JACC. Clinical electrophysiology最新文献

{"title":"MYL4 Identifies Intramural Anatomy of Purkinje Fibers in Human Hearts.","authors":"Matthew L Hillestad, Matthew Amontree, Ryan C Mahlberg, Monique S Bagwell, Skylar A Rizzo, D Kent Arrell, Parisa K Kargaran, Ruben J Crespo-Diaz, Faisal F Syed, Elli N Lockhart, Tyra A Witt, Paul G Stalboerger, Andre Terzic, Christopher J McLeod, Christopher V DeSimone, Samuel J Asirvatham, Atta Behfar","doi":"10.1016/j.jacep.2025.03.039","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.039","url":null,"abstract":"<p><strong>Background: </strong>Cardiac Purkinje fibers (PFs) orchestrate myocardial synchrony, but in regions of myocardial scarring, drive ventricular arrhythmia. It is hypothesized that arrhythmias refractory to ablation may be driven by PFs deep in the scarred myocardium. However, knowledge of human PF anatomy remains reliant on data generated in animal models, obscuring understanding of the substrate underpinning dysrhythmia and pacing strategies.</p><p><strong>Objectives: </strong>This study sought to establish and utilize a human biomarker to delineate PF anatomy in humans.</p><p><strong>Methods: </strong>RNA-sequencing and differential expression analysis of transcriptomes from human hearts (N = 10) revealed 99 genes up-regulated in PFs vs ventricular myocardium and endocardium. Whole-mount megablock cross-sectional analysis was performed with cardiac troponin, MYL4, periodic acid-Schiff, Masson's Trichrome, pro-ANP, and GJA5 colocalization.</p><p><strong>Results: </strong>Comparative transcriptomics from human hearts (N = 10) identified myosin light chain 4 (MYL4) as a promising human PF marker for distinguishing conductive from contractile myocardium. Using PF-rich bundle branch and subendocardial regions, MYL4 specificity was validated using canonical PF markers in human (n = 3), dog (n = 3), goat (n = 3), and pig (n = 3) hearts. Cross-sectional histology of the entire human ventricular myocardium uncovered a deep-seated network of transmurally intercalated, MYL4-positive PFs. This previously unrecognized distribution of the cardiac conduction system accounted for over 60% of human myocardial PF content.</p><p><strong>Conclusions: </strong>Such significant intramural prevalence exposes limitations associated with treatment approaches based on dogma that PF anatomy is restricted to the subendocardium. MYL4 here enabled a comprehensive visualization of human cardiac conduction system, offering an intricate bioanatomical map for heart rhythm management.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234088","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":"Peri-Atrial Adipose Tissue Inflammation in Atrial Fibrillation: Quantification of Electrophysiological Effects Using Electroanatomic Mapping.","authors":"Keeran Vickneson, Ali Gharaviri, Vinush Vigneswaran, Johanna Tonko, Neil Bodagh, Magdalena Klis, Irum Kotadia, Matthew Wright, David E Newby, Marc R Dweck, Michelle C Williams, Mark O'Neill, John Whitaker, Steven E Williams","doi":"10.1016/j.jacep.2025.04.023","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.04.023","url":null,"abstract":"<p><strong>Background: </strong>Peri-atrial adipose tissue is associated with atrial fibrillation (AF). Increased peri-atrial adipose volume and attenuation, detected by cardiac computed tomography angiography (CTA), have been observed in patients with AF. However, the electrophysiological correlates of both peri-atrial adipose tissue volume and attenuation are unknown.</p><p><strong>Objectives: </strong>This study sought to investigate the spatial relationship between peri-atrial adipose tissue, peri-atrial adipose tissue attenuation, and atrial electrophysiological remodeling.</p><p><strong>Methods: </strong>Cardiac CTA was performed in 37 control subjects and 44 patients with AF. Left atrial bipolar voltage and conduction velocity were co-registered with cardiac CTA-derived peri-atrial adipose tissue segmentations. Mean adipose tissue volume and attenuation were compared with local voltage and conduction velocity measurements.</p><p><strong>Results: </strong>Peri-atrial adipose tissue volume was greater in patients with AF (20.9 cm³ vs 14.2 cm³; adjusted odds ratio: 1.11; 95% CI: 1.01-1.24), independent of left atrial volume indexed to body mass index, left atrial mass, age, sex, sleep apnea, and coronary heart disease. In patients with AF, areas with the highest burden of peri-atrial adipose tissue had lower voltage (1.75 ± 1.72 mV vs 2.11 ± 2.02 mV; P < 0.001) and conduction velocity (0.627 ± 0.55 ms^-1 vs 0.683 ± 0.48 ms^-1; P < 0.001), compared with areas with the lowest burden of peri-atrial adipose tissue. Mean peri-atrial adipose tissue attenuation was similar in both groups. In patients with AF, low peri-atrial adipose tissue attenuation was weakly correlated with reduced bipolar voltage (1.69 ± 1.68 mV vs 2.16 ± 2.07 mV; P < 0.001) and conduction velocity (0.615 ± 0.47 ms^-1 vs 0.684 ± 0.43 ms^-1; P < 0.001).</p><p><strong>Conclusions: </strong>Peri-atrial adipose tissue volume was greater in patients with AF. Increased peri-atrial adipose tissue burden and reduced attenuation were spatially but weakly correlated with adverse electrophysiological remodeling in patients with AF.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274894","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":"High-Density Mapping for Ablation of a Manifest Nodofascicular/Ventricular Pathway.","authors":"Nawin L Ramdat Misier, William A Scott, Natasja M S de Groot, Hoang H Nguyen","doi":"10.1016/j.jacep.2025.03.036","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.036","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173745","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 of Ventricular Tachycardia Ablation Quantity and Quality.","authors":"Wendy S Tzou","doi":"10.1016/j.jacep.2025.04.021","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.04.021","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274892","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":"Purkinje-Related Ventricular Fibrillation Ablation: First Results With Pulsed Field Ablation Using a Lattice-Tip Catheter.","authors":"Marine Arnaud, Benjamin Bouyer, Frederic Sacher, Pierre Jais, Michel Haissaguerre, Meleze Hocini, Josselin Duchateau","doi":"10.1016/j.jacep.2025.04.013","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.04.013","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234089","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":"Conduction System Pacing for Resynchronization Therapy: CONSYSTent and Beyond.","authors":"Mihail G Chelu, Kenneth A Ellenbogen","doi":"10.1016/j.jacep.2025.04.025","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.04.025","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274893","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":"Decades of Defibrillation in Brugada Syndrome: Appropriate or Inappropriate?","authors":"Andrew D Krahn, Benjamin M Moore","doi":"10.1016/j.jacep.2025.03.034","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.034","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173742","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":"Preventing Atrial Tachycardia by Overcoming Residual Conduction.","authors":"Christian Meyer, Ann-Kathrin Kahle","doi":"10.1016/j.jacep.2025.03.026","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.026","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173810","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, Chris J George, River Jiang, Brianna Davies, Deepti Ranganathan, Zachary W M Laksman, Julia Cadrin-Tourigny, Rafik Tadros, Habib R Khan, Joseph Atallah, Christian Steinberg, Shubhayan Sanatani, Mario Talajic, Rahul G Krishnan, Andrew D Krahn, Christopher C Cheung","doi":"10.1016/j.jacep.2025.04.003","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.04.003","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-06","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}

{"title":"Focal Pulsed Field Ablation for Atrial Tachycardia Adjacent to the Phrenic Nerve.","authors":"Jakrin Kewcharoen, Thomas Dewland, Edward P Gerstenfeld","doi":"10.1016/j.jacep.2025.04.004","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.04.004","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234086","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}