JACC. Clinical electrophysiology最新文献

{"title":"Clinical Response to Resynchronization Therapy: Conduction System Pacing vs Biventricular Pacing. CONSYST-CRT trial.","authors":"Margarida Pujol-López, Freddy R Graterol, Roger Borràs, Cora Garcia-Ribas, J Baptiste Guichard, Mariona Regany-Closa, Rafael Jiménez-Arjona, Mireia Niebla, Marina Poza, Esther Carro, M Ángeles Castel, Elena Arbelo, Andreu Porta-Sánchez, Marta Sitges, Ivo Roca-Luque, Adelina Doltra, Eduard Guasch, José M Tolosana, Lluís Mont","doi":"10.1016/j.jacep.2025.03.024","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.024","url":null,"abstract":"<p><strong>Background: </strong>Randomized studies comparing conduction system pacing (CSP) with biventricular pacing (BiVP) are scarce and do not include clinical outcomes.</p><p><strong>Objectives: </strong>The CONSYST-CRT (Conduction System Pacing vs Biventricular Resynchronization Therapy in Systolic Dysfunction and Wide QRS) trial aimed to test the noninferiority of CSP as compared with BiVP in patients with an indication for cardiac resynchronization therapy, with respect to a combined clinical endpoint at 1-year follow-up.</p><p><strong>Methods: </strong>CONSYST-CRT is a randomized, controlled, noninferiority trial (NCT05187611). One hundred thirty-four patients with cardiac resynchronization therapy indication were randomized to BiVP or CSP and followed up for 12 months. Crossover was allowed when the primary allocation procedure failed. The atrioventricular interval was optimized to obtain fusion with intrinsic conduction. The primary combined endpoint was all-cause mortality, cardiac transplant, heart failure hospitalization, or left ventricular ejection fraction (LVEF) improvement <5 points at 12 months. Secondary endpoints were LVEF increase, LV end-systolic volume (LVESV) decrease, echocardiographic response (≥15% LVESV decrease), QRS shortening, septal flash correction, NYHA functional class improvement, and a combined endpoint of all-cause mortality, cardiac transplantation, and heart failure hospitalization.</p><p><strong>Results: </strong>Sixty-seven patients were allocated to each group. Eighteen patients (26.9%) crossed from CSP to BiVP; 5 (7.5%) crossed over from BiVP to CSP. Noninferiority (NI) was observed for CSP compared with BiVP for the primary endpoint (23.9% vs 29.8%, respectively; mean difference -5.9; 95% CI: -21.1 to 9.2; P = 0.02) and for the combined endpoint of all-cause mortality, cardiac transplantation, and heart failure hospitalization (11.9% vs 17.9%; P < 0.01 NI); echocardiographic response (66.6% vs 59.7%; P = 0.03 NI); NYHA functional class (P < 0.001 NI); and QRS shortening (P < 0.01). LVEF, LVESV, and septal flash endpoint values were similar, but noninferiority was not met (14.1 ± 10% vs 14.4 ± 10%, -27.9 ± 27% vs -27.9 ± 28%, -2.2 ± 2.7 mm vs -2.7 ± 2.4 mm, respectively).</p><p><strong>Conclusions: </strong>CSP was noninferior to BiVP in achieving clinical and echocardiographic response, suggesting that CSP could be an alternative to BiVP. (Conduction System Pacing vs Biventricular Resynchronization Therapy in Systolic Dysfunction and Wide QRS [CONSYST-CRT]; NCT05187611).</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077833","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":"PVI With CF-Sensing Large-Tip Focal PFA Catheter With 3D Mapping for Paroxysmal AF: Omny-IRE 3-Month Results.","authors":"Mattias Duytschaever, Massimo Grimaldi, Tom De Potter, Atul Verma, Laurent Macle, Josef Kautzner, Dominik Linz, Ante Anic, Hugo Van Herendael, Gediminas Rackauskas, Petr Neuzil, Julian Chun, Boris Schmidt, Sebastien Knecht, Alexandre Almorad, Benjamin Berte, Vivek Y Reddy, Johan Vijgen","doi":"10.1016/j.jacep.2025.04.008","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.04.008","url":null,"abstract":"<p><strong>Background: </strong>Omny-IRE (A Study For Treatment of Paroxysmal Atrial Fibrillation [PAF] With the OMNYPULSE Catheter and the TRUPULSE Generator; NCT05971693) evaluated safety and effectiveness of a novel large-tip focal, multielectrode, contact force-sensing, pulsed field ablation catheter with electroanatomic mapping integration.</p><p><strong>Objectives: </strong>This study sought to assess 3-month safety and effectiveness of the platform for treating symptomatic paroxysmal atrial fibrillation.</p><p><strong>Methods: </strong>Pulmonary vein isolation (PVI) was performed using the OMNYPULSE Platform. Primary effectiveness was adenosine/isoproterenol-proof entrance block. Primary safety was occurrence of primary adverse events. Prespecified patient subsets underwent systematic brain imaging, esophageal endoscopy, cardiac computed tomography/magnetic resonance angiogram, and mandatory 3-month remapping for PVI durability assessment.</p><p><strong>Results: </strong>Of 188 patients enrolled, 136 were included in the per-protocol analysis. Primary effectiveness was 100% (136 of 136). Median (Q1-Q3) procedure, left atrial dwell, total ablation, and total fluoroscopy times were 105.5 (91.0-124.0), 70.0 (56.0-81.5), 46.9 (37.1-58.8), and 5.0 (3.1-9.8) minutes, respectively. The primary adverse event rate was 3.0% (4 of 135 patients with 3-month follow-up; 3 major vascular access complications, 1 pericarditis). Brain imaging (n = 30) revealed 1 patient (3.3%) with an asymptomatic silent cerebral event at discharge, which resolved at 1 month without neurological change. No esophageal injury was observed. Computed tomography/magnetic resonance angiogram imaging (n = 24) showed no incidences of pulmonary vein narrowing >70%. During remapping, PVI was durable in 84.5% (98 of 116) of veins and 62.1% (18 of 29) of patients. With an optimized workflow, PVI durability improved to 89.3% (75 of 84) and 71.4% (15 of 21) of veins and patients, respectively.</p><p><strong>Conclusions: </strong>The force-sensing, large-focal pulsed field ablation catheter with 3-dimensional electroanatomic mapping integration showed 100% acute success with a promising safety profile for treating paroxysmal atrial fibrillation. Prespecified remapping showed good PVI durability. (A Study For Treatment of Paroxysmal Atrial Fibrillation [PAF] With the OMNYPULSE Catheter and the TRUPULSE Generator; NCT05971693).</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010200","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":"Use of High-Power, Short-Duration Radiofrequency Applications to Target Purkinje Tissue and Ablate Ventricular Fibrillation.","authors":"Robert N Kerley, Uyanga Batnyam, Babak Nazer, Esseim Sharma, Jorge E Romero, Usha B Tedrow, William H Sauer","doi":"10.1016/j.jacep.2025.04.014","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.04.014","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015799","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":"Effect of Anterior vs Posterior Dispersive Patch Placement on Radiofrequency Ablation Lesion Size in Swine.","authors":"Ramkumar V Venkateswaran, Shohei Kataoka, Chang Hee Kwon, Sung Ho Lee, Edward P Gerstenfeld","doi":"10.1016/j.jacep.2025.04.009","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.04.009","url":null,"abstract":"<p><strong>Background: </strong>Ablation of ventricular tachycardia using radiofrequency (RF) energy can be challenging for deep circuits. Standard RF ablation is monopolar, with energy delivered between the catheter and a dispersive patch (DP). Aligning the DP with the direction of RF application may shift the RF field to create deeper lesions.</p><p><strong>Objectives: </strong>The authors sought to compare left ventricular lesion size with concordant (patch oriented in the direction of ablation) versus discordant DP placement in swine.</p><p><strong>Methods: </strong>An irrigated, contact force sensing RF catheter was used to apply lesions to the anterior and posterior left ventricles in swine. Two DPs were attached, and the ground was randomly chosen so that one-half of the lesions were concordant (eg, anterior RF/anterior DP) and one-half were discordant (eg, anterior RF/posterior DP). Ablation parameters otherwise remained constant.</p><p><strong>Results: </strong>A total of 77 lesions (38 concordant, 39 discordant) in 10 swine were analyzed. Contact force (18.0 ± 3.2 g vs 17.6 ± 3.5 g; P = 0.606) and baseline impedance (111.3 ± 7.5 Ω vs 110.9 ± 7.3 Ω; P = 0.782) were similar between groups. Lesions with concordant compared with discordant DP had greater lesion depth (7.4 ± 1.8 vs 6.1 ± 1.6 mm; P = 0.001) and area (72.5 ± 22.2 mm² vs 59.6 ± 17.5 mm²; P = 0.006).</p><p><strong>Conclusions: </strong>Placing the DP on the body surface concordant with the direction of RF ablation results in ∼20% increase in lesion depth. This simple modification can be used to enhance RF lesion size.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996970","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 and Electrophysiological Characteristics of Inducible Polymorphic Ventricular Tachycardia in Repaired Tetralogy of Fallot.","authors":"Jeremy P Moore, Eihab Ghantous, Victor Waldmann, Francis Bessière, Nawel Babouri, Mitchell I Cohen, Edward T O'Leary, Nimesh S Patel, Babak Nazer, Weiyi Tan, Frank A Fish, Aarti S 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.2025.04.016","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.04.016","url":null,"abstract":"<p><strong>Background: </strong>Although sustained monomorphic ventricular tachycardia (MVT) in repaired tetralogy of Fallot (TOF) is linked to abnormally conducting anatomical isthmuses, the clinical importance of inducible polymorphic ventricular tachycardia (PVT) is unclear.</p><p><strong>Objectives: </strong>The aim of this study was to determine the clinical and electrophysiological characteristics of inducible PVT in TOF.</p><p><strong>Methods: </strong>Patients from the ongoing CATAPULT-TOF (Catheter Ablation of Ventricular Tachycardia Before Transcatheter Pulmonary Valve Replacement in Repaired Tetralogy of Fallot) registry with inducible sustained PVT at index electrophysiology study were included. Abnormal anatomical isthmus was defined as conduction velocity <0.5 m/s. Centrally adjudicated episodes with ≥3 consecutive beats of similar morphology (10 of 12 leads) were labeled transiently organized PVT (TO-PVT). TO-PVT was analyzed in relation to three-dimensional substrate characteristics and postablation inducibility.</p><p><strong>Results: </strong>Of 186 patients (mean age 40 years; 55% male), sustained PVT was induced at 27 procedures (15%). Patients with PVT vs MVT were more likely to undergo operation in the current era (P = 0.008), not require palliative shunt (P = 0.01), exhibit a lower right ventricular end-diastolic volume/left ventricular end-diastolic volume ratio (P = 0.02), and harbor faster anatomical isthmus conduction velocity (P = 0.03). Of those with available electrocardiography data, greater number of TO beats was associated with ≥1 anatomical isthmus (median 3 vs 0 beats; P = 0.001). The proportion with TO-PVT decreased with catheter ablation, with 14 of 24 identified at baseline (58%; median 3.5 beats; cycle length 181 milliseconds), 3 (23%) of 13 postablation, and 1 (8%) of 13 at follow-up electrophysiology study (P_trend = 0.001).</p><p><strong>Conclusions: </strong>Patients with inducible PVT display a lower clinical risk profile and healthier myocardial substrate than those with MVT. Organized beats at episode onset appear to be associated with anatomical isthmuses that can be targeted by catheter ablation.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001197","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":"S-ICD Implantation Following TV-ICD: Insights Into Patients With Infections and Abandoned Leads-the HONEST Cohort.","authors":"Vasileios Sousonis, Peggy Jacon, Fawzi Kerkouri, Rodrigue Garcia, Christelle Marquié, Walid Amara, Fréderic Anselme, Nicolas Badenco, Nathalie Behar, Mohamed Belhameche, Abdeslam Bouzeman, Samir Fareh, Benoît Guy-Moyat, Alexis Hermida, Jérome Hourdain, Laurence Jesel, Pierre Khattar, Ziad Khoueiry, Gabriel Laurent, Vladimir Manenti, Alexis Mechulan, Aymeric Menet, Antoine Milhem, Pierre Mondoly, Pierre Ollitrault, David Perrot, Michael Peyrol, Bertrand Pierre, Nicolas Sadoul, Didier Scarlatti, Jerome Taieb, Claire Vanesson, Pierre Winum, Vincent Probst, Eloi Marijon, Pascal Defaye, Serge Boveda","doi":"10.1016/j.jacep.2025.04.020","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.04.020","url":null,"abstract":"<p><strong>Background: </strong>Subcutaneous implantable cardioverter-defibrillators (S-ICDs) can be a viable option for patients with transvenous ICDs experiencing complications (rescue S-ICD).</p><p><strong>Objectives: </strong>This study sought to evaluate the outcomes of rescue S-ICD implantation using data from the HONEST French nationwide S-ICD cohort.</p><p><strong>Methods: </strong>All rescue S-ICD patients were identified. Outcomes (complications, reinterventions, and mortality) were compared between rescue and de novo S-ICD patients. Subgroup analyses were performed based on the implantation indication (infective vs noninfective) and the presence of abandoned leads.</p><p><strong>Results: </strong>Among 4,924 patients in the HONEST cohort, 651 underwent rescue S-ICD implantation (295 with infective indications, 244 with abandoned leads). Over a follow-up of 4.2 ± 2.2 years, complications and reinterventions were similar in rescue and de novo S-ICD patients (22.6% vs 21.0%; P = 0.35 and 8.7% vs 7.2%; P = 0.17, respectively), in infective and noninfective rescue S-ICD patients (21.6% vs 23.5%; P = 0.55 and 8.9% vs 8.6%; P = 0.90, respectively) and in patients with abandoned and extracted leads (24.3% vs 21.7%; P = 0.46 and 8.3% vs 9.0%; P = 0.77, respectively). Mortality was higher in rescue compared to de novo S-ICD patients (16.9% vs 10.2%; P < 0.001) and in rescue S-ICD patients with infective indications (29.2% vs 6.7%; P < 0.001) and extracted leads (21.9% vs 8.6%; P < 0.001), mainly due to a higher burden of comorbidities, as none of these parameters was independently associated with mortality in multivariate analyses. No S-ICD-related deaths were observed.</p><p><strong>Conclusions: </strong>Rescue S-ICD implantation is an acceptable option for patients with device-related complications. Lead abandonment in the setting of a noninfective indication appears to be safe. (S-ICD French Cohort Study [HONEST]; NCT05302115).</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002343","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":"Patient Centered mobile Health TECHnology Enabled Atrial Fibrillation Management (mTECH Afib): A Pilot Randomized Controlled Trial.","authors":"Nino Isakadze, Natalie A Horstman, Jie Ding, Courtney Eddy, Stephney Blair, Chang H Kim, Luu V Pham, Francoise A Marvel, Erin M Spaulding, Mansi Nimbalkar, Erin D Michos, Jeffrey Sham, Patrick Dunn, Joseph E Marine, Hugh Calkins, Seth S Martin, David Spragg","doi":"10.1016/j.jacep.2025.02.015","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.015","url":null,"abstract":"<p><strong>Background: </strong>Digital health technologies provide a scalable, efficient approach to implementing guideline-recommended risk factor modification in the care of patients with atrial fibrillation (AF).</p><p><strong>Objectives: </strong>This study aimed to evaluate the feasibility of a 12-week, multicomponent, virtual AF management program using a smartphone application, connected devices, and virtual coaching calls for risk factor modification.</p><p><strong>Methods: </strong>Patients with AF were enrolled from outpatient clinics. Patients were randomized in a 1:1 ratio to either usual care only or the virtual program. The study objectives were to assess feasibility, with the goal of achieving at least 60% participant retention at 12 weeks, intervention engagement, and participant satisfaction.</p><p><strong>Results: </strong>Among 61 patients enrolled (76% of those approached), the mean age was 65 ± 8 years, and 36% were women. A total of 89% of all participants were retained by 12-week follow-up. In the intervention group, at 12-weeks, 88% continued using the smartphone application, 73% continued participation in virtual coaching calls, and 80% reported being satisfied with the program.</p><p><strong>Conclusions: </strong>The mTECH Afib (Patient Centered mobile health TECHnology Enabled Atrial Fibrillation Management) trial demonstrates feasibility of conducting a randomized controlled trial using an innovative digital health technology-enabled intervention with broad patient engagement and acceptance of the program components. Large-scale clinical trials powered for health outcomes will be necessary to establish intervention efficacy.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017736","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":"Health Care Cost Burden of Atrial Fibrillation Presentations to Emergency Departments.","authors":"Luke P Dawson, Jocasta Ball, Andrew Wilson, Lance Emerson, Aleksandr Voskoboinik, Ziad Nehme, Mark Horrigan, David Kaye, Jonathan M Kalman, Peter M Kistler, Dion Stub","doi":"10.1016/j.jacep.2025.03.023","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.023","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077842","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":"Flecainide for the Treatment of Andersen-Tawil Syndrome.","authors":"Tomer D Mann, Ayhan Yoruk, Raquel A Neves, Auke T Bergman, Martijn J Bos, Christian van der Werf, Michael H Gollob, Jason D Roberts, Habib Khan, Shubhayan Sanatani, Vasanth Vedantham, Byron K Lee, Anastasiea Yesaulov, Andrew D Krahn, Rafik Tadros, Arthur A Wilde, Michael J Ackerman, Melvin M Scheinman","doi":"10.1016/j.jacep.2025.03.020","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.020","url":null,"abstract":"<p><strong>Background: </strong>Andersen-Tawil syndrome type 1 (ATS1) is a rare arrhythmogenic disorder resulting from loss-of-function mutations in KCNJ2. Although the use of flecainide has been proposed to treat and prevent life-threatening arrhythmic events in ATS1, it has only been tested in small case series with limited follow-up. We performed a multicenter cohort study to determine the impact of flecainide on ATS.</p><p><strong>Objectives: </strong>This study aimed to assess the efficacy and safety of flecainide in reducing ventricular arrhythmia and related symptoms in patients with ATS1.</p><p><strong>Methods: </strong>Clinical and genetic data from consecutive ATS1 patients from 9 centers were collected and entered into a database at UCSF Medical Center, San Francisco, California, USA, and pooled for analysis.</p><p><strong>Results: </strong>The study included 31 ATS1 patients with a median age of 27 years (Q1-Q3: 24-38 years). The median follow-up time was 4.2 years (Q1-Q3: 1.6-9.7 years), and the median daily dose of flecainide was 150 mg (Q1-Q3: 100-200 mg). A positive exercise treadmill test was defined as any ventricular arrhythmia other than occasional single premature ventricular contractions, and was seen in 16 of 18 patients before treatment. This decreased to 5 of 18 patients with flecainide (OR: 0.13; P = 0.035). One episode of nonsustained ventricular tachycardia was observed on exercise treadmill test during flecainide treatment, compared with 6 observed during pretreatment. The ventricular arrhythmia score, defined as the most severe arrhythmia on Holter monitoring, improved in 66% of patients (mean improvement 0.62 ± 1.6 U; P = 0.005). Premature ventricular contraction burden decreased by 84.8% (71.5%-100%), from 22.3% at baseline to 3.8% with flecainide (P < 0.001). While on flecainide, symptomatic patients had a 77.7% chance of becoming symptom-free (95% CI: 56.2%-100%). Most patients (21/25, 84%) reported no side effects. One patient experienced a VT storm while treated with flecainide but tolerated a lower dose with a good response.</p><p><strong>Conclusions: </strong>These data demonstrate that flecainide treatment may be effective and well-tolerated in ATS1 patients. The occurrence of an arrhythmic storm in 1 patient underscores the potential for toxicity and mandates careful dose titration monitored by rest and exercise electrocardiogram for QRS widening.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077838","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 Mitral Regurgitation on Outcomes of Catheter Ablation for AF With Left Ventricular Systolic Dysfunction.","authors":"Louise Segan, Sandeep Prabhu, Shane Nanayakkara, Andrew Taylor, James Hare, Rose Crowley, Jeremy William, Kenneth Cho, Michael Lim, Youlin Koh, Souvik Das, David Chieng, Hariharan Sugumar, Aleksandr Voskoboinik, Liang-Han Ling, Benedict Costello, David M Kaye, Alex McLellan, Geoffrey Lee, Joseph B Morton, Jonathan M Kalman, Peter M Kistler","doi":"10.1016/j.jacep.2025.04.002","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.04.002","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) and left ventricular (LV) systolic dysfunction (LVSD) may be associated with function mitral and tricuspid regurgitation (FMR/FTR). Prior studies have largely assessed impact of MR on AF ablation outcomes in the presence of preserved LV ejection fraction.</p><p><strong>Objectives: </strong>This study sought to determine the impact of FMR on the outcomes of catheter ablation (CA) in patients with AF and LVSD.</p><p><strong>Methods: </strong>We examined baseline clinical characteristics, CA outcomes, and change in echocardiographic parameters (FMR and FTR severity, LV and left atrial [LA] dimensions, LVEF) at baseline and 12 months in individuals with AF and LVSD with at least mild FMR undergoing CA. Patients with primary mitral valve disease were excluded.</p><p><strong>Results: </strong>235 patients (age 62.8 years,16.2% female, NYHA functional class III (Q1-Q3: II-III)) underwent CA and were categorized by FMR severity at baseline (mild n = 117; moderate/severe n = 118). Baseline characteristics were comparable irrespective of degree of FMR, other than lower LVEF (LVEF 29% [Q1-Q3: 22.8%-35.0%] vs 35% [Q1-Q3: 30.0%-41.0%]; P < 0.001) and increased tricuspid regurgitation in moderate/severe MR (22%) vs mild MR (8%, P < 0.001). LA size did not differ significantly across FMR groups (P = 0.233). At 12 months following CA, recurrent atrial arrhythmia occurred in 101 of 235 (43.0%) including 42.7% in mild vs 43.2% in moderate-to-severe MR (P = 0.940). The severity of FMR did not influence arrhythmia recurrence (OR: 1.15; 95% CI: 0.54-1.86; P = 0.601) nor LV recovery (OR: 1.07; 95% CI: 0.67-1.25; P = 0.153). After CA, 89% of those with significant FMR and 85% with significant FTR exhibited ≥1 grade reduction at 12 months. Change in LV dimensions was associated with MR responders (OR: 0.93; 95% CI: 0.87-0.99; P = 0.022) with a greater reduction in LV size at 12 months in MR improvement (-5.0 (Q1-Q3: -9.3 to -1.0) vs non-improvement -1.0 (Q1-Q3: -5.0 to 2.5), P = 0.004) whereas change in LA size was not (OR: 0.98; 95% CI: 0.97-1.03; P = 0.984).</p><p><strong>Conclusions: </strong>In patients with AF and LVSD, the degree of FMR did not impact the success of ablation. There was a significant reduction in FMR and FTR at 12 months following CA. Patients with AF and LVSD should be strongly considered for AF ablation irrespective of the degree of mitral regurgitation.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015774","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}