JACC. Clinical electrophysiology最新文献

{"title":"Acute Modulation of Arrhythmogenic Ventricular Substrate Following Cardiac Stereotactic Body Radiation Therapy.","authors":"Negar Raissi-Dehkordi, Nastaran Raissi-Dehkordi, Jonathan A Salas, Weihow Hsue, Julia Wilson, Myles S Miller, Spencer Moavenzadeh, Michele M Kim, Sarah Hagan, Jeffrey Arkles, David J Callans, Timothy M Markman, Francis E Marchlinski, Keith A Cengel, Cory M Tschabrunn","doi":"10.1016/j.jacep.2026.08.009","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.08.009","url":null,"abstract":"<p><strong>Background: </strong>Cardiac stereotactic body radiation therapy (cSBRT) is a noninvasive, investigational treatment for refractory ventricular tachycardia (VT). The antiarrhythmic effects and time course of action of cSBRT on abnormal ventricular substrate remain poorly understood.</p><p><strong>Objectives: </strong>This study aimed to investigate the electrophysiological, molecular, and structural changes following cSBRT in a porcine infarct model.</p><p><strong>Methods: </strong>Anterior myocardial infarction was created in a porcine model of infarct-related re-entrant VT (n = 8). Swine were randomized to cSBRT (n = 4) or control infarct (n = 4) groups. Baseline electrophysiology study and high-resolution electroanatomic maps were performed 8 to 10 weeks postinfarction. The cSBRT group received 25 Gy single-fraction photon radiation guided by initial left ventricular substrate maps. Cardiac magnetic resonance imaging followed by repeat electrophysiology study and mapping studies were performed 6 weeks later.</p><p><strong>Results: </strong>cSBRT resulted in significant prolongation of the effective refractory period in remote, nontargeted myocardium (cSBRT: 216 ± 21-252 ± 11 ms, Δ +17% vs control: 234 ± 7-249 ± 1 ms, Δ +6.5%) and targeted scar tissue (cSBRT: 258 ± 10-291 ± 18 ms, Δ +13% vs control: 274 ± 13-284 ± 8 ms, Δ +3.7%; group × timepoint interaction P = 0.048). Sustained VT was inducible in all 8 subjects at the terminal timepoint. There was a trend toward more prolonged VT cycle length (cSBRT: 195 ± 19-295 ± 55 ms, Δ +53% vs control: 212 ± 15-261 ± 14 ms, Δ +23%; P = 0.22). Connexin-43 immunoreactive area density in the infarct region was lower in the cSBRT group (1.4% vs 2.7%, respectively; P < 0.01). There was no difference detected in late gadolinium enhancement volume (cSBRT: 29.3% ± 7.8% vs control: 27.2% ± 11.3%; P = 0.8) or histologic fibrosis (cSBRT: 54.9% ± 13.4% vs control: 54.6% ± 20.6%; P = 0.95).</p><p><strong>Conclusions: </strong>Delivery of 25 Gy cSBRT produced early electrical remodeling with increased effective refractory period and decreased connexin-43 area density, without evidence of increased fibrosis.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038151","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":"Multimodality Imaging and Pace-Mapping Patterns in Patients With Cardiac Sarcoidosis and Ongoing Inflammation Undergoing Ventricular Tachycardia Ablation.","authors":"Boldizsar Kovacs, Chaitanya Madamanchi, Venkatesh L Murthy, Michael Ghannam, Jackson J Liang, Kelly Arps, Amrish Deshmukh, Hubert Cochet, Frederic Sacher, Pierre Jais, Mélèze Hocini, Rakesh Latchamsetty, Krit Jongnarangsin, Fred Morady, Frank Bogun","doi":"10.1016/j.jacep.2026.07.020","DOIUrl":"10.1016/j.jacep.2026.07.020","url":null,"abstract":"<p><strong>Background: </strong>The arrhythmogenesis in cardiac sarcoidosis (CS) is poorly understood. The recent ability to register fluorodeoxyglucose (FDG)-avid (FDG+) areas from positron emission tomography studies enables us to correlate the location of areas containing late gadolinium enhancement (LGE+) on cardiac magnetic resonance imaging with FDG-avid areas.</p><p><strong>Objectives: </strong>This study sought to characterize ventricular tachycardia (VT) target sites with respect to FDG uptake and to correlate with VT recurrence post-VT ablation.</p><p><strong>Methods: </strong>In 14 patients (4 women; age 55 ± 11 years; ejection fraction 43% ± 14%) with definite CS and active inflammation referred for VT ablation, positron emission tomography and cardiac magnetic resonance findings were registered to electroanatomic maps. VT target areas were identified with pace- and entrainment-mapping, and conduction patterns were assessed based on different stimulus-QRS intervals of VA target sites.</p><p><strong>Results: </strong>A total of 43 distinct VTs with 59 VT target sites were identified. A total of 88% of the identified VT target sites were in LGE+ areas, whereas 71% were in FDG+ areas. The LGE+ and FDG+ sites colocalized at 59% of all VT target sites. VT exit sites were identified for 42 of 59 VT target sites and nonexit sites for 17 of 59 VT target sites. VT exit sites were associated with FDG+ areas. During a follow-up time of 32 ± 33 months, 6 patients in whom only VT exit sites were identified had a higher VT recurrence rate than patients (n = 8) in whom both nonexit sites and exit sites for individual VTs were identified (100% vs 25%; P = 0.01), indicating that ablation at both exit and nonexit sites yielded superior results.</p><p><strong>Conclusions: </strong>In patients with CS and active inflammation, most VT target sites were confined to LGE+ and FDG+ areas. VT exit sites were associated with FDG+ areas. Patients in whom only VT exit sites were identified had higher VT recurrences.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944937","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":"Stereotactic Body Radiation Therapy for VT in Chagas Cardiomyopathy: A Prospective Phase I/II Pilot Study.","authors":"Bernardo Salvajoli, Cristiano F Pisani, Rodrigo M Kulchetscki, Jason Cook, Léa Maria Macruz Ferreira Demarchi, Victor Augusto Bertotti Ribeiro, João Victor Salvajoli, William G Stevenson, Mauricio Ibrahim Scanavacca","doi":"10.1016/j.jacep.2026.06.023","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.06.023","url":null,"abstract":"<p><strong>Background: </strong>Stereotactic body radiation therapy (SBRT) is a novel noninvasive therapy for ventricular tachycardia (VT), but its role in Chagas cardiomyopathy remains unexplored.</p><p><strong>Objectives: </strong>This study aimed to evaluate the safety and preliminary efficacy of SBRT for refractory VT in patients with chronic Chagas cardiomyopathy.</p><p><strong>Methods: </strong>We prospectively enrolled patients with Chagas cardiomyopathy and refractory VT who had failed or were ineligible for catheter ablation. A single 25-Gy fraction of SBRT was delivered to an arrhythmogenic substrate identified by multimodality imaging. The primary outcomes were a reduction in VT burden and treatment-related adverse events.</p><p><strong>Results: </strong>Eleven patients (age: 64.9 ± 6.7 years; LVEF: 31.6 ± 9.8%) with implantable cardioverter-defibrillators, 9 of whom had prior failed ablations, underwent SBRT. The median internal target volume was 27.3 cm³, and the planning target volume was 91.1 cm³. During a median follow-up of 160 days, VT recurred in 10 patients. The median time to recurrence after a 6-week blanking period was 79 days (IQR: 51.5-167). The patient without recurrence died of noncardiac causes 22 days after SBRT. Comparing the 12 months after SBRT with the 6 months before SBRT, there was a statistically significant reduction in the burden of VT episodes (P = 0.040), antitachycardia pacing therapies (P = 0.012), and combined antitachycardia pacing/shocks (P = 0.022), although isolated implantable cardioverter-defibrillator shocks were not statistically significantly reduced. The 12-month overall survival was 45.5%, and no severe treatment-related adverse events were reported.</p><p><strong>Conclusions: </strong>SBRT is a feasible approach for refractory VT in Chagas cardiomyopathy. Despite a high rate of VT recurrence, SBRT statistically significantly reduced the burden of ventricular arrhythmia, warranting further investigation.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109720","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":"Targeting the Cardiac Neuroaxis for Prevention of Postoperative Atrial Fibrillation: Are We Ready for Prime Time?","authors":"Sunny S Po, Praloy Chakraborty","doi":"10.1016/j.jacep.2026.08.005","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.08.005","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990016","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":"Prevalence and Prognostic Significance of Exercise-Accentuated J-Point Elevation in Brugada Syndrome.","authors":"Mayank Sardana, Christopher N Kanaan, Amal Youssef, J Martijn Bos, Thomas G Allison, Michael J Ackerman, John R Giudicessi","doi":"10.1016/j.jacep.2026.07.018","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.07.018","url":null,"abstract":"<p><strong>Background: </strong>The clinical significance of accentuation of precordial J-point elevation during exercise in Brugada syndrome (BrS) remains unclear.</p><p><strong>Objectives: </strong>This study sought to determine the prevalence and prognostic significance of accentuation of J-point elevation during exercise in a large single-center BrS cohort.</p><p><strong>Methods: </strong>In this retrospective study, 141 consecutive patients referred for BrS evaluation (95 with type 1 BrS pattern-BrS1 cohort, 46 without type 1 pattern but with loss-of-function sodium voltage-gated channel alpha subunit 5 variants-SCN5A cohort) who underwent exercise stress testing (EST) from January 1, 2000, through October 31, 2025 were included. Two blinded cardiologists reviewed all tracings. An exercise-accentuated BrS phenotype was defined as J-point elevation increase ≥1 mm in V1/V2 during exercise. Cardiac events included arrhythmic syncope, cardiac arrest, and appropriate implantable cardioverter-defibrillator shocks. Firth penalized logistic regression was used for unadjusted and adjusted analyses.</p><p><strong>Results: </strong>Overall, 41 patients (29%) demonstrated an exercise-accentuated BrS phenotype, emerging near peak exercise (median 90% age-predicted maximum heart rate). The phenotype was highly reproducible on serial testing (88% of follow-up ESTs). Exercise-accentuated phenotype was not associated with overall cardiac events (unadjusted OR: 1.83 [0.84-3.99]; P = 0.13; adjusted OR: 1.22 [0.47-3.21]; P = 0.69). However, it was strongly associated with exertion-triggered cardiac events (unadjusted OR: 10.50 [2.94-37.50]; P < 0.001; adjusted OR: 10.04 [2.76-36.53]; P < 0.001), independent of sex, exercise workload, and baseline type 1 pattern. Consistent results were noted in SCN5A variant-positive patients.</p><p><strong>Conclusions: </strong>Exercise-induced accentuation of J-point elevation reproducibly identifies a subset of BrS patients at risk for exertional cardiac events. These findings support the inclusion of EST in the evaluation of patients with a clinical diagnosis or genetic susceptibility to BrS and may inform exercise-related risk counseling.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944860","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-Voltage Focal PFA Catheter for \"Instant\" Point-By-Point Ablation: The First-In-Human FIELD-PULSE Trial to Treat AF.","authors":"Vivek Y Reddy, Jan Petru, Jacob S Koruth, Moritoshi Funasako, Jan Skoda, Jonathan A Salas, Steven R Mickelsen, Petr Neuzil","doi":"10.1016/j.jacep.2026.09.001","DOIUrl":"10.1016/j.jacep.2026.09.001","url":null,"abstract":"<p><strong>Background: </strong>Single-shot pulsed-field ablation (PFA) catheters are widely used for pulmonary vein isolation (PVI) because of their efficiency, but they are less suited for flexible lesion sets. Existing focal PFA technologies permit individualized ablation but require energy delivery over multiple cardiac and respiratory cycles, making sustained catheter stability important and potentially reducing procedural efficiency.</p><p><strong>Objectives: </strong>The authors sought to evaluate a focal PFA catheter delivering a novel subsecond pulsed-field waveform designed for \"instantaneous\" point-by-point ablation.</p><p><strong>Methods: </strong>An 8.5-F force-sensing PFA catheter delivers a single QRS-synchronized, high-voltage (≥10 kV; <200 ms) pulsed field application. Three sequential waveform/electrode-configuration cohorts were evaluated. PVI was guided by conventional electroanatomic mapping, with impedance-based catheter localization. A subset underwent post-PFA brain magnetic resonance imaging. Invasive remapping at ∼90 days assessed lesion durability.</p><p><strong>Results: </strong>Thirty-five patients underwent PFA with waveform A (n = 15), B (n = 5), or C (n = 15). Acute PVI was achieved in all patients, requiring 39 (IQR: 35-45) PF lesions per patient, with a median elapsed ablation time of 13 (IQR: 10-15) minutes. Remapping in 32 patients demonstrated progressive improvement in PVI durability with waveform evolution: Waveform C achieved 94.2% per-vein PVI durability. Brain magnetic resonance imaging (n = 14) demonstrated no diffusion-weighted imaging (DWI)+/fluid-attenuated inversion recovery (FLAIR)+ lesions and 2 DWI+/FLAIR- lesions (14%). There were no primary safety events, haptoglobin depletion, or acute kidney injury. Twelve-month freedom from atrial arrhythmia was 73.9% (95% CI: 60.6%-90.2%).</p><p><strong>Conclusions: </strong>Subsecond, high-voltage focal PFA enabled efficient point-by-point ablation and individualized lesion sets without the need for prolonged catheter stability. These first-in-human data support continued clinical development of an instantaneous focal PFA workflow.</p><p><strong>Clinicaltrials: </strong>gov: (The FIELD-PULSE Study; A Pre-Market, First-In-Human, Pilot, Interventional, Clinical Investigation to Evaluate Safety and Feasibility of the FieldForce Ablation System in Patients with Atrial Fibrillation; NCT06452589).</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911981","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":"Ambulatory Surgery Centers in Cardiac Electrophysiology: Current Status and Future Directions.","authors":"Rajesh Kabra, Kamala P Tamirisia, Sotirios Nedios, Rachita Navara, Dhanunjaya Lakkireddy, Pamela K Mason","doi":"10.1016/j.jacep.2026.07.015","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.07.015","url":null,"abstract":"<p><p>Ambulatory surgical centers (ASCs) are rapidly expanding their role in cardiac electrophysiology (EP). Several studies have demonstrated that they provide comparable safety, effectiveness, and efficiency to hospital settings for elective, nonacute EP procedures. ASC's provide superior patient-centered care with increased convenience, improved access, operational efficiency, and cost savings, which might potentially mitigate delays in EP procedures and improve patient outcomes. Use of appropriate patient selection criteria, standardized workflows, protocols for same-day discharge, and transfer agreements are key for the success of ASC's. However, there are several challenges. The need for Certificate of Need and other regulatory barriers in several states, as well as variability in private insurance coverage, may impede widespread adoption of ASC's. The shift of low-risk, high-margin procedures to ASC's may disrupt the revenue cycle of the health care systems, impacting other service lines. Although physician ownership in ASC's can be a source of increasing technical revenue, the upfront costs and operational challenges may motivate them to partner with private equity firms, thereby decreasing their autonomy and available resources. It is important to track the patient selection and outcomes with a standardized EP-ASC registry overseen by medical professional societies. The current ACC EP leadership perspective article discusses the pros and cons of EP ASC's from the viewpoint of patients, physicians, health care systems, and insurance payors. In addition, it also provides best practices, patient/case selection criteria, and an insight into the future directions of EP ASC's.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944927","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":"Ring-Like Scar Architecture and Arrhythmic Outcomes of Patients With Nondilated Left Ventricular Cardiomyopathy Treated With Ventricular Tachycardia Ablation.","authors":"Raimondo Pittorru, Nicola Pierucci, Deni Kukavica, Pranav Bhagirath, Thomas Rosseel, Mariona Regany-Closa, José T Ortiz-Perez, Susanna Prat-Gonzalez, Anna Victor-Baldomà, Jean Baptiste Guichard, Federico Migliore, Jose-Maria Tolosana, Eduard Guasch, Lluis Mont, Josep Brugada, Elena Arbelo, Marta Sitges, Ana Garcia-Alvarez, Andreu Porta-Sánchez, Ivo Roca-Luque","doi":"10.1016/j.jacep.2026.07.019","DOIUrl":"10.1016/j.jacep.2026.07.019","url":null,"abstract":"<p><strong>Background: </strong>Nondilated left ventricular cardiomyopathy (NDLVC) is characterized by an elevated arrhythmic burden and frequent presence of ring-like late gadolinium enhancement (RL-LGE) pattern. However, the arrhythmic substrate and outcomes after ventricular tachycardia (VT) ablations remain undefined.</p><p><strong>Objectives: </strong>This study sought to characterize the arrhythmogenic substrate using postprocessed cardiac magnetic resonance and assess VT recurrence after ablation in patients with NDLVC.</p><p><strong>Methods: </strong>Consecutive patients with NDLVC undergoing VT ablation at the Hospital Clínic of Barcelona were included.</p><p><strong>Results: </strong>Thirty-seven patients were included (age 44 years [IQR: 39-55]; 78% male; left ventricular ejection fraction 45% [IQR: 40-52]). RL-LGE was observed in 21 of 37 (57%) patients. Compared with patients without it, patients with RL-LGE had lower left ventricular ejection fraction (40% [38% to 45%] vs 51% [49% to 55%], P < 0.0001), greater scar burden (16.2% [12.7% to 20.0%] vs 5.4% [5.0% to 6.0%], P < 0.0001), larger number of arrhythmogenic conducting channels (3 [2-4] vs 1 [1-2], P < 0.0001), and longer conducting channels (34 mm [29-38 mm] vs 12 mm [10-14 mm], P < 0.0001). Over a median of 3 years of follow-up, 30% of patients had VT recurrence with event rate of 10.2%/year. Dense scar (HR: 1.13, per 1% increment; 95% CI: 1.05-1.22; P = 0.002) and borderzone scar burden (HR: 1.27; 95% CI: 1.11-1.45; P = 0.001), number (HR: 2.35; 95% CI: 1.42-3.91; P = 0.001) and the length of conducting channels (HR: 1.04 per 1 mm increase; 95% CI: 1.01-1.06; P = 0.006) were associated with VT recurrence. The adjusted risk of VT recurrence was 24-fold higher in patients with RL-LGE (HR: 24.0; 95% CI: 2.8-207.1; P = 0.004).</p><p><strong>Conclusions: </strong>RL-LGE identifies patients with NDLVC with a more complex arrhythmogenic substrate and a poorer outcome after VT ablation.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911922","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":"Pulsed Field Ablation and the Bystander Vein of Marshall: Collateral Benefit?","authors":"Jacob W Groenendyk, Christopher F Liu","doi":"10.1016/j.jacep.2026.06.046","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.06.046","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944880","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":"Adjunctive Purkinje Denetworking During Ventricular Tachycardia Ablation in Patients With Prior Ventricular Fibrillation","authors":"Robert N. Kerley MD,&nbsp;Henry D. Huang MD,&nbsp;Esseim Sharma MD,&nbsp;Elisabeth Wong MD,&nbsp;Mohamed Gabr MD,&nbsp;Nikolas Nozica MD,&nbsp;Usha B. Tedrow MD, MS,&nbsp;William H. Sauer MD","doi":"10.1016/j.jacep.2026.04.001","DOIUrl":"10.1016/j.jacep.2026.04.001","url":null,"abstract":"<div><h3>Background</h3><div>Recurrence after ventricular tachycardia (VT) ablation remains common in patients with monomorphic VT and spontaneous polymorphic ventricular tachycardia (PMVT) or ventricular fibrillation (VF), suggesting mechanisms beyond myocardial scar alone. The Purkinje system plays a central role in both triggering and sustaining malignant ventricular arrhythmias. Whether adjunctive Purkinje de-networking (PDN) improves outcomes in this high-risk population is unknown.</div></div><div><h3>Objectives</h3><div>This study sought to determine whether adjunctive PDN during VT ablation is associated with improved arrhythmia outcomes in patients with prior spontaneous PMVT/VF.</div></div><div><h3>Methods</h3><div>Multicenter retrospective cohort study of patients undergoing monomorphic VT ablation (2023-2025) with prior spontaneous PMVT or VF. Patients underwent VT ablation with adjunctive PDN (n = 27) or VT ablation alone (n = 28). The primary endpoint was 12-month VT/VF-free survival. Secondary endpoints included ICD therapies, repeated ablation, and procedural safety.</div></div><div><h3>Results</h3><div>At 12 months, VT/VF-free survival was higher with adjunctive PDN (80.8% vs 49.2%; absolute difference: 31.6%). Adjunctive PDN was associated with lower VT/VF recurrence (HR: 0.29; 95% CI: 0.11-0.72; <em>P</em> = 0.017). When limited to PMVT/VF events, recurrence rates were lower in both absolute (7.4% vs 39.3%) and relative (HR: 0.20; 95% CI: 0.07-0.59; <em>P</em> = 0.018) terms. Implantable cardioverter-defibrillator therapies declined significantly after ablation in both groups (<em>P</em> &lt; 0.001). Iatrogenic left bundle branch block occurred more frequently with PDN (14.8% vs 3.6%; <em>P</em> = 0.19), although no patients required permanent pacing or device upgrade.</div></div><div><h3>Conclusions</h3><div>In this high risk cohort, adjunctive PDN during VT ablation was associated with a substantial reduction in recurrent ventricular arrhythmias, with a modest increase in risk of left bundle branch block. These findings support prospective evaluation of PDN in patients with prior VF.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"12 9","pages":"Pages 2148-2158"},"PeriodicalIF":7.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771436","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}