JACC. Clinical electrophysiology最新文献

{"title":"How to Use 3D Intracardiac Echocardiography in Left Atrial Appendage Closure: A Guide to Systematic Procedural Imaging.","authors":"Carlos E Sanchez, Sandeep K Goyal, Lynne M Brown, Mohammed A Alkouhli, Gagan D Singh, Shepal K Doshi, Matthew J Price, Anish K Amin, Christopher J Wasco, Mani A Vannan","doi":"10.1016/j.jacep.2025.01.014","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.01.014","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719329","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":"Implantable Cardioverter-Defibrillator Therapy in Brugada Syndrome: A 30-Year Single-Center Experience.","authors":"Cinzia Monaco, Maria Cespon-Fernandez, Luigi Pannone, Alvise Del Monte, Domenico Della Rocca, Anais Gauthey, Sahar Mouram, Lorenzo Marcon, Giampaolo Vetta, Charles Audiat, Ioannis Doundoulakis, Antonio Bisignani, Vincenzo Miraglia, Gudrun Pappaert, Ivan Eltsov, Gezim Bala, Antonio Sorgente, Ingrid Overeinder, Alexandre Almorad, Erwin Stroker, Andrea Sarkozy, Francis Wellens, Gian Battista Chierchia, Mark La Meir, Juan Sieira, Pedro Brugada, Carlo de Asmundis","doi":"10.1016/j.jacep.2025.01.013","DOIUrl":"10.1016/j.jacep.2025.01.013","url":null,"abstract":"<p><strong>Background: </strong>Brugada syndrome (BrS) continues to pose clinical challenges, despite 3 decades of dedicated research and therapeutic advancements. The pivotal role of implantable cardioverter-defibrillator (ICD) therapy in safeguarding high-risk BrS patients from sudden cardiac death due to ventricular arrhythmias is undeniable. However, the debate on risk stratification and the use of ICDs for primary prevention remains ongoing.</p><p><strong>Objectives: </strong>This study aimed to evaluate the clinical features, management, and long-term outcomes of ICD therapy in patients with Brugada syndrome.</p><p><strong>Methods: </strong>BrS-diagnosed patients were prospectively enrolled. Inclusion criteria were: 1) a Brugada type 1 electrocardiogram pattern, either spontaneous or drug induced; 2) ICD implantation; and 3) consistent follow-up. Risk stratification was based on prior arrhythmic events, and the multiparametric Brussel risk score was used from 2017. High-risk patients underwent video-thoracoscopic epicardial ablation starting in 2016. ICD implantation strategies evolved over time, guided by patients' clinical and demographic characteristics.</p><p><strong>Results: </strong>A total of 306 consecutive Brugada patients (186 male [61%]; mean age 41 ± 17 years; range: 1-82 years) received ICDs at our institution from 1992 to 2022. ICDs were implanted for secondary prevention in 16% of patients. Over the 3 decades, the proportions of secondary prevention implants and asymptomatic patients remained stable, while risk factors fluctuated in the first two decades before stabilizing. During long-term follow-up (median 103 months [63-147 months]), 14% of patients experienced at least 1 sustained ventricular arrhythmia (VA) (1.59 per 100 person-years), 15% had at least 1 inappropriate ICD shock-unaffected by the presence of single or dual leads-and 27% required device revision and/or lead replacement. Patients with secondary prevention ICDs had a higher incidence of both ventricular and supraventricular arrhythmias compared to those with primary prevention ICDs. Loss-of-function mutations and prior nonsustained VAs were associated with sustained VAs. Among high-risk patients, those who underwent epicardial ablation experienced significantly fewer ventricular events. The overall mortality rate was 5.88%, with 22.2% of deaths attributed to cardiac causes.</p><p><strong>Conclusions: </strong>This 30-year study highlights ICD therapy's critical role in preventing fatal arrhythmias in Brugada syndrome, but also reveals frequent device-related complications, especially in younger patients. Thoracoscopic epicardial ablation significantly reduced VA in high-risk patients, offering a promising adjunctive therapy. These findings emphasize the need for individualized treatment strategies to balance the benefits of ICDs with their risks, and underscore the potential of ablation to improve long-term outcomes.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633954","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":"Real-World Artificial Intelligence-Based Electrocardiographic Analysis to Diagnose Hypertrophic Cardiomyopathy.","authors":"Milind Y Desai, Shada Jadam, Mohammed Abusafia, Katy Rutkowski, Susan Ospina, Andrew Gaballa, Sanaa Sultana, Maran Thamilarasan, Bo Xu, Zoran B Popovic","doi":"10.1016/j.jacep.2025.02.024","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.024","url":null,"abstract":"<p><strong>Background: </strong>There is an emerging interest in artificial intelligence-enhanced 12-lead electrocardiogram (AI-ECG) in detection of hypertrophic cardiomyopathy (HCM).</p><p><strong>Objectives: </strong>This study describes the initial real-world experience of using AI-ECG (Viz-HCM, developed using a convolutional neural network trained algorithm) in our center.</p><p><strong>Methods: </strong>All patients undergoing 12-lead electrocardiograms at Cleveland Clinic, Cleveland, Ohio, between February 19, 2024, and November 1, 2024, were prospectively analyzed for potential HCM using AI-ECG. The numbers of patients flagged for potential HCM were recorded. Presence of confirmed HCM, a new diagnosis of HCM following AI-ECG assessment (with a negative prior clinical evaluation), and alternative non-HCM diagnosis were recorded. Assessment of AI-ECG diagnostic performance was done using various HCM probability thresholds (≥0.95, ≥0.90, and ≥0.85).</p><p><strong>Results: </strong>Of 103,492 electrocardiograms analyzed in 45,873 patients, AI-ECG flagged potential HCM in 1,265 (2.7%) unique patients. Of these, 511 (40.4%) had confirmed HCM, 63 (5%) had new HCM diagnosis, and 691 (54.6%) had an alternate diagnosis. HCM probability threshold of ≥0.85 provided the highest sensitivity (95%) for diagnosis of HCM with high specificity and accuracy (all >98%). The positive predictive value was the highest (66%) at the cutoff ≥0.95 but with a lower sensitivity at 50%. The AI-ECG algorithm performed similarly in both men and women, and was more sensitive in individuals <50 years but more specific in individuals ≥50 years.</p><p><strong>Conclusions: </strong>Prospective real-world application of the AI-ECG algorithm to detect HCM was associated with a high degree of accuracy, varying with the chosen probability threshold. It also enabled the identification of 5% of patients with no prior HCM diagnosis.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656748","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":"Reduction of AF Burden After Cryoballoon Ablation in Patients With Early Persistent AF: The COOL-PER Trial.","authors":"So-Ryoung Lee, Eue-Keun Choi, Kyung-Yeon Lee, JungMin Choi, Hyo-Jeong Ahn, Soonil Kwon, Young-Keun On, Ji Hyun Lee, Youngjin Cho, Il-Young Oh, Hong-Euy Lim, Min-Soo Cho, Gi-Byoung Nam, Gregory Y H Lip, Seil Oh","doi":"10.1016/j.jacep.2025.02.006","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.006","url":null,"abstract":"<p><strong>Background: </strong>Limited data exist on reducing the atrial fibrillation (AF) burden, the regression from persistent to paroxysmal AF, and symptom improvement after cryoablation in patients with persistent AF.</p><p><strong>Objectives: </strong>This study sought to evaluate the efficacy of cryoablation in reducing the AF burden, regression to paroxysmal AF, and symptom improvement in patients with early persistent AF.</p><p><strong>Methods: </strong>This investigator-initiated, multicenter, and prospective cohort study enrolled the patients with early persistent AF (≤3 years). All patients were inserted an implantable loop recorder at the time of trial entry. AF burden (percentage of time in AF) and actual AF type were evaluated during pre-cryoablation and 12-month follow-up after cryoablation. AF-related symptoms and quality of life were assessed.</p><p><strong>Results: </strong>A total of 130 patients were enrolled (median age 61 years [Q1-Q3: 54-67 years]; median duration of persistent AF 6 months [Q1-Q3: 4-10 months]). The mean AF burden before cryoablation was 77 ± 34% (25.4% of high-burden paroxysmal AF; 74.6% of implantable loop recorder-confirmed persistent AF), which was reduced to 9 ± 21% after 12-month follow-up (mean 68 ± 37% of AF burden reduction; P < 0.001). Of the total, 38.5% had no recurrence of AF, 43.1% had a recurrence of paroxysmal AF, and 18.5% had a recurrence of persistent AF. Among those with confirmed persistent AF at baseline, 76% of patients showed regression to paroxysmal AF or no recurrence. After cryoablation, 77% of patients improved AF-related symptoms and quality of life as assessed by 36-Item Short Form Survey questionnaires.</p><p><strong>Conclusions: </strong>In patients with early persistent AF, cryoablation significantly reduced AF burden and achieved regression of AF type followed by symptom improvement. (Cryoablation for Pulmonary Vein Isolation Alone in Patients with Early Persistent AF Assessed by Continuous Monitoring [COOL-PER]; NCT05507749).</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719280","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":"Optimizing Interelectrode Distance for Accurate Mapping of Postinfarct Scars: Insights on Electrogram Characteristics.","authors":"Michael Barkagan, Ofir Brem, Arwa Younis, Zachary P Bubar, Jonathan Yarnitsky, Anat Milman, Maxime Zabern, Vladimir Vasilenko, Dor Yadin, Elad Anter","doi":"10.1016/j.jacep.2025.01.018","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.01.018","url":null,"abstract":"<p><strong>Background: </strong>There is an ongoing effort to develop catheters with closer interelectrode spacing to improve mapping resolution. However, the optimal distance for mapping postinfarct scar has yet to be established.</p><p><strong>Objectives: </strong>This study sought to assess the effect of interelectrode distance on ventricular scar electrograms.</p><p><strong>Methods: </strong>In 8 swine with healed myocardial infarction, the left ventricle was mapped using an experimental 48-electrode array with a 1.2 mm center-to-center distance. Additional maps with 2.4, 3.6, and 4.8 mm distances were created using nonadjacent electrodes. The impact of interelectrode distance on voltage amplitude and near-field (NF) and far-field (FF) activity relationships was analyzed.</p><p><strong>Results: </strong>At a 1.2 mm interelectrode distance, voltage amplitudes <1.5 mV accurately correlated with the endocardial infarct surface area, while increasing the distance to 4.8 mm progressively overestimated the infarct area (P < 0.001). However, adjusting voltage cutoffs for each interelectrode distance restored the correlation to the actual infarct size. The primary distinction between distances was the ability to differentiate NF from FF potentials. At 4.8 mm and 3.6 mm, FF potential amplitude often exceeded NF amplitude (NF/FF ratios of 0.8 ± 0.3 and 0.9 ± 0.2, respectively). Reducing the distance to 2.4 mm attenuated FF potentials, yielding an NF/FF ratio of 1.2 ± 0.4. Further reduction to 1.2 mm showed no significant additional effect (NF/FF ratio 1.3 ± 0.3; P = 0.09).</p><p><strong>Conclusions: </strong>Bipoles with a 2 mm interelectrode distance most effectively match endocardial scar tissue and attenuate NF potentials. These benefits plateau at 2 mm, suggesting that it may represent the optimal distance for delineating postinfarction substrates.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719276","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":"The Personal and Therapeutic Choices We Make Really Matter When It Comes to Atrial Fibrillation Ablation.","authors":"T Jared Bunch","doi":"10.1016/j.jacep.2025.01.015","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.01.015","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673876","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":"Automated Diagnosis of Pediatric ECG through AI-ECG: As good (and bad) as the experts.","authors":"Dustin Nash, Anthony G Pompa, Jennifer N Avari Silva","doi":"10.1016/j.jacep.2025.03.002","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.03.002","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656825","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 Anterior Right Ventricular Outflow Tract Conduction Block on QRS Morphology in Repaired Tetralogy of Fallot.","authors":"Jeremy P Moore, Katja Zeppenfeld","doi":"10.1016/j.jacep.2025.02.007","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.007","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719333","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":"Acute Coronary Occlusion Following Radiofrequency Ablation for Premature Ventricular Complexes in the Distal Great Cardiac Vein.","authors":"Jeanne du Fay de Lavallaz, Ashwini Kerkar, Brett Wanamaker, Frank Bogun","doi":"10.1016/j.jacep.2025.02.005","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.02.005","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719328","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":"Nanosecond vs Microsecond Pulsed Field Ablation: Lesion Durability and Muscle Contraction in a Canine Model.","authors":"Lei Ding, Aikai Zhang, Yang Sun, Yuandong Liu, Yingjie Qi, Zihan Jiang, Lijie Mi, Fengyuan Yu, Hongda Zhang, Min Tang","doi":"10.1016/j.jacep.2025.01.017","DOIUrl":"https://doi.org/10.1016/j.jacep.2025.01.017","url":null,"abstract":"<p><strong>Background: </strong>A nanosecond pulsed field generator and a circular multielectrode catheter have been introduced.</p><p><strong>Objectives: </strong>The aim of this study was to compare the durability, safety, and muscle contraction of ablation via microsecond or nanosecond pulsed field ablation (PFA) in canines.</p><p><strong>Methods: </strong>Under general anesthesia without muscle relaxants, 24 canines were subjected to isolation of the superior vena cava (SVC) and pulmonary veins (PVs) using nanosecond or microsecond PFA. Repeat mapping was performed and the animals were sacrificed acutely (7 days, n = 9), subacutely (30 days, n = 9), or chronically (3 months, n = 6).</p><p><strong>Results: </strong>All SVCs were isolated with durable isolation. A total of 161 sections from the SVC revealed transmural lesions in all sections, with a mean depth of 1.3 ± 0.7 mm. Similarly, all the PVs were isolated. Durable isolation was achieved in 23 (95.8%) of 24 PVs in nanosecond PFA and 22 (91.7%) of 24 PVs in microsecond PFA. Nanosecond PFA resulted in transmural lesions in 148 (97.4%) of 152 sections and a median lesion depth of 2.7 ± 1.2 mm. Microsecond PFA created transmural lesions in 155 (96.9%) of 160 sections with a median depth of 2.6 ± 1.0 mm. There were no significant differences in depth or transmurality between groups. Nanosecond PFA caused no, slight, and severe muscle contraction in 70.8%, 12.5%, and 16.7% PVs, respectively, and microsecond PFA resulted in no and severe muscle contraction in 29.2% and 70.8% PVs, respectively. Nanosecond PFA demonstrated a significantly lower incidence of severe muscle contraction (P < 0.001).</p><p><strong>Conclusions: </strong>Nanosecond PFA yields comparable lesion durability, safety, and significantly reduced muscle contractions to microsecond PFA, which may help enable PV isolation without general anesthesia.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673858","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}