.014425","DOIUrl":"10.1161/CIRCEP.125.014425","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014425"},"PeriodicalIF":9.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13082454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688486","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":"Quantitative Vector Screening to Improve Sensing and Reduce Inappropriate Shocks With the Subcutaneous Implantable Cardioverter Defibrillator.","authors":"Thomas A Boyle, David C Callans, Rajat Deo, Sanjay Dixit, Andres Enriquez, Andrew E Epstein, Fermin Garcia, Gustavo Guandalini, Balaram K Hanumanthu, Matthew C Hyman, Ramanan Kumareswaran, David Lin, Francis E Marchlinski, Timothy M Markman, Maiwand Mirwais, Saman Nazarian, Michael Riley, Vincent See, Poojita Shivamurthy, Gregory E Supple, Robert Schaller, David S Frankel","doi":"10.1161/CIRCEP.125.014581","DOIUrl":"10.1161/CIRCEP.125.014581","url":null,"abstract":"<p><strong>Background: </strong>The subcutaneous implantable cardioverter defibrillator (S-ICD) offers protection from sudden cardiac death without transvenous leads. Although contemporary techniques and programming have reduced inappropriate shocks, high rates persist in certain populations. The objective of this study was to evaluate the impact of a novel quantitative vector screening (QVS) protocol on the incidence of sensing-related complications and inappropriate shocks in patients undergoing S-ICD implantation.</p><p><strong>Methods: </strong>We analyzed 223 consecutive patients who underwent S-ICD implantation at the Hospital of the University of Pennsylvania from December 2018 to July 2025. Traditional vector screening was used before 2023. In 2023, we implemented QVS, which incorporated quantitative sensing scores for each candidate and raised the threshold for S-ICD implantation. The primary end point was time to first inappropriate shock or under-sensed ventricular arrhythmia. Secondary outcomes included SMART Pass deactivation and need for device revision. Outcomes were reported as survival analyses.</p><p><strong>Results: </strong>During preimplant screening, the QVS protocol reduced patient eligibility from 96% to 83%. The median follow-up after implant was 42 months (interquartile range, 48) in the traditional vector screening arm and 18 months (interquartile range, 15) in the QVS arm. The primary end point of time to first inappropriate shock or under-sensed ventricular arrhythmia was longer in the QVS arm (log-rank, <i>P</i>=0.02). There were 23 primary end point events among 145 patients in the traditional vector screening arm (5.2 per 100 patient-years [95% CI, 3.1-7.4]) and 2 primary end point events among 78 patients in the QVS arm (1.8 per 100 patient-years [95% CI, 0.01-4.38]).</p><p><strong>Conclusions: </strong>Implementation of a novel S-ICD screening protocol with stricter eligibility thresholds reduced sensing-related complications, particularly inappropriate shocks.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014581"},"PeriodicalIF":9.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147722011","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":"Screening Smarter: A Quantitative Approach to Reduce Inappropriate Shocks From Subcutaneous ICDs.","authors":"Oliver Monfredi, Pamela K Mason","doi":"10.1161/CIRCEP.126.015114","DOIUrl":"10.1161/CIRCEP.126.015114","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e015114"},"PeriodicalIF":9.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811935","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":"RACGAP1 as a Circulating Biomarker of Atrial Fibrillation in Heart Failure: A Dual-Cohort Proteomic Study.","authors":"Amen Bekele Zelleke, Joe David Azzo, Jonathan D Moreno, Douglas L Mann, Thomas P Cappola, Julio A Chirinos, Ali Javaheri","doi":"10.1161/CIRCEP.125.014024","DOIUrl":"10.1161/CIRCEP.125.014024","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014024"},"PeriodicalIF":9.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669966","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":"Win Ratio Analysis of an Extensive Ablation Strategy in Patients With Persistent Atrial Fibrillation: Insights From the EARNEST-PVI Randomized Trial.","authors":"Yuki Matsuoka, Akihiro Sunaga, Daisuke Sakamoto, Hideaki Hasegawa, Daisaku Nakatani, Katsuki Okada, Hirota Kida, Tetsuhisa Kitamura, Nobuaki Tanaka, Masaharu Masuda, Tetsuya Watanabe, Hitoshi Minamiguchi, Yasuyuki Egami, Takafumi Oka, Miwa Miyoshi, Masato Okada, Yasuhiro Matsuda, Masato Kawasaki, Koichi Inoue, Shungo Hikoso, Tomoharu Dohi, Yohei Sotomi, Yasushi Sakata","doi":"10.1161/CIRCEP.125.014463","DOIUrl":"10.1161/CIRCEP.125.014463","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014463"},"PeriodicalIF":9.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580640","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":"Post-Catheter Ablation Long-Term Antithrombotic Strategies in Atrial Fibrillation: A Network Meta-Analysis of Randomized Controlled Trials.","authors":"Juan F Rodriguez-Riascos, Dravid Navale, Aakash Somappa, Ricardo J Estrada-Mendizabal, Luis R Scott, Win-Kuang Shen, Komandoor Srivathsan","doi":"10.1161/CIRCEP.125.014692","DOIUrl":"10.1161/CIRCEP.125.014692","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation for atrial fibrillation is a widely used rhythm-control strategy, yet its role in reducing thromboembolic risk and enabling oral anticoagulation (OAC) discontinuation remains uncertain. This meta-analysis aims to comprehensively synthesize and evaluate randomized controlled trial evidence supporting long-term antithrombotic strategies in patients with atrial fibrillation undergoing catheter ablation.</p><p><strong>Methods: </strong>A systematic literature search was performed in MEDLINE/PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials evaluating antithrombotic strategies after catheter ablation for atrial fibrillation. The primary outcome was ischemic stroke. A frequentist network meta-analysis comparing reported treatment arms, along with a pooled incidence meta-analysis for outcomes of interest, was conducted.</p><p><strong>Results: </strong>Four randomized controlled trials, including 3924 patients, met the inclusion criteria. Three trials compared long-term OAC continuation versus OAC discontinuation, and 1 compared OAC continuation with left atrial appendage occlusion after catheter ablation. No significant differences in stroke incidence were observed when comparing OAC or left atrial appendage occlusion with no antithrombotic therapy (incidence rate ratio, 0.90 [95% CI, 0.02-33.85]; <i>P</i>=0.95; incidence rate ratio, 0.79 [95% CI, 0.00-241.01]; <i>P</i>=0.94, respectively). Among patients who discontinued antithrombotic therapy without undergoing left atrial appendage occlusion (n=1161), with 2864 cumulative person-years of follow-up, the pooled incidence of stroke was 0.23 events per 100 person-years (95% CI, 0.02-2.43; I²=0%).</p><p><strong>Conclusions: </strong>This analysis reinforces that, across randomized data, the incidence of thromboembolic events in patients who discontinued OAC after successful ablation remained low. However, the evaluation of net clinical benefit is limited by the low number of events across all treatment arms, underscoring the need for larger studies with prolonged follow-up to further validate the safety of this strategy, particularly in higher-risk populations.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014692"},"PeriodicalIF":9.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13098661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608130","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":"Delivery System Support Prevents Endocardial Entanglement and Delamination During Left Bundle Branch Area Pacing.","authors":"Yuichiro Miyazaki, Hiroshi Nakajima, Mark Rimmer, Peter Hanna, Justin H Hayase, Duc H Do, Kalyanam Shivkumar, Shumpei Mori","doi":"10.1161/CIRCEP.125.014355","DOIUrl":"10.1161/CIRCEP.125.014355","url":null,"abstract":"<p><strong>Background: </strong>The mechanisms behind endocardial entanglement and resultant delamination during left bundle branch area pacing, as well as potential solutions, have not been fully demonstrated in the human heart.</p><p><strong>Methods: </strong>Active fixation of a lumenless screw-in lead into the right ventricular septum was attempted with or without delivery system support using donor human hearts rejected for transplant. Delivery sheath support was ensured through firm catheter support maintained by a fixed clip. Endocardial entanglement, endocardial delamination after unscrewing, and lead penetration were evaluated using both macroscopic and microscopic analyses.</p><p><strong>Results: </strong>Each of 10 lead deployments with or without support was attempted using 4 donor human hearts. There was a higher incidence of endocardial entanglement and resultant helix-only penetration in the nonsupport group than the support group (70% versus 0%). Unscrewing after the endocardial entanglement consistently revealed extensively delaminated endocardium entwined around the helix. The median endocardial delamination area was larger in the entanglement group than in the nonentanglement group (25.0 mm² versus 0.9 mm², <i>P</i><0.001). In the regions with endocardial entanglement, histological analysis confirmed extensive endocardial delamination with minimal myocardial injury. On the other hand, localized endocardial delamination and deep intramural penetration were observed in the regions without entanglement. Screw-in procedures reattempted into the regions with extensive endocardial delamination following entanglement achieved deep penetration even without delivery system support.</p><p><strong>Conclusions: </strong>Endocardial entanglement and delamination were confirmed in donor human hearts. Adequate delivery system support, particularly its coaxiality and counterforce effect, is likely to prevent endocardial entanglement and facilitate effective penetration of a lumenless screw-in lead into the human ventricular septum.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014355"},"PeriodicalIF":9.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638097","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":"Anticoagulation De-escalation After Atrial Fibrillation Ablation: Evidence From the OCEAN and ALONE-AF Randomized Trials.","authors":"Song Peng Ang, Julia H Indik","doi":"10.1161/CIRCEP.125.014679","DOIUrl":"10.1161/CIRCEP.125.014679","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014679"},"PeriodicalIF":9.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580696","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":"Differential Impact of Low Voltage Area Radiofrequency Ablation on Recurrence of Atrial Fibrillation Versus Atrial Tachycardia in Patients With Persistent Atrial Fibrillation.","authors":"Daisuke Sakamoto, Akihiro Sunaga, Yuki Matsuoka, Hideaki Hasegawa, Hirota Kida, Tomoharu Dohi, Daisaku Nakatani, Katsuki Okada, Tetsuhisa Kitamura, Masaharu Masuda, Nobuaki Tanaka, Tetsuya Watanabe, Hitoshi Minamiguchi, Yasuyuki Egami, Takafumi Oka, Tomoko Minamisaka, Takashi Kanda, Masato Okada, Masato Kawasaki, Yasuhiro Matsuda, Koji Tanaka, Nobuhiko Makino, Shungo Hikoso, Koichi Inoue, Yohei Sotomi, Yasushi Sakata","doi":"10.1161/CIRCEP.125.014408","DOIUrl":"10.1161/CIRCEP.125.014408","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014408"},"PeriodicalIF":9.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13098648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590298","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":"Female Sex-Related Stroke Risk in Atrial Fibrillation: A Thing From the Past?","authors":"Konsta Teppo, K E Juhani Airaksinen, Jari Haukka, Ville L Langén, Olli Halminen, Jukka Putaala, Miika Linna, Pirjo Mustonen, Juha Hartikainen, Gregory Y H Lip, Mika Lehto","doi":"10.1161/CIRCEP.125.014728","DOIUrl":"10.1161/CIRCEP.125.014728","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014728"},"PeriodicalIF":9.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13098662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147662257","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}