JACC. Clinical electrophysiology最新文献

{"title":"The State of the Cardiac Electrophysiology Workforce in the United States","authors":"Rajesh Kabra MD , Pamela K. Mason MD , Rachita Navara MD , Dhanunjaya Lakkireddy MD, MBA , Jim W. Cheung MD","doi":"10.1016/j.jacep.2025.02.018","DOIUrl":"10.1016/j.jacep.2025.02.018","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 4","pages":"Pages 870-872"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143881471","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":"Functional and Structural Remodeling as Atrial Fibrillation Progresses in a Persistent Atrial Fibrillation Canine Model","authors":"Eugene Kwan MS ,&nbsp;Bram Hunt MS ,&nbsp;Eric N. Paccione MS ,&nbsp;Ben A. Orkild BS ,&nbsp;Jake A. Bergquist PhD ,&nbsp;Yuki Ishidoya MD ,&nbsp;Kyoichiro Yazaki MD ,&nbsp;Jason K. Mendes PhD ,&nbsp;Ed V.R. DiBella PhD ,&nbsp;Rob S. MacLeod PhD ,&nbsp;Derek J. Dosdall PhD ,&nbsp;Ravi Ranjan MD PhD","doi":"10.1016/j.jacep.2024.10.001","DOIUrl":"10.1016/j.jacep.2024.10.001","url":null,"abstract":"<div><h3>Background</h3><div>Contractile, electrical, and structural remodeling has been associated with atrial fibrillation (AF), but the progression of functional and structural changes as AF sustains has not been previously evaluated serially.</div></div><div><h3>Objectives</h3><div>Using a rapid-paced persistent AF canine model, the authors aimed to evaluate the structural and functional changes serially as AF progresses.</div></div><div><h3>Methods</h3><div>Serial electrophysiological studies in a chronic rapid-paced canine model (n = 19) prior to AF sustaining and repeated at 1, 3, and 6 months of sustained AF were conducted to measure changes in atrial conduction speed and direction. Cardiac late gadolinium enhancement magnetic resonance imaging was performed prior to and following sustained AF to evaluate structural remodeling.</div></div><div><h3>Results</h3><div>As AF progressed, the overall area of the left atrium with fibrosis increased. Over time, conduction speeds slowed, with speeds decreasing by 0.15 m/s after 3 months and 0.26 m/s after 6 months of sustained AF. Regions that developed fibrosis experienced greater slowing compared with healthy regions (0.32 ± 0.01 m/s decrease vs 0.21 ± 0.01 m/s decrease; <em>P</em> &lt; 0.001). Conduction directions became more aligned (conduction direction heterogeneity decreased from 19.7 ± 0.1° to 17.5 ± 0.1° after 6 months of sustained AF; <em>P</em> &lt; 0.001). Fibrotic regions had a greater decrease in conduction direction heterogeneity (2.7 ± 0.3° vs 2.0 ± 0.2°; <em>P</em> = 0.008).</div></div><div><h3>Conclusions</h3><div>As AF progressed, functional changes occurred globally throughout the left atrium. Conduction speed slowed, and conduction directions became more aligned over time, with the greatest changes occurring within regions that developed fibrosis.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 4","pages":"Pages 720-734"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768888","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":"Modular Leadless Pacing","authors":"James E. Ip MD","doi":"10.1016/j.jacep.2024.11.006","DOIUrl":"10.1016/j.jacep.2024.11.006","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 4","pages":"Pages 854-864"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965106","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":"Cardiovascular Disease-Specific Responses to Autonomic Denervation","authors":"Yuji Zhang MD ,&nbsp;Sunny S. Po MD, PhD ,&nbsp;Fangran Xin PhD ,&nbsp;Jikai Zhao MD ,&nbsp;Keyan Zhao MD ,&nbsp;Dengshun Tao MD ,&nbsp;Praloy Chakraborty MD ,&nbsp;Zongtao Yin MD ,&nbsp;Guannan Liu MD ,&nbsp;Huishan Wang MD","doi":"10.1016/j.jacep.2024.11.014","DOIUrl":"10.1016/j.jacep.2024.11.014","url":null,"abstract":"<div><h3>Background</h3><div>Calcium-mediated autonomic denervation has been shown to suppress postoperative atrial fibrillation (POAF) after coronary artery bypass grafting.</div></div><div><h3>Objectives</h3><div>This study sought to evaluate whether similar autonomic denervation can prevent POAF after mitral or aortic valve surgeries.</div></div><div><h3>Methods</h3><div>This research consisted of 2 single-center, randomized, double-blind, sham-controlled trials: CAP-AF2 (Calcium Autonomic Denervation Prevents Postoperative Atrial Fibrillation in Patients Undergoing Isolated Mitral Valve Surgery for Mitral Regurgitation) for mitral valve (MV) surgery and CAP-AF3 (Calcium Autonomic Denervation Prevents Postoperative Atrial Fibrillation in Patients Undergoing Isolated Aortic Valve Surgery) for aortic valve surgery. Patients were randomized to receive injections of either 5% CaCl₂ or 0.9% NaCl (control) into the atrial ganglionated plexi during surgery. The primary outcome was the incidence of POAF ≥30 seconds within 7 days after surgery. Secondary outcomes included hospital stay, AF burden, actionable antiarrhythmic therapy for POAF, and inflammatory marker.</div></div><div><h3>Results</h3><div>After 160 patients were enrolled into the CAP-AF2 trial, mid-term analysis revealed a significant increase in POAF incidence in the CaCl₂ group (55.13%, CaCl₂ vs 37.80%, NaCl; <em>P</em> = 0.028). The CAP-AF2 trial was terminated by the safety committee. In the CAP-AF3 trial, 239 patients were randomized; final analysis showed no significant difference in the POAF incidence between the CaCl₂ and NaCl groups (35.59% vs 39.67%, <em>P</em> = 0.516). Postoperative hospital stay, AF burden, antiarrhythmic therapy for POAF, and plasma levels of inflammatory markers were not different between the 2 groups in both trials. Immunohistochemical analyses showed parasympathetic predominance at the tissue level in patients receiving MV surgery.</div></div><div><h3>Conclusions</h3><div>Calcium-mediated autonomic denervation did not uniformly prevent POAF across all cardiac surgeries, with an increased incidence observed in the MV surgery group, highlighting the need for disease-specific strategies to prevent POAF. (Calcium Autonomic Denervation Prevents Postoperative Atrial Fibrillation in Patients Undergoing Isolated Mitral Valve Surgery for Mitral Regurgitation [CAP-AF2]; <span><span>ChiCTR2000029314</span><svg><path></path></svg></span>; Calcium Autonomic Denervation Prevents Postoperative Atrial Fibrillation in Patients Undergoing Isolated Aortic Valve Surgery [CAP-AF3]; <span><span>ChiCTR2000029313</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 4","pages":"Pages 776-788"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023149","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":"Cardioverter-Defibrillator Implantation as a Risk Factor For Motor Vehicle Crash","authors":"John A. Staples MD, MPH ,&nbsp;Daniel Daly-Grafstein PhD ,&nbsp;Isaac Robinson BSc (candidate) ,&nbsp;Mayesha Khan MA ,&nbsp;Nathaniel M. Hawkins MD ,&nbsp;Herbert Chan PhD ,&nbsp;Shannon Erdelyi MSc ,&nbsp;Christian Steinberg MD ,&nbsp;K. Malcolm Maclure ScD ,&nbsp;Andrew D. Krahn MD ,&nbsp;Jeffrey R. Brubacher MD, MSc","doi":"10.1016/j.jacep.2024.12.002","DOIUrl":"10.1016/j.jacep.2024.12.002","url":null,"abstract":"<div><h3>Background</h3><div>Limited empirical evidence informs fitness-to-drive recommendations after implantable cardioverter-defibrillator (ICD) implantation. Cohort designs can be deceptive because ICD recipients differ from control individuals and may temporarily cease driving after implantation.</div></div><div><h3>Objectives</h3><div>This study sought to generate evidence to inform medical driving restrictions after ICD implantation.</div></div><div><h3>Methods</h3><div>We used population-based data to identify all drivers involved in a serious motor vehicle crash in British Columbia, Canada, from 1997 to 2019. Exposure was defined as ICD implantation in the 6 months before a crash. One analysis used a case-crossover design to control for relatively fixed individual characteristics like driving experience. Another analysis used a responsibility design to account for road exposure (miles of driving per week). Both analyses used logistic regression with adjustment for potential confounders.</div></div><div><h3>Results</h3><div>In the case-crossover analysis of crash-involved ICD recipients, ICD implantation occurred in 212 of 3,299 precrash intervals and in 485 of 6,598 control intervals, suggesting no temporal association between ICD implantation and subsequent crash (6.4% vs 7.4%; adjusted OR [aOR]: 0.86; 95% CI: 0.71-1.03; <em>P</em> = 0.11). In the analysis of all crash-involved drivers with determinate crash responsibility, 14 of 22 drivers with recent ICD implantation and 532,741 of 1,035,433 drivers without recent ICD implantation were deemed responsible for their crash, suggesting no association between ICD implantation and crash responsibility (crude proportion responsible, 64% vs 51%; aOR: 2.20; 95% CI: 0.94-5.30; <em>P</em> = 0.08).</div></div><div><h3>Conclusions</h3><div>The 6-month interval after ICD implantation is not associated with increased odds of crash nor with increased likelihood of crash responsibility. Contemporary driving restrictions in the first weeks after ICD implantation appear to adequately mitigate the potential increase in crash risk.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 4","pages":"Pages 801-814"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079997","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":"In Memoriam: Victor Parsonnet, MD, FHRS, A Heart Rhythm Society Founder and Pioneer in Cardiac Pacing and Electrophysiology","authors":"David G. Benditt MD, FHRS, CCDS ,&nbsp;Eric N. Prystowsky MD, FHRS ,&nbsp;Sanjeev Saksena MBBS, MD, FHRS","doi":"10.1016/j.jacep.2025.02.013","DOIUrl":"10.1016/j.jacep.2025.02.013","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 4","pages":"Pages 875-877"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730011","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 Accuracy of Cardiac Surface Conduction Velocity Measurements","authors":"Edward J. Vigmond PhD ,&nbsp;Stéphane Massé MSc ,&nbsp;Caroline H. Roney PhD ,&nbsp;Jason D. Bayer PhD ,&nbsp;Kumaraswamy Nanthakumar MD","doi":"10.1016/j.jacep.2024.11.004","DOIUrl":"10.1016/j.jacep.2024.11.004","url":null,"abstract":"<div><h3>Background</h3><div>Conduction velocity (CV) is a measure of the health of myocardial tissue. It can be measured by taking differences in local activation times from intracardiac electrodes. Several factors introduce error into the measurement, among which ignoring the 3-dimensional aspect is a major detriment.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to determine if, nonetheless, there was a specific region where CV could be accurately measured.</div></div><div><h3>Methods</h3><div>Computer simulations of 3-dimensional ventricles with a realistic His-Purkinje system were performed. Ventricles also included a dense scar or diffuse fibrosis.</div></div><div><h3>Results</h3><div>A finer spatial sampling produced better agreement with true CV. Using an error limit of 10 cm/s as a threshold, measurements taken within a region &lt;2 cm from the pacing site proved to be accurate. Error increased abruptly beyond this distance. The Purkinje system and tissue fiber orientation played equally major roles in leading to a surface CV that was not reflective of the CV propagation through the tissue.</div></div><div><h3>Conclusions</h3><div>In general, surface CV correlates poorly with tissue CV. Only surface CV measurements close to the pacing site, taken with an electrode spacing of ≤1 mm, give reasonable estimates.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 4","pages":"Pages 694-705"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005487","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":"Pacemaker Implantation in a Woman With Transcatheter Edge-to-Edge Repair of Tricuspid Valve","authors":"Cheng Zheng PhD,&nbsp;Lucia D’Angelo MD,&nbsp;Shea Michaela James MD,&nbsp;Jia-Feng Lin MD","doi":"10.1016/j.jacep.2024.12.010","DOIUrl":"10.1016/j.jacep.2024.12.010","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 4","pages":"Pages 868-869"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364685","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":"Neuropeptide Y as a Prognostic Biomarker in Electrical Storm","authors":"Jianjun Tang MD ,&nbsp;Chengfeng Liu BSc ,&nbsp;Zhuo Wang MD ,&nbsp;Tongjian Zhu MD ,&nbsp;Min Zhong BSc ,&nbsp;Yasai Li BSc ,&nbsp;Mingxian Chen MD","doi":"10.1016/j.jacep.2024.11.021","DOIUrl":"10.1016/j.jacep.2024.11.021","url":null,"abstract":"<div><h3>Background</h3><div>Electrical storm (ES), characterized by recurrent ventricular arrhythmias, presents a major clinical challenge, so the identification of dependable biomarkers of mortality is essential for risk stratification and targeted intervention.</div></div><div><h3>Objectives</h3><div>The aim of this study was to investigate the potential utility of neuropeptide Y (NPY) levels in association with mortality in patients experiencing drug-refractory ES.</div></div><div><h3>Methods</h3><div>A prospective cohort study was conducted, enrolling 95 patients diagnosed with ES. They were divided into 2 groups: a control group (n = 62) and a refractory group (n = 33). Demographic and clinical data were collected at enrollment. Plasma NPY levels were measured in hospitalization. A receiver-operating characteristic curve was used to define an NPY threshold, with Youden’s index applied to identify the optimal cutoff point for heightened mortality risk in patients with ES. According to NPY threshold, patients were divided into a low NPY group and a high NPY group. The log-rank test was used for Kaplan-Meier survival curve comparison between 2 groups. Cox proportional hazards modeling was used to assess the association between NPY level and mortality.</div></div><div><h3>Results</h3><div>Patients in the refractory group exhibited significantly higher venous NPY levels compared with those in the control group. Receiver-operating characteristic analysis identified an NPY threshold of 44.4 pg/mL with sensitivity of 0.91 and specificity of 0.90. Elevated baseline NPY levels were significantly associated with an increased risk for mortality in patients with ES (95% CI: 0.89-0.99). The survival curves depicted a clear divergence between patients with high and low NPY levels, highlighting the association of elevated NPY level with increased mortality.</div></div><div><h3>Conclusions</h3><div>NPY emerges as a potential biomarker for risk stratification in patients experiencing ES.</div></div>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 4","pages":"Pages 655-663"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364780","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 Reappraisal of Neuropeptide Y as Biomarker and Therapeutic Target in Arrhythmic Disorders","authors":"Tania Zaglia PhD ,&nbsp;Olujimi A. Ajijola MD, PhD","doi":"10.1016/j.jacep.2025.01.012","DOIUrl":"10.1016/j.jacep.2025.01.012","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":"11 4","pages":"Pages 664-666"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633957","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}