JACC. Clinical electrophysiology最新文献

{"title":"Machine Learning Integration of Ablation Quality Metrics for Predicting Atrial Fibrillation Recurrence: A Multicenter Study.","authors":"Kexin Wang, Cao Zou, Xiaomeng Yin, Jingcheng Chen, Xuefeng Zhu, Xiaoli Chen, Yuegang Wang, Hao Su, Xiangwei Ding, Chengzong Li, Fangyi Xiao, Yunlong Wang, Fu Yi, Shuanglun Xie, Long Chen, Qi Jiang, Minglong Chen, Weizhu Ju","doi":"10.1016/j.jacep.2026.09.007","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.09.007","url":null,"abstract":"<p><strong>Background: </strong>Current prediction models for atrial fibrillation (AF) recurrence after ablation rely predominantly on nonmodifiable clinical characteristics, demonstrating limited predictive accuracy and offering little guidance for intraprocedural decision-making and outcome optimization.</p><p><strong>Objectives: </strong>This study aimed to develop and externally validate a machine learning model that integrated clinical characteristics with ablation quality metrics to individually predict AF recurrence.</p><p><strong>Methods: </strong>We conducted a multicenter, retrospective cohort study of patients undergoing their first AF ablation in 14 hospitals from mainland China. Patients aged 18 to 80 years were enrolled, and data on clinical characteristics and quality metrics were collected. An XGBoost model was developed using 7 selected features to predict 1-year AF recurrence. The model was developed using 5-fold cross-validation for internal validation and was further externally validated on data from 2 independent hospitals.</p><p><strong>Results: </strong>Among 1,782 patients enrolled between December 2021 and December 2023, 294 (16.5%) experienced AF recurrence within 1 year. The final XGBoost model achieved strong discrimination in internal validation (area under the curve [AUC]: 0.918, 95% CI: 0.874-0.962). In feature-combination analyses, model performance improved from an AUC of 0.588 using clinical features alone to 0.918 after incorporating ablation quality metrics. In 2 independent external validation centers (n = 239), the model showed good discrimination, with AUCs of 0.992 and 0.951 and precision-recall AUCs of 0.960 and 0.815, respectively.</p><p><strong>Conclusions: </strong>Integrating ablation quality metrics yielded an validated model that showed strong discrimination for 1-year AF recurrence, outperforming clinical features alone. This approach highlights the prognostic value of intraprocedural quality assessment and may support personalized patient management.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193878","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":"Left Bundle Branch Pacing or Left Bundle Branch Area Pacing: Is It Time to Abandon the \"Area\"?","authors":"Pugazhendhi Vijayaraman, Kentaro Goto","doi":"10.1016/j.jacep.2026.09.009","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.09.009","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193845","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 Lazarus Protocol: Rescue Catheter Ablation of Incessant Ventricular Fibrillation by Purkinje Substrate Denetworking in Critically Ill Patients With Ischemic Cardiomyopathy.","authors":"Choudhary Anwar Ahmed Chahal, Kristian Galanti, Mohamad AlKhayat, Nishi Patel, Meghan Christie, Danielle Notarangelo, Pasquale Santangeli, Frank Bogun, Mélèze Hocini, Edmond Obeng-Gyimah","doi":"10.1016/j.jacep.2026.08.006","DOIUrl":"10.1016/j.jacep.2026.08.006","url":null,"abstract":"<p><p>We report a case series of 3 critically ill patients with refractory incessant ventricular fibrillation (VF) who underwent catheter ablation using high-density mapping of the Purkinje system during ongoing VF, combined with targeted Purkinje denetworking and myocardial substrate modification. All patients were supported with advanced mechanical circulatory support, including venoarterial extracorporeal membrane oxygenation or venoarterial extracorporeal membrane oxygenation with Impella support, and procedures were guided by electroanatomic mapping with multimodality imaging integration. Purkinje potentials and abnormal electrograms within infarcted and border-zone myocardium were targeted, resulting in restoration and maintenance of sinus rhythm with no inducible ventricular arrhythmias after ablation. These findings suggest that, in carefully selected patients, combined Purkinje-targeted ablation and substrate modification may provide a life-saving rescue strategy for otherwise refractory incessant VF.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109812","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":"Running to a Type 1 - Exercise-Provoked Brugada.","authors":"Andrew D Krahn, Benjamin M Moore","doi":"10.1016/j.jacep.2026.09.008","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.09.008","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227787","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":"Effects of Dual-Energy Lattice-Tip Catheter Ablation of Ventricular Arrhythmias on Cardiac Implantable Electronic Device Performance.","authors":"Ehsan Mahmoodi, Arwa Younis, Koji Higuchi, Jakub Sroubek, Justin Z Lee, Roy Chung, Osama Dasa, Shady Nakhla, Brittany Paulin-Mosho, Nolan Hight, Niraj Varma, Ayman A Hussein, Tyler Taigen, Mohamed Kanj, Mandeep Bhargava, Walid I Saliba, Oussama M Wazni, Pasquale Santangeli","doi":"10.1016/j.jacep.2026.08.028","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.08.028","url":null,"abstract":"<p><strong>Background: </strong>The Sphere-9 lattice-tip catheter (Affera, Medtronic) enables delivery of both radiofrequency ablation (RFA) and pulsed field ablation (PFA) for ventricular arrhythmia (VA) ablation. Data on its impact on cardiac implantable electronic devices (CIEDs) are limited.</p><p><strong>Objectives: </strong>This study sought to evaluate changes in CIED function following VA ablation using the Sphere-9 catheter.</p><p><strong>Methods: </strong>We reviewed 65 consecutive patients (median age 71 years, 94% male, 63% ischemic cardiomyopathy, median left ventricular ejection fraction 31%) with pre-existing CIEDs who underwent VA ablation (62 ventricular tachycardia [95%], 3 premature ventricular contraction [5%]) using the Sphere-9 catheter (combined RFA/PFA (53 [82%]), RFA alone (6 [9%]), PFA alone (6 [9%])). Device interrogation was performed within 30 days preprocedure, within 7 days postprocedure, and at 3-month (+/- 30 days) follow-up.</p><p><strong>Results: </strong>At 3-months, right ventricular leads demonstrated reduced sensing amplitude (11.7-10.0 mV, P = 0.04), pacing impedance (441-422 Ω, P < 0.001), shock impedance (64-59 Ω, P = 0.01), and increased capture threshold (0.9-1.0 V at 0.4-0.5 milliseconds, P = 0.03). Left ventricular (LV) leads demonstrated reduced pacing impedance (544-475 Ω, P = 0.04), whereas LV capture threshold remained elevated (1.0-1.4 V, P = 0.08). Right atrial lead parameters remained stable. No patient required CIED revision. One patient experienced cardiac resynchronization therapy-D pulse generator failure during PFA delivery 7.5 mm from an LV lead tip electrode, requiring generator replacement.</p><p><strong>Conclusions: </strong>Ventricular arrhythmia ablation using the Sphere-9 dual-energy lattice-tip catheter was associated with small but persistent changes in right and left ventricular lead parameters. Serious CIED interactions were uncommon, and further studies are needed to better understand the underlying mechanisms.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136669","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":"Electrophysiological Manifestations of Suspected Bachmann's Bundle Infarction Due to Occlusion of the Right Sinus Node Artery.","authors":"Tetsuma Kawaji, Shumpei Mori, Yuichiro Miyazaki, Misaki Naka, Saki Yamano, Bingyuan Bao, Tomoya Kimura, Shun Hojo, Shintaro Matsuda, Masashi Kato, Takafumi Yokomatsu, Shinji Miki","doi":"10.1016/j.jacep.2026.08.032","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.08.032","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193875","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":"Four Distinct Morphologies of Bundle Branch Reentrant Ventricular Tachycardia Eliminated by Right Bundle Branch Ablation.","authors":"Miki Amemiya, Atsushi Suzuki, Seiji Fukamizu, Yasuteru Yamauchi","doi":"10.1016/j.jacep.2026.08.029","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.08.029","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136708","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 Regional Atrial Metabolic Inflexibility in Atrial Fibrillation: Evidence From Human Vein of Marshall Arteriovenous Samplings.","authors":"Lee Bockus, Ahmad Kassar, Romanos Haykal, Nadia Chamoun, Yaacoub Chahine, Dennis Wang, Daniel Raftery, Rong Tian, Zoltan Arany, Nazem Akoum","doi":"10.1016/j.jacep.2026.08.030","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.08.030","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136697","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 Low-Voltage Area Ablation Reduces Atrial Fibrillation Recurrence in Persistent Atrial Fibrillation: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis.","authors":"Sohaib A Virk, Vincenzo Somma, Peter M Kistler, Jonathan M Kalman","doi":"10.1016/j.jacep.2026.08.023","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.08.023","url":null,"abstract":"<p><strong>Background: </strong>Adjunctive low-voltage area ablation (LVAA) has been proposed as a substrate modification strategy to improve outcomes of catheter ablation in persistent atrial fibrillation (AF); however, randomized controlled trials (RCTs) evaluating LVAA have yielded inconsistent findings.</p><p><strong>Objectives: </strong>This meta-analysis sought to evaluate the efficacy of LVAA in addition to pulmonary vein isolation (PVI) compared with PVI alone in patients with persistent AF.</p><p><strong>Methods: </strong>Electronic databases were searched from inception to September 2026 for eligible RCTs. The primary endpoint was recurrent AF/atrial tachyarrhythmia ≥12 months after index ablation. Secondary endpoints included major periprocedural complications and procedural durations. Meta-analyses were performed using random-effects models. Trial sequential analysis was performed to assess the robustness of cumulative evidence.</p><p><strong>Results: </strong>Seven RCTs comprising 1,487 participants (weighted mean age 68 years, 60% male) were included. Compared with PVI alone, PVI + LVAA was associated with significantly lower recurrence of AF/atrial tachyarrhythmia (HR: 0.67; 95% CI: 0.50-0.88; I² = 55%; P = 0.004). Trial sequential analysis demonstrated that the cumulative Z-curve crossed the monitoring boundary for benefit, supporting the robustness of the observed treatment effect. Adjunctive LVAA increased total procedure duration (mean difference: 30.5 minutes; 95% CI: 5.8-55.2; P = 0.02) and radiofrequency ablation duration (mean difference: 12.3 minutes; 95% CI: 5.4-19.1; P < 0.001) without increasing fluoroscopy time or major periprocedural complications (relative risk: 1.12; 95% CI: 0.60-2.10; P = 0.7).</p><p><strong>Conclusions: </strong>Among patients with persistent AF, adjunctive LVAA in addition to PVI significantly reduces recurrent atrial tachyarrhythmia compared with PVI alone. These findings support electroanatomically guided substrate modification as a promising individualized ablation strategy in persistent AF.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136724","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 Transmural Substrate: Noninvasive Radioablation for Refractory Chagasic VT.","authors":"Paul C Zei","doi":"10.1016/j.jacep.2026.09.002","DOIUrl":"https://doi.org/10.1016/j.jacep.2026.09.002","url":null,"abstract":"","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193881","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}