JACC. Clinical electrophysiology最新文献

{"title":"Associations Between Biomarkers of Myocardial Injury and Systemic Inflammation and Risk of Incident Ventricular Arrhythmia","authors":"","doi":"10.1016/j.jacep.2024.04.017","DOIUrl":"10.1016/j.jacep.2024.04.017","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac troponins (cTns) and biomarkers of inflammation are elevated in heart failure (HF) and predict cardiovascular risk. Whether these biomarkers associate with risk of ventricular arrhythmias (VAs) is unclear.</div></div><div><h3>Objectives</h3><div>This study sought to assess whether cTnT, growth differentiation factor 15 (GDF-15), interleukin-6 (IL-6), and C-reactive protein (CRP) concentrations are associated with incident VA.</div></div><div><h3>Methods</h3><div>In a prospective, observational study of patients treated with implantable cardioverter-defibrillator, cTnT, GDF-15, IL-6, and CRP were measured at baseline and after 1.4 ± 0.5 years and were associated with implantable cardioverter-defibrillator–detected incident VA, HF hospitalizations, and mortality.</div></div><div><h3>Results</h3><div>This study included 489 patients aged 66 ± 12 years and 83% were men. Median concentrations of cTnT were 15 (Q1-Q3: 9-25) ng/L at inclusion, and higher concentrations were associated with higher age, male sex, diabetes mellitus, coronary artery disease, and HF. During 3.1 ± 0.7 years of follow-up, 137 patients (28%) had ≥1 VA. cTnT concentrations were associated with an increased VA risk (per log-unit, HR: 1.63; 95% CI: 1.31-2.01; <em>P</em> &lt; 0.001), also after adjustment for age, sex, body mass index, coronary artery disease, HF, renal function, and left ventricular ejection fraction (P &lt; 0.001). GDF-15, IL-6, and CRP concentrations were not associated with incident VA, but all (including cTnT) were associated with HF hospitalization and mortality. Changes in cTnT, GDF-15, IL-6, and CRP from baseline to 1.4 years were not associated with subsequent VA.</div></div><div><h3>Conclusions</h3><div>Higher concentrations of cTnT, GDF-15, IL-6, and CRP associate with HF hospitalization and death, but only cTnT predict incident VA. These findings suggest that myocardial injury rather than inflammation may play a pathophysiological role in VA and sudden cardiac death.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"10 9","pages":"Pages 2021-2032"},"PeriodicalIF":8.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405500X24002950/pdfft?md5=c6a2c1e37bd7d0d7b34766d6a448ff9e&pid=1-s2.0-S2405500X24002950-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141431956","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":"Cardiac Imaging, Histopathologic, and Electrical Correlation of Ventricular Tachycardia Isthmus Substrate in Desmoplakin Cardiomyopathy","authors":"Afsana Rahman MD ,&nbsp;Zhe Zhu MD ,&nbsp;Bruce B. Lerman MD ,&nbsp;Miroslav Sekulic MD, MA ,&nbsp;Jim W. Cheung MD","doi":"10.1016/j.jacep.2024.06.021","DOIUrl":"10.1016/j.jacep.2024.06.021","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"10 9","pages":"Pages 2111-2115"},"PeriodicalIF":8.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995736","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":"Prediction of Sudden Cardiac Death With Ultra-Short-Term Heart Rate Fluctuations","authors":"","doi":"10.1016/j.jacep.2024.04.018","DOIUrl":"10.1016/j.jacep.2024.04.018","url":null,"abstract":"<div><h3>Background</h3><div>Conventional measures of heart rate variability (HRV) have shown only modest associations with sudden cardiac death (SCD). Detrended fluctuation analysis (DFA), with novel methodological developments to evaluate the short-term scaling exponent, is a potentially superior method compared to conventional HRV tools.</div></div><div><h3>Objectives</h3><div>In this study, the authors studied the analysis of the association between DFA and SCD.</div></div><div><h3>Methods</h3><div>The investigators studied the predictive value of ultra-short-term heart rate fluctuations (1-minute electrocardiogram samples) with DFA at rest and during different stages of physical exertion for incident SCD among 2,794 participants undergoing clinical exercise testing in the prospective FINCAVAS (Finnish Cardiovascular Study). The novel key DFA measure, the short-scale scaling exponent computed with second-order detrending (DFA2 α₁), was the main exposure variable. SCDs were defined by American Heart Association/European Society of Cardiology criteria using death certificates with written accounts of the events.</div></div><div><h3>Results</h3><div>During a median follow-up of 8.3 years (Q1-Q3: 6.4-10.5), 83 SCDs occurred. DFA2 α₁ measured at rest (but not in exercise) associated highly significantly with the risk of SCD, with 1-SD lower values associating with a 2.4-fold (Q1-Q3: 2.0-3.0) risk (<em>P</em> &lt; 0.001). The results persisted when adjusting for other major risk factors for SCD, including age, cardiovascular morbidities, cardiorespiratory fitness, heart rate reduction, and left ventricular ejection fraction. Associations between conventional HRV parameters (measured at any stage of exercise or at rest) and SCD were substantially weaker and statistically nonsignificant after adjusting for other risk factors.</div></div><div><h3>Conclusions</h3><div>Ultra-short-term DFA2 α₁, when measured at rest, is a powerful and independent predictor of SCD. The association between DFA2 α₁ and SCD is modified by physical exertion.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"10 9","pages":"Pages 2010-2020"},"PeriodicalIF":8.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405500X24002962/pdfft?md5=4a8d884e07d1b15152f916f65fd09ed9&pid=1-s2.0-S2405500X24002962-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327447","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":"Epicardial Pulsed Field Ablation for the Treatment of Paroxysmal Atrial Fibrillation During Cardiac Surgery","authors":"Daniel R. Musikantow MD ,&nbsp;Vivek Y. Reddy MD ,&nbsp;Tamaz Shaburishvili MD, PhD ,&nbsp;Martin van Zyl MD ,&nbsp;Barry O’Brien PhD ,&nbsp;Ken Coffey BE ,&nbsp;John Reilly BE ,&nbsp;Samuel Asirvatham MD ,&nbsp;Joris R. de Groot MD, PhD","doi":"10.1016/j.jacep.2024.06.012","DOIUrl":"10.1016/j.jacep.2024.06.012","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"10 9","pages":"Pages 2097-2099"},"PeriodicalIF":8.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788056","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":"Mortality in Recipients of Durable Left Ventricular Assist Devices Undergoing Ventricular Tachycardia Ablation","authors":"Patrick T. Lynch MD ,&nbsp;Alexandra Maloof MD ,&nbsp;Anish Badjatiya MD ,&nbsp;Payam Safavi-Naeini MD, MPH ,&nbsp;Matthew W. Segar MD ,&nbsp;Jitae A. Kim MD ,&nbsp;Qussay Marashly MD ,&nbsp;Joanna E. Molina-Razavi MD ,&nbsp;Leo Simpson MD ,&nbsp;Selby B. Oberton MD ,&nbsp;Lola X. Xie MD ,&nbsp;Andrew Civitello MD ,&nbsp;Nilesh Mathuria MD ,&nbsp;Jie Cheng MD, PhD ,&nbsp;Abdi Rasekh MD ,&nbsp;Mohammad Saeed MD ,&nbsp;Mehdi Razavi MD ,&nbsp;Ajith Nair MD ,&nbsp;Mihail G. Chelu MD, PhD","doi":"10.1016/j.jacep.2024.04.037","DOIUrl":"10.1016/j.jacep.2024.04.037","url":null,"abstract":"<div><h3>Background</h3><div>Left ventricular assist device<span> (LVAD) recipients have a higher incidence of ventricular tachycardia (VT). However, the role of VT ablation in this population is not well-established.</span></div></div><div><h3>Objectives</h3><div>This single-center retrospective cohort study sought to examine the impact of post-LVAD implant VT ablation on survival.</div></div><div><h3>Methods</h3><div>This retrospective study examined a cohort of patients that underwent LVAD implantation at Baylor St. Luke’s Medical Center and Texas Heart Institute between January 2011 and January 2021. All-cause estimated mortality was compared across LVAD recipients based on the incidence of VT, timing of VT onset, and the occurrence and timing of VT ablation utilizing Kaplan-Meier survival analysis and Cox proportional hazards models.</div></div><div><h3>Results</h3><div><span>Post-implant VT occurred in 53% of 575 LVAD recipients. Higher mortality was seen among patients with post-implant VT within a year of implantation (HR: 1.62 [95% CI: 1.15-2.27]). Among this cohort, patients who were treated with a catheter ablation had superior survival compared with patients treated with medical therapy alone for the 45 months following VT onset (HR: 0.48 [95% CI: 0.26-0.89]). Moreover, performance of an ablation in this population aligned </span>mortality rates with those who did not experience post-implant VT (HR: 1.18 [95% CI: 0.71-1.98]).</div></div><div><h3>Conclusions</h3><div>VT occurrence within 1 year of LVAD implantation was associated with worse survival. However, performance of VT ablation in this population was correlated with improved survival compared with medical management alone. Among patients with refractory VT, catheter ablation aligned survival with other LVAD participants without post-implant VT. Catheter ablation of VT is associated with improved survival in LVAD recipients, but further prospective randomized studies are needed to compare VT ablation to medical management in LVAD recipients.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"10 9","pages":"Pages 2049-2058"},"PeriodicalIF":8.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633485","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":"Idiopathic Ventricular Fibrillation","authors":"Duc H. Do MD, MS,&nbsp;Kalyanam Shivkumar MD, PhD","doi":"10.1016/j.jacep.2024.06.014","DOIUrl":"10.1016/j.jacep.2024.06.014","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"10 9","pages":"Pages 1995-1997"},"PeriodicalIF":8.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788025","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":"Ablation as Salvation…Via Transplantation?","authors":"Joshua D. Moss MD","doi":"10.1016/j.jacep.2024.06.011","DOIUrl":"10.1016/j.jacep.2024.06.011","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"10 9","pages":"Pages 2059-2061"},"PeriodicalIF":8.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901740","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":"Comparative Efficacy and Safety of Pulsed Field Ablation Versus Radiofrequency Ablation of Idiopathic LV Arrhythmias","authors":"","doi":"10.1016/j.jacep.2024.04.025","DOIUrl":"10.1016/j.jacep.2024.04.025","url":null,"abstract":"<div><h3>Background</h3><div>Comparative efficacy and safety data on radiofrequency ablation (RFA) versus pulsed field ablation (PFA) for common idiopathic left ventricular arrhythmia (LV-VAs) locations are lacking.</div></div><div><h3>Objectives</h3><div>This study sough to compare RFA with PFA of common idiopathic LV-VAs locations.</div></div><div><h3>Methods</h3><div>Ten swine were randomized to PFA or RFA of LV interventricular septum, papillary muscle, LV summit via distal coronary sinus, and LV epicardium via subxiphoid approach. Ablations were delivered using an investigational dual-energy (RFA/PFA) contact force (CF) and local impedance-sensing catheter. After 1-week survival, animals were euthanized for lesion assessment.</div></div><div><h3>Results</h3><div>A total of 55 PFA (4 applications/site of 2.0 KV, target CF ≥10 g) and 36 RFA (CF ≥10 g, 25–50 W targeting ≥50 Ω local impedance drop, 60-second duration) were performed. LV interventricular septum: average PFA depth 7.8 mm vs RFA 7.9 mm (<em>P</em> = 0.78) and no adverse events. Papillary muscle: average PFA depth 8.1 mm vs RFA 4.5 mm (<em>P</em> &lt; 0.01). Left ventricular summit: average PFA depth 5.6 mm vs RFA 2.7 mm (<em>P</em> &lt; 0.01). Steam-pop and/or ventricular fibrillation in 4 of 12 RFA vs 0 of 12 PFA (<em>P</em> &lt; 0.01), no ST-segment changes observed. Epicardium: average PFA depth 6.4 mm vs RFA 3.3 mm (<em>P</em> &lt; 0.01). Transient ST-segment elevations/depressions occurred in 4 of 5 swine in the PFA arm vs 0 of 5 in the RFA arm (<em>P</em> &lt; 0.01). Angiography acutely and at 7 days showed normal coronaries in all cases.</div></div><div><h3>Conclusions</h3><div>In this swine study, compared with RFA, PFA of common idiopathic LV-VAs locations produced deeper lesions with fewer steam pops. However, PFA was associated with higher rates of transient ST-segment elevations and depressions with direct epicardium ablation.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"10 9","pages":"Pages 1998-2009"},"PeriodicalIF":8.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405500X24003530/pdfft?md5=6ee53d28c3d328374d9a4773685279c0&pid=1-s2.0-S2405500X24003530-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327516","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":"Association of Left Atrial Late Gadolinium Enhancement With Electrogram Abnormalities, Impedance, and Aortic Proximity","authors":"Mirmilad Khosknab MD,&nbsp;Tarek Zghaib MD,&nbsp;Lingyu Xu MD, PhD,&nbsp;Erica S. Zado PA-C,&nbsp;David Callans MD,&nbsp;Francis Marchlinski MD,&nbsp;Timothy M. Markman MD,&nbsp;Benoit Desjardins MD, PhD,&nbsp;Walter Witschey PhD,&nbsp;Saman Nazarian MD, PhD","doi":"10.1016/j.jacep.2024.06.031","DOIUrl":"10.1016/j.jacep.2024.06.031","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"10 9","pages":"Pages 2100-2102"},"PeriodicalIF":8.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142311698","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 Intradevice Leak Due to Torn Left Atrial Appendage Occlusion Device Membrane","authors":"Daniel J. Miklin MD,&nbsp;James K. Gabriels MD,&nbsp;Ronald Wharton MD,&nbsp;Lissa Sugeng MD,&nbsp;Jonathan Willner MD,&nbsp;Stuart Beldner MD,&nbsp;Laurence M. Epstein MD,&nbsp;Ramanak Mitra MD, PhD","doi":"10.1016/j.jacep.2024.05.020","DOIUrl":"10.1016/j.jacep.2024.05.020","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"10 9","pages":"Pages 2108-2110"},"PeriodicalIF":8.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603644","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}