JACC. Clinical electrophysiology最新文献

{"title":"Mechanistic Insights Into Reduced Arrhythmia Prevalence in Female Endurance Athletes.","authors":"Paolo D'Ambrosio, Jarne De Paepe, Stephanie J Rowe, Kristel Janssens, Amy M Mitchell, Tim Van Puyvelde, Luke W Spencer, Jan Bogaert, Olivier Ghekiere, Rik Pauwels, Lieven Herbots, Tomas Robyns, Peter M Kistler, Jonathan M Kalman, Hein Heidbuchel, Rik Willems, Guido Claessen, André La Gerche","doi":"10.1016/j.jacep.2025.05.023","DOIUrl":"10.1016/j.jacep.2025.05.023","url":null,"abstract":"<p><strong>Background: </strong>Female athletes exhibit lower rates of atrial fibrillation (AF) and sudden cardiac death compared with male athletes, but the mechanisms behind this sex disparity in arrhythmia risk remain unclear.</p><p><strong>Methods: </strong>This study analyzed findings from Holter monitors, echocardiograms, and cardiac magnetic resonance imaging in a cohort of 397 endurance athletes enriched with prevalent AF. Athletes with cardiomyopathies, channelopathies, pre-excitation, and/or myocardial infarction were excluded.</p><p><strong>Results: </strong>Female athletes (n = 125; age 27 [18-47] years) had a lower prevalence of AF (6% vs 31%; P < 0.001) and nonsustained ventricular tachycardia (2% vs 11%; P = 0.004) than male athletes (n = 272; age 44 [22-61] years). Despite comparable exercise volume and sports duration, female athletes had lower maximal oxygen consumption. Female athletes had smaller age-adjusted left atrial volume (40 [34-47] mL/m² vs 44 [37-52] mL/m²; P = 0.007) and ventricular volume (indexed left ventricular end-diastolic volume: 98 ± 16 mL/m² vs 109 ± 21 mL/m²; P < 0.001; indexed right ventricular end-diastolic volume: 109 ± 20 mL/m² vs 123 ± 23 mL/m²; P < 0.001). Age-adjusted hinge (13% vs 24%; P = 0.120) and non-hinge-point (12% vs 20%; P = 0.875) fibrosis were equally prevalent between the sexes. Lower left ventricular mass, similar native T1 times, and higher extracellular volume in female athletes suggested less cardiomyocyte hypertrophy than in male athletes. Compared with a subset of 125 age-matched male athletes, female athletes had a similar prevalence of atrial and ventricular ectopy. Less bradycardia and lower resting and peak exercise blood pressure in female athletes suggested additional modulating factors.</p><p><strong>Conclusions: </strong>Lower rates of AF and nonsustained ventricular tachycardia in female athletes may be attributed to smaller atrial and ventricular volumes and reduced cardiomyocyte hypertrophy, although there are likely additional modulating factors. A comparable prevalence of ectopy suggests that the disparity in arrhythmia risk may be more attributable to differences in underlying substrate than arrhythmogenic triggers.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698543","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":"Right Coronary Artery Occlusion due to Adventitial Hematoma During Cavotricuspid Isthmus Ablation.","authors":"Hiroyuki Asada, Mitsuru Takami, Shumpei Mori, Yu Izawa, Hiroyuki Kawamori, Koji Fukuzawa","doi":"10.1016/j.jacep.2025.06.008","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.06.008","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753344","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":"Microvascular Rarefaction in the Sinoatrial Node: A Potential Mechanism for Pacemaker Dysfunction in Early HFpEF.","authors":"Declan Manning, Ernesto J Rivera, Paula Rhana, Collin Matsumoto, Zhihui Fong, Phung N Thai, Manuel F Muñoz, Jorge E Contreras, Sei Kim, Nathan Grainger, Nipavan Chiamvimonvat, Geoanna M Bautista, L Fernando Santana","doi":"10.1016/j.jacep.2025.06.007","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.06.007","url":null,"abstract":"<p><strong>Background: </strong>Microvascular rarefaction is a feature of heart failure with preserved ejection fraction (HFpEF) that may underlie associated rhythm disturbances. Angiotensin II (AngII) signaling has been implicated, but its role in sinoatrial (SA) node dysfunction remains unclear.</p><p><strong>Objectives: </strong>The authors tested whether changes in SA node microvascular architecture contribute to pacemaker dysfunction in early HFpEF.</p><p><strong>Methods: </strong>Mice received a 28-day subcutaneous infusion of a sub-pressor dose of AngII. Electrocardiography, echocardiography, confocal imaging, spatial RNA detection, and optical mapping were used to assess SA node structure and function.</p><p><strong>Results: </strong>Heart rate declined progressively during AngII infusion, with males falling from 605 ± 6 beats/min to 490 ± 6 beats/min and females from 646 ± 23 beats/min to 511 ± 10 beats/min by day 28. Bradycardia was accompanied by increased beat-to-beat variability: the percentage of consecutive heartbeats that differed in duration by >6 milliseconds increased from 3.5% ± 1.3% to 32.1% ± 4.5% in males and from 3.8% ± 1.1% to 27.7% ± 2.5% in females. These changes coincided with reduced microvessel density in the superior SA node (males: 6.1 ± 0.5 nm/μm³ to 3.9 ± 0.2 nm/μm³; females: 5.6 ± 0.4 to 2.8 ± 0.5 nm/μm³), whereas vessels in the inferior SA node remained unchanged. Despite preserved myocyte density, these changes were accompanied by up-regulation of oxidative stress and the hypoxia-inducible factor 1α and vascular endothelial growth factor signaling pathways.</p><p><strong>Conclusions: </strong>These findings highlight microvascular rarefaction in the superior SA node as a key early event in HFpEF pathology. The loss of redundant vascular loops compromises metabolic support for pacemaking, illustrating a broader principle: rarefaction can impair excitability in metabolically demanding excitable tissues.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698544","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":"Scar Wars: Ethanolization Strikes Back in Atrial Tachyarrhythmia Post-Mitral Valve Surgery.","authors":"Reshma Amin, Sebastien Knecht","doi":"10.1016/j.jacep.2025.05.024","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.05.024","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753345","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 Ventricular Pacing-Induced Ventricular Tachycardia: Electrophysiological Mechanisms of Pacing Site-Driven Activation Pattern and Conduction Delay.","authors":"Natnicha Pongbangli, Akiko Ueda, Yumi Katsume, Akiko Maeda, Seiichiro Matsuo, Kyoko Soejima","doi":"10.1016/j.jacep.2025.05.011","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.05.011","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698542","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":"Ventricular Intramyocardial Navigation for Tachycardia Ablation Guided by Electrograms (VINTAGE): Initial Human Experience.","authors":"Neal K Bhatia, Rim N Halaby, Christopher G Bruce, Anand D Shah, Nitish Badhwar, Adam B Greenbaum, Vasilis C Babaliaros, Robert J Lederman","doi":"10.1016/j.jacep.2025.06.003","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.06.003","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation for ventricular arrhythmias is limited by a high first-attempt failure rate approaching 50% to 60%. Failure appears driven by physical inaccessibility of mapping and ablating deep intramyocardial substrate. Ventricular Intramyocardial Navigation for Tachycardia Ablation Guided by Electrograms (VINTAGE) is a novel procedure to steer guidewires within the walls of the beating left ventricle (LV) from a right ventricular entry point and deliver a deep intramural ablation electrode anywhere within the LV.</p><p><strong>Objectives: </strong>The objective of this work is to assess the provisional safety and efficacy of VINTAGE intramyocardial navigation and ablation as first offered to patients.</p><p><strong>Methods: </strong>This is a retrospective review of all patients who underwent VINTAGE at Emory University in the practice of medicine for recurrent ventricular tachycardia (VT) or a high burden of premature ventricular contractions (PVC) despite prior ablation and antiarrhythmic drugs.</p><p><strong>Results: </strong>Thirteen patients (39% female) with a median of 2 (IQR: 1-3) prior ablations underwent VINTAGE (1 repeat, total 14 procedures), of whom 5 (39%) had VT and 8 (62%) had PVCs. Arrhythmias originated in the LV summit (n = 3), basal-lateral wall (n = 4), septum (n = 3), inferior wall (n = 1), and papillary muscles (n = 2). Technical success was 100%. At median follow-up of 150 days, clinical success by patient (reduction in VT therapy of PVC burden >80%) was 85% (100% for VT and 75% for PVC). Four of 5 (80%) of the VT cohort were free from appropriate implantable cardiac defibrillator shocks, appropriate antitachycardia pacing, or hospital admission due to recurrent VT. One suffered a nondisabling stroke and another a vascular complication.</p><p><strong>Conclusions: </strong>VINTAGE was effective at creating intramural ablation lesions and treating ventricular arrhythmias arising from targets traditionally considered inaccessible from the endocardium and epicardium, including infarcted myocardium.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698545","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":"A Long and Winding Road to Understand and Milk the Paced QRS.","authors":"Marek Jastrzębski","doi":"10.1016/j.jacep.2025.06.002","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.06.002","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649450","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":"Ventricular Pre-Excitation and Long QT Syndrome-Related Ventricular Arrhythmias: Is There a Link?","authors":"Mireia Llevadot, Roger Villuendas, Martina de Raffele, Felipe Bisbal, Axel Sarrias, Daniel Cea-Primo, Júlia Aranyó, Victor Bazan","doi":"10.1016/j.jacep.2025.06.005","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.06.005","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753346","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":"Slow Down; Sharp Curve Ahead!","authors":"Stavros E. Mountantonakis MD, MBA","doi":"10.1016/j.jacep.2025.03.032","DOIUrl":"10.1016/j.jacep.2025.03.032","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 7","pages":"Pages 1451-1452"},"PeriodicalIF":7.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173815","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":"Detecting Arrhythmogenic Right Ventricular Cardiomyopathy From the Electrocardiogram Using Deep Learning","authors":"Sophie Sigfstead ,&nbsp;Chris J. George BSc ,&nbsp;River Jiang MD ,&nbsp;Brianna Davies MSc ,&nbsp;Deepti Ranganathan MD ,&nbsp;Zachary W.M. Laksman MD ,&nbsp;Julia Cadrin-Tourigny MD, PhD ,&nbsp;Rafik Tadros MD ,&nbsp;Habib R. Khan MD, PhD ,&nbsp;Joseph Atallah MD, MSc ,&nbsp;Christian Steinberg MD ,&nbsp;Shubhayan Sanatani MD ,&nbsp;Mario Talajic MD ,&nbsp;Rahul G. Krishnan PhD ,&nbsp;Andrew D. Krahn MD ,&nbsp;Christopher C. Cheung MD, MPH","doi":"10.1016/j.jacep.2025.04.003","DOIUrl":"10.1016/j.jacep.2025.04.003","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 7","pages":"Pages 1613-1615"},"PeriodicalIF":7.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234085","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}