Europace最新文献

{"title":"Cellular consequences of non-ablative radiotherapy, a novel approach to ventricular tachycardias.","authors":"Claudia Maniezzi, Stefano Busti, Angela S Maione, Elena Sommariva, Chiara Florindi, Francesca Misitano, Ilenia Anzaldi, Francesco P Cammarata, Giusi I Forte, Roberto Catalano, Gaetano M De Ferrari, Francesco Lodola, Antonio Zaza","doi":"10.1093/europace/euag282","DOIUrl":"https://doi.org/10.1093/europace/euag282","url":null,"abstract":"<p><strong>Background and aims: </strong>Radiotherapy (RT) with a single application of ionizing radiation (STAR) has been suggested as a non-invasive alternative to radiofrequency in ablating ventricular tachycardia (VT). Emerging data reveal that STAR may suppress VT without substrate destruction, by enhancing impulse conduction instead, through increased expression of NaV1.5 channels and connexin 43. The study aims to investigate electrophysiology and intracellular Ca2+ dynamics in cardiomyocytes (CMs) from mice subjected to in-vivo RT. The emerging data led us to evaluate biochemical changes potentially linking electrophysiological response to ionizing irradiation.</p><p><strong>Methods: </strong>CMs isolated 2 weeks after RT with low-dose (15 Gy) or high-dose (25 Gy) were compared to those of sham-treated mice (CTRL). We evaluated: i) the properties of the transient (INaT) and sustained (INasus) components of INa; ii) AP parameters, including the prevalence of Early After-Depolarizations (EADs); iii) intracellular Ca2+ dynamics; iv) CaMKII phosphorylation and v) ROS content.</p><p><strong>Results: </strong>25 Gy RT i) increased INaT and, to a larger extent, INasus (increased INasus/INaT ratio); ii) increased AP amplitude, +dV/dtMAX and duration (APD) and facilitated EADs; iii) depressed intracellular Ca2+ dynamics. 15 Gy RT had similar but smaller effects (dose-dependency). 25 Gy RT reduced CaMKII phosphorylation but increased cell ROS content, thus providing a mechanism for the late component of INa (INaL) enhancement.</p><p><strong>Conclusions: </strong>The results support the view that STAR may supress VT by increasing conduction velocity, with APD prolongation providing an additional mechanism. On the other hand, INasus enhancement and Ca2+ handling depression may impair electrical stability and contractility in the irradiated region.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":10.2,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206684","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":"Coexistance of Carotid Sinus Hypersensitivity and Orthostatic Hypotension in Patients with Unexplained Syncope.","authors":"Sara Hassan, Hannes Holm, Frederik de Lange, Rose Anne Kenny, Michele Brignole, Artur Fedorowski","doi":"10.1093/europace/euag295","DOIUrl":"https://doi.org/10.1093/europace/euag295","url":null,"abstract":"<p><strong>Background: </strong>Carotid sinus hypersensitivity (CSH) and orthostatic hypotension (OH) are established causes of syncope but are often considered separate entities. However, evidence suggests that CSH and OH may coexist and jointly contribute to syncope. This study investigates the relationship between CSH and OH in patients with unexplained syncope.</p><p><strong>Methods: </strong>A total of 1,908 patients aged ≥40 years (age, 63.7 ± 13.0 years; men, 45.3%) with unexplained syncope underwent carotid sinus massage (CSM) and head-up tilt testing (HUT). Occurrence of CSH in classical and delayed OH, including asystolic CSM responses was analysed.</p><p><strong>Results: </strong>Six-hundred-and-eighteen patients (32.4%, 68.9 ± 11.3 years) had OH, while CSH was present in 320 patients (16.8%, 72.2 ± 9.9 years), and was more common in patients with OH than without OH (24.1% vs. 13.3%, p < 0.001). Among patients with CSH, 46.6% also had OH. CSH occurred equally in both classical OH (62/275, 22.5%) and delayed OH (87/345, 25.2%). Among OH patients, CSH was associated with older age, male sex, lower supine diastolic blood pressure, hypertension, and syncope-related hospital admission. An asystolic CSM response was observed more often in OH patients (n = 42; 6.8%) compared with non-OH patients (n = 44, 3.4%, p < 0.001) and was associated with older age and lower resting heart rate.</p><p><strong>Conclusions: </strong>CSH and OH frequently coexist in adults over 40 years evaluated for syncope. CSM may reveal a clinically relevant cardioinhibitory reflex in a subgroup of OH patients, supporting comprehensive cardiovascular autonomic testing in unexplained syncope.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":10.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192256","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 as First-Line Therapy for the Treatment of Atrial Fibrillation: a FARADISE Sub-Analysis.","authors":"Ignacio García-Bolao, Nándor Szegedi, Johan Vijgen, Gábor Széplaki, Antonio Dello Russo, Michael Efremidis, Stephan Willems, Haris Haqqani, Estelle Gandjbakhch, Martin Fiala, Georgios Andrikopoulos, Armin Luik, Pascal Defaye, Alexandre Ouss, Patrick Lugenbiel, Pawel Balsam, Alan Bulava, Michael Gramlich, Lars Eckardt, Azlan Hussin, Claire A Martin, Mattias Duytschaever, Joaquín Osca, Alexis Elfstrum, Nele Cielen, Madeline Johnson, Angelo Auricchio, Lucas Va Boersma","doi":"10.1093/europace/euag275","DOIUrl":"https://doi.org/10.1093/europace/euag275","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":10.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180165","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 Procedural Experience Implanting a Next Generation Left Atrial Appendage Occluder -VERITAS Study Insights.","authors":"Devi Nair, Dhanunjaya Lakkireddy, Mohamad Alkhouli, Xavier Freixa, Christopher R Ellis, Akash Makkar, Dipak Shah, Courtney Weiler, Jens Erik Nielsen-Kudsk","doi":"10.1093/europace/euag289","DOIUrl":"https://doi.org/10.1093/europace/euag289","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":10.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106172","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":"Potassium-Increasing Regimens in Patients at High Risk of Ventricular Arrhythmias: A Prespecified Observational Analysis of the Randomized POTCAST Trial.","authors":"Elisabeth Margrethe Danielsen, Emil Anton Frandsen, Ulrik Christian Gudbrand Winsløw, Chaoqun Zheng, Tharsika Sakthivel, Kasper Karmark Iversen, Helle Skovmand Bosselmann, Niels Risum, Henning Bundgaard, Christian Jøns","doi":"10.1093/europace/euag272","DOIUrl":"https://doi.org/10.1093/europace/euag272","url":null,"abstract":"<p><strong>Background and aims: </strong>The POTCAST trial (n=1,200) showed that targeting high-normal plasma potassium levels reduced ventricular arrhythmias in patients with Implantable Cardioverter-Defibrillators (ICDs). We compared changes in plasma potassium and described outcomes across the three regimens used to increase plasma potassium.</p><p><strong>Methods: </strong>We studied 600 control participants and 572 intervention participants who completed potassium up-titration in POTCAST. Participants in the intervention arm were categorized according to treatment after plasma-potassium up-titration into: a) mineralocorticoid-receptor antagonists (MRAs) monotherapy, b) potassium-supplement monotherapy, or c) combination-therapy with both. The primary endpoint was a composite of sustained ventricular arrhythmia, appropriate ICD-therapy, hospitalization for arrhythmia or heart-failure or all-cause mortality. Safety outcomes included death and electrolyte/renal disturbances.</p><p><strong>Results: </strong>After six months, plasma potassium increased from 4.12 to 4.27 mmol/L (p=0.004) with MRA, from 3.99 to 4.24 mmol/L (p<0.001) with potassium-supplements, and from 3.98 to 4.34 mmol/L (p<0.001) with combination-therapy. The primary endpoint occurred in 29% (n=175) of controls, 22% (n=16) in the MRA group, 21% (n=31) in the potassium-supplements group and in 22% (n=72) in the combination-therapy group (p=0.8 between regimens). Hypokalemia occurred in 13% of controls and in 3%, 9%, and 5% of participants receiving MRA, potassium-supplements and combination-therapy, respectively. Hyperkalemia occurred in 0.2% of controls and in 0%, 3%, and 4% of participants receiving MRA, potassium-supplements, and combination-therapy (p>0.1 between regimens).</p><p><strong>Conclusions: </strong>Treatment with MRA, potassium-supplements or both increased potassium levels. All regimens were associated with numerically lower endpoint rates than controls. We detected no statistically significant differences in endpoints or safety between regimens.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":10.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106227","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":"Percutaneous Left Atrial Appendage Closure: The CHAMPION-like vs CLOSURE-like Patient Phenotype Framework.","authors":"Sergio Berti, Philippe Garot, Giancarlo Trimarchi, Jens Erik Nielsen-Kudsk, Gregory Y H Lip, Carsten Skurk, Valeria Caso, Lucas V A Boersma, Domenico G Della Rocca, Giuseppe Boriani, Alan John Camm","doi":"10.1093/europace/euag286","DOIUrl":"https://doi.org/10.1093/europace/euag286","url":null,"abstract":"<p><strong>Aims: </strong>The near-simultaneous publication of CHAMPION-AF and CLOSURE-AF produced apparently discordant evidence regarding percutaneous left atrial appendage closure (LAAC) for stroke prevention in atrial fibrillation. We aimed to reconcile these findings through a phenotype-based framework and identify the determinants of net clinical benefit.</p><p><strong>Methods and results: </strong>This narrative review integrates randomized trials, registries, consensus documents, and guidelines, focusing on patient selection, procedural risk, post-implant antithrombotic therapy, endpoint construction, competing mortality, and time to benefit. CHAMPION-AF evaluated LAAC against direct oral anticoagulation in an elective, anticoagulation-eligible population with lower bleeding risk, demonstrating non-inferior thromboembolic protection and less non-procedural bleeding. Conversely, CLOSURE-AF enrolled an older, multimorbid population with substantial renal dysfunction, previous bleeding, and high competing mortality. Although implantation success and stroke rates were comparable between treatment groups, early procedural and antithrombotic-related bleeding, a composite endpoint incorporating procedural events, and limited survival reduced the opportunity for delayed benefit. The highly selective recruitment pathway further limits generalisability. These findings define a continuum from the \"CHAMPION-like\" patient, with sufficient physiological reserve and life expectancy to realise long-term benefit, to the \"CLOSURE-like\" patient, in whom frailty and competing risk may outweigh the advantage of appendage exclusion.</p><p><strong>Conclusion: </strong>LAAC efficacy is not determined by device performance alone but by matching the intervention to patient phenotype and time horizon. Selection should integrate thromboembolic and bleeding risk, frailty, renal function, post-implant treatment tolerance, and expected survival. Future trials require transparent screening data, time-sensitive endpoints, landmark analyses, and competing-risk methods.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":10.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106211","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":"Delayed structural myocardial injury after stereotactic arrhythmia radioablation: A serial CMR study in a porcine model.","authors":"Eva Goethals, Luka Nys, Robin De Roover, Kenneth Poels, Patricia Holemans, Maarten Blondeel, Vincent Vandenboer, Dylan Vermoortele, Tom Depuydt, Patrick Berkovic, Joris Ector, Piet Claus, Bert Vandenberk, Eef Dries","doi":"10.1093/europace/euag283","DOIUrl":"https://doi.org/10.1093/europace/euag283","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":10.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106121","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":"Clinical relevance of lead-induced tricuspid regurgitation after transvenous ICD implantation in arrhythmogenic cardiomyopathy.","authors":"Federico Migliore, Raimondo Pittorru, Alberto Cipriani, Giulia Winnicki, Gaia Zancanaro, Jacopo Rosso, Sara Pisoni, Marco Previtero, Veronica Azzolin, Manuel De Lazzari, Nicolò Martini, Alessandro Rizzo, Barbara Bauce, Domenico Corrado","doi":"10.1093/europace/euag284","DOIUrl":"https://doi.org/10.1093/europace/euag284","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":10.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106196","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":"Safety of catheter ablation for atrial fibrillation during hospitalization for acute heart failure: a nationwide analysis from the jROAD-dpc database.","authors":"Haruka Matsuura, Koshiro Kanaoka, Shoko Chishaki, Koki Takegawa, Yoshitaka Iwanaga, Tetsuhisa Kitamura, Yoshihiro Miyamoto, Kengo Kusano","doi":"10.1093/europace/euag273","DOIUrl":"10.1093/europace/euag273","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":10.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029951","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":"Cognitive function and telemedicine-based, village doctor-led care for atrial fibrillation.","authors":"Mingfang Li, Yang Chen, Shimeng Zhang, Ming Chu, Shu Yang, Youmei Shen, Gregory Y H Lip, Minglong Chen","doi":"10.1093/europace/euag233","DOIUrl":"10.1093/europace/euag233","url":null,"abstract":"<p><strong>Aims: </strong>Cognitive impairment is common among older patients with atrial fibrillation (AF). We aimed to evaluate whether baseline cognitive function modifies the effectiveness of a telemedicine-based, village doctor-led integrated care in older patients with AF.</p><p><strong>Methods: </strong>This was a post hoc subgroup analysis of the MIRACLE-AF cluster-randomized trial conducted across 30 village clinics in China from December 2020 to May 2024. Rural participants aged ≥65 years with AF received telemedicine-based, village doctor-led integrated AF care or usual care. Participants were categorized by baseline Mini-Mental State Examination (MMSE) score into severe cognitive impairment (MMSE < 18), mild-to-moderate cognitive impairment (MMSE 18-23), and preserved cognition (MMSE ≥ 24). The primary outcome was a composite of cardiovascular death, all strokes, hospitalization for worsening heart failure or acute coronary syndrome, and emergency visits for AF.</p><p><strong>Results: </strong>Among 1039 participants enrolled in the MIRACLE-AF trial [mean (SD) age, 75.8 (5.7) years; 460 women (44.3%)], 1028 (98.9%) had baseline MMSE assessed (388 with MMSE < 18, 305 with MMSE 18-23, and 335 with MMSE ≥ 24). Compared with control, the intervention reduced the risk of the primary outcome among patients with MMSE 18-23 [adjusted hazard ratio (HR), 0.56; 95% CI, 0.34-0.92], MMSE ≥ 24 (adjusted HR, 0.55; 95% CI, 0.32-0.93), and MMSE < 18 (adjusted HR, 0.86; 95% CI, 0.54-1.35). P for interaction was 0.336.</p><p><strong>Conclusion: </strong>A telemedicine-based, village doctor-led integrated care model was associated with favourable outcomes across baseline cognitive strata, warranting further evaluation among cognitively vulnerable adults with AF in rural settings.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov (identifier NCT04622514).</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":10.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839671","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}