JACC. Clinical electrophysiology最新文献

{"title":"Adrenergic Hypersensitivity Drives Ventricular Arrhythmias Following Loss of Plexin-Mediated Cardiac Innervation.","authors":"Ching Zhu, Takako Makita, Emilio Y Lucero, Arun Jyothidasan, Rhea Patel, Jessica J Wang, Yang Cao, Howard A Rockman, Kalyanam Shivkumar","doi":"10.1016/j.jacep.2025.08.016","DOIUrl":"10.1016/j.jacep.2025.08.016","url":null,"abstract":"<p><strong>Background: </strong>Ventricular arrhythmias (VAs) are a leading cause of death and arise from a combination of cardiac muscle injury and dysfunction of the intramyocardial sympathetic nerves that control cardiac electrophysiology. The adrenergic mechanisms by which intramyocardial nerves contribute to arrhythmogenesis are poorly understood. Semaphorin-plexin signaling pathways are responsible for developmental guidance of sympathetic nerves onto the heart and have previously been associated with VAs in humans.</p><p><strong>Objectives: </strong>This study sought to investigate adrenergic control of arrhythmogenesis, this study explored the cardiac electrophysiology of a Plexin-A3/-A4 double knockout mouse model with loss of cardiac adrenergic nerves.</p><p><strong>Methods: </strong>Cardiac structure and function were studied by using tissue clearing, immunohistochemistry, and echocardiography. Electrocardiogram and optical mapping of action potentials were used to evaluate electrophysiological responses to pharmacologic β-adrenergic stimulation and blockade. Circulating catecholamines were measured and β-adrenergic receptor density quantified in cardiac membranes. Finally, a phenome-wide association study was performed by using data from the UK Biobank to search for associations between PLXNA4 and human arrhythmias.</p><p><strong>Results: </strong>Mice with loss of plexin-dependent cardiac innervation had structurally normal hearts but displayed spontaneous VAs driven by adrenergic hypersensitivity, as well as increased cardiac β-adrenergic receptor density. Several human PLXNA4 variants were associated with arrhythmia phenotypes.</p><p><strong>Conclusions: </strong>These data establish a model of VAs driven by enhanced adrenergic receptor signaling, in the absence of structural heart disease. This model can be used to investigate adrenergic mechanisms of arrhythmogenesis and to identify novel antiarrhythmic targets.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212729","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":"An Isthmus Runs Through It.","authors":"Geoffrey A Rubin, Hirad Yarmohammadi","doi":"10.1016/j.jacep.2025.08.015","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.08.015","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212767","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":"Atrial Fibrillation Burden: Not All Measures Are Created Equally.","authors":"Jason G Andrade","doi":"10.1016/j.jacep.2025.08.013","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.08.013","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212690","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":"TEMPORARY REMOVAL: Survival of Older Patients Who Receive Cardiac Resynchronization Therapy Devices With or Without Defibrillation Capability.","authors":"Samir Saba, Sandeep Jain, N A Mark Estes, Madhurmeet Singh, Alaa Shalaby","doi":"10.1016/j.jacep.2025.08.010","DOIUrl":"10.1016/j.jacep.2025.08.010","url":null,"abstract":"<p><p>The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies-and-standards/article-withdrawal.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137654","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 Device Compression on Peridevice Leak After Left Atrial Appendage Closure: The Impression LAAC Study.","authors":"Vincenzo Mirco La Fazia, Roberto Galea, Domenico Giovanni Della Rocca, Carola Gianni, Antanas Gasys, Sanghamitra Mohanty, Raouf Madhkour, Nicola Pierucci, Prem Geeta Torlapati, Konstantina Chalkou, Gaetano Chiricolo, Caroline Chong-Nguyen, Rodney Horton, Amin Al-Ahmad, Luigi Di Biase, Lorenz Räber, Andrea Natale","doi":"10.1016/j.jacep.2025.08.014","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.08.014","url":null,"abstract":"<p><strong>Background: </strong>Left atrial appendage closure (LAAC) is an established therapeutic strategy to prevent ischemic stroke in selected patients with atrial fibrillation. However, residual peridevice leaks (PDLs) post-LAAC remain a critical concern.</p><p><strong>Objectives: </strong>This study sought to assess the clinical impact of Watchman FLX device overcompression.</p><p><strong>Methods: </strong>Data on consecutive patients undergoing a transesophageal echocardiography (TEE)-guided LAAC between 2020 and 2023 in 2 high-LAAC volume centers were collected and patients with a device compression higher (overcompression group) or lower (normal compression group) than 30% as evaluated by procedural TEE were compared in terms of procedural complications, composite of cardiovascular death, ischemic stroke, or systemic embolism, and PDL at TEE follow-up.</p><p><strong>Results: </strong>This study included 61 overcompression and 175 normal compression patients. Baseline and procedural characteristics did not differ between the 2 groups. Both composite of procedural complications (1.6% vs 1.7%; P = 0.968) and of cardiovascular death, ischemic stroke, or systemic embolism during follow-up (9.8% vs 12%; P = 0.971) did not significantly differ between the 2 groups. At 2-month TEE follow-up, the rate of residual PDL was significantly lower in the overcompression group (8.2% vs 32.6%; P < 0.001). At the multivariate analysis, the device compression rate was the only variable independently associated to risk of PDL at TEE follow-up (adjusted OR: 0.935; 95% CI: 0.927-0.948; P = 0.003).</p><p><strong>Conclusions: </strong>In this dual-center cohort of TEE-guided LAAC, the overcompression group was independently associated to a higher rate of LAA occlusion at TEE follow-up.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212679","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":"Venous Ethanol Ablation as the Sole Treatment for Intramural Ventricular Arrhythmias.","authors":"Mustapha Amin, Maarten De Smet, Adi Lador, Apoor Patel, Paul A Schurmann, Amish Dave, Rene Tavernier, Sebastien Knecht, Mattias Duytschaever, Jean-Benoît le Polain de Waroux, Miguel Valderrábano","doi":"10.1016/j.jacep.2025.08.009","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.08.009","url":null,"abstract":"<p><strong>Background: </strong>Venous ethanol ablation (VEA) can be effective in radiofrequency ablation (RFA) failure but has not been tested as a stand-alone procedure.</p><p><strong>Objectives: </strong>The goal of this study was to determine the value of VEA alone as the sole ablation strategy in intramural ventricular arrhythmias (VAs).</p><p><strong>Methods: </strong>Patients (N = 52; prior failed RFA procedures in 24 patients) underwent mapping of the right and left ventricular endocardium and coronary sinus (CS) branches identified by venography. VEA was a first strategy if the CS intramural veins had earlier pre-systolic or mid-diastolic signals than those elsewhere. If VEA was successful, RFA was omitted. Ablated volume was estimated by intracardiac echocardiography or cardiac magnetic resonance imaging.</p><p><strong>Results: </strong>VAs were either premature ventricular contraction (n = 36) or ventricular tachycardia (VT) (n = 16). Intramural venous signals were 40 milliseconds pre-QRS (Q1-Q3: 32-44 milliseconds) compared with 8 milliseconds (Q1-Q3: 0-15 milliseconds) for best endocardial or CS signals (P < 0.0001). Acute VA suppression occurred in all patients after a median 8 mL (Q1-Q3: 5-15 mL) of ethanol. Ablated volume was 2.5 mL (Q1-Q3: 1.6-4 mL) according to intracardiac echocardiography or 2.8 mL (Q1-Q3: 2.3-7.4 mL) according to cardiac magnetic resonance imaging. VEA resulted in reduction in premature ventricular contraction burden from 21% to 0.5% (P < 0.0001) and the need for ICD therapy in 71% of patients. Six patients experienced recurrence after a median follow-up of 9.5 months, which required repeat procedures in 3 patients. Postoperative complications included pericarditis in 3 patients, groin hematoma in 1, and transient right bundle branch block in 2.</p><p><strong>Conclusions: </strong>VEA-only can be effective as the sole ablation strategy when vein mapping indicates an intramural origin.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137617","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 Atrial Appendage Occlusion in Patients With Prior Intracranial Hemorrhage.","authors":"Moussa Mansour, Victor Novack, James V Freeman, Sarah Zimmerman, William J Tate, Jeptha P Curtis, Zoltan G Turi","doi":"10.1016/j.jacep.2025.07.017","DOIUrl":"10.1016/j.jacep.2025.07.017","url":null,"abstract":"<p><strong>Background: </strong>Patients with atrial fibrillation (AF) and prior intracranial hemorrhage (ICH) have been excluded from clinical trials of left atrial appendage occlusion (LAAO). Because of clinician resistance to oral anticoagulation (OAC) for these patients, alternative stroke prevention methods are needed.</p><p><strong>Objectives: </strong>The aim of this study was to assess outcomes after LAAO in patients with prior ICH.</p><p><strong>Methods: </strong>Patients enrolled in the National Cardiovascular Data Registry Left Atrial Appendage Occlusion Registry (LAAO Registry) from January 2016 to September 2021 with no history of ICH (Group 1) were compared vs those with prior ICH (Group 2). Primary outcomes were combined ischemic/undetermined stroke/transient ischemic attack and ICH.</p><p><strong>Results: </strong>Of 178,918 patients in the LAAO Registry, 133,947 met enrollment criteria (118,519 in Group 1 and 15,428 in Group 2). Group 1 had more cardiovascular comorbidities, whereas Group 2 had higher CHA₂DS₂-VASc and HAS-BLED scores. In-hospital as well as through a median 380-day follow-up, myocardial infarction and gastrointestinal bleeding were more common in Group 1, while neurologic complications occurred more often in Group 2; actual event rates were low. The non-neurologic bleeding in Group 1 was associated with greater use of OAC, while Group 2 had more device-related thrombosis. On multivariable analysis, the adjusted HRs of combined ischemic/undetermined stroke/transient ischemic attack (1.39; 95% CI: 1.25-1.54) and ICH (3.15; 95% CI: 2.69-3.68) were higher in Group 2.</p><p><strong>Conclusions: </strong>Patients with prior ICH undergoing LAAO have increased neurologic complications. However, overall event rates are well below those associated with similar patients not receiving OAC. LAAO seems to be a reasonable option for patients with prior ICH.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080655","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":"Electrical Storm and Hypertrophic Cardiomyopathy: A Bad Combination.","authors":"Thomas Basso, John L Sapp","doi":"10.1016/j.jacep.2025.08.018","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.08.018","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212715","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":"Failure of Transmural Posterior Wall Isolation by Pulse Field Ablation Demonstrated With Epicardial Mapping.","authors":"Luke Sanborn, Amir A Schricker, James Tooley, Carlos Hernandez Borges, Raj Shah, Tom Oka, Christopher Woods","doi":"10.1016/j.jacep.2025.08.017","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.08.017","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212763","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 Slowly Conducting Anatomical Isthmuses and Ventricular Tachycardia Inducibility in Tetralogy of Fallot.","authors":"Victor Waldmann, Jeremy P Moore, Francis Bessière, Nawel Babouri, Mitchell I Cohen, Edward T O'Leary, Nimesh S Patel, Babak Nazer, Weiyi Tan, Frank A Fish, Aarti Dalal, Elisabetta Mariucci, Reina B Tan, Michael S Lloyd, Christopher J McLeod, Charles C Anderson, Ronald J Kanter, Bryce V Johnson, Bo Wang, Philip M Chang, Paul Khairy","doi":"10.1016/j.jacep.2025.08.008","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.08.008","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation of sustained monomorphic ventricular tachycardia (SMVT) guided by the identification of slowly conducting anatomical isthmuses (SCAIs) has been proposed to mitigate the risk of ventricular tachycardia in tetralogy of Fallot (TOF). However, the prevalence and clinical significance of SCAI remain uncertain.</p><p><strong>Objectives: </strong>This study aimed to assess the association between SCAI and SMVT inducibility in patients with TOF.</p><p><strong>Methods: </strong>A multicenter international cohort with retrospective (2017-2021) and prospective (commencing 2021) components enrolled patients with TOF referred for electrophysiological study before transcatheter pulmonary valve replacement. The proportion with SCAI and its association with SMVT inducibility were analyzed.</p><p><strong>Results: </strong>A total of 162 patients (mean age 39.5 ± 14.2 years; 57.4% male) were included. SMVT was induced in 42 (25.9%) patients, and ≥1 SCAI was present in 76 (46.9%) patients. The prevalence of SCAI was higher in patients with inducible SMVT (78.6% vs 31.1%; P < 0.001). However, 21.4% of patients with inducible SMVT had normally conducting anatomical isthmus (14.3%) or a non-anatomical isthmus substrate (7.1%). The area under the curve of SCAI in predicting SMVT inducibility was 0.71 (sensitivity 78.6%; specificity 64.2%). Although SCAI was independently associated with SMVT (OR: 6.4; 95% CI: 2.6-18.2), the association with other clinical parameters improved prediction of SMVT inducibility.</p><p><strong>Conclusions: </strong>SCAI is highly prevalent in patients with TOF and is associated with inducible SMVT. However, the proportion of SCAI in noninducible patients is substantial, and some inducible patients have no SCAI. These findings suggest that SCAI alone is insufficient for arrhythmia management decisions, highlighting the need for an integrative approach combining electrophysiological study with other clinical parameters.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080618","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}